LABORATORY SERVICES MANUAL AND TEST COMPENDIUM
TABLE OF CONTENTS
I
LABRegOP7900 GENERAL INFORMATION
I
Laboratory Services at RQHR Sites............................................................1
II
Hours of Operation .....................................................................................2
III
Laboratory Administration..........................................................................2
IV
Phlebotomy Services ...................................................................................3
V
Laboratory Requisitions ..............................................................................4
VI
Test Priority.................................................................................................5
VII
Test Order Entry..........................................................................................6
VIII Requisition Test Add-Ons or Changes........................................................7
IX
Specimen Requirements.............................................................................. 7
X
Specimen Collection
1. Client Identification.............................................................................8
2. Typenex Red Arm Bands ....................................................................8
3. Collection of Blood Specimens...........................................................9
4. Specimen Labelling...........................................................................10
XI
Transporting Specimens to the lab ............................................................ 10
XII
Specimen Rejection................................................................................... 11
XIII Laboratory Information System ................................................................11
XIV Results Reporting ......................................................................................12
XV
Types of Reports .......................................................................................13
XVI Requests for Results .................................................................................13
XVII Availability of Tests “After Hours” ..........................................................13
XVIII Laboratory Tests Available on 24 Hour Basis ..........................................14
XIX Turn Around Time ....................................................................................14
XX
Critical Values ..........................................................................................15
XXI Laboratory Abbreviations .........................................................................15
APPENDIXES
LABRegOP7109 Laboratory Specimen Portering Competency
LABRegOP7109A1 Instructions for Portering Laboratory Specimens
LABRegOP7109A2 Portering Laboratory Specimens Competency Quiz
LABRegOp7109A3 Portering Laboratory Specimens Competency Quiz Answers
LABPhlbOP7009A1 Sending Patient Specimens using the Pneumatic Tube
Critical Values:
LABChemOP8200T1 Chemistry Critical Values
LABHemaOP7019T1 Hematology Critical Values
LABMicOP8000A1 Microbiology Critical Values
LABTranOP7001W3Transfusions Critical Values
LABHistOP1000T1 Anatomic Pathology Critical Results
LABCytoOP7047 Communication of Cytopathology Critical Results
LABRlabOP7900A2 Rural Lab Critical Results
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Turn Around Times:
LABChemOP8202C1 Chemistry Tests
LABHemaOP7031C1 Guidelines for Expected TAT in Hematology
LABMicOP8000A2 Anticipated TAT for Microbiology Tests
LABTranOP7001W2 TAT for Transfusions
SDCL Requisition Completion Instructions
LABRlabOP7900A3 Tests Performed at Rural RQHR sites
II
LABChemOP7269 CHEMISTRY
Purpose ........................................................................................................ 1
Procedure..................................................................................................... 1
Blood Specimens......................................................................................... 2
Rapid ACTH Test (Cortrosyn) ......................................................... 2
Blood Ethanol ................................................................................... 2
Blood Gases ...................................................................................... 2
Dexamethasone Suppression Test .................................................... 3
Glucose Tolerance ............................................................................ 3
Growth Hormone Suppression Test.................................................. 4
Insulin ............................................................................................... 4
Xylose Test ....................................................................................... 5
Urine Specimens ......................................................................................... 5
Specimen Collection ......................................................................... 5
Urine Testing Notes .......................................................................... 6
Feces Specimens ......................................................................................... 6
Feces Tests........................................................................................ 6
CSF Specimens ........................................................................................... 7
Toxicology Specimens ................................................................................ 7
Fluid Specimens .......................................................................................... 8
Specimen Collection ......................................................................... 8
Tests Performed ................................................................................ 8
Fluid Notes........................................................................................ 8
Therapeutic Drug Testing...........................................................................9-11
LABChemOP7352A1 ACTH Stimulation Test
LABChemOP7317A1 75 Gm Maternal Glucose Tolerance
III
LABAccnOP7200 CYTOGENETICS
I
General Information .................................................................................... 1
II
Blood Chromosome Studies........................................................................ 2
III
Bone Marrow Studies.................................................................................. 2
IV
Aminotic Fluid Analysis ............................................................................. 2
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V
VI
VII
VIII
IV
V
Products of Conception Analysis ................................................................ 3
Cord Blood Studies ..................................................................................... 3
Buccal Smears for Sex Chromatin Studies ................................................. 3
Out Patient Services .................................................................................... 3
LABCytoOP7000 CYTOLOGY
I
Purpose ........................................................................................................ 1
II
Specimens – Types, Collection Methods, Identification and Labelling ..... 1
III
Specimen Submission and Transportation .................................................. 2
IV
Cytology Requisitions ................................................................................. 2
V
Specimen Rejection Criteria........................................................................ 3
VI
RQHR Cytology Laboratory Address and Hours of Operation .................. 3
VII
General Techniques
A. Pap Smears .................................................................................... 4
B. Sputum ............................................................................................ 5
C. Bronchial Brushings ...................................................................... 6
D. Bronchial Washings ...................................................................... 6
E. Urine Specimens/Bladder Washings ............................................. 6
F. Serous Effusions (Pleural, Peritoneal, Pericardial Fluids) ............ 7
G. Cerebrospinal Fluids ..................................................................... 7
H. Abdominal and Pelvic Washings .................................................. 8
I. Gastrointestinal, Esophageal and Gastroesophageal Brushings...... 8
J. Breast Secretions (Nipple Discharges) .......................................... 8
K. Joint Fluids .................................................................................... 9
L. Cyst Fluids ..................................................................................... 9
M. Ocular Specimens .......................................................................... 9
N. Guided Fine Needle Aspiration Biopsies (Cat Scan, Ultrasound)
Adequacy Check ......................................................................... 10
O. Fine Needle Aspiration Clinic, Pasqua Hospital........................... 11
LABHemaOP7001 HEMATOLOGY
Hematology
I
General Information .................................................................................. 1
II
Requisition Forms ..................................................................................... 1
III
Collection of Specimens.............................................................................. 2
IV
Bone Marrow Examinations ...................................................................... 2
V
List of Tests Provided in Hematology ....................................................... 3-4
VI
Blood Required for Laboratory Tests ........................................................ 5
VII
Normal (Reference) Ranges ...................................................................... 6-9
LABHemaOP7037 Flowcytometry
General Information .................................................................................... 1
Collection of Specimens.............................................................................. 1
List of Tests provided in Flowcytometry .................................................... 2
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VI
VII
LABHistOP1000 HISTOPATHOLOGY
Hours of Operation.................................................................................................. 1
I
Submission of Tissues for Examination .................................................... 1
1. Routine Pathological Examination.................................................. 1
2. Urgent or Overnight Reports ......................................................... 1
3. Tissues for Microbiological Examination Prior to Pathological
Examination .................................................................................. 1
4. Tissues for Quick Section ............................................................. 2
5. Tissue for Electron Microscopy .................................................... 2
6. Photography ................................................................................... 2
7. Immunofluorescence for Bound Immunoglobulin ........................ 2
8. Lymph Nodes and Open Lung Biopsies ....................................... 3
9. Testicular Biopsies ........................................................................ 3
10. Amputated Limbs .......................................................................... 3
11. Specimens Sent to Lab After 1630 Hours ..................................... 3
12. Muscle Biopsies for Enzyme Histochemistry ............................... 3
13. Nerve Biopsies .............................................................................. 3
14. Flow Cytometry ............................................................................. 4
15. Chromosome Studies ..................................................................... 4
16. Kidney Biopsies ............................................................................ 4
II
Autopsies ................................................................................................... 4
1. Coroner’s Cases............................................................................... 4
2. Hospital Autopsies .......................................................................... 5
3. Courtesy Autopsies ......................................................................... 5
Consent for Autopsy........................................................................ 5
LABMicOP7204 MICROBIOLOGY
Hours of Operation...................................................................................... 1
Scope of Service.......................................................................................... 1
Specimens for Microbiology....................................................................... 2
Reporting Results ........................................................................................ 3
APPENDIXES
LABMicOp7204A1 Specimen Containers for Microbiology
LABMicOP7204A2 Microbiology Collection and Test Compendium
LABMicOP7204A3 Sputum Collection
LABMicOP7204A4 Stool Collection
LABMicOP7204A5 Urine Collection
LABMicOP7204A6 Pinworm Collection
LABMicOP7204T1 Criteria for Rejection of Microbiology Specimens
LABMicOP7021 Collection of Blood Cultures
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VIII
LABTranOP7001 TRANSFUSIONS
I
Legal Responsibility.................................................................................... 1
II
Supply of Blood .......................................................................................... 1
III
Ordering Blood Transfusions ...................................................................... 1
IV
Issue of Blood.............................................................................................. 3
V
Patient Notification ..................................................................................... 3
VI
Blood Infusion............................................................................................. 3
VII
Canceling Blood.......................................................................................... 4
VIII Shortages of Blood ...................................................................................... 4
IX
Emergent and Routine Transfusions ........................................................... 4
X
Confirmatory Blood Group ......................................................................... 5
XI
Crossmatches for Surgery ........................................................................... 5
XII
Cord Blood .................................................................................................. 5
XIII Exchange Transfusion ................................................................................. 5
XIV Neonate Transfusion ................................................................................... 6
XV
Autologous and Directed Donations ........................................................... 6
XVI Blood Required for Laboratory Tests.......................................................... 6
XVII Adverse Effects of Transfusions ................................................................7-10
XVIII Product Information .................................................................................. 10
APPENDIXES
• LABTranOP7011 Use of the Typenex Red Arm Band
• LABTranOP7001W4 Canadian Blood Services CIRCULAR OF
INFORMATION
IX
LABLisOP8007F2 TEST COMPENDIUM
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Subject/Title: LABRegOP7900.3.4 LABORATORY SERVICES
MANUAL GENERAL INFORMATION
Last Approved Time: 7/4/2013 2:24:13 PM
Revision: 3.4
Approving Authority and Contact for Interpretation: Assistant Manager Laboratory Services
Regulatory Affairs
Phone: (306) 766-4470
Current Version on Print Date
Policy
Process Control
Purpose
The purpose of this procedure is to provide specific instructions for the proper collection
and handling of laboratory specimens. These instructions have been developed for those
collecting specimens to be submitted to Regina Qu’Appelle Health Region (RQHR)
laboratories for analysis.
Procedure
I
Laboratory Services at Regina Qu’Appelle Health Region (RQHR) Sites
The laboratory at the Wascana Rehabilitation Centre functions as a specimen
collection service only. All specimens are referred to other laboratories for
processing.
The laboratory at the Pasqua Hospital consists of a:
 Centralized Histopathology Laboratory
 Centralized Cytopathology Laboratory
 Autopsy Suite
 Rapid Response Lab which offers stat service for a limited test menu in
clinical pathology (Chemistry, Haematology and Transfusions)
 Phlebotomy service
 Accession service
The laboratory at the Regina General Hospital consists of a:
 Centralized clinical pathology service (Chemistry, Haematology,
Transfusions, Microbiology, Chemistry Specialized Testing)
 Satellite Cytopathology service
 Satellite Histopathology service which performs quick sections only on
surgical specimens
 Autopsy suite
 Phlebotomy service
 Accession service
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II
Hours of Operation
The Wascana Rehabilitation Centre laboratory operates from 0730 to 1600 hours,
Monday to Friday. It is closed on weekends and statutory holidays.
The Regina General Hospital and Pasqua Hospital laboratories operate 24 hours a
day, seven days a week. Full services are available Monday to Friday, 0730 1600 hours (there may be some variation in hours from one lab discipline to
another), while a limited test menu is available outside of regular hours.
Laboratory services must not be abused. Routine work, whenever possible should
be requested during the day shift. The staffing level during evenings, nights and
weekends is greatly reduced and cannot accommodate excessive routine requests
without jeopardizing the laboratory’s ability to respond to emergencies in a timely
fashion.
III
Laboratory Administration
The Medical Head, Laboratory Services and the Director-Operations, Laboratory
Services are ultimately responsible for the overall operation of laboratory services
in the RQHR.
The Director-Operations, Laboratory Services is responsible for the operation of
the Laboratory Services financial management and human resources for
laboratory services within the RQHR in Regina and is responsible for the
regulatory and safety requirements for all laboratories within the RQHR.
The Manager, Laboratory Information System, with the assistance of one
supervisor, is responsible for management of the Laboratory Information System
at all sites.
The Assistant Manager, Regulatory Affairs, Laboratory Services, with the
assistance of one supervisor, is responsible for all issues related to quality
assurance, safety and regulatory requirements at all sites.
The Assistant Manager, Finance and Human Resources/Labour Relations,
Laboratory Services is responsible for all issues related to financial management
and human resources/labour relations of all Regina laboratory sites of the RQHR.
There are six Unit Managers. Responsibility for each laboratory discipline is
assigned to the Unit Managers as follows:


Unit Manager, Chemistry, with the assistance of two supervisors, is
responsible for Chemistry, Specialized Chemistry and Point of Care Testing at
all sites.
Unit Manager, Haematology/Transfusions, with the assistance of two
supervisors, is responsible for Haematology and Transfusions services at all
sites.
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



Unit Manager, Histopathology/Cytopathology, with the assistance of two
supervisors, is responsible for Histopathology and Cytopathology services at
all sites.
Unit Manager, Microbiology, with the assistance of one supervisor, is
responsible for Microbiology services at all sites.
Unit Manager, Laboratory Support Services, with the assistance of two
supervisors, is responsible for Phlebotomy, Accessioning and other support
personnel and services at the RGH and Pasqua sites.
Unit Manager, Rural and Inter-Regional Support is responsible for Laboratory
Services at the rural sites.
Each laboratory discipline is also under the direction of a Medical Section Head
that is a medically qualified specialist in his/her field of laboratory medicine.
All issues and concerns related to specific disciplines or services should be
directed to the Unit Manager or supervisor responsible. Physicians should direct
their concerns to the Medical Section Head of the specific laboratory discipline or
the Medical Head, Laboratory Services.
IV
Phlebotomy Services
Wascana Rehabilitation Centre
Collections begin at 0730 hours each morning on days the laboratory is in
operation. Fastings are collected first, followed by the remainder of the requests.
Additional requests that arise during the day should be phoned to the laboratory.
Regina General Hospital
Daily collection rounds are as follows:
0630 hours - all routine collections for which requisitions have been received are
collected.
1030 hours - any routine orders that have accumulated between 0630 and 1030
hours will be collected during this round.
1300 hours - any routine orders that have accumulated between 1030 and 1300
hours will be collected during this round.
Timed requests will be collected at the times specified throughout the day. STAT
and URGENT requests will be collected throughout the day as the need arises.
Phlebotomy staff will respond STAT to Trauma, MI (Myocardial Infarction) and
Stroke alerts. All routine orders will be batched according to the above schedule
unless instructions to the contrary are communicated to the phlebotomists.
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Pasqua Hospital
0630 hours - all routine collections for which requisitions have been received are
collected.
0900 hours and hourly until 2200 hours - all routine collections for which
requisitions have been received in the laboratory are collected on each collection
round.
Timed requests will be collected at the times specified throughout the day. STAT
and URGENT requests will be collected throughout the day as the need arises.
Phlebotomy staff will respond STAT to Trauma, MI (Myocardial Infarction) and
Stroke alerts. All routine orders are batched according to the above schedule
unless instructions to the contrary are communicated to the phlebotomists.
V
Laboratory Requisitions
1. Laboratory requisitions serve as a mechanism for placing a client test order in
the Laboratory Information System (LIS).
The following requisitions are available:
Biochemistry / Haematology
Microbiology
Transfusions
Flow Cytometry
Surgical Pathology Consultation
Gastrointestinal Biopsy
Prostate Biopsy
Women’s Health Centre Pathology
Cytopathology – Non Gynecologic
Cytopathology - Gynecologic
Biochemistry EIA
Cytogenetics
Saskatchewan Disease Control Laboratory
Ova & Parasite Examination
Community
green
white
pink
salmon
cream
yellow
cream
cream
canary
mauve
canary
white
(Royal Columbian requisition)
Choose the appropriate
requisition
Green (full page form)
blue
2. A supply of requisitions is available from the RQHR Print Shop. Copies of the
Royal Columbian Cytogenetics requisition may be obtained from the
Accession department. Canadian Blood Services requisitions for HLA Typing
may be obtained from the Accession Department, Laboratory Services.
3. Orders for tests, which are referred to Saskatchewan Disease Control
Laboratory, must be submitted on the appropriate SDCL requisition. Do not
use RQHR requisitions.
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4.
VI
When completing requisitions:
 stamp the top right-hand corner of RQHR requisitions with the client’s
addressograph. In the absence of an addressograph, print legibly the
required information. Be sure to include all of the following
information:
 first and last name
 date of birth (day/month/year)
 MRN / HSN
 Stay Number
 gender
 name of ordering physician, including the first name or initial
 in-patient location, or physician address for out-patients and
referred-in specimens
 indicate “copy to” physician, if required. Clearly indicate this
physician’s first name or initial and location.
 indicate the priority, i.e. stat, urgent, routine or timed
 indicate date and time to be collected (when required)
 indicate the diagnosis and other relevant information such as
anticoagulant therapy, antibiotic therapy, therapeutic drug dosage or
client’s height and weight.
 indicate tests required. If test order is uncommon or unclear, verify test
order for accuracy. For unusual test requests refer to the Laboratory
Specimen Requirements in the Test Compendium on the RQHR
Intranet or on the RQHR internet website. For tests not listed in the
test compendium, contact the SDCL for client preparation and
specimen collection requirements.
 all changes made to a requisition must be authorized and initialled by
the nursing staff making the change.
Test Priority
The terms STAT, Urgent, Routine and Timed Collection will be used consistently
when ordering laboratory tests.
STAT - refers to life threatening medical emergencies.
Laboratory staff gives top priority to STAT requests at the expense of other
orders, therefore this priority should only be used when absolutely necessary.
Urgent - refers to tests that are required as soon as possible but are not involved in
life threatening medical emergencies.
Routine – these specimens are processed after STATs and Urgent collections.
Timed - used when specimens are to be collected at specified times of the day.
Timed collections are ordered in the following instances only:
- pre-op bloodwork
- special procedures (eg: angioplasty, ACTH stimulation tests)
- TPN bloodwork
- timed drug levels
- INR - timed due to medication adjustment
- CK, Troponin ordered as per physician request for CCU protocol
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VII
Test Order Entry
At the RGH and Pasqua sites, laboratory test orders must be data entered
(accessioned) into the Laboratory Information System (LIS) before the blood
specimen is collected by the phlebotomist. The patient identification will be
confirmed at the time of collection using the SoftID electronic identification
system.
It is the responsibility of the client service area to ensure that requisitions for
routine, timed and urgent blood tests are sent to the laboratory well in advance of
the required time of collection.
Requisitions should be in the laboratory no later than 2100 hours the day
prior to collection to facilitate processing the AM blood work.
Requisitions received after 2100 hours may not be entered in time for collection
on the first A.M. collection run. Occasional exceptions may occur for critical
care areas.
Requisitions for blood work on new admission patients should be delivered to the
lab. When this is not possible due to work load during the night shift, mark the
requisition with “New Admission” and FAX it to the lab to be data entered into
the LIS for the Morning Collection.
The requisitions for next day collections are accessioned into the LIS throughout
the day and evening. A daily log of patients entered into the LIS is printed each
morning at 4:00 AM. This daily log is faxed to the nursing units so that they can
confirm which requisitions have been sent to the lab for the AM Collection run
(morning swarm). This daily log can be used to avoid sending duplicate
requisitions for patient collection, thus avoiding patients being collected twice for
the same order.
Urines and Microbiology swabs will be entered into the LIS post-Collection.
For STAT collections:
1. First - FAX all STAT requisitions to the Lab for data entry into the LIS.
RGH FAX 766-4307
Pasqua FAX 766-2223
2. Second - Call the STAT phone number to notify the Phlebotomist of the
STAT collection.
RGH phone 766-1658
Pasqua phone 766-8412
The phlebotomist will always confirm that the STAT requisition has been
faxed to lab for data entry into the Laboratory Information System.
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VIII
Requisition Test Add-Ons or Changes
Call the Laboratory, as indicated below, with any additions or changes to tests on
a requisition that has already been sent to the laboratory. These additions must be
data entered into the LIS before collection, if additional specimen tubes are
required.
At the RGH, For Add-On tests:
BEFORE the specimen has been collected, call Accession at 4495
AFTER the specimen has been collected, call Chemistry at 4490, or
Hematology at 4477
At the PASQUA, For ALL Add-On tests, call Chemistry at 2256.
Tests Which May be Added On
Chemistry tests can be added onto previous chemistry orders, in most
circumstances. However, Ammonia and Blood Gases cannot be added on.
Blood Cultures cannot be added onto previously collected test requests.
Coagulation tests (INR, APTT, D-Dimer) cannot be added onto an order already
collected. Previously collected Coagulation tubes may have a D-Dimer added, if
collected within the last 4 hours.
Hematology tests may be added onto a previously collected hematology EDTA
tube within the last 24 hours.
RQHR Lab Specimen Requirements – see link below
http://www.rqhealth.ca/programs/lab/pdf_files/rqhr_lab_specimen_requirements.p
df
Use the SEARCH button to quickly find the test you are requesting.
IX
Specimen Requirements
The type of specimen required for each test is listed in the Test Compendium.
The Test Compendium is available for viewing on the RQHR Intranet and may be
accessed from the Home Page by choosing “Departments”, then “Laboratory” and
“RQHR Lab Specimen Requirements”. Use the SEARCH button to quickly find
the required test.
Detailed, pre-test preparation required for tests is listed in the appropriate section
(laboratory department) of this manual. Take particular care to use the correct
specimen container (e.g. stool collection container with SAF for parasite
investigation).
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X
Specimen Collection
1. Client Identification
Client identification must be confirmed using two client identifiers by all
physicians and staff prior to the collection of all laboratory specimens.
Client identification is a process that includes confirmation of at least two client
identifiers through observation of documented identifiers, then requesting the
client to recite their first and last name and date of birth when the client is able to
participate in the identification process. Best practice for client identification is to
actively involve the client.
Two client identifiers include of the first and last name, and unique identifying
number. The unique identifying number consists of the Health Services Number
(HSN) or Medical Record Number (MRN). For Transfusions specimens also
check the client’s date of birth as a third identifier.
Confirm the client’s identity by checking the first and last name and the MRN (or
HSN) on the requisition against the first and last name and MRN (or HSN) on the
client’s armband.
The client’s room or bed number may not be used as an identifier.
Clients presenting to a Specimen Collection area without an armband, must
present their pink form completed by SWADD or HSN card to confirm their first
and last name and HSN. Ensure the identifiers match the corresponding identifiers
on the requisition.
WRC residents without an armband must be positively identified by a staff
member who is familiar with the client. Identification must be documented by a
signature of the identifier on the requisition prior to specimen collection.
Requisitions signed only by the specimen collector will denote responsibility
for both identification and specimen collection.
2. Typenex (Red) Arm bands
A Typenex Red Arm band must be used when a group and antibody screen is
ordered on a patient who is not staying in the hospital (pre-admission, outpatient
transfusion, Emergency, Wascana Rehab Centre) or on a patient who may be
transferred to another facility for diagnostic procedures.
For instructions on using the Typenex Arm band, refer to the procedure
LABTranOP7011Use of the Typenex Red Arm Band System found in the
Transfusions section of this Manual.
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3. Collection of Blood Specimens
When drawing blood from indwelling line (e.g. arterial, PICC, Hickman, etc.),
discard at least the first 7 ml of blood in the case of an adult and 3 ml of blood in
the case of a child. It will often be contaminated with heparin, which will interfere
with many analyses.
To ensure that specimen integrity is maintained collect the specimen tubes in the
following order:






Blood cultures (Aerobic then Anaerobic)
Blue top tube with citrate for coagulation (completely fill the tube)
Serum tube with or without clot activator, with or without gelYellow Serum Separator Tube (SST) with gel, or
Red top tube, or
Orange Rapid Serum Tube (RST)
Green top tube with heparin
Mauve top tube with EDTA
Tube with other additives (e.g. grey top tube)
Gently invert all the tubes 5 times to mix the blood with the additives. To invert
turn the filled tube upside-down and then return it to an upright position.
When drawing blood using a winged collection set (e.g. butterfly), consideration
must be given to the air space of the tubing when it is connected to an evacuated
blood collection tube, as less blood will enter the evacuated tube than with the
usual venipuncture technique. Prior to drawing the coagulation Blue top tube, a
partially filled discard tube or a serum tube for other laboratory tests must be
collected first.
If blood is to be drawn into a syringe and transferred into a vacutainer tube, the
transfer should occur immediately following phlebotomy. If there is a delay, the
specimen will begin to clot or cellular elements will begin to separate from the
plasma leading to erroneous results.
 Use the BD Blood Transfer Device (female luer adapter).
 Collect the blood into the syringe and ensure that the safety
mechanism has been activated.
 Disconnect the syringe from the needle and discard the needle.
 Attach the Transfer Device to the syringe.
 With the syringe tip facing down, insert the vacutainer tubes into the
transfer device. Allow the blood to transfer from the syringe to the
tube using the tube’s vacuum. Do not depress the plunger of the
syringe.
 Do not unthread syringe from the transfer device after use. Dispose of
the syringe and transfer device as one piece in a sharps container.
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4. Specimen Labelling
Do not pre-label the tubes.
Label all specimens in the immediate presence of the client at the time of
collection.
a) Blood samples:
Label tubes from the armband / requisition with the client’s first and last name
and the MRN (or HSN). Specimens for crossmatches, group and reserve
serum or group and Rh must also be labelled with the client’s date of birth and
the date of collection.
The signature of the person collecting the specimen, and the date and time of
collection must be recorded on each requisition available at the time of
collection. For Pink Transfusion requisitions, the person performing the
phlebotomy MUST sign the requisition with the date and time of collection.
Record on the requisition if the specimen was collected from a “line”.
b) Cord blood specimens:
Label cord blood gases with the mother’s last name and the mother’s MRN.
Label cord blood specimens with the baby’s last name and the baby’s MRN.
Record the date and time of collection on the requisition.
c) Blood gases, urines, swabs, blood cultures, stools and body fluids are
collected in containers that do not lend themselves to easy labelling. These
specimens will be accepted if labelled with the numbered tear-off requisition
label and the client’s first and last name and MRN is recorded on the label.
Record the date and time of collection and the initials of the person collecting
the specimen on the requisition.
d) Tissue specimens for histology examination must be labelled with name of
client, MRN, HSN, surgeon, nursing unit, nature of specimen and date of
surgery. Indicate nature of specimen on Cytopathology and Histopathology
requisitions. Cytopathology and Histopathology requisitions MUST be legibly
signed by physician performing procedure.
XI
Transporting Specimens to the Lab
All laboratory specimens and containers should be considered contaminated.
Ensure that all containers with screw on lids have the lid placed on securely.
Biohazard bags are not necessary for transport of specimens; however, personal
protective equipment must be used (i.e. gloves). Gross contamination of specimen
containers must be removed prior to transport (i.e. wipe visible contamination
from specimen container with cotton ball soaked in 0.5% hypochlorite solution or
Virox 5 working solution or use an alcohol swab).
For further information concerning the delivery of specimens to the laboratory,
refer to the appendix for LABRegOP7109 Instructions for Portering Laboratory
Specimens.
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
Laboratory Services Regina QuAppelle Health Region
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XII
Specimen Rejection
Specimens that are not labelled correctly will be assessed according to the Lab
Services Specimen Rejection protocol. The specimen may be rejected and a repeat
draw requested. This decision is made based on the type of error, the nature of the
specimen, and the degree of difficulty in obtaining a repeat specimen.
XIII
Laboratory Information System
Laboratory Services has a Laboratory Information System (LIS) in place. The
LIS is a vital component to laboratory consolidation in the city of Regina and
allows Laboratory Services to centralise clinical pathology at the Regina General
Hospital and anatomic pathology at the Pasqua Hospital. The LIS is being
implemented in the RQHR rural laboratories, beginning with Moosomin and
Indian Head.
The use of bar code labels reduces the risk of specimen identification errors. The
process of ordering laboratory tests is simplified through the use of standardized
requisitions that combine many tests into fewer forms.
The Regina General Hospital and Pasqua Hospital laboratories are fully
computerized. Specimens referred to either site from the community, centres
outside of Regina, or other hospitals will be processed in a computerised
environment. Therefore, standardized requisitions should be used to order tests
and users can expect to see test results on computer generated reports. Many
physicians in RQHR are receiving laboratory results by EMR (Electronic Medical
Record).
Glossary of Terms
LIS - Laboratory Information System
Accession - the process whereby an order is entered into the laboratory computer
system and assigned an Order Number. This is a function performed by
laboratory staff. The Order Number will appear on reports.
MRN / HIN - clients are given a seven digit Hospital Identification Number
(HIN) when they enter a hospital in the Regina Qu’Appelle Health Region. In the
LIS, all references to the HIN are noted as MRN (Medical Record Number).
These terms are used interchangeably.
Stay Number - is an eight-digit number generated by RQHR hospital computer
systems (Admission/Discharge/Transfer systems) and is unique to each client stay
in the hospital.
Interim Report - contains partial results from a single order.
Biochemistry/Haematology reports will be flagged in the top right-hand corner as
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“INTERIM”. In the case of Microbiology reports, each individual test result will
be identified as “INTERIM” or “FINAL”.
Final Report - contains all results from a single order. It contains all of the
information that has been previously reported on an Interim Report. It is flagged
with “FINAL” in the top right-hand corner of the report. All new results that have
not previously been reported will be flagged with an asterisk (*).
HSN – is a nine digit Provincial Health Services Number
XIV
Results Reporting
Printers are in place on most nursing units at the Regina General Hospital, Pasqua
Hospital, Wascana Rehabilitation Centre and some physician offices. Results
print directly to the nursing unit in these locations. Any location not having a
printer will have reports delivered via the Mail Messenger service or pneumatic
tube system.
Results from STAT, Urgent and Routine requests print as soon as they are
available.
1. Biochemistry/Haematology Report
Biochemistry and Haematology results are combined on the same report.
The reference range for each test will be shown in the right-hand column
of the report. The range shown is appropriate for the age and sex of the
client. Abnormal results are flagged with abnormal codes such as “C”,
“L” or “H”. A key at the bottom of the report explains each code.
2. Microbiology Report
When a specimen culture yields a pathogenic organism, a list of antibiotics
to which the organism is sensitive is recorded at the bottom of the report.
Note: The recommended dosage shown will not necessarily be
appropriate to the client’s age. The dosage shown will always be a
standard adult dosage. Adjustments must be made for other age groups.
Each individual test on a Microbiology report will be flagged as “interim”
or “Final”.
3. Transfusion Report
Transfusion Reports are cumulative in nature for a given order. A list of
blood products which are available, issued or transfused is recorded.
A pink slip of paper called a “Transfusion Record” is issued with each
blood product. The Record is permanently filed in the client’s Health
Record by attaching it to a “Laboratory Reports” form.
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
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XV
Types of Reports
The LIS prints the following four types of reports; Interim, Final, Cumulative and
Discharge Report. The type of report will be indicated in the top-right corner of
the report.
Interim - contains partial results of an order. It can be discarded when the Final
Report is received.
Final - contains all results for an order (except tests referred to Sask. Disease
Control Laboratory). Results not previously printed are flagged with an asterisk
(*).
Cumulative Report - available upon request only. This is a report, which is
formatted in four columns containing results of the last four orders on a client.
Discharge Report - prints upon discharge. This report prints in Health Records
only and is a summary of all Chemistry and Haematology tests done during a
client stay. New results obtained after discharge will be reported and sent to the
physician and Health Records on a report called “New Results After Discharge”.
XVI
Requests For Results
Laboratory test results are printed as soon as available. Check the “Lab Results
Viewer” if available. Do not phone for results unless there is an unusual delay in
receiving a report.
When it is necessary to phone for:
 clinical pathology (Chemistry, Haematology, Microbiology,
Transfusions) results call the Inquiry Centre at local 4915
 anatomic pathology results call local 2245
XVII Availability of Tests “After Hours”
The laboratory is staffed continuously seven days a week. The staff covering the
period 1600 - 0015 hours is considerably fewer in number than the daytime staff
and after 0015 hours only two technologists are on duty. IT IS IN EVERYONE'S
INTEREST TO RESTRICT TESTING AFTER HOURS TO ESSENTIAL
WORK ONLY. Clinicians gain by getting improved turn round times on urgent
tests; the laboratory gains by increased efficiency.
There is a list of tests, which are available on a 24-hour basis. Several points
should be noted when ordering tests from this list during the evening and night
shifts.
1.
The tests listed should only be used when the performance is necessary for
the diagnosis or therapy at the time the request is made.
2.
From time to time there may be an urgent need for tests not on the list.
When this is the case, the clinician in charge should phone the pathologist
or professional on call for the relevant laboratory section. If the test is
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needed and can be performed he/she will then authorize the technologist to
perform the test. It will be understood that this provision must be used
sparingly. The name and pager number for the individual on call can be
obtained from laboratory staff.
3.
When it is possible to predict that an esoteric test will be required out-ofhours, advance warning should be given to the professional head of the
laboratory division concerned.
XVIII Laboratory Tests Available On 24-Hour Basis
A.
Chemistry
Refer to “CHEMISTRY TESTS” in the appendix for 24 hr. test
availability.
B.
Hematology
Refer to “GUIDELINES FOR EXPECTED TURN AROUND TIMES IN
HEMATOLOGY” in the appendix for 24 hr test availability.
C.
Transfusions
1.
2.
D.
Microbiology
1.
2.
XIX
Group and screens
Direct antiglobulin test
Stat Gram stain and culture of the following:
- all aspirated fluids including CSF
- all tissues
- other specimens on physician’s request
Collection of blood cultures
Turn Around Time (TAT)
TAT for the purpose of this document and unless otherwise indicated is defined
as the interval between the time the specimen is collected by phlebotomy to
reporting of the test result.
Lab services will strive to meet this target for at least 90% of STAT orders.
The reader must be aware that circumstances will occasionally arise that will
limit the ability to meet these deadlines i.e. equipment failure, excessive volume
of STAT orders, limited staff coverage on certain shifts.
The expected Turn Around Times for the Chemistry, Hematology, Microbiology
and Transfusions departments are listed in the appendix to this procedure. These
TAT are for in hospital clients. For clinic or referred in specimens, the routine
TAT is 24-72 hours.
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
Laboratory Services Regina QuAppelle Health Region
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XX
Critical Values
When results fall within ranges identified as “Critical”, laboratory staff will
telephone verified results to the nurse on the unit concerned or to the physician, or
in the case of out-patient or referred-in specimens to the clinic or physician’s
office to communicate the results. A statement will be made to the effect that the
result is seriously abnormal and that the attending physician should be notified
immediately. Each critical value communicated verbally or by phone will be
verified by having the listener read back each result to confirm the accuracy
of the transmission.
When critical results are sent electronically through the LIS or by FAX, the
laboratory will telephone to confirm receipt of the critical result.
For critical values listed by department, please refer to the appendix.
XXI
Laboratory Abbreviations
When ordering laboratory tests, use accepted abbreviations only or, if in doubt,
write the name out in full. Refer to the following list of abbreviations:
a1AT
ABO
ACTH
ADH
AFB
AFP
AGBMAb
ALA
ALG
AMA
ANA
Anti-HB
Anti-HC
ASMA
AS0 or ASOT
ATP
BCG
HCG
BT
CBC
CEA
CO2
CK
CMV
CRP
C&S
CSF
CT
CVI
DAT
Alpha-1-Antitrypsin
Main blood group system
Adrenocorticotrophic hormone
Antidiuretic hormone
Acid fast bacilli
Alpha-fetoprotein
Antiglomerular Basement Membrane Antibodies
Amino levulinic acid
Anti-lymphocyte globulin
Antimitochondrial Antibodies
Anti-nuclear antibody
Hepatitis B Antibody
Hepatitis C Antibody
Antismooth Muscle Antibodies
Antistreptolysin "O"
Adenosine triphosphate
Bacilli- Calmette Guerin Vaccine
Beta Human Chorionic Gonadotropin (serum or urine)
Bleeding Time
Complete Blood Count
Carcinoembryonic Antigen
Carbon Dioxide Content
Creatine Kinase (Enzyme)
Cytomegalovirus
C-Reactive Protein
Culture and Sensitivity
Cerebrospinal Fluid
Clotting Time
Cell Volume Index
Direct Antiglobulin Test
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
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Diff
DNA
ECF
ECHO
EDTA
ERA
ESR
FBS
FSH
FTA-ABS
FVIIIR:Ag
GC
GFR
GGT
G-6-PD
GSM
GTT
Hct
Hb or Hgb
HbF
HBsAg
HBcAg
HBeAg
HGH
5-HIAA
Hp
IFE
IgA
IgD
IgE
IgG
IgM
IVIgG
K
17-KS
17-KGS
L
LDH
LE
LH
MCD
MCH
MCHC
MCT
MCV
MPV
N
Na
02
OPL
Differential
Deoxyribonucleic Acid
Extra Cellular Fluid
Enteric Cytopathogenic Orphan (Virus)
Ethylene-diamine tetra acetate (anticoagulant for blood
specimens)
Estradiol receptor assay
Erythrocyte Sedimentation Rate
Fasting Blood Sugar
Follicle Stimulating Hormone
Fluorescent Treponemal Antibody Absorption Test
Factor VIII Related Antigen
Gonococcus (N. gonorrhoeae)
Glomerular Filtration Rate
Gamma Glutamyl Transferase
Glucose-6-phosphate dehydrogenase
Group and Screen Crossmatch
Glucose Tolerance Test
Hematocrit
Haemoglobin
Haemoglobin F
Hepatitis B Surface Antigen
Hepatitis B Core Antigen
Hepatitis B Envelope Antigen
Human growth hormone
5-Hydroxyindole Acetic Acid
Haptoglobin
Immunofixation electrophoresis
Immunoglobulin A
Immunoglobulin D
Immunoglobulin E
Immunoglobulin G
Immunoglobulin M
Intravenous Immune Globulin
Potassium
17-Ketosteroids
17-Ketogenic steroids
Litre
Lactate Dehydrogenase
Lupus Erythematosus
Luteinizing Hormone
Mean Cell Diameter
Mean Corpuscular Haemoglobin
Mean Corpuscular Haemoglobin Concentration
Mean Cell Thickness
Mean Corpuscular Volume
Mean Platelet Volume
Nitrogen
Sodium
Oxygen
Out-Client Live
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
Laboratory Services Regina QuAppelle Health Region
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OPS
OT
PCV
PCO2
PE
pH
PKU
Plt
PO2
PPL0
PSA
PT
PTH
PTT or APTT
RA Factor
RDW
RF
RBC
Rh
RNA
RSV
RST
AST (SGOT)
ALT (SGPT)
Sp.Gr.
SED OR ESR
SST
TBG
TIBC
Tr
TRH
TSH
TPI
TT
TWBC
VDRL
VMA
WBC
WR
Out-Client Specimen
Old Tuberculin
Packed Cell Volume
Partial Pressure Carbon Dioxide
Protein Electrophoresis
Hydrogen Ion Concentration
Phenylketonuria
Platelets
Partial Pressure Oxygen
Pleuropneumonia-like Organism
Prostate Specific Antigen
Prothrombin Time
Parathyroid Hormone
Partial Thromboplastin Time
Rheumatoid Arthritis Factor
Red Cell Distribution Width
Rheumatoid Factor
Red Blood Cell Count
Rhesus Factor
Ribonucleic Acid
Respiratory Syncitial Virus
Rapid Serum Tube (orange top blood collection tube)
Glutamic Oxalacetic Transaminase
Glutamic Pyruvate Transaminase
Specific Gravity
Erythrocyte Sedimentation Rate
Serum Separator Tube (yellow top tube containing gel)
Thyroxine-binding Globulin
Total Iron Binding Capacity
Transferrin
Thyrotrophin Releasing Hormone
Thyroid Stimulating Hormone
Treponema Pallidum Immobilization
Thrombin Time
Total White Blood Count
Flocculation Test for Syphilis
Vanillylmandelic Acid
White Blood Cell Count
Wasserman Reaction
Related documents
1.
2.
3.
4.
LABRegOP2109 Review and Distribution of Lab Services Manual
LABRegOP7950 Laboratory Services Manual for Physician Offices
LABRegOP3651 Triage and Treatment Manual
LABPhlbOP7017 Protocol for Performing a Venipuncture
Appendixes
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
Laboratory Services Regina QuAppelle Health Region
Page 17 of 18
Last printed 7/4/2013 2:24 PM
1. LABRegOP7109 Laboratory Specimen Portering Competency
2. LABRegOP7109A1 Instructions for Portering Laboratory Specimens
3. LABRegOP7109A2 Portering Laboratory Specimens Competency Quiz
4. LABRegOP7109A3 Portering Laboratory Specimens Competency Quiz Answers
5. LABPhlbOP7009A1.2 Sending Patient Specimens using the Pneumatic Tube
6. LABChemOP8200T1 Chemistry Critical Values
7. LABHemaOP7019T1 Hematology Critical Values
8. LABMicOP8000A1 Microbiology Critical Values
9. LABTranOP7001W3 Transfusions Critical Values
10. LABHistOP1000T1 Anatomic Pathology Critical Results
11. LABCytoOP7047 Communication and Documentation of Cytopathology Critical
Results
12. LABRlabOP7900A2 Rural Laboratories Critical Results
13. LABChemOP8202C1 Chemistry Tests
(Tests, Turn Around Times, 24 hr Availability and testing site)
14. LABHemaOP7031C1 Guidelines for Expected Turn Around Times in Hematology
(Tests, Turn Around Times, 24 hr Availability and testing site)
15. LABMicOP8000A2 Anticipated Turn Around Times for Microbiology Tests
16. LABTranOP7001W2 Turn Around Time (TAT) for Transfusions
17. LABRlabOP7900A3 Tests Performed by Rural Laboratories
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author
J. Hill, MLT, ART
L. Engel MLT revised
LABRegOP7900.3.4 LABORATORY SERVICES MANUAL GENERAL INFORMATIO
Laboratory Services Regina QuAppelle Health Region
Page 18 of 18
Last printed 7/4/2013 2:24 PM
Subject/Title: LABRegOP7109.1.1 Laboratory Specimen Portering
Competency
Last Approved Time: 4/6/2010 11:40:41 AM
Revision: 1.1
Approving Authority and Contact for Interpretation: Assistant Manager Laboratory Services
Regulatory Affairs
Phone: (306) 766-4470
Current Version on Print Date
Policy
Process Control
Purpose
This procedure provides instruction for competency assessment of portering staff
members who are transporting patient specimens to the laboratory. All RQHR staff that
transport patient specimens to the laboratory must read the instruction sheets for
Portering Specimens and Sending Patient Samples using the Pneumatic Tube, then
complete the quiz.
Procedure
STEP
1.
2.
3.
ACTION
Read LABRegOP7109A1 Instructions for Portering Laboratory Specimens
Read LABPhlbOP7009A1 Sending Patient Samples in Using the Pneumatic
Tube
Complete LABRegOP7109A2 Portering Laboratory Specimens Competency
Quiz using the e-Quiz function of the Intranet. Log onto RQHR Intranet
e-Quiz/Attendance.
Related documents
1.
2.
LABPhlbOP7009 Operation of Pneumatic Tube
LABPhlbOP7009A1 Sending Patient Samples Using the Pneumatic Tube
Appendixes (charts, form, job aids, labels, logs, tables, tags, worksheets)
1.
2.
3.
LABRegOP7109 A1 Instructions for Portering Laboratory Specimens
LABRegOP7109 A2 Portering Laboratory Specimens Competency Quiz
LABRegOP7109 A3 Portering Laboratory Specimens Competency Quiz
Answers
LABRegOP7109.1.1 Laboratory Specimen Portering Competency
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 2
Last printed 4/6/2010 11:40 AM
Revision History
Found in Softtech Health Lab QMS™ Document Management System
Author
Marsh, Virginia, MLT, CAdmin, CCE
Page 2 of 2
Last printed 4/6/2010 11:40 AM
Instructions for Portering Laboratory Specimens
Proper transportation of laboratory specimens is a vital link in providing RQHR patients
with timely accurate test results. This document provides instruction on the safe
transportation of laboratory specimens from the various departments and wards to the
laboratory.
Precautions






Confidentiality of patient information on specimens must be maintained
during transport. (i.e. name should not be visible)
All laboratory specimens and containers are considered contaminated.
Prior to transport ensure that all specimen containers with screw tops and caps are
securely fastened to prevent leaking.
Grossly contaminated specimen containers or requisitions should not be accepted
for transport.
Gloves (personal protective equipment) must be worn to deliver laboratory
specimens.
Use Isagel or wash hands after removal of gloves.
Transport






Transport patient specimens directly to the laboratory.
Refer to the Lab Services Manual for specific specimen transport storage and time
requirements.
Drop off all laboratory specimens at the Accession counter.
Exceptions include:
o Blood gas specimens should be delivered directly to the chemistry
department and a technologist notified of their arrival.
o Pathology specimens which are delivered to the Histopathology /
Cytology department.
o STAT specimens physically handed over to a person within the laboratory.
Transport via pneumatic tube following the instructions Sending Patient Samples
Using the Pneumatic Tube.
All specimens must be accompanied by an appropriately completed requisition.
LABRegOP7109A1.1.2 Instructions for Portering Lab Specimens
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 2
Last printed 7/4/2013 9:27 AM
After Hours




RGH - After day shift hours, deliver specimens to the Accession desk in
Laboratory Services. If you do not have card access and the lab staff are
unavailable, the Pass-Through specimen box will be unlocked to enable specimen
drop off.
Pasqua - After day shift hours, continue to deliver specimens to the Accession
desk in Laboratory Services. If you do not have card access and the lab staff are
unavailable, please call 2256 or 2200. Or if you need to contact the lab staff
STAT please page 2564 or 4803.
RQHR staff that frequent the lab, are encouraged to obtain card access.
Transport via pneumatic tube following the instructions LABPhlbOP7009A1.2
Sending Patient Specimens using the Pneumatic Tube.
Compromised Specimens

When a laboratory specimen is dropped and broken, or damaged during transport:
o Alert the next RQHR Employee passing by to contact housekeeping. Do
not leave the damaged specimen unattended.
o Immediately notify the department or ward to recollect the specimen.
o Fill out an Employee Report of Incident/Hazard and an Incident
Investigation with your supervisor. Submit to Employee Health.
Note: It is important for laboratory specimens to be delivered in a timely manner to
ensure specimen integrity, viability and prompt turn around times.
LABRegOP7109A1.1.2 Instructions for Portering Lab Specimens
Laboratory Services Regina Qu'Appelle Health Region
Page 2 of 2
Last printed 7/4/2013 9:27 AM
Portering Laboratory Specimens Competency Quiz
Name: __________________________ Contact Number: _____________________
1.
Are gloves required to transport patient specimens to the laboratory?
a. Yes
b. No
2.
What is the importance of delivering patient specimens directly to the
laboratory?
a. Assurance of specimen integrity and viability.
b. Prompt turn around times of testing results.
c. Ensure specimens are not misplaced and confidentiality compromised.
d. Biohazard material is not accessible in public or designated clean areas.
e. All of the above.
3.
Where are patient specimens delivered during the day shift?
a. Accession area of the laboratory, except Blood gases, Pathology
and STAT specimens.
b. To the Out-patient collection laboratory.
4.
Is it acceptable practice to leave patient specimens in public areas such as
hallways, elevator foyers, waiting rooms, etc?
a. No
b. Yes
5.
If a patient specimen is dropped, broken and spilled on route to the laboratory,
what should be done?
a. Carry on with your deliveries, leaving the broken specimen in the
corridor.
b. Alert the next RQHR Employee passing by to contact housekeeping. Do
not leave the damaged specimen unattended. Immediately notify the
department or ward to recollect the specimen.
c. Recover the specimen remains and deliver to the laboratory.
LABRegOP7109A2.1.2 Portering Lab Specimens Competency Quiz
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 1
Last printed 7/4/2013 9:27 AM
Portering Laboratory Specimens Competency Quiz Answers
1.
Are gloves required to transport patient specimens to the laboratory?
a. Yes
Rational: All laboratory specimens and containers are considered a potential
source of infection.
2.
What is the importance of delivering patient specimens directly to the
laboratory?
a. Assurance of specimen integrity and viability.
b. Prompt turn around times of testing results.
c. Ensure specimens are not misplaced and confidentiality compromised.
d. Biohazard material is not accessible in public or designated clean areas.
e. All of the above.
Rational: Patient specimens must be delivered promptly to the
laboratory to ensure specimens do not deteriorate. The accuracy of the
patient test results depends on the specimen reliability.
3.
Where are patient specimens delivered during the day shift?
a. Accession area of the laboratory, except Blood gases, Pathology
and STAT specimens.
Rational: It is important to deliver laboratory specimens to the appropriate
receiving area, so that specimens are not misplaced or lost. STAT
specimens should be physically handed to a person in the laboratory to
allow priority processing.
4.
Is it acceptable practice to leave patient specimens in public areas such as
hallways, elevator foyers, waiting rooms, etc?
a. No
Rational: It is unacceptable to leave patient specimens in public areas due to
considerations such as: breach of confidentiality, accessible biohazardous
material, and misplaced or lost specimens.
LABRegOP7109A3.1.2 Portering Lab Specimens Competency Quiz Answers
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 2
Last printed 7/4/2013 9:28 AM
5.
If a patient specimen is dropped, broken and spilled on route to the laboratory,
what should be done?
b. Alert the next RQHR Employee passing by to contact housekeeping.
Do not leave the damaged specimen unattended. Immediately notify
the department or ward to recollect the specimen.
Rational: To ensure patient, staff and visitor safety, it would be unacceptable
to leave the biohazardous spill unattended. Safe work practices would be
ensured by contacting appropriately trained staff with safety equipment
specific to the task to clean up a biohazardous spill.
LABRegOP7109A3.1.2 Portering Lab Specimens Competency Quiz Answers
Laboratory Services Regina Qu'Appelle Health Region
Page 2 of 2
Last printed 7/4/2013 9:28 AM
Subject/Title: LABChemOP8200T1.3.2 Chemistry Critical Values
Last Approved Time: 1/6/2014 2:32:50 PM
Revision: 3.2
Approving Authority: Medical Biochemist
Contact for Information: Chemistry
Phone: (306) 766-4490
Current Version on Print Date
CHEMISTRY CRITICAL VALUES
TEST (Blood)
Sodium
Potassium
Potassium (newborn)
Bicarbonate
Calcium (total – check
corrected value)
Glucose
Glucose (newborn)
Magnesium
Phosphorus
Iron (< 14 years)
pH
pCO2
pO2
Acetaminophen
Amikacin
LOW
HIGH
UNITS
 120
 2.8
 2.5
 10
 1.8
155
 6.0
 7.0
 2.2
 1.7
<0.50
 0.30
 25
 17
> 2.10
 7.20
 20
 40
Carbamazepine
Digoxin
Gentamicin
Lithium
Phenytoin
Phenobarbital
Salicylate
Theophylline
Tobramycin
Vancomycin
HIV
Hepatitis C Antibody
LABChemOP8200T1.3.2 Chemistry Critical Values
Laboratory Services Regina QuAppelle Health Region
 3.0
> 50.0
 7.60
 70
 600
>10 mg/L (Pre)
>30 mg/L (Post)
 63
≥ 3.0
≥ 2.0 (Pre)
≥ 15.0 (Post)
≥ 2.0
≥ 119
≥ 200
 2.3
>110
≥ 2.0 (Pre)
≥ 15.0 (Post)
≥ 21.0 (Pre)
≥ 60.0 (Post)
Reactive*
Reactive*
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
umol/L
mmHg
mmHg
umol/L
mg/L
umol/L
nmol/L
mg/L
mmol/L
umol/L
umol/L
mmol/L
umol/L
mg/L
mg/L
Hepatitis B Surface
Antigen
HTLV
Reactive*
Reactive*
*Indicate to ward that sample is being referred to SDCL for confirmation
LABChemOP8200T1.3.2 Chemistry Critical Values
Laboratory Services Regina QuAppelle Health Region
LABChemOP8200T1 Chemistry Critical Results
Laboratory Services, Regina Qu’Appelle Health Region
Page 2 of 2
Last printed 1/6/2014 2:32 PM
JOB AID
LABHemaOP7019T1 HEMATOLOGY CRITICAL VALUES
Any critical/ urgent value where the Physician can not be notified must be paged to the Hematologist
on call and an occurrence report initiated. (Refer to the time notification for paging Hematologist)
Any new critical finding must have a HEMR ordered and a slide sent to the Hematologist on a
separate tray
Test Name
Critical Value
Alert/Urgent Value
(called to the Physician immediately)
(Physician notified within 24 hours)
Platelet
≤ 20 x 109 /L (new case)
≤ 50 x 109 /L (out-patient/community)
≤ 70 x 109 /L (patient bleeding)
≤ 100 x 109 /L PAC, DS, DAS
≤ 100 x 109 /L (neo)
Hemoglobin ≤ 60 g/L (new case)
≥ 200 g/L adult male
≥ 220 g/L (new born)
≥ 180 g/L adult female
≤ 90 g /L PAC, DS, DAS
Malaria
Positive
WBC
≥ 30 x 109 /L (inpatients-new case)
≤ 1.5 x 109 /L (new case)
Monotest
Positive: if reflexed from lab
PT
INR > 6.0
PTT
≥ 100 sec.
Fibrinogen
≤ 1.0 g/L
D-Dimer
CSF
≥ 20 x 109 /L outpatients
≥ 5000 μg/L
ASAP INR ≥ 1.5 pre-op patients or
first time on none
ASAP ≥ 39 sec pre-op patients or
first time on none
Call all Referred In D-Dimers-(including
Rural labs: G, H, I, J, L, M, and N Depots)
TNC ≥ 10
Any test result that the technologist feels is significant should be called
Test Name
Abnormal
blood films
Brown
Plasma
Critical Value
(Notify the Hematologist on call immediately)
1. New Leukemia
2. Schistocytes-Any with platelets ≤ 50 x 109 /L
and/or hgb drop ≥ 30 g/L (except hemodialysis
patients)
3. Spherocytes- 2 + with anemia-new case
4. Sickle cells-Any new case
5. Positive Malaria
When plasma sample has severe hemolysis (not
from difficult poke)
Order: CBC, scan, Hemr, renal, & liver panel, LD,
plasma hgb, methemalbumin, PT, PTT, Fib, DDimer and DAT-if not done previously within 6 hr.
Kleihauer
Urgent Value
(Hematologist notified within 24 hrs)
1. Marked Rouleaux- new or
significant change.
2. 3+ Agglutination - new.
3. ANEUT ≤ 0.5 x 109 /L (first time)
Positive with an actual ml bleed
(Blood Bank notified ASAP)
Note:
 New Leukemias-First time Blasts(add comment: refer to Hematologist’s review for verification)
 Fluid/CSF cell counts and differentials should be called to physician/ward when the LIS is down.
LABHemaOP7019T1 Hematology Critical Values
Laboratory Services Regina QuAppelle Health Region
Page 1 of 1
Last printed 7/4/2013 9:26 AM
LABMicOP8000.A.1.6 Microbiology Critical Values~~000010012.doc
Microbiology Critical and Significant Values
When results fall within "Critical" ranges, results should be verified, and then within 1 hour the Ward, or Physician concerned must be
notified. This notification may be a phone call, with read back, followed by a hard copy of the report sent to their printer, or it may be a phone
call notifying them you are sending a report, followed by confirmation that they have received the report. All calls must be documented.
The following are considered Critical Values in Microbiology:
Gram Smears
Cultures
Test
Critical Value
Notification to:
Blood Culture
Any new positive on In Patients or
Emergency Patients.
Immediate call & send report to appropriate
ward.
CSF
Any positive Gram smear.
Immediate call & send report to appropriate
ward.
STAT
All Gram smear results.
Immediate call & send report to appropriate
ward.
OR specimens
All Gram smear results if marked STAT
Any positive Gram smear
CSF culture
Any new positive result.
Group A Streptococcus
isolated from sterile sites,
patients with history of
necrotising fascitis, and/or
deep wounds.
Any new positive result.
Sterile body fluids and tissue
specimens
E. coli 0157
LABMicOP8000.A.1 Microbiology Critical Values
Laboratory Services Regina Qu'Appelle Health Region
Any new positive result.
Page 1 of 3
Last printed 6/11/2013 2:52 PM
Immediate call & send report to appropriate
OR.
Immediate call & send report to appropriate
ward.
Immediate call & send report to Public
Health (Regina 766-7789).
After Hours call MHO on call. Regina
766-7773
Other Health Regions – refer to call list.
Immediate call & send report to Infection
Control for isolates from In Patients,
Nursing Homes, and WRC.
LABMicOP8000.A.1.6 Microbiology Critical Values~~000010012.doc
When results fall within “Significant” ranges, the Ward, Clinic, or Physician concerned should be notified. Depending on the specimen and the
result, notification may require a phone call or it may just be the electronic sending of the report. Notification should occur within that day.
All calls must be documented.
The following are considered Significant Values in Microbiology:
Gram Smears
Calcofluor White
AFB Smears
Test
Protocol
Blood Culture
Call & send report for any new positive on patients from Referred In or Clinics.
Sterile body fluids and tissues
(NOT STAT or OR)
Just send results, no call required.
Pneumocystis Positive
Just send results, no call required.
Acid fast bacilli seen on initial smear.
Call & send report of new positives to Ward / Clinic, & Infection Control.
Call SDCL to notify them that a positive is coming.
Tech 2’s will send electronic report during regular hours to Public Health.
Immediate call & send report to Infection Control
Clostridium difficile New positives
Toxin Positive (regardless of method)
In Patient (including Rural), Emerg., Nursing Home, - Call & send report to Ward, &
Infection Control.
Out Patient or Clinic: Just send results to location. No calls required.
Public Health does not need to be notified.
Non-culture
Influenzae Screen Positive
RSV Positive
Norovirus Positive
Mycology
Growth of dimorphic or pathogenic fungi
(Blastomyces, Coccidiodes, Histoplasma,
Paracoccidioides).
Call & send report of new positives to Ward.
If In patient notify Infection Control.
Tech 2’s will send electronic report during regular hours to Public Health.
(Public Health does not need to be notified about positive RSV’s)
Call & send interim report on new positives to Ward, & Notify Microbiologist.
Dialysis Waters
Call & send report to Clinical Engineering for any positive result that falls outside the
acceptable limits for Dialysis Waters.
Laboratory Waters
No action required.
Water sterility
LABMicOP8000.A.1 Microbiology Critical Values
Laboratory Services Regina Qu'Appelle Health Region
Page 2 of 3
Last printed 6/11/2013 2:52 PM
LABMicOP8000.A.1.6 Microbiology Critical Values~~000010012.doc
Test
Bioterrorism Agent
Blood culture growth report
Body fluid, & Tissues
Enteric Pathogens
(Campylobacter sp., Salmonella, Shigella,
Yersinia, Aeromonas, Plesiomonas ,
Vibrio cholerae).
Listeria
MRSA Screen Positive
VRE Screen Positive
ESBL Positive Organism
Cultures
Neisseria gonorrhoeae
Neisseria meningitidis (sterile site)
Protocol
Call all confirmed or highly suspicious organisms to Ward or Clinic, SDCL, &
Infection Control.
Just send results, no call required.
Just send results, no call required.
Call & send report of new positives to Ward / Clinic.
If In patient notify Infection Control.
Tech 2’s will send electronic report during regular hours to Public Health.
Just send results, no call required.
Interim reports on new RQHR In patient positive – Call & send report to Ward.
If In patient notify Infection Control. If Out Patient no notification required.
Final reports - Just send results, no calls required.
Tech 2’s will send electronic report during regular hours to Public Health.
(Only notify Public Health of ESBL from sterile sites)
Send report of new positives to Ward / Clinic if isolate is from non-genital source. If
genital culture, no call required.
Tech 2’s will send electronic report during regular hours to Public Health.
NEVER notify Infection Control
Immediate call & send report to Public Health (Regina 766-7789).
After Hours call MHO on call. Regina 766-7773
Other Health Regions – refer to call list.
Immediate call & send report to Infection Control for isolates from In Patients,
Nursing Homes, and WRC.
Tech 2’s will send electronic report during regular hours to Public Health.
Streptococcus agalactiae (Group B)
Isolated from children <4weeks of age
Parasitology
Positive for:
Amoebiasis,
Cryptosporidia
Entamoeba histolytica
Giardia,
Cyclospora
LABMicOP8000.A.1 Microbiology Critical Values
Laboratory Services Regina Qu'Appelle Health Region
Immediate call & send report to Infection Control for isolates from In Patients,
Nursing Homes, and WRC.
Tech 2’s will send electronic report during regular hours to Public Health.
Send printed report to Infection Control for isolates from In Patients, Nursing Homes,
and WRC.
Page 3 of 3
Last printed 6/11/2013 2:52 PM
LABTranOP7001W3 Transfusions Critical Values
Undue delay in filling crossmatch request for any reason.
Inability to crossmatch with compatible blood.
Inability to procure blood or blood products
LABTranOP7001W3 Transfusion Critical Values
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 1
Last printed 5/7/2010 4:25 PM
ANATOMIC PATHOLOGY CRITICAL RESULTS
Significant or unexpected surgical pathology findings are to be promptly communicated
to the patient’s physician by telephone. Documentation of the date and time of
notification and name of the recipient of the notification are to be included in the
pathology report. Significant or unexpected surgical pathology findings include but are
not limited to the following:
1. Malignancy in an uncommon location or specimen type (e.g. hernia sac,
intervertebral disk material, tonsil, etc.).
2. Absence of chorionic villi when clinically expected (potential ectopic
pregnancy).
3. Change of a frozen section diagnosis after review of permanent sections.
4. Mycobacterial, fungal or other significant organisms identified on special stains.
The pathologist will document the name of the physician notified and the date and time
of the call on the surgical report.
LABHistOP1000T1.1.2 Anatomic Pathology Critical Results
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 1
Last printed 11/06/2013 2:50 PM
Subject/Title: LABCytoOP7047 Communication and Documentation of
Cytopathology Critical Results
Last Approved Time: 10/15/2012 10:01:01 AM
Revision: 1
Approving Authority: Cytopathologist
Phone: (306) 766-2641
Contact for Interpretation: Cytology
Current Version on Print Date
Policy
Process Control
Purpose
There are certain cytopathology diagnoses that may be considered particularly significant
and unexpected. There are no consensus guidelines developed on Critical Values in
cytology, so we will address the type of cases that the RQHR Cytopathology Department
has designated as Critical Results. It is important to have prompt communication and
documentation of these particular diagnoses.
Procedure
Cytology Critical Value (CV) cases:
 Bacteria or fungi in cerebrospinal fluid
 Pneumocystis, fungi, or viral cytopathic changes in BAL, wash, or brush
 Bacteria in FNA
 Fungi in FNA
 Acid-fast bacilli in any specimen
 Completely unexpected malignancy (malignancy in a fluid with a negative history
and no clinical suspicion)
 Malignancy (suspected or not) in critical places (sup.vena cava synd., risk of spinal
cord injury)
1. The Cytotechnologist screening the case, will identify the Critical Result and will
take it immediately to the pathologist reporting the case.
2. The pathologist will promptly communicate the significant or unexpected findings
to the patient’s physician or other clinical personnel responsible for patient care
by telephone.
3. The pathologist will document the date and time of notification and name of the
recipient of the notification on the cytology report.
4. If after 3 tries, a physician cannot be reached by telephone, the report will be
faxed to the physician / ward within 24 hours.
LABCytoOP7047 Communication and Documentation of Cytopathology Critical Results
Laboratory Services Regina QuAppelle Health Region
Page 1 of 2
Last printed 10/15/2012 10:01 AM
References
Diagnostic Cytopathology, Vol 34, No 6, “Critical Values in Cytology”
Related documents
RQHR Quality Manual, LABRegOP8101 Timely Communication of Critical Values and
New Diagnosis
LABRegOP7900 Laboratory Services Manual General Information
Appendixes (charts, form, job aids, labels, logs, tables, tags, worksheets)
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author
Ronald Angeles, MD, FRCPC, PATHOLOGIST, L. Kozak, MLT
Page 2 of 2
Last printed 10/15/2012 10:01 AM
RURAL LAB CRITICAL RESULTS
CHEMISTRY
TEST (Blood)
Sodium
Potassium
Potassium (newborn)
Bicarbonate
Bilirubin (newborn)
Calcium (total – check corrected
value)
Glucose
Glucose (newborn)
Magnesium
Phosphorus
PH
PCO2
PO2
Acetaminophen
Digoxin
Salicylate
Phenytoin
LOW
HIGH
 120
 2.8
 2.5
 10
 1.8
 2.2
 1.7
<0.50
 0.30
< 7.20
≤ 20
≤ 40
UNITS
155
 6.0
 7.0
 280
 3.0
 25
 17
> 2.10
> 7.60
≥ 70
 600
≥ 3.0
 2.3
 119
mmol/L
mmol/L
mmol/L
mmol/L
umol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
mmHg
mmHg
umol/L
nmol/L
mmol/L
umol/L
HEMATOLOGY
 Any new critical finding must have a HEMR (Hematologist Review) ordered. Send 2 unstained slides and CBC report to RGH hematology.
Test Name
Critical Value
Alert/Urgent Value
(called to the Physician immediately)
(Physician notified within 24 hours)
Platelet
≤ 20 x 109 /L (new case)
≤ 50 x 109 /L (out-patient/community)
9
≤ 70 x 10 /L (patient bleeding)
≤ 100 x 109 /L Pre-Op
9
≤ 100 x 10 /L (neo)
Hemoglobin
≤ 60 g/L (new case)
≥ 200 g/L adult male
≥ 220 g/L (new born)
≥ 180 g/L adult female
≤ 90 g /L Pre-Op
Malaria
Positive
WBC
≥ 30 x 109 /L (inpatients-new case)
≤ 1.5 x 109 /L (new case)
Monotest
LABRlabOP7900A2.1.2 Rural Lab Critical Result Appendix
Laboratory Services, Regina Qu’Appelle Health Region
≥ 20 x 109 /L outpatients
Positive: if reflexed from lab
Page 1 of 2
Last printed 7/4/2013 2:04 PM
RURAL LAB CRITICAL RESULTS
PT
INR > 5.0
ASAP INR ≥ 1.5 pre-op patients or first time on none
PTT
≥ 100 sec.
ASAP ≥ 39 sec pre-op patients or first time on none
Any test result that the technologist feels is significant should be called
Test Name
Abnormal
blood films
Brown Plasma
Critical Value
(Notify the Hematologist on call immediately) Send unstained slides (2) along
with CBC report to RGH for HEMR)
1. New Leukemia
2. Schistocytes-Any with platelets ≤ 50 x 109 /L and/or hgb drop ≥ 30 g/L
(except hemodialysis patients)
3. Spherocytes- 2 + with anemia-new case
4. Sickle cells-Any new case
5. Positive Malaria
When plasma sample has severe hemolysis (not from difficult poke)
Order: CBC, scan, Hemr, renal, & liver panel, LD, PT, PTT, (some tests may not
be available on site. Refer those tests to RGH for testing.)
Urgent Value
(Hematologist notified within 24 hrs)
1.
2.
3.
Marked Rouleaux- new or significant change.
3+ Agglutination - new.
Absolute Neutrophil < 0.5 x 109 /L-first time
Note:
 New Leukemias-First time Blasts(add comment: refer to Hematologist’s review for verification)
TRANSFUSION
The laboratory will call whenever there will be a delay in filling the crossmatch request – detailing the reason for the delay.
MICROBIOLOGY
All POSITIVE blood culture results will be phoned.
NOTES
1.
2.
3.
Any result that the technologist feels is significant should be phoned, especially if there is a change from a previous result.
Critical results telephoned from the testing facility should be telephoned to the inpatient ward, office/clinic or directly to the ordering physician.
Any critical/ urgent value where the Physician can not be notified must be paged to the Medical Section professional “on call” and an occurrence report initiated.
a. Page the appropriate medical section. To locate the medical section personnel on call, go to the “intranet” →choose “on call lists”→ choose either
“clinical chemistry” for chemistry personnel on call or choose “hematology and transfusion lab consult” for hematology and transfusions section
personnel on call. Please ensure you have the patient’s phone number prior to prior to initiating the page. The “on call” profession requires
the patient phone number.
LABRlabOP7900A2.1.2 Rural Lab Critical Result Appendix
Laboratory Services, Regina Qu’Appelle Health Region
Page 2 of 2
Last printed 7/4/2013 2:04 PM
CHEMISTRY TESTS
TEST
Acetaminophen
AFP (alpha fetoprotein)
Albumin (serum/fluid)
Alcohol (Ethanol)
Alkaline Phosphatase
ALT
Amikacin
Ammonia (plasma)
Amylase (serum/urine/fluid)
AST
B12
B2 Microglobulin
BhCG - Quantitative
Bilirubin-total and direct
(serum/fluid)
Blood and Body Fluid Exposure
Blood Gases
BNP (plasma)
CA125
Calcium (serum/urine)
Carbamazepine
Carbon Dioxide (CO2)
Carboxyhemoglobin (whole
blood)
CEA
Chloride (serum/urine)
Cholesterol (serum/fluid)
CK
CKMB Mass
CMV
Creatinine (serum/urine/fluid)
CRP
CSF Glucose
CSF Protein
Cyclosporine (whole blood)
Digoxin
Dilantin (Phenytoin)
Estradiol
Ferritin
Folates (serum and rbc)
Free PSA
Free T3
Free T4
LABChemOP8202C1 Chemistry Tests
Laboratory Services, Regina Qu’Appelle Health Region
STAT TAT
(in minutes)
70
24 hr
Availability
*
70
70
70
70
70
70
70
70
*
*
*
*
*
*
*
*
70
70
*
*
2.5 hours
10
70
*
*
*
70
70
70
30
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
70
70
70
70
70
70
70
4 hours
70
70
70
*
*
*
*
*
*
Test Site
RGH / PH
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Page 1 of 4
Last printed 6/12/2013 11:43 AM
CHEMISTRY TESTS
FSH
Gentamicin
GGT
Glucose
Glucose Tolerances
HDL / LDL Cholesterol
Hemoglobin – fetal (APT test)
Iron
Ketones
Lactate
LD
LH
Lithium
Magnesium (serum/urine)
Methotrexate
Microalbumin (urine)
Occult Blood (feces/gastric)
Osmolality (serum/urine)
Phenobarbital
Phosphorus (serum/urine)
Potassium (serum/urine)
Pregnancy test (serum/urine)
Prolactin
Protein (serum/urine/fluid)
PSA
PTH
Salicylate
Sirolimus
Sodium (serum/urine)
Tacrolimus
Theophylline
TIBC
Tobramycin
Triage (urine)
Triglyceride (serum/fluid)
Troponin I
TSH
Urea (serum/urine/fluid)
Uric Acid (serum/urine/fluid)
Urinalysis
Valproic Acid
Vancomycin
70
70
70
70
70
60
70 - plasma
60 – whole blood
70
LABChemOP8202C1 Chemistry Tests
Laboratory Services, Regina Qu’Appelle Health Region
70
70
2 hours
*
*
*
*
*
*
*
*
*
*
*
*
70
70
70
70
60
*
*
*
*
*
70
*
70
70
4 hours
70
4 hours
70
*
*
70
60
70
70
70
70
60
70
70
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Page 2 of 4
Last printed 6/12/2013 11:43 AM
CHEMISTRY TESTS
Chemistry Specialized Testing
Chemistry Specialized Testing is staffed Monday to Friday 0730 – 1600 @ RGH
Limited testing is available on the weekend. Call back may be required for some stat tests.
TEST
α-1 antitrypsin
Acid Glycerol Lysis Time
AGBMA
Alkaline Phosphatase Isoenzymes
AMA
Amino Levulinic Acid
Amniotic Fluid Scan
ANA Screen
Anti-dsDNA
Anti-RNP/SM
Anti-Scl 70
Anti-Smith
Anti-SSA
Anti-SSB
ASMA
Barbiturate Quantitation (Pentobarbital)
Bence Jones Protein – Urine
C3 – C4
Cryoglobulin / Cryofibrinogen
Free Light Chains
Galactose (serum/urine)
Glucose 6 Phosphate Dehydrogenase
Haptoglobin
Hemoglobin A1C
Hemoglobin A2
Hemoglobin F
Hemoglobin Electrophoresis
Hemoglobin in Plasma
H-pylori IgG
IFE with Quant Immunoglobulins
Methemalbumin
Methemoglobin/Sulfhemoglobin
Oligoclonal Bands in CSF
PE with IFE – Quant Immunoglobulins
Porphobilinogen
LABChemOP8202C1 Chemistry Tests
Laboratory Services, Regina Qu’Appelle Health Region
STAT
TAT
4 hours
2 hours
2 hours
2 hours
2 hours
2 hours
ROUTINE
TAT
3 days
3 days
14 days
3 days
14 days
1 week
2 hours
14 days
21 days
21 days
21 days
21 days
21 days
21 days
14 days
8 hours
10 days
3 days
14 days
*batch runs – 30 days
1 week
5 days
3 days
3 days
2 weeks
2 weeks
2 weeks
24 hours
7 days
10 days
24 hours
2 days
1 week
10 days
1 week
Page 3 of 4
Last printed 6/12/2013 11:43 AM
CHEMISTRY TESTS
Porphyrin Screen, Urine or Stool
Protein Electrophoresis – Serum
Protein Electrophoresis – Urine
Pseudocholinesterase/Dibucaine #
Pyrogens
Quant Immunoglobulins
RF
Sugar Chromatography
Sweat Chloride
Transferrin
2 hours
4 hours
2 hours
3 days
5 days
10 days
4 days
3 days
3 days
3 days
1 week
3 days
3 days
All testing performed is approved by Health Canada regulations.
LABChemOP8202C1 Chemistry Tests
Laboratory Services, Regina Qu’Appelle Health Region
Page 4 of 4
Last printed 6/12/2013 11:43 AM
GUIDELINES FOR EXPECTED TURN AROUND TIMES IN
HEMATOLOGY
TEST
CBC
STAT “ TAT”
24 HR
AVAILABILITY
I HR
*
CBC
DIFFERENTIAL
90 MINS
*
MALARIA SCREEN
90 MINS
*
1 HR
*
1 HR
*
1 HR
*
3 HR
*
1 HR
*
2 HR
*
2 HR
*
2 HR
*
90 MINS
*
APTT
PT
FIBRINOGEN
D-DIMER
CSF
CSF DIFFERENTIAL
PERITONEAL
FLUID &
DIFFERENTIAL
ESR
MONOTEST
KLEIHAUER
BONE MARROWS
FLOWCYTOMETRY
90 MINS
NOTIFICATION
SAME DAY
12HRS-(VERBAL
RESULT BY PHONE)
LABHemaOP7031C1.1.3 Guidelines for Expected Turn Around Times in Hematology
Laboratory Services, Regina Qu’Appelle Health Region
TEST PERFORMED
RGH
PASQUA
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Page 1 of 4
Last printed 6/12/2013 11:44 AM
GUIDELINES FOR EXPECTED TURN AROUND TIMES IN
HEMATOLOGY
TEST
ROUTINE
CBC
6 HRS
DIFFERENTIALS
24 HRS
*
*
APTT
4 HRS
*
*
PT
4 HRS
*
*
FIBRINOGEN
4 HRS
*
*
OTHER FLUIDS
4 HRS
*
*
ESR
6 HRS
*
*
RETICS
24 HRS
*
*
MONOTEST
6 HRS
*
*
KLEIHAUER
24 HRS
*
SEMEN ANALYSIS
48 HRS
*
BONE MARROWS
72 HRS
*
FLOWCYTOMETRY
48 HRS
*
CD4/CD8
24 HRS
*
LABHemaOP7031C1.1.3 Guidelines for Expected Turn Around Times in Hematology
Laboratory Services, Regina Qu’Appelle Health Region
TEST PERFORMED
RGH
PASQUA
*
*
*
Page 2 of 4
Last printed 6/12/2013 11:44 AM
GUIDELINES FOR EXPECTED TURN AROUND TIMES IN
HEMATOLOGY
The following tests are available but they are to be approved by the hematologist mainly
because:
a) These tests are time consuming.
b) These tests are difficult to interpret.
TEST
RGH
SERUM VISCOSITY
*
SICKLE CELL TEST
*
HEINZ BODY TEST
*
SUCROSE LYSIS TEST
*
HAM’S TEST
*
LEUKOCYTE ALKALINE
PHOSPHATASE
*
NBT TEST
*
MYELOPEROXIDASE STAIN
*
COMBINED ESTERASE
STAIN
*
IRON STAIN
*
SUDAN BLACK STAIN
*
LEUKOCYTE ACID
PHOSPHATASE
*
MALARIA IDENTIFICATION
*
LABHemaOP7031C1.1.3 Guidelines for Expected Turn Around Times in Hematology
Laboratory Services, Regina Qu’Appelle Health Region
Page 3 of 4
Last printed 6/12/2013 11:44 AM
GUIDELINES FOR EXPECTED TURN AROUND TIMES IN
HEMATOLOGY
The following special coagulation tests have to be approved by the Hematologist. These
tests are time consuming and difficult to interpret. The TAT for these tests is 8-12 weeks.
BLEEDING TIME
TEST
RGH
*
FACTOR ASSAYS
*
RISTOCETIN
*
FACTOR VIII RELATED ANTIGEN
*
PLATELET AGGREGATION STUDY
*
PROTEIN S
*
PROTEIN C
*
ANTITHROMBIN III
*
APC RESISTANCE RATIO
*
ANTICARDIOLIPIN ANTIBODIES
*
DRVVT
*
THROMBIN TIME
*
EUGLOBULIN LYSIS
*
FACTOR XIII
*
HEPARIN ASSAY
*
INHIBITOR STUDIES
*
HIT TEST
*
PFA
*
LABHemaOP7031C1.1.3 Guidelines for Expected Turn Around Times in Hematology
Laboratory Services, Regina Qu’Appelle Health Region
Page 4 of 4
Last printed 6/12/2013 11:44 AM
Anticipated Turn Around Times for Microbiology Tests
Turn-around time (TAT) for Microbiology specimens is from the time of receipt of
specimen in the laboratory to the time of generation of the final report.
Specimen
Initial Processing
Final culture
Comments
Negative
Positive
Abscess
Microscopy performed
72 hours
24 – 48 hours
Mixed cultures, with
Aspirate
and reported.
after isolation
anaerobic organisms
Body fluids
Specimen cultured
of organism.
may require longer
Deep Wound
time.
Blood Cultures Bottles are placed in an
5 days
24 – 48 hours
Mixed cultures may
automated system for
after isolation
require longer time.
continuous monitoring.
of organism.
Bottles that are flagged as
**Fungal blood
positive are subcultured
cultures are incubated
immediately, and Gram
for 5 days.
stains are called STAT.
**If extended
incubation is
requested, & approved
by MOC:
Blood culture bottles
will be monitored on
the automated system
for 5 days. If negative
after 5 days, terminal
subculture will be
performed.
≤ 24 hours
≤ 24 hours
Appropriate ward and
C. difficile
Toxin Test
the Infection Control
department are
notified of all positive
results.
Eyes / Ears
Microscopy performed
48 hours
48 – 72 hours
**Conjunctiva
and reported.
specimens must
Specimen cultured
include swabs from
both the infected and
the uninfected eyes
LABMicOP8000.A.2 Anticipated Turn Around Times For Microcioloby Tests
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 4
Last printed 6/12/2013 11:46 AM
Anticipated Turn Around Times for Microbiology Tests
Specimen
Rapid FLU
Test
Fungal cultures
Genital
Initial Processing
In house testing only
performed on In Patients.
Specimens from out
patients are referred to
Reference Laboratory for
testing.
Preliminary report is
issued at 7 days.
Microscopy performed
and reported.
Specimen cultured
Final culture
Negative
Positive
≤ 2 hours
≤ 2 hours
4 weeks
4 weeks
48 hours for
Candida
48 – 72 hours
72 hours for
GC
MRSA Screen
RSV
Skin
(superficial)
Sputum
PCR negative test results
are released. PCR
positive test results are
confirmed by culture.
Presumptive positive
results should be reported
as soon as mauve
colonies grow on MRSA
Select agar & test
positive with the slide
coagulase test.
In house testing only
performed on In Patients.
Specimens from out
patients are referred to
Reference Laboratory for
testing.
Microscopy performed
and reported.
Specimen cultured
24 hours
72 – 96 hours
≤ 2 hours
≤ 2 hours
48 hours
48 – 72 hours
Microscopy performed
and reported.
Specimen cultured.
48 hours
48 – 72 hours
LABMicOP8000.A.2 Anticipated Turn Around Times For Microcioloby Tests
Laboratory Services Regina Qu'Appelle Health Region
Comments
*Testing only
performed at RQHR
during Flu season.
** All suspected
isolates of
N. gonorrhoeae are
referred to Reference
laboratory for
confirmation.
Ward and Infection
control notified
immediately when
MRSA is isolated.
**If salivary
specimen, ward will
be notified and asked
to recollect.
Page 2 of 4
Last printed 6/12/2013 11:46 AM
Anticipated Turn Around Times for Microbiology Tests
Specimen
Initial Processing
Final culture
Negative
Positive
24 - 48 hours 24 – 48 hours
Throat
GenProbe DNA probe
assay.
Throat culture
(Non-routine
Throat)
Specimen cultured
48 hours
48 – 72 hours
Stool Culture:
Urine
VRE Screen
Specimen cultured
72 hours
24 hours
≤ 72 hours
72 – 96 hours
48 – 72 hours
≤ 96 hours
Specimen cultured
Comments
Testing not performed
on Weekends. Throat
swabs on children
received on Fridays
are cultured
Antimicrobial
susceptibility testing
performed only upon
request.
Ward and Infection
control notified
immediately when
VRE is confirmed.
Microscopy Results
Turn-around time (TAT) for Microbiology specimens is from the time of receipt of
specimen in the laboratory to the time of generation of the final report.
Test
STAT
Routine
Gram Stain
1 hour
Same day
Auramine O
(ZN) In Patients
2 hour
24 hours
PCP
2 hour
24 hours
Parasitology
(O&P)
LABMicOP8000.A.2 Anticipated Turn Around Times For Microcioloby Tests
Laboratory Services Regina Qu'Appelle Health Region
48 – 72 hours
Page 3 of 4
Last printed 6/12/2013 11:46 AM
Anticipated Turn Around Times for Microbiology Tests
Notes:
1.
Additional interim reports are sent when delays in identification and / or
susceptibility testing occur, as with fastidious organisms and mixed cultures. All
positive cultures will have interim reports issued within 48 hours. Prompt and
updated reports aid the physician in appropriate clinical interventions and proper
patient management.
2.
If these TAT limits cannot be met because of problems within the laboratory such
as equipment, media, or reagents, the client will be notified (physician / ward),
and if necessary, testing at an alternate site will be arranged.
3.
Audits of TAT’s for interim and final reports is performed on a quarterly basis,
evaluating different specimen types each quarter. The goal for interim reports is
100% of reports issued in ≤ 48 hours.
LABMicOP8000.A.2 Anticipated Turn Around Times For Microcioloby Tests
Laboratory Services Regina Qu'Appelle Health Region
Page 4 of 4
Last printed 6/12/2013 11:46 AM
Turn Around Time (TAT) – for Transfusions
The following is the expected time frames for commonly requested blood products:
Test Requested
TAT
Group O Uncrossmatched Packed cells
10 minutes
Group-specific Uncrossmatched Packed
Cells
15 minutes from sample receipt in Lab
Fully Crossmatched Packed Cells
45 minutes from sample receipt in Lab
(assuming no serological problems)
Frozen Plasma
25 minutes (product must be thawed)
(need a current admission blood group or
issue universal donor group)
Platelets (if available on site)
10 minutes
(need a current admission blood group)
Cryoprecipitate
(need a current admission blood group or
issue universal donor group)
25 minutes (product must be pooled and
thawed)
Blood Group – Stat
15 minutes from sample receipt in Lab-
Blood Group - Routine
24 hours
Group and Screen – Stat
45 minutes
Group and Screen – Routine
4 hours
Cold Agglutinin test
24 hours
Direct Antiglobulin Test – Stat
30 minutes
Direct Antiglodulin Test - Routine
24 hours
NOTE: The Pasqua Hospital does not do serological testing. All serological testing is
completed at the Regina General Hospital, therefore for the group-specific
uncrossmatched packed cells and the fully crossmatched packed cells the TAT is from
when sample is received at the Regina General Hospital.
Laboratory Services, Regina Qu’Appelle Health Region
Page 1 of 1
Last printed 6/12/2013 11:47 AM
APPENDIX
Tests Referred to Saskatchewan Disease Control Laboratory
Orders for tests, which are referred to the Saskatchewan Disease Control
Laboratory, must be submitted on the appropriate SDCL requisition. Do not use
RQHR requisitions.
The following is a list of the more common tests referred to the Saskatchewan
Disease Control Laboratory:
Aldosterone
ASOT
Catecholamine
Chlamydia
Cortisol
DHEA-SO4
Fructosamine (Glycosylated Protein)
HBsAg
HCV
Hepatitis A,B, and C screen
HIV
Insulin
Metanephrines
Mycobacterium Culture
PKU
Progesterone
PTH
Testosterone
Thyroid Antibody
Urine Drug Screen
VDRL
Viral Culture
Viral Serology – Rubella, Torch screen, Cytomegalovirus (CMV)
Herpes, Legionella, Epstein-Barr virus
LABRegOP7900A1.1.1 Tests Referred to SDCL
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 1
Last printed 5/7/2010 4:22 PM
Specimen & Requisition Reminders:
Please help SDCL reduce turnaround time and thus improve patient care by accurately submitting
specimens and requisitions.
Saskatchewan
Ministry of Health
Saskatchewan Disease
Control Laboratory
Patient Demographics
MUST:
- Include the complete last
name and first names
- Include the patient’s
address for all MHO
reportable test orders.
Place Saskatchewan
Disease Control
Laboratory number
sticker here
Chemistry Requisition
Patient's Name & Address (required - print clearly)
Patient PHN
XXX XXX XXX
Last Name, First Name
123 City Street
Regina, SK S4X 4C2
Birthdate
D 12 /
01 M
Gender
Male
/ 2011
Y
Female
Sending Location Phone #
Requisitions/packing
slips MUST contain the
patient’s Personal
Health Number (PHN)
and Birthdate
Hospital ID, Ward or Room #
Patient Type
In
Diagnosis
Collection Date
Medication
Collection Time
Physician name (include initials)
Physician MCIB#
D
/
H
Physician’s Last Name, First
Name or Initials MUST be
included on all requisitions.
- Include Physician’s MCIB #
-Indicate if out of province
physician
Please do not use:
- Interns or residents
- Abbreviated last names
or ‘Nick’ names for
physicians
To ensure results are sent
to the correct location,
include complete return
address
Note: All specimens must
have two unique
identifiers:
- Patient Last & First Names
- PHN
- Birthdate
Clearly mark off all
tests on the
requisitions or list
them on the packing
slips
Out
M
/
/
Y
M
Dr. First Name OR Initials, Last Name
XXXX
Return Address (Doctor/Clinic/Hospital)
In addition to mail/courier, please copy to:
Mail*
or
Fax (_____) _____- _________
Dr.'s Name
Phone report (_____) _____ - _________
Please ensure that requisitions and specimens are properly labeled.
Specimen Type
Serum
Urine
Plasma
Blood
CSF
Gastric
Other (specify) _________________________________________
Additional Information
If this is 24 hr. urine collection, enter volume ________ (Liters/day)
Body wt. _________ kg
Timed series: number of tubes _____. Indicate collection time on tube(s) and requisition. ________
Tests
(Compendium of tests contains additional information)
Estradiol
DHEA-SO4
Progesterone
Phenylalanine
Prolactin
Cholinesterase (Pseudo)
Testosterone
Lipase
SHBG/FAI
Oxalate
LH & FSH
Catecholamine
B12
VMA
Ferritin
Metanephrines
Iron Studies
UFC
(iron, Transferrin, Ferritin)
Drugs of Abuse – Urine – 5 Panel
Amphetamines
Benzodiazepines
Cannabinoids
Cocaine
Opiates
Drugs of Abuse: (other)
________________________
________________________
________________________
Magnesium
5HIAA
Cortisol
HVA
Toxicology Tests
17-OHP
Porphyrins
Reason for Request
HGH*
Primidone
PTH (Intact)*
Quinidine
ACTH*
Ethosuximide
C-Peptide*
NAPA/Procainamide
Therapeutic
Overdose
Other
Drugs suspected (specify)
Lead*
Gastrin*
Insulin
RBC Folate ** (Hematocrit __________)
* See Test in compendium for special handling
** CBC result required for RBC folates
Health 13 126 09/09
Other tests requested (specify)
Chemistry
Please use "Thyroid Function" requisition if only thyroid tests are requested.
SUBMISSION OF SPECIMENS
Attention to the following points will ensure useful results on submitted specimens:
1. Collect specimen properly and complete the requisition carefully.
2. Send sufficient specimen for tests requested.
3. For tests not listed, consult SDCL Laboratory Test Compendium, enquire by mail or telephone. (The laboratory offers
many additional chemical tests whose frequency does not warrant inclusion on the standard form).
CLOTTED BLOOD OR SERUM
1. If possible, collect fasting blood. Turbidity or lactescences of postprandial specimens may interfere with many tests.
2. Complete requisition and record any concurrent medications.
3. a) Avoid hemolysis,. Constituents such as potassium, phosphates, and most enzymes are unequally distributed between
the cellular elements and extracellular plasma.
b) Use a 20 or 22 gauge needle (smaller lumens may rupture erythrocyte membranes in the vacuum draw).
c) Avoid excessive stasis. (After 5 minutes of venous occlusion, many enzymatic activities are increased 20-25%).
4. Separate serum wherever possible. Submission of serum free of r.b.c. eliminates risk of leakage from cellular elements
and risk of hemolysis enroute to the laboratory.
5. a) Store specimen in refrigerator until transporting.
b) Pack to avoid breakage.
6. The following must be frozen and received frozen:
ACTH C-peptide Gastrin
Specimen Volume Required (See Compendium)
Serum (double the volume stated if sending clotted blood)
Serum Separator Vacutainer (SST) should be avoided in therapeutic drug and hormone testing.
Please centrifuge whole blood and submit plasma or serum as per compendium.
URINE CHEMISTRY
Record 24hr volume and body weight on requisition. Send required aliquot for testing.
Specimen Volume Required
1. Catchecholamines .............................................. 25 mL
5 HIAA ................................................................. 25 mL
VMA .................................................................... 25 mL
MET .................................................................... 25 mL
HVA .................................................................... 25 mL
Oxalates ............................................................. 25 mL
On above tests, check pH which should be 2-4. Add 6N HCl if necessary.
2. 17 - Ketosteroids ................................................ 25 mL
Adjust pH to less than 5 with glacial acetic acid or send frozen.
3. Urine "drugs of abuse" screen..............................20 mL random urine
and/or urine "drugs of abuse (other)"
Submission of Specimens
Alcohol(s) ..................................
Barbiturates ...........................
Carbon Monoxide ..................
Clobazam .................................
Ibuprofen .................................
Tricyclic Antidepressants .......
Other specific drugs ..............
Lead ....................................
3 mL whole blood (grey top)
2 mL serum
2 mL whole blood
4 mL serum
2 mL serum
4 mL serum
4 mL serum
2 mL whole blood
For a more complete list of laboratory tests and specimen requirements, refer to the SDCL Compendium
of Laboratory Tests on-line (www.health.gov.sk.ca/compendium).
For further information, please phone:
For after hour STAT testing please phone:
For interpretation, please phone:
787-3193
787-3197
536-4653
787-7900
Chemistry
Toxicology
Cell phone
Dr. Denis Lehotay
Laboratory Test Menu-Rural Facilities
Wolseley **On Call
Fort Qu'Appelle **On Call
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Bilirubin - Total
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Bilirubin - Conjugated
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Bilirubin - Total (Neo-Natal)
√
Blood Gases
√
Calcium
√
Cholesterol (total)
√
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Cholesterol HDL
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Cholesterol LDL
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Carbon Dioxide (C02)
√
Creatinine
√
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Chloride
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Sodium
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Potassium
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Glucose
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Glucose Tolerance Collection
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Magnesium
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Phosphorus
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Protein, Total - Serum
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Triglyceride
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Urea
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Uric Acid
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Alkaline Phosphatase
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Alanine Transaminase
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Amylase
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Aspartate Transaminase
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Creatine Kinase
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TROPONIN T
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Gamma Glutamyl Transferase (GGT)
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Lestock
Indian Head ** On Call
√
Whitewood
√
Montmartre
√
Imperial
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Grenfell
Broadview ** On Call
Albumin
Cupar
Test
Balcarres
** On Call Sites testing Available 24 hours
Moosomin ** On call
STAT Testing
Turn Around Time: 70 minutes
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LABRlabOP7900A3.1.3
Laboratory Services Regina Qu'Appelle Health Region
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Fort Qu'Appelle **On Call
Indian Head ** On Call
Broadview ** On Call
Urinalysis - Microscopic
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Urinalysis - Dipstick Only
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Occult Blood - Feces (STAT only)
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Icotest
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Acetaminophen (Tylenol)
√
Salicylate
√
Lestock
√
Wolseley **On Call
Pregnancy Test - Serum
Whitewood
√
Montmartre
Pregnancy Test - Urine
Imperial
√
Grenfell
√
Lactate Dehydrogenase
Cupar
Moosomin ** On call
Lactate
Balcarres
Test
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Digoxin
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Phenytoin
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Drugs of Abuse
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HIV - POCT
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CBC
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Automated Differential
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Cell Morphology
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Semen Analysis - Post vasectomy
APTT
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Prothrombin Time (INR reported)
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ABO Forward and Reverse
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Rh typing
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Direct Antiglobulin Test
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Antibody Detection Screen
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Crossmatching Units of Blood
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Issue of packed cells / blood products
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Wet Prep (Hanging Drop)
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Monotest
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ECG
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LABRlabOP7900A3.1.3
Laboratory Services Regina Qu'Appelle Health Region
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Subject/Title: LABChemOP7269 Chemistry Lab Services
Last Approved Time: 5/6/2013 2:47:39 PM
Revision: 5.1
Approving Authority: Medical Biochemist
Contact for Information: Chemistry
Phone: (306) 766-4490
Current Version on Print Date
Policy
Process Control
Purpose
The purpose of this procedure is to provide information about the services provided by
the Chemistry department at the Regina General Hospital and the Pasqua Hospital. The
department is operational 24 hours a day to provide essential diagnostic testing. Routine
and specialized testing is performed Monday to Friday from 0730 – 1600. Evening and
night shifts are staffed to handle essential coverage only.
A Biochemist is always on call to handle any unusual issues or problems that may arise.
Procedure
The Chemistry department has two sections, Routine Chemistry (RGH and Pasqua) and
the Specialized Testing section at the RGH.
The testing profile of the Chemistry department is quite extensive. Requirements for all
tests are listed on the RQHR Intranet – Department / Laboratory / RQHR Lab
Specimen Requirements.
Critical result list is found in an appendix in the General Lab Services procedure.
Test availability and turn-around-time is found in an appendix in the General Lab
Services procedure.
The following tables provide extra information regarding specimen collection that may
be needed by the nursing unit.
The tables are separated by specimen type.
There are two additional tables regarding toxicology and therapeutic drug monitoring.
LABChemOP7269 Chemistry Lab Services
Laboratory Services Regina QuAppelle Health Region
Page 1 of 12
Last printed 5/6/2013 2:47 PM
Blood Specimens
Rapid ACTH Test
(Cortrosyn)
Blood Ethanol
Blood Gases

This test is used as a screening test for
adrenocortical function
 Cortrosyn is a synthetic 1-24 ACTH.
 Baseline Cortisol is collected
250 ug of cortrosyn is injected intravenously
by the ward
 30 min Cortisol is collected
 60 min Cortisol is collected
 See attached Appendix for specific ordering
and collection instructions
 Chemistry only tests ethanol for medical
purposes
 The legal driving limit of 0.08 is equal to 17.4
mmol/L
 Plasma ethanol results are about 7% higher
than whole blood
Capillary
 Ward notifies the Chemistry department that a
capillary blood gas is needed
 Chemistry staff will inform ward to warm the
foot or the hand (this depends on the size and
age of the patient)
 The site is usually warmed with a wet cloth
and then wrapped up with something to hold
the heat in (for example wrapping a diaper
around the cloth). The temperature should not
exceed 45° C
 The site is ideally warmed for 3 – 4 minutes
prior to the collection
Arterial
 Arterial samples are drawn by a Respiratory
Therapist or may be collected from an arterial
line by a RN
 It is of utmost importance that the sample be
correctly labeled (2 identifiers)
 The time of collection should also be indicated
on the requisition. If the time is not stated, the
technologist will default the entry to the time
received in the laboratory.
 When dropping off specimens in Chemistry or
when sending them through the pneumatic tube
LABChemOP7269 Chemistry Lab Services
Laboratory Services Regina QuAppelle Health Region
Page 2 of 12
Last printed 5/6/2013 2:47 PM


Dexamethasone Suppression
Test






Glucose Tolerance




system, it is EXTREMELY important the staff
know that there is a sample to run
Staff should be paged or phoned if no one was
present in the department when the sample was
dropped off
Blood gas samples should not be left in the
porthole at the RGH but should be brought
directly to the department
Blood gases are always analyzed STAT
Report will print to ward immediately
Screen for Cushing’s syndrome
Baseline Cortisol levels are drawn at 0800 and
2000 hrs
1.0 mg of dexamethasone is given at 2300 hr
A 0800 (post dose) Cortisol is drawn the next
morning
Patient should have been on a diet that
contained adequate carbohydrates (150 g) for
three days prior to testing
Patient must fast for 10 hours prior to test (not
required for gestational screen – see below)
The commercially prepared glucose drink is
obtained from the Chemistry department
For patients that may be allergic to the dye in
the orange drink, an alternative drink is
available but the lab must be notified by the
physician’s office so alternative drink can be
ordered.
Non-Pregnant Adult Glucose Tolerance (75 g)
 Fasting glucose sample is collected
 75 g drink (296 ml) is given
 Patient should consume drink within 5 minutes
 2 hour glucose sample is collected
Gestational Diabetes Screen (50 g)
 Women are tested between their 24th and 32nd
weeks of gestation
 Patient does not have to be fasting
 50 g drink (296 ml) is given
 1 hour glucose sample is collected
Gestational Diabetes Tolerance (75 g)
 Test is done when woman has an elevated
LABChemOP7269 Chemistry Lab Services
Laboratory Services Regina QuAppelle Health Region
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




result with the screening test
Fasting glucose sample is collected
75 g drink (296 ml) is given
Patient should consume drink within 5 minutes
1 and 2 hour glucose samples are collected
See attached Appendix for specific ordering
and collection instructions
Children
 Dosage of drink must be calculated based on
patient’s weight (not to exceed 75g of glucose)
 Calculation will be performed by a Chemistry
technologist
 Fasting glucose sample is collected
 Drink is given
 Patient should consume drink within 5 minutes
 2 hour glucose sample is collected
Calculation of drink volume
 patient’s weight (kg) X 1.75 = #gm of drink
 #gm X 3.95 = # mLs of drink
 LIS test code GLMLS will calculate # mLs
when patient weight (kg) is entered
Growth Hormone
Suppression Test
Insulin
Hypoglycemic Screen ( 5hr GTT)
 Approval by Medical Biochemist/Clinical
Chemist should be sought prior to ordering this
test as poor correlation with symptoms are
typically seen
 Fasting glucose sample is collected
 75 g drink is given
 Blood samples are drawn at 0.5, 1, 1.5, 2, 3, 4,
5 hour times
 Patient fasts overnight
 Fasting blood sample drawn for Growth
Hormone
 75 g glucose drink (296 mL) given
 Blood samples are drawn for Growth Hormone
at the intervals requested by the physician
 Insulinoma is a rare condition that can cause
organic hypoglycemia
 Measure blood glucose when symptoms of
hypoglycemia are exhibited (glucose should be
<2.5 mmol/L)
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

Toxicology
Therapeutic Drug Monitoring
Xylose Test
Insulin levels should then be requested
Measurement of glucose, insulin and C-peptide
may be indicated if administration of
exogenous insulin is suspected
 See separate section
 See separate section
Children
 Food and fluids are withheld from patient for
at least 8 hours prior to the test
 Patient is asked to void and specimen is
discarded
 Pharmacy will prepare xylose drink based on 1
g of xylose per kilogram of body weight in a
10% solution (need weight of child in kg)
 Drink is given to patient followed by equal
amount of water
 Patient is kept at rest and is given nothing by
mouth for the next 5 hours
 All urine passed in the 5 hour period is
collected and pooled for testing
Adult
 Food and fluids are withheld from patient for
at least 8 hours prior to the test
 Fasting blood sample is taken (pre drink level)
 25 g of xylose dissolved in 250 mL of water is
given to patient – followed by an extra 250 mL
of water
 Patient is kept at rest and is given nothing by
mouth for the next hour
 1 hour sample is taken (1 hour post drink
level)
Urine Specimens
Specimen Collection


All specimens received must be labeled
following standard laboratory labeling practice
(2 identifiers)
All specimens are accessioned into the LIS
1st morning urine specimen
 ideal specimen for testing as most concentrated
 patient voids first morning sample into a clean
80 mL sterile container or a graduated urine
LABChemOP7269 Chemistry Lab Services
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tube, specimen is labeled and sent to lab
Urine Testing Notes
Feces Specimens
Feces Tests
Random urine specimen
 specimen collected at any time of day
 patient voids into a clean 80 mL sterile
container or a graduated urine tube, specimen
is labeled and sent to laboratory
24 hour urine specimen
 Disposable 24 hour urine container are used for
collection
 It is important to have a complete and accurate
specimen collected for valid results
 Patient empties bladder in a.m. (do not save
this sample)
 Record start time and date
 For the next 24 hour collect all urine
specimens that are voided during the day and
night
 Last sample should be when patient empties
bladder the next morning at the same time as
start time
 Record stop time and date
 Label specimen and send to laboratory
 If possible specimen should be kept cool
during collection
 The testing requirements can all be found on
the Intranet
 Specimens should NOT be collected in
containers containing boric acid for tests
performed by the Chemistry department
 The collection for metals requires a special
acid washed container – Obtain from the
Chemistry department prior to beginning the
24 hour collection
 Required preservatives are added by the
Chemistry staff after the 24 hour collection is
completed
Occult Blood
 Tests for the presence of blood
 Label specimens with two identifiers
 Specimen to be collected in sterile plastic
container (be careful not to contaminate the
LABChemOP7269 Chemistry Lab Services
Laboratory Services Regina QuAppelle Health Region
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outside of the container with specimen)
Fecal Fat
 Test requires the approval of SDCL prior to
testing (contact Dr Lehotay or Jeff Eichhorst
787-3284)
 Test requires a 72 hour stool collection
 Pre-weighed containers, instruction for
collection and shipping are provided by SDCL
 Start test after bowel movement. Discard this
sample.
 Record start time and date
 Collect all stool passed in the next 72 hours
 Record stop time and date
 Specimen should be kept cold and entire
specimen delivered to lab when complete
 Patient should not have any procedures that
could alter the stool specimen (ie enema)
CSF Specimens
Routine Chemistry
 Protein, Glucose, LD, Lactic Acid, Chloride
IgG Index
 Requires a CSF and a serum sample in order to
calculate the IgG Index
 If physician writes order with the CSF tests,
the ward MUST also order a blood collection
on the patient
 CSF – IgG and albumin
 Serum - IgG
 Make sure patient has the blood test before
being discharged
Oligoclonal Bands
 Requires at least 2 mL CSF specimen
 If possible a serum sample is collected and run
simultaneously with the CSF sample
Toxicology Specimens

Quantitative measurement is available on a 24
hour basis for: Acetaminophen, Ethanol,
Salicylate on blood samples
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Laboratory Services Regina QuAppelle Health Region
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



Fluid Specimens
Specimen Collection
Tests Performed
Fluid Notes
Stat Qualitative testing for Drugs of Abuse is
available on urine specimens on a 24 hour
basis by ordering a Urine Triage –
Acetaminophen/Paracetamol, Amphetamines,
Methamphetamines, Barbiturates,
Benzodiazepines, Cocaine, Methadone,
Opiates, Phencyclidine, THC, Tricyclic
Antidepressants
Methanol and Isopropanol levels are measured
by SDCL – call back required if after normal
business day
Routine urine drug screens are sent to SDCL
for testing
Suspected overdose of Therapeutic Drugs can
be tested on a 24 hour basis for those drugs
that are performed by the Chemistry
department



Specimens are collected by ward
Specimens must be labeled with 2 identifiers
Specimens for pH must be collected in a
syringe or a green top tube – Specimen must
be on ice and brought down immediately or
pH will be rejected
 All other Chemistry tests should be collected in
a red top tube or in a sterile C&S container
Pleural Fluid
 Protein, Amylase, LD, Cholesterol,
Triglyceride, pH, Glucose, Chylomicrons
Peritoneal Fluid (ascites fluid)
 Protein, Amylase, Creatinine, Bilirubin, pH,
Albumin
Synovial Fluid
 Glucose, Uric Acid, Cholesterol, Triglyceride
Pericardial Fluid
 pH, Amylase, LD, Protein,
Dialysate
 Glucose, Creatinine, Protein, Urea, Volume
Pancreatic Cyst Fluid
 CEA
 The matrix of fluids is different than serum
samples and therefore may affect results
 The testing of fluids for many tests is not
LABChemOP7269 Chemistry Lab Services
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


indicated as there are no reference values for
comparison
Testing is often done to determine if specimen
is a transudate or an exudate
Transudate – low protein, no cells present
Exudate – high protein, cells present
Therapeutic Drug Testing
For TDM to be effective, it is essential that the requisition is completed with the drug
dosage regimen and administration time
Separate requisitions are required for pre and post samples
Ideal sampling times are indicated below – guidelines from the Pharmacy and
Therapeutics Committee
Test
Amikacin
Ideal sampling time
Pre level –
30 minutes before dose
Post level –
30-60 minutes after dose
Carbamazepine
Digoxin
Ethosuximide
Gentamicin
Once daily –
6-14 hours after dose
Pre level –
0 – 1 hour before dose
Pre level –
0 – 1 hour before dose
Pre level –
0 – 1 hour before dose
Pre dose 0 – 30 minutes before dose
Post dose 30 minutes after dose
Lidocaine
Once daily Gentamicin –
6 – 14 hours after dose
12 hours should elapse
before collecting level
Test notes
Just before 3rd regular dose or as
ordered by pharmacy
After 3rd regular dose or as ordered
by pharmacy
After 3rd dose
Steady state reached on day 7 of
dosing regime
Post load dose – done on day 2
Maintenance dose – done on day 5
(do not collect if less than 6 hours
after dose)
Steady state reached on day 7 of
dosing regime
Just before 3rd regular dose or as
ordered by pharmacy
After 3rd regular dose or as ordered
by pharmacy
After 1st or 2nd dose
Pre level not recommended
Indication for collection
- when toxicity is suspected
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Laboratory Services Regina QuAppelle Health Region
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- when ventricular arrhythmias
occur despite lidocaine
administration
Lithium
Post level –
Collect 12 hours after
evening dose
Phenobarbital
Pre level –
0 – 1 hour before dose
Phenytoin (Dilantin)
Pre level –
0 – 1 hour before dose
Pre level –
0 – 1 hour before dose
IV Loading levels
1) Immediately after
loading infusion
2) 2 hours post infusion
3) 24 hours post infusion
Primidone
Procainamide / NAcetylprocainamide
Quinidine
Salicylate
(therapeutic)
Theophylline
(Aminophylline)
Maintenance levels
Pre level –
0 – 60 minutes before dose
Post level –
75 minutes after oral dose
Pre level –
0 – 1 hour before dose
Post level –
1 – 3 hours after dose
Infusion
Collect level any time
Intermittent (IV or po)
Pre level –
0 – 30 minutes before dose
Post level –
regular release – 2 hours
slow release – 3 – 5 hours
Steady state reached on day 4 of
dosing regime
(do not collect before 8 hours post
dose)
IV loading – no restrictions
Maintenance – day 3
Steady state –
Children/Infant – day 8
Adult/Adolescent – day 10
Maintenance – day 3
Steady state – day 7
Steady state reached on day 3 of
dosing regime
Maintenance – 24 hours
Peak level may not occur until 2-4
hrs following dose in some patients
Steady state reached on day 2 of
dosing regime
Steady state reached on day 3 of
dosing regime
Steady state – 24 – 48 hours
Steady state – day 2
(do not collect pre dose greater than
60 minutes before dose)
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Tobramycin
Pre level –
0 – 30 minutes before dose
Just before 3rd regular dose or as
ordered by pharmacy
Post level –
30 – 60 minutes after dose
After 3rd regular dose or as ordered
by pharmacy
(collections times must be followed
for accurate interpretation of result)
Vancomycin
Pre level –
0 – 30 minutes before dose
Just before 3rd regular dose or as
ordered by pharmacy
Post level –
60 - 90 minutes after dose
After 3rd regular dose or as ordered
by pharmacy
(collections times must be followed
for accurate interpretation of result)
References
A Handbook of Routine Urinalysis, Sister Laurine Graff
Saskatchewan Disease Control Laboratory Test Compendium
Pharmacy and Therapeutics Committee
Related documents
Lab Services Manual General Information LABRegOP7900
Revision History
Found in Softtech Health Lab QMS™ Document Management System
Author
Tammy Ottenbreit, MLT, ART
LABChemOP7269 Chemistry Lab Services
Laboratory Services Regina QuAppelle Health Region
Page 11 of 12
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Appendix
LABChemOP7352A1 ACTH Stimulation Test
Ward
- stamp 3 SDCL requisitions with patient addressograph
- Requisition 1 – write ACTH Stimulation Test – BASELINE CORTISOL.
(state required time for baseline collection. ie 0700 hrs – patient must be fasting)
- Requisition 2 – write ACTH Stimulation Test – 30 MINUTE CORTISOL
- Requisition 3 – write ACTH Stimulation Test – 60 MINUTE CORTISOL
For Phlebotomy Draw
- staple requisitions together before sending to Laboratory.
- requisitions must be in the Laboratory before 2100 hrs to ensure test is ordered in
LIS and phlebotomy is prepared for collection in a.m.
- testing (fasting collection or injection) should not be started before 0700 hrs.
- phlebotomy will collect the baseline sample
- DO NOT give injection until phlebotomy informs you that baseline sample has
been collected
- immediately after patient has been given the injection, phone 4527 (RGH) or
8412 (PH) and say “patient name” has been given injection for ACTH
Stimulation Test
- phlebotomy will return at 30 minute and 60 minute intervals to collect cortisol
samples
For Ward /Arterial line draw
- ward is responsible for following protocol
- yellow top tube is required for cortisol level
- patients first and last name and MRN must be written on each tube
- exact collection time must be noted on each requisition
- baseline/ 30 minute/60 minute must be written on tube and matched to requisition
to ensure specimens are processed correctly
Accession
- test is accessioned with LIS code – RACTH
- it will ask for date and collection time
- time marked is for the baseline collection
- collection times for 30 minute and 60 minute collections will automatically fill in
Phlebotomy
- PDA will display collection for the ACTH stimulation test
- patient order will have 3 labels with timed collections
- collect baseline sample and print label
- mark other 2 collections as “no” so labels are not printed
- inform the ward that the baseline sample has been collected and that the injection
can be given
- the ward will call 4527 (RGH) or 8412 (PH) and say when the injection has been
given
LABChemOP7352A1 ACTH Stimulation Test
Lab Services Regina Qu’Appelle Health Region
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-
phlebotomist that receives the call will go into patient order in the LIS and modify
the collection times
EXAMPLE
1. ward will say injection has been given at 0900 hrs
2. 30 minute will be 0930 hrs and 60 minute will be 1000 hrs
3. go into patient order
4. specimen tab
5. place cursor on collection to be modified (ie 30S for 30 minute)
6. select “Specimen” from top tool bar
7. select “Modify Specimen”
8. enter in the correct time for collection (ie 0930 hrs)
9. repeat for 60 minute specimen
10. save order
-
collections will now appear in the PDA’s with the proper collection time and all
phlebotomists will be aware
LABChemOP7352A1 ACTH Stimulation Test
Lab Services Regina Qu’Appelle Health Region
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Appendix
LABChemOP7317A1 75 gm Maternal Glucose Tolerance
Ward
-
stamp a green requisition with patient’s addressograph
order MAT 75gm 2 hr only (do not mark fasting glucose)
enter collection time for fasting sample (ie 0700)
ensure requisition is received in laboratory the day before test is required
phlebotomy will collect fasting sample
DO NOT give drink until phlebotomist informs you that fasting sample has been
collected
when patient has finished drink, call 4527 and say “patient name” has finished
drink at _____ time.
phlebotomy will return at the 1 and 2 hour interval to collect glucose sample
Accession
- requisition is accession with LIS code - GTTGE
- it will ask for date and collection time
- time marked is for the fasting collection
- collection times for 1 and 2 hour will automatically fill in
Phlebotomy
- PDA will display collection for the tolerance
- patient order will have 3 labels with timed collections
- collect fasting sample and print this label
- mark other 2 collection as ‘no’ so labels are not printed
- inform the ward that the fasting sample has been collected and that the drink can
be given
- the ward will call 4527 and will say when patient has finished the drink (or they
will leave message)
- phlebotomist that receives call will go into patient order in the LIS and modify the
collection times
EXAMPLE
1. ward says drink complete at 0830
2. 1 hr will be at 0930 and 2 hr will be at 1030
3. go into patient order
4. Specimen tab
5. place curser on collection to be modified (ie CHEM1 CH1 for 1 hr)
6. select ‘Specimen’ from top tool bar
7. select ‘Modify Specimen’
8. enter in the correct time for collection (ie 0930)
9. repeat for 2 hr specimen
10. save order
-
collections will now appear in the PDAs with the proper collection time and all
phlebotomists will be aware
LABChemOP7317A1
Lab Services Regina Qu’Appelle Health Region
Page 1 of 1
Last printed 6/12/2013 3:12 PM
-
phlebotomist that receives the call will go into patient order in the LIS and modify
the collection times
EXAMPLE
1. ward will say injection has been given at 0900 hrs
2. 30 minute will be 0930 hrs and 60 minute will be 1000 hrs
3. go into patient order
4. specimen tab
5. place cursor on collection to be modified (ie 30S for 30 minute)
6. select “Specimen” from top tool bar
7. select “Modify Specimen”
8. enter in the correct time for collection (ie 0930 hrs)
9. repeat for 60 minute specimen
10. save order
-
collections will now appear in the PDA’s with the proper collection time and all
phlebotomists will be aware
LABChemOP7352A1 ACTH Stimulation Test
Lab Services Regina Qu’Appelle Health Region
Page 2 of 2
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Subject/Title: LABAccnOP7200 Cytogenetics
Last Approved Time: 4/16/2010 1:55:25 PM
Revision: 1
Approving Authority Manager of Support Services
Contact for Interpretation: Accession
Phone: (306) 766-4495
Current Version on Print Date
CYTOGENETICS
I
GENERAL INFORMATION
Specimens for cytogenetic (chromosome) and DNA studies are sent to a referral
laboratory for testing. Specimens are to be collected MONDAY THROUGH
THURSDAY ONLY AND MUST BE RECEIVED IN THE LABORATORY
BEFORE NOON ON THE DAY OF COLLECTION. NOTE: Specimens are
NOT to be collected or sent on a statutory holiday or on Thursday when Friday is
a statutory holiday.
 Chromosome studies may be performed on blood, amniotic fluid, bone marrow
or skin/tissue. No prior approval is required.
 Different specimens require different treatment and methodology. Therefore it is
important to check the Test Compendium for type of vacutainer to use when
collecting blood samples for chromosome studies.
DNA studies MUST receive prior approval from Dr. E. Alport @ 766-2778
before collection. Specimen(s) must be kept at room temperature at all times.
Specimen(s) must be received at RGH by noon. Specimens will be processed
immediately and be ready for FED-EX pick-up by 1400 hr the same day of
collection.
Requisitions must be carefully completed with particular emphasis on
relevant cytogenetic information ie: suspected chromosome abnormality or
indication for request.
Testing for specific abnormalities (e.g. Fragile X) must be specifically
requested as they are not part of routine testing.
LABAccnOP7200 Cytogenetics
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 3
Last printed 4/19/2010 10:24 AM
II
BLOOD CHROMOSOME STUDIES
1. Routine – determines constitutional karyotype. Check test compendium for type
of specimen container required for collection.
Special Studies (e.g. Fragile-X, high-resolution studies) - Special arrangements
must be made with the referral lab.
Hemochromatosis - Approval to order this test is to be obtained from the
Hematologist, Dr. Devaraj. He may be contacted by telephone at 766 - 4464
(pager # 4230)
2. For Hematological Disorders
For patients who have a high WBC count and more than 10 percent circulating
immature myeloid cells (myelocytes or younger), peripheral blood may be examined
for acquired chromosome abnormalities.
III
BONE MARROW STUDIES
(i) Marrow is the tissue of choice for the detection of chromosome abnormalities
in hematological malignancies.
(ii) Can be set up mornings only Monday to Thursday.
(iii) Please notify the Hematology lab well before the marrow tap is begun so that
the necessary preparations may be made.
IV
AMNIOTIC FLUID
Fluid should be collected at 13+ weeks gestation.
(a) Use plastic syringes and sterile tubes Approximately 20 - 30 ml of fluid is
required. Withdraw 2 - 3 ml and DISCARD. This minimizes contamination
with maternal macrophages.
(b) The next 10-12 ml of fluid drawn is gently inserted into a sterile tube.
(c) Using a NEW SYRINGE withdraw another 10-12 ml of fluid and insert into a
second sterile tube.
(d) Approximately 5ml in a third tube are required for Alpha -fetoprotein.
Page 2 of 3
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V
PRODUCTS OF CONCEPTION
Products-of-conception tissue is not routinely submitted for cytogenetic studies.
However if the testing is requested be sure to:
VI
VII
1.
Collect spontaneous abortion material in its entirety into sterile containers.
To keep specimen from drying out, cover with sterile saline-soaked gauze
and deliver to the lab as soon as possible. The sample should be kept at
room temperature if it is delivered the same working day. Samples that
cannot be delivered the same day should be refrigerated.
2.
Therapeutic abortion material (larger fetuses) should be kept from drying out
by covering with sterile saline/water-soaked gauze or adding a small amount
of sterile water or saline to the container and bring to the lab as soon as
possible.
CORD BLOOD
1.
Collect into heparinized tube (green top), mix thoroughly and bring to
laboratory.
2.
May be kept refrigerated if necessary until morning.
BUCCAL SMEARS FOR SEX CHROMATIN STUDIES
This test is no longer performed.
VIII
OUT-PATIENT SERVICE
Patient reports to the Specimen Collection Laboratory before Noon Monday to
Thursday except statutory holidays.
Physician’s Name, Address and
Telephone number must be clearly marked on the requisition. Specimens must
be delivered to the RGH Laboratory by NOON on day of collection.
Note: Specimens are not collected or shipped on a Thursday when Friday is a
statutory holiday.
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author
D. Fox, ART
Page 3 of 3
Last printed 4/19/2010 10:24 AM
Subject/Title: LABCytoOP7000 Diagnostic Cytology Lab Services Manual
and Testing Compendium
Last Approved Time: 7/15/2011 3:50:11 PM
Revision: 2.1
Approving Authority: Cytopathologist
Phone: (306) 766-2641
Contact for Interpretation: Cytology
Current Version on Print Date
Diagnostic Cytology Laboratory Services Manual and Testing Compendium
I. PURPOSE
The primary purpose of this manual is to provide a guideline for clinical specimen
collection, and handling that are submitted for cytological diagnosis.
II. SPECIMEN
A. Types:
1. Endocervix
2. Exocervix
3. Vaginal wall
4. Vulva
5. Cerebrospinal fluids
6. Joint fluids (synovial)
7. Ocular fluids
8. Serous effusions - pleural, pericardial, peritoneal
9. Urine
10.Respiratory
11.Skin
12.Various lesions - superficial, deep-seated
B. Collection Methods:
1. Scrapings
2. Brushings
3. Lavages
4. Drainage
5. Washings
6. Fine needle aspiration biopsies
7. Aspirations
8. Secretions
C. Specimen Identification and Labeling:
LABCytoOP7000 Diagnostic Cytology Lab Services Manual and Testing Compendium
Laboratory Services Regina QuAppelle Health Region
Page 1 of 12
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Inadequately identified specimens will not be accepted.
1. Containers must be labeled with 2 identifiers at the time of collection. Examples of
acceptable identifiers are: patient name, date of birth, HSN (Health Services Number),
MRN (Medical Record Number).
2. Submitted slides may be labeled with a single identifier, but two identifiers are
preferred. Specimen Slides are to be labeled with a lead pencil on the frosted end with
the patient’s full name. Please do not use pen-type inks because ink tends to run during
cytology processing.
3. If more than one site is sampled on the same patient, the specific source/site must be
indicated on each specimen submitted, as well as, indicated on individual cytology
requisitions.
III. SPECIMEN SUBMISSION & TRANSPORTATION
A.




Prepared Slide Submission:
all slides must be labeled with patient’s first and last name
a completed cytology requisition must accompany the slide(s)
all prefixed smears/slides are allowed to dry prior to transportation
slides are packaged within a blue plastic slide mailer to prevent slide breakage.
(Note: Patient identification on the blue mailer is not acceptable; must be on
specimen slides. The Regina Qu’Appelle Health Region Cytology Laboratory will
supply mailers upon request)
B. Fresh (Liquid) Specimen Submission:
 fresh specimens are submitted in a separate clearly labeled, secure, leakproof
container. Do not transport specimen in a syringe or other collectable device.
 the specimen container is placed within a secondary container. Examples are a
sealable plastic bag or a secondary leakproof container.
 cytology requisitions must accompany the specimen, and should not be placed within
the secondary container.
IV. CYTOLOGY REQUISITION FORM:
1. The requisition form must accompany the labeled cytology specimen.
2.




The requisition must provide identifying information:
patient’s full name
provincial hospitalization number
date of birth and/or age
ordering physician’s name and address
(copy to physician’s name and address)
 date of specimen collection
Page 2 of 12
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


source and site of specimen
type of collection method
relevant clinical information and history
The Gyne requisition order # is RQHR 694. The NonGyne requisition order # is RQHR
220 (NOTE: The RQHR Cytology Laboratory will supply requisitions upon request.)
V. SPECIMEN REJECTION CRITERIA
1. Specimen Container/Slide improperly labeled or unlabeled
2. Discrepancy of information between specimen and requisition form
3. Slide(s) broken beyond repair
4. Specimen received without accompanying requisition or vise versa
5. Inadequate preservation of specimen
6. Specimen container broken or leaking
7. Specimen received from an unauthorized source
8. Requisition lacking pertinent information on:
 patient’s full name
 patient demographics
 ordering physician
 source/site of specimen
VI. RQHR CYTOLOGY LABORATORY ADDRESS & HOURS of OPERATION
RQHR Diagnostic Cytology Division,
Anatomical Pathology Laboratory
Pasqua Hospital
4101 Dewdney Avenue
Regina, SK S4T 1A5
1-306-766-2641 - Cytology Supervisor
1-306-766-2642 - Microscopy Area
1-306-766-2519 - Cytopreparatory Area
1-306-766-2752 - Fax
Hours of operation:
0730-1600 hours
Monday-Friday
Page 3 of 12
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The Satellite Cytology service is located at the:
RQHR Regina General Hospital
Satellite Cytology Laboratory
1440 14th Avenue
Regina, SK
1-306-766-4488 - Cytotechnologist
1-306-766-4772 - FAX
Hours of operation: 0730-1530
Monday-Friday
The Fine Needle Aspiration Clinic is located at the:
RQHR Pasqua Hospital
Ambulatory Clinic
4101 Dewdney Avenue
Bookings:
Regina, Sask. S4T 1A1
1-306-766-2240
Hours of Operation:
Wednesday: 0900-1200
NOTE: The Cytology laboratories are not staffed on Saturdays, Sunday or Statuary
Holidays.
VII. GENERAL TECHNIQUES
A. PAP SMEAR PROCEDURE
The objective of an adequate Pap smear is to provide a sampling of the
squamocolumnar junction between the ectocervix and endocervix (Transformation
Zone). Combinations of various types of sampling are possible and can vary. Please
note that use of cotton-tip applicator is NOT recommended. Sampling devices are
available from the RQHR Cytology laboratory and can be ordered directly on the
requisition.
The Pap smear is considered a screening test only and has been demonstrated to
produce false negative rates however it is still considered to be a highly effective tool
for detecting cancerous and precancerous cervical lesions
1. Complete cytology requisition. Include all pertinent information, including the
clinical information section, the reason for the Pap smear, age, LMP date, hormone
replacement therapy, post menopause history, and the sampling tools used.
2. Prepare slide by writing the patient’s name on the frosted end of the slide.
3. Wooden Spatula: Transformation Zone Scrape (and vaginal pool sample, if
indicated)
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insert and rotate one full turn
spread material over top-half of slide
spray immediately with fixative, holding spray bottle 3-4 inches away from slide
pump 5-6 times or until saturated
the spray will contact the bottom half of the slide. This will not jeopardize the
remainder of the procedure
Cytobrush: endocervix sampling
 gently insert cytobrush into the endocervix
 rotate slowly one turn
 remove cytobrush
 spread material on the bottom-half of the slide by rolling and twisting the cytobrush
 spray immediately as described above. There is no need to direct spray away from
material already on the slide. Additional spray will not alter the specimen.
4. Place slide in slide holder, leaving open until dry
5. When completely dry, close folder. Wrap the requisition around the holder and secure
with rubber band
6. Mail or deliver to the RQHR Pasqua Hospital Cytology division.
PRECAUTIONS: USE OF CYTOBRUSH
Manufacturers of cytobrush suggest these precautions:
You may want to inform your patients that due to thorough sampling of the endocervical
canal by the Cytobrush, there may become minor painless spotting for a day or two
following the Pap test.
B. SPUTUM
1. Specimen
 the first morning sputum is generally considered to be the most representative for
cytological examination
2. Specimen Collection
 the patient receives a labeled specimen container the night before, and is instructed
how to expectorate sputum
 upon awakening the next morning, the patient is to rinse his/her mouth, clean his/her
throat with a gentle cough, and deep cough from the diaphragm and expectorate all
sputum into an appropriate seal proof specimen container
 the procedure should be repeated once a day for three days
3. Submission
 the cup should be collected by early morning and immediately taken to the laboratory
 specimens collected after hours or on the weekend should be refrigerated.
 An equal volume of 50% ethyl alcohol should be added to the specimen if there will
be a delay in reaching the laboratory (more than one day). The addition of alcohol
should be noted on the requisition and specimen container
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4. Limitations
 If pulmonary macrophages are not seen, the specimen will be reported as
unsatisfactory
C. BRONCHIAL BRUSHING
1. Specimen
 bronchial brushings is a selective brushing of the bronchial tree, and is performed by
the physician during fiberoptic bronchoscopy
 brushings are usually taken and immersed in a balanced salt solution
2. Specimen Collection
 bronchial brushing is performed by the physician
 the brush is immersed in a seal proof specimen collection tube that contains saline or
Cytolyt (preservative)
3. Submission
 the specimen is to be immediately taken to the laboratory
 the specimen collected after hours or on the weekend should be refrigerated, making
sure preservative of Cytolyt or 50% ethyl alcohol has been added
D. BRONCHIAL WASHINGS
1. Specimen
 bronchial washings selectively washes a specific area of the bronchial tree, and is
performed by the physician during fiberoptic bronchoscopy
 washings are usually taken using a balanced salt solution
2. Specimen Collection
 the distal airways are rinsed with normal saline
 the fluid is collected via suction
 the specimen is collected within an appropriate seal proof container
3. Submission
 the specimen is to be immediately taken to the laboratory
 specimens collected after hours or on the weekend should be refrigerated
 an equal volume of Cytolyt or 50% ethyl alcohol should be added to the specimen if
there will be a delay in reaching the laboratory (more than one day). The addition of
alcohol should be noted on the requisition and specimen container.
E.
1.
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2.

URINE SPECIMENS/BLADDER WASHINGS
Specimen
voided or catheterized urine specimens; bladder washings
Specimen Collection
voided urine: the patient is hydrated and the subsequent midstream voided urine is
collected in a labeled container
 bladder washing: is usually done at cystoscopy by irrigating the bladder with
normal saline
 catheterized urine: is collected through the catheter and is transferred into a labeled
container
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3.
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4.
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F.
1.
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2.
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3.
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renal pelvis and ureters: hydrate patient one glass water every 15 minutes for 2
hours. Patient should void and discard urine. Catheterize ureter below level of
suspected lesion and collect urine for ½ hour. Other ureter catheterized as control.
Same for renal pelvis with or without saline irrigation.
Submission
the specimen is immediately taken to the laboratory
specimens collected after hours or on the weekend should be refrigerated.
if the specimen cannot be refrigerated, the addition of equal volume of 50% alcohol
should be added. This addition should be noted on the requisition form, and on the
specimen container
Limitations
Low grade papillary urethelial carcinoma may not be diagnosed by cytologic
examination alone as recent instrumentation or calculi may produce similar atypical
changes in the urothelial cells
SEROUS EFFUSIONS
Specimen
pleural (thoracic) fluids, peritoneal (ascites) fluids, pericardial fluids
Specimen Collection
serous effusions collections are performed by a physician
fluid is withdrawn from the serous body cavity
fluid is collected in a clearly labeled, screw-top leakproof container
if possible patient should be moved into several positions in order to well suspend the
cellular material prior to collection
Submission
the specimen is immediately taken to the laboratory
fluids should be submitted fresh
the size of the fluid sample should not exceed 200 ml. If the amount is greater than
200 ml., the fluid should be well mixed and the specimen should be centrifuged in a
few tubes to obtain a button of cells. Decant the supernatant and add 50% ethyl
alcohol to the button. Resuspend the cells. Place the entire resuspended specimen
(with added 50% ethyl alcohol) into a leakproof container
the practice of salvaging large amounts of fluids is not recommended
fluids collected after hours or on the weekend should be refrigerated.
the addition of an equal volume of 50% ethyl alcohol should be added if the specimen
will be delayed in reaching the laboratory (more than one day). This addition must be
noted on the requisition and the specimen container
G. CEREBROSPINAL FLUID
1. Specimen
 cerebrospinal fluid specimens
2. Specimen Collection
 the specimen is obtained by the physician while performing a lumbar puncture
 fluid is collected in a clearly labeled, leakproof tube
3. Submission
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the specimen is to be immediately taken to the laboratory
specimens collected after hours or on the weekend should be refrigerated.
if the specimen cannot be refrigerated, the addition of equal volume of Cytolyt or
50% alcohol should be added. This addition must be noted on the requisition form,
and on the specimen container
*NOTE: Please indicate on the requisition if lymphoma/leukemia is suspected
H. ABDOMINAL and PELVIC WASHINGS
1. Specimen
 abdominal and pelvic washings
2. Specimen Collection
 abdominal and pelvic washings are performed by a physician
 washings are usually collected in balanced salt solution
 washings are collected in a clearly labeled, screw-top leak proof container
3. Submission
 the specimen is immediately taken to the laboratory
 fluids should be sent fresh and unfixed if at all possible
 fluids collected after hours or on the weekend should be refrigerated
 if the specimen cannot be refrigerated, the addition of equal volume of Cytolyt or
50% alcohol should be added. This addition must be noted on the requisition form,
and on the specimen container
I. GASTROINTESTINAL, ESOPHAGEAL, and GASTROESOPHAGEAL
BRUSHINGS
1. Specimen
 brushings from the gastrointestinal, esophageal, and gastroesophageal sites
2. Specimen Collection
 the gastroenterologist performs the brushing
 after the brushing technique is completed, the brush is cut with wire cutters from the
flexible wire leaving approximately 1 inch of wire
 the brush is dropped immediately into a test tube filled with Cytolyt or 50% alcohol
3. Submission
 the specimen is to be immediately taken to the laboratory
 specimens collected after hours or on the weekend should be refrigerated.
J.
1.
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2.
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BREAST SECRETIONS (NIPPLE DISCHARGES)
Specimen
nipple discharges
Specimen Collection
slide is labeled with patient’s name
secretion is expressed by gently squeezing the areolar area between the thumb and
index finger
 the secretion is smeared across a glass slide
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3.
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the smear is immediately sprayed with fixative
if secretion is thick, place another labeled glass slide on top and gently pull apart
slide; fix with spray fixative
prepare as many slides as there is secretion
Submission
allow slides to dry and place in slide mailer
requisition is attached to slide mailing container
specimen is immediately delivered to the laboratory
K. JOINT FLUIDS (SYNOVIAL FLUIDS)
1. Specimen
 synovial fluids, joint fluids
2. Specimen Collection
 the physician aspirates the fluid from the joint
 the synovial fluid is aspirated into a sterile test tube
 do not add fixative (alcohol)
3. Submission
 the synovial fluid is transported immediately to the cytology laboratory
 the requisition must indicate if the test is for the presence of crystals
L.
1.
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2.
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3.
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4.
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CYST FLUIDS
Specimen
cellular material extracted from suspected cysts
Specimen Collection
the clinician aspirates the contents of the cyst, and samples the wall and adjacent
tissue by means of fine needle aspiration
the aspirated material may be submitted in a clean leak proof container
Submission
the specimen is immediately taken to the laboratory
specimens collected after hours or on the weekend should be refrigerated
if the specimen cannot be refrigerated, the addition of equal volume of Cytolyt or
50% alcohol should be added. This addition must be noted on the requisition form,
and the specimen container
Limitations
improper fixation, failure to include pertinent history
specimens lacking representative cyst lining will be considered unsatisfactory
M. OCULAR SPECIMENS
1. Specimen
 ocular discharges, secretions, conjunctival lesion, corneal lesions
2. Specimen Collection
 mucoid discharges are collected with a sterile cotton swab pre-moistened with sterile
saline
 conjunctiva scrapings are collected with a rounded spatula or instrument to avoid
abrasion
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material is gently smeared on a glass slide and is immediately immersed in 95%
alcohol or is sprayed with fixative
the scraping tool may be rinsed in a sterile saline and the solution is submitted for
cytology
intra-ocular aspiration for fluid cytology should be treated like a FNAB
Submission
any fluid, secretion or scraping is immediately transported to the laboratory
fresh specimens collected after hours or on the weekend should be refrigerated
specimens are fixed immediately in 95% alcohol or sprayed with fixative
N. GUIDED FINE NEEDLE ASPIRATION BIOPSIES ( CT SCAN,
ULTRASOUND, ETC): ADEQUACY CHECK
Introduction: The Cytotechnologist will assist the clinician in the fine needle aspiration
biopsy procedure of deep-seated lesions. You may contact the cytology lab at one of the
following numbers:
Pasqua site……………..ext. 2519 or 2642
Regina General site……ext. 4488
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the cytology lab is notified at the hospital site where the procedure is being performed
adequacy check will be provided on all aspirated specimens by the cytotechnologist,
and a pathologist can be contacted if necessary
1.
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2.
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Specimen
radiologically guided fine needle aspiration of a deep-seated lesion
Collection & Procedure
the cytotechnologist prepares an area for FNAB preparation upon arrival. He
confirms the patient and site with the radiology staff, and labels slides and a
preservative- filled falcon tube
following the aspiration technique, the cytotechnologist assists the clinician in the
preparation of the specimen. Adequacy of specimen and difficulty of biopsy being
performed determine the number of direct smears
the clinician expels material on the slide
the cytotechnologist makes pull-apart smears. Both air-dried and spray fixed smears
are made. Air-dried smears are stained for adequacy using Diff Quick stain
if at any time during the aspiration, the needle appears to be a dry tap, draw up a little
preservative into the hub of the needle and then expel material on a slide
the cytotechnologist views the stained smears (Diff Quick) with a light microscope,
and indicates whether the sample contains representative cellular material of the
aspirated lesion
*this preliminary assessment of adequacy is documented on the back of the
requisition and in the cytopathology report
after an adequate number of smears are prepared, the needle is rinsed in the
appropriate preservative tube for further testing
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the cytotechnologist makes sure that each prepared slide is labeled separately and that
patient identifiers are placed on any specimen container with collected material
(including different sites, if warranted)
 NOTE: It is very important that the cytology requisition is properly filled-out,
including relevant clinical history, clinical suspicions, and if STAT diagnosis is
required
3. Transportation
 the cytotechnologist transports the specimen to the cytology laboratory and the
specimen is immediately processed
O. FINE NEEDLE ASPIRATION CLINIC, PASQUA HOSPITAL
Introduction: The Regina Qu’Appelle Health Region has a Fine Needle Aspiration
Clinic within the Pasqua Hospital, Ambulatory Care, Level 1. The Aspiration Clinic is
run by the Pasqua Hospital Pathology Department. A Pathologist performs the aspiration
and interprets the specimen for adequate sampling. A Cytotechnologist is also present to
assist the Pathologist.
Address and Bookings:
Regina Qu’Appelle Health Region- Pathology Department
Fine Needle Aspiration Clinic
Pasqua Hospital, 5’th level
4101 Dewdney Avenue
Regina, Sask S4T 1A5
Appointment Booking: (306) 766-2240 or 2245
Fax number:
(306) 766-2752
Hours of Operation: Wednesday 0900-1200
1.
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2.
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Specimen
head and neck lesions (thyroid, lymph nodes, salivary glands)
breast lesions
miscellaneous (superficial soft tissue)
Collection and Procedure
the cytotechnologist prepares the area for fine needle aspiration upon the patient’s
arrival. He checks the name band on the patient to make sure it matches the name on
the requisition
 the pathologist discusses the fine needle aspiration procedure with the patient,
including FNA site and any relevant clinical history. The patient is asked to provide
written consent before the procedure begins
 upon patient consent, the patient is then prepared for the procedure. The
cytotechnologist labels slides and a preservative-filled falcon tube
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3.
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the pathologist performs the fine needle aspiration. The number of direct smears will
be determined by the adequacy of the specimen and difficulty of the biopsy being
performed
the pathologist expels material onto glass slides
pull- apart smears are made. Both air-dried and spray fixed smears are made. Air
dried smears are stained for adequacy using Diff Quik stain.
the pathologist views the Diff Quik smears using a light microscope and indicates
whether the sample contains representative cellular material of the aspirated lesion.
after an adequate number of smears are prepared, the needle is rinsed in the
appropriate preservative tube for further processing.
*the cytotechnologist makes sure that each prepared slide is labeled separately and
that patient identifiers are placed on any specimen container with collected material
(including different sites, if warranted).
Transportation
the cytotechnologist makes sure the specimen is transported to the cytology
laboratory for immediate processing and reporting
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author
Y. Shelley Taylor, ART (CSMLS) / H. Budinski, MLT / L. Kozak, MLT
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Subject/Title: LABHemaOP7001.2 Hematology
Last Approved Time: 10/27/2014 8:49:10 AM
Revision: 2.5
Approving Authority: Medical Hematopathologist
Contact for Interpretation:Hematology
Phone: (306) 766-4477
Current Version on Print Date
HEMATOLOGY
I
GENERAL INFORMATION
The laboratory provides a comprehensive series of hematology tests, and processes
hundreds of specimens per day. A department with such a large volume of work
requires a degree of organization and rostering of procedures to achieve maximal
efficiency. This means that certain tests are not constantly available. Whenever
investigations are urgently required for medical reasons, the laboratory staff will be
pleased to be of service as quickly and as completely as possible. Out-of-hours tests
are restricted to those on the STAT list unless authorization is obtained by the
physician of record from the hematologist.
The laboratory hematologist will be pleased to discuss problems at any time.
II
REQUISITION FORMS
These should be accompanied by relevant information like anticoagulant therapy or
diagnosis, particularly in those tests outside the routine work of the laboratory.
All test requests for PT and APTT must have specific anticoagulant therapy, if any,
stated on the requisition. If information is incomplete, laboratory staff will phone the
ward for this information before the test results will be released.
1. BIOCHEMISTRY/HEMATOLOGY Form (green): for CBC, PT/INR, APTT,
MONO and other tests not listed.
This form is used for requests from the hospital wards.
2. COMMUNITY LAB REQUISITION Form (blue): for CBC, PT/INR,
APTT, MONO and other tests ordered from the physician offices.
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
Page 1 of 9
Laboratory Services Regina Qu'Appelle Health Region
III
COLLECTION OF SPECIMENS
Usually a phlebotomist or technologist is available to take blood specimens, but
medical staff may need to take blood in emergencies, or when the laboratory staff find
it impossible to obtain blood.
The following vacutainer specimen tubes are used:
Mauve top (EDTA) - CBC, platelets, ESR
Blue top (citrate) - Coagulation tests
Red top (clotted blood) – Monotest, H.I.T.
For coagulation tests it is essential that an unhemolyzed specimen without frothing is
taken as rapidly as possible. Therefore, choose a large vein and aspirate with a large
bore needle without undue delay. The collection of a frothy, hemolyzed and slowly
taken specimen will initiate the early stages of the coagulation system and invalidate
results. It is always worth remembering that a syringe is often more useful in taking
blood from "difficult" patients. Also, a full tube of blood is required for all
coagulation testing.
IV
BONE MARROW EXAMINATIONS
A. Requests
These should be booked (Monday – Friday) 24 hours in advance whenever
possible and will normally be done only before 1300 hours in order to facilitate
histology processing.
Marrows with chromosome studies (or other genetic testing) must be collected
Monday – Thursday to facilitate shipping procedures and referral laboratories.
When a marrow examination is urgently required outside normal hours, this
may be arranged on consultation with the laboratory hematologist. All
requests for bone marrow examination must be accompanied by relevant
clinical information.
B. Collection of Specimen
A good marrow specimen needs a meticulous method of aspiration.
Only the first 0.5 ml of aspirate contains a good concentration of particles and
this should be drawn out as rapidly as possible since marrow, being rich in
thromboplastic substances, clots rapidly. If more marrow is required, i.e.
chromosome analysis, flow cytometry, culture, etc., use a second syringe.
If the first aspiration fails, use a new needle at a different site.
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
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V
LIST OF TESTS PROVIDED IN HEMATOLOGY
A. General Hematology:
1.
2.
3.
4.
5.
6.
7.
CBC: This gives print out of Hemoglobin, Hematocrit,
WBC,
RBC, platelets, MCV, MCHC, MCH, MPV, RDW and five-part
differential count.
ACT DIFF 2: This back-up analyzer provides hemoglobin, hematocrit,
WBC, RBC, platelets, MCV, MCH, MCHC and a three part differential
count.
Reticulocyte count
Erythrocyte sedimentation rate (ESR).
Monotest
Serum Viscosity
Kleihauer test
Malaria Identification
B. The following tests are available but they are to be approved by the hematologist
mainly
because:
(i) these tests are time consuming and
(ii) they are difficult to interpret
1. Sickle cell test
2. Heinz body test
3. Hb electrophoresis
4. Test for Hb 'H'
5. Sucrose lysis test
6. Hams test
7. Acid Glycerol Lysis Test (previously Osmotic fragility)
8. Plasma Hb
9. Methemalbumin
10. Urinary hemosiderin
11. NBT Test
12. Myeloperoxidase Stain
13. Combined Esterase Stain
14. Iron stain
15. Sudan Black Stain
16. Leukocyte Acid Phosphatase
C.
Coagulation Tests:
Coagulation Screen includes the following tests:
1.
2.
3.
4.
Prothrombin Time
Activated partial thromboplastin time
Fibrinogen
D-Dimer
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
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The following special coagulation tests have to be approved by
Hematologist:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
14.
15.
16.
17.
18.
19.
D.
Bleeding Time
Factor Assays
Ristocetin Cofactor
von Willebrand Factor Antigen
Platelet Aggregation Study
Protein C
Protein S
Antithrombin
APC Resistance Ratio
Anticardiolipin Antibodies
DRVVT/KCT
Thrombin Time
Euglobulin Lysis
Factor XIII
Heparin/Anti Xa Assay
Inhibitor Studies
HIT test
PFA
Body Fluids:
Cell counts are done on CSF, pleural, peritoneal, synovial fluid, dialysate and
bronchial washings.
E. Semen Analysis:
1. Sperm count is done on post vasectomy.
2. Semen Analysis is done on specimens for fertility studies.
(Semen analysis for fertility study or post vasectomy are done weekdays only
from 08:00 – 14:45 except statuary holidays.)
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
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VI
BLOOD REQUIRED FOR LABORATORY TESTS
TEST TYPE
VOL. OF BLOOD
ANTICOAGULANT
VACUTAINER
CBC (hemoglobin
WBC, RBC)
Min. 2 mL
EDTA
mauve
Fibrinogen
2.7 mL
1.8 mL
3.2% Na Citrate
3.2% Na Citrate
adult blue
pediatric
blue
Partial Thromboplastin Time
2.7 mL
1.8 mL
3.2% Na Citrate
3.2% Na Citrate
adult blue
pediatric
blue
Prothrombin Time
2.7 mL
1.8 mL
3.2% Na Citrate
3.2% Na Citrate
adult blue
pediatric
blue
Sedimentation Rate
Min. 2 mL
EDTA
mauve
Monotest
Min. 2 mL
Min. 2 mL (preferred)
EDTA
none (serum)
mauve
red
Kleihauer
Min. 2 mL
Viscosity
Min. 5 mL
EDTA
mauve
none (serum)
red
CSF
none
red
Pleural, peritoneal,
synovial, dialysate fluids,
and bronchial washings
EDTA
mauve
NOTE: When an analysis is required for which capillary blood is required, the
Laboratory Technologist will obtain the specimen.
KEY TO VACUTAINERS
RED
No anticoagulant
for clotted blood
GREY
Potassium oxalate
for chemistry
GREY
T.S.Thymol/Sodium Fluoride for chemistry (lactic acid)
MAUVE
EDTA
for Hematology
GREEN
Heparin
for pH, Carboxyhemoglobin,
"Stat" Electrolytes only,
Flowcytometry
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
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BLUE
VII
Liquid Sodium Citrate
for Prothrombin Time, P.T.T. and
other coagulation tests
ESTABLISHED NORMAL (REFERENCE) RANGES
A.
CBC (12 years or older)
WBC 4 - 10 x 109/L
RBC Men
Women
4.3 - 5.4 x 1012/L
3.7 - 5.1 x 1012/L
Hb
Men
Women
140 - 180 g/L
120 - 160 g/L
Hct
Men
Women
0.400 - 0.500 L/L
0.370 - 0.470 L/L
MCV 82 - 97 fL
MCH 27 - 32 pg
MCHC 320 - 360 G/L
RDW 11.5 - 14.5
Platelet 150 - 400 x 109/L
MPV 7.4 - 10.4 fl
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
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CBC reference ranges (under 12 years old)
Test
0 - 3 Day
4 Day-3 Mo 3 – 12 Mo
12 Mo-3 Yr 3 - 6 Yr
6 - 12 Yr
WBC
10.0 - 30.0
10.0 - 26.0
6.0 – 18.0
6.0 - 18.0
5.0 - 15.0
4.5 - 13.5
RBC
4.00 - 6.00
4.00 - 6.00
3.20 - 4.80
3.60 - 5.20
4.10 - 5.50 4.00 - 5.40 x 1012/L
Hgb
135 – 195
135 - 195
96 – 126
110 – 130
120 - 140
Hct
.440 - .640
.440 - .640
.320 - .440
.360 - .440
.370 - .450 .370 - .450 L/L
MCV
98.0 - 114.0
98.0 - 114.0
87.0 - 103.0
70.0 - 86.0
77.0 - 91.0 77.0 - 91.0 fL
MCH
24.0 - 34.0
24.0 - 34.0
24.0 - 34.0
23.0 - 31.0
24.0 - 30.0 24.0 - 30.0 pg
MCHC
320 – 360
320 - 360
320 - 360
320 – 360
320 - 360
RDW
11.5 - 14.5
11.5 - 14.5
11.5 - 14.5
11.5 - 14.5
11.5 - 14.5 11.5 - 14.5
Platelet
150 – 400
150 - 400
150 - 400
150 – 400
150 - 400
150 - 400
MPV
7.4 – 10.4
7.4 - 10.4
7.4 – 10.4
7.4 – 10.4
7.4 - 10.4
7.4 - 10.4
Neutrophil 5.0 – 13.0
5.0 - 13.0
2.0 – 6.0
2.0 – 6.0
2.0 - 6.0
2.0 - 6.0
x 109/L
Lymph
3.5 - 8.3
3.5 - 8.3
5.5 – 8.5
5.5 – 8.5
5.5 - 8.5
5.5 - 8.5
x 109/L
Monocyte
0.5 - 1.5
0.5 - 1.5
0.7 – 1.5
0.7 – 1.5
0.7 - 1.5
0.7 - 1.5
x 109/L
Eosinophil 0.1 - 2.5
0.1 - 2.5
0.3 – 0.8
0.3 – 0.8
0.3 - 0.8
0.3 - 0.8
x 109/L
Basophil
0.0 - 0.1
0.0 – 0.1
0.0 – 0.1
0.0 - 0.1
0.0 - 0.1
x 109/L
0.0 - 0.1
B.
115 - 145
320 - 360
WBC Differential Counts (12 years or older)
Absolute Neutrophils:
1.5 - 6.5 x 109/L
Absolute Lymphocytes:
1.2 - 3.4 x 109/L
Absolute Monocytes Count: 0.2 - 0.8 x 10 9/L
Absolute Eosinophil Count: 0.0 - 0.4 x 109/L
Absolute Basophil Count:
0.0 - 0.2 x 109/L
Neutrophil
Lymphocytes
Monocytes
Eosinophils
Basophils
42.2 - 75.2%
20.5 - 51.1%
1.7 - 7.6%
0.0 - 5.0%
0.0 - 0.8%
%
%
%
%
%
-
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
Page 7 of 9
Last printed 10/27/2014 12:57 PM
x 109/L
g/L
g/L
x 109/L
C.
D.
E.
Coagulation
1.
INR: 0.9 – 1.3
Therapeutic Range INR:
2.
Activated Partial Thromboplastin Time: 25 - 38 sec.
Therapeutic Range: 55 - 80 seconds.
3.
Fibrinogen: 1.8 – 3.5 g/L
4.
D-Dimer: less than 500 ug/L FEU
DVT
2.0 - 3.0
Recurrent P.E. 2.5 - 3.5
Chromogenic Assays and Special Coagulation Tests
1.
Anti-Thrombin:
80% - 120%
2.
Protein C:
70% - 130% of normal
3.
Women
Men
Protein S Free
50 - 130%
70 -150%
Functional Protein S
67 – 132%
4.
APC Resistance
2.0 – 5.0
5.
Anticardiolipin IgM
Anticardiolipin IgG
Anticardiolipin IgA
0 – 10 MPL/ml
0 – 22 GPL/ml
0 – 21 APL/ml
6.
DRVVT
Ratio 0.0 – 1.3
KCT
Ratio 0.0 – 1.2
7.
Bleeding Time
2 - 9 ½ minutes
8.
VW Factor Antigen
50-200% of normal
Lower Limit of normal is 40% for blood
Group O individuals
9.
Ristocetin CoFactor
50-200% of normal
10.
Factor XII Assay
0.45 – 1.50 units/mL
11.
Factor Assays
(V,VII,VIII,IX,X,XI)
0.50 – 1.50 units/mL
Erythrocyte Sedimentation Rate (ESR)
0 - 20 mm/hr
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
Page 8 of 9
Last printed 10/27/2014 12:57 PM
F.
Body Fluids
CSF: Clear, colorless
RBC - 0
WBC - adults 0 - 5 x 106/L
neonates 0 - 30 x 106/L
Differential
Lymphocytes
Monocytes
Neutrophils
Eosinophils
Adults
60% + 20%
30% + 15%
2% + 4%
less than 1%
Neonates
20% + 15%
70% + 20%
4% + 4%
less than 1%
Pleural, synovial fluids
Clear, pale yellow
WBC: Pleural 0 - 1.0 x 109/L
Synovial 0 - 0.2 x 109/L
RBC: 0 x 1012/L
Differential - less than 25% neutrophils
Peritoneal fluids
Clear, pale yellow
WBC: 0 - 300 per mm3
Dialysate fluids
Clear, colorless
WBC: 0.0 – 0.10 x 109/L
RBC: 0 x 1012/L
G.
Lamellar Bodies
< 15,000 /µL
15,000 – 49,000 /µL
≥ 50,000 /µL
Immature
Transitional
Mature
Revision History
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Author: Revised by Joan Isaak
LABHemaOP7001.2 Hematology
Laboratory Services Regina QuAppelle Health Region
Page 9 of 9
Last printed 10/27/2014 12:57 PM
Subject/Title: LABHemaOP7037.1.1 Flowcytometry
Last Approved Time: 5/22/2013 9:08:05 AM
Revision: 1.3
Approving Authority: Pathologist
Contact for Interpretation:Flowcytometry
Phone: (306) 766-6191
Current Version on Print Date
Policy
General Information
Technical staff is available weekdays 0730 to 1630 hours (except statutory holidays).
Specimens should be received at Pasqua laboratory by 1400 hours to facilitate
processing.
Out of hours tests are restricted unless authorization is obtained by physician of record
from the Pathologist.
Collection of Specimens
Specimen
Whole Blood for
Flowcytometry
Requirement
5 ml EDTA or Sodium Heparin
(green). ACD is acceptable but
Lithium Heparin is not.
Whole Blood for
3-5 ml EDTA (mauve).
CD4/CD8
1 microtainer EDTA (minimum of
250ul)
Whole Blood for PNH 5 ml EDTA (mauve) or
(Paroxysmal nocturnal 10 ml ACD (Yellow)
hemoglobinuria)
Bone Marrow
Body Fluids
Tissue specimen
Fine Needle Aspirates
(FNA)
1-3 ml collected in heparinized
syringe and then placed in EDTA
or Sodium Heparin tube
Minimum of 40 ml in container
with RPMI preservative and
without any anticoagulant.
Between 0.5 and 3.0 cm in RPMI
preservation media.
Place in 10ml RPMI
preservation media.
Additional Information
Store and transport at room
temperature. Specimen must be
processed within 24 hrs of collection.
Keep at room temperature. Specimen
must be processed within 24 hrs of
collection.
Keep specimens at room temperature.
EDTA specimen must be processed
within 8 hrs of collection. ACD
specimen must be processed within 24
hrs of collection
Store and transport at room
temperature. Specimens must be
processed within 24 hrs of collection.
Freshly collected and sent immediately.
Store and transport at 4°C. Must be
processed within 24 hrs of collection.
Store and transport at 4°C. Specimens
must be processed within 24 hrs of
collection. DO NOT FREEZE.
Store and transport at 4°C. Must be
processed within 24 hrs of collection.
LABHemaOP7037.1.1 Flowcytometry
Laboratory Services Regina QuAppelle Health Region
Page 1 of 2
Last printed 5/22/2013 9:08 AM
List of Tests provided in Flowcytometry
1.
2.
3.
4.
CD4/CD8
Leukemia Immunophenotyping
Lymphocyte/Lymphoma Phenotyping
PHN Testing (Paroxysmal nocturnal hemoglobinuria)
Revision History
Found in Softtech Health Lab QMS™ Document Management System
Author
Joan Isaak, MLT
LABHemaOP7037.1.1 Flowcytometry
Laboratory Services Regina QuAppelle Health Region
Page 2 of 2
Last printed 5/22/2013 9:08 AM
Subject/Title: LABHistOP1000 Histopathology Clinical Support Services
Man
Last Approved Time: 5/6/2013 8:14:15 AM
Revision: 3.3
Approving Authority: Medical Pathologist
Contact for Interpretation: Histology
Phone: (306) 766-2075
Current Version on Print Date
HISTOPATHOLOGY CLINICAL SUPPORT SERVICES MANUAL
Hours of Operation:
Technical Staff are available Monday to Friday, 0600 to 1530 hours.
Non-technical staff are available Monday to Friday, until 1700 hours.
Saturdays, Sundays and Statutory Holidays are not worked.
I.
SUBMISSION OF TISSUES FOR PATHOLOGICAL EXAMINATION
1.
For routine pathological examination, the requirements are:
Tissues should be immersed in 10% neutral buffered formalin
immediately after removal.
Volume of the 10% neutral buffered formalin should be at least 10
times the volume of the specimen.
Tissues should not be squashed into small containers.
10% neutral buffered formalin for the nursing units and operating
room is available from Histopathology at the Pasqua Hospital or
the laboratory at the Regina General Hospital.
affix gummed label to each specimen jar clearly indicating name of
patient, HIN, HSN, surgeon, nursing unit, nature of specimen and
date of surgery.
the attending physician must complete and legibly sign the
Histopathology request form and provide relevant clinical history,
nature of specimen and date of surgery (include operative findings
and details of previous surgery with dates). Where relevant
provide obstetrical and gynaecological history. THIS IS A
STATUTORY REQUIREMENT.
2.
URGENT or over-night reports on tissue
These tissues must be submitted to Histopathology no later than
1500 hours; only small biopsies can be processed this quickly. If it
is considered that fixation is not complete; the specimen will not
be processed: every effort will be made to notify the clinician.
3.
Tissues for Microbiological Culture and subsequent Pathological
Examination.
These tissues should be submitted in a sterile container and should
be sent immediately to Microbiology at the RGH in the fresh state
with no formalin added.
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
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-
The requisition should state clearly that a culture is required and,
wherever possible, what organism is suspected.
If pathologic examination is also required, a pathology requisition
must also be completed.
4.
Tissues for Quick Section
This is routinely available Monday through Friday (except
statutory holidays) and available at other times by direct
arrangement between the physician of record and the pathologist
on call.
The equipment to perform Quick Sections is kept in the
Histopathology laboratory and specimens should be sent by
pneumatic tube or special messenger to Histopathology without
delay.
A pathologist should be informed before the specimen leaves the
operating room. Call local 2228 at PH or use Phillips intercom
system to call the Histology Lab. At RGH, call the pathologist at
4466 or page on pathologist’s pager 6290.
The tissue should be fresh with no added formalin.
5.
Tissue for Electron Microscopy
If electron microscopy on tissue is required, Histopathology should
be notified a day in advance so the proper solutions can be made.
Phone local 2228 at PH.
Dispatch the tissue immediately to the Histopathology laboratory
in the fresh state with NO added solution.
The requisition should state clearly that ELECTRON
MICROSCOPY is required.
A full clinical history must be supplied.
For specimens originating from the RGH, notify the onsite
pathologist at local 4466.
Tests for Electron Microscopy are referred outside the region.
6.
Tissues requiring photography with subsequent pathological examination.
These should be sent immediately to the laboratory in the fresh
state with no formalin added (Monday to Friday only).
The requisition should state clearly that a photograph is required
and also indicate what features are to be demonstrated.
The pathologist on call must be notified for specimens procured
out of normal working hours.
7.
Immunofluorescence for bound immunoglobulin
Tests ordered on renal biopsies are referred to Saskatoon City
Hospital Pathology Department for testing. Pediatric (0-16 yr)
renal biopsies are referred to Winnipeg Health Sciences Centre for
testing.
Testing of skin and oral mucosa biopsies is performed by
Histopathology on a weekly basis.
Tissues should be placed in Michel's fixative without refrigeration
or freezing. Michel's fixative is available from Histopathology
(local 2228).
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
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8.
Tissue for conventional light microscopy should be submitted at
the same time.
Lymph Nodes and Open Lung Biopsies
At PH
Notify the Histology department (local 2228).
Send immediately by special messenger to Histopathology, in the
fresh state with NO added formalin.
After 1700 h, special arrangements must be made with the
pathologist on call.
-
At RGH
Notify the on-site pathologist (local 4466).
Send immediately by special messenger to the Laboratory,
in the fresh state with NO added formalin.
After 1700 h, special arrangements must be made with the
pathologist on call.
9.
Testicular Biopsies:
Bouin's fixative is available from Histopathology upon request
(local 2228).
Notify a day in advance.
10.
Amputated limbs
Limbs which do not require pathological examination should be
accompanied by a requisition clearly marked FOR DISPOSAL and
should be placed in a vault in the Autopsy suite for later disposal.
11.
After 1630 hours
Specimens without fixative (i.e. fresh specimens) must not be left
in the Histopathology Laboratory.
For lymph node biopsies, kidney biopsies, thoracic biopsies, flow
cytometry and other urgent specimens, contact the on call
pathologist.
12.
Muscle Biopsies:
Processing and reporting of all muscle biopsies is performed by an
external reference laboratory.
The Histology laboratory requires 48 hours notice of the intent to
perform a muscle biopsy. It is essential that the on-call pathologist
receives notification of intent to do a muscle biopsy.
Liquid nitrogen is not stored in the laboratory and can only be
delivered Tuesdays and Thursdays, effectively restricting our
ability to offer the service to Wednesday, Thursday and Friday.
13.
Nerve biopsies:
Processing and reporting of all nerve biopsies is performed by an
external reference laboratory.
It is essential that the Histopathology Laboratory (local 2228),
receive 24 hour notification of the intent to perform a nerve biopsy
so that the proper solutions can be made.
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
Page 3 of 7
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-
II.
Prior to commencement of the procedure, the pathologist on call
must be notified so that they may ensure that proper protocol is
followed.
14.
Flow Cytometry:
This is routinely available Monday through Friday (except
statutory holidays) and available at other times by direct
arrangement between the physician of record and the pathologist
on call.
Tissue submitted for Flow Cytometry must be submitted in RPMI
medium and delivered immediately to the laboratory.
15.
Chromosome Studies:
Tissues submitted for chromosome studies are sent to an external
reference laboratory for testing.
Tissues submitted should be fresh with no added formalin and
delivered immediately to the laboratory.
The pathologist on call should be notified that a specimen has been
sent for chromosome studies
16.
Kidney Biopsies:
Notify the pathologist on call prior to performing the biopsy.
Ideal specimen: two kidney needle core biopsies each measuring
1-1.5 cm in length. These biopsies are placed between two pieces
of filter paper that have been dampened with normal saline.
Dispatch the tissue immediately to the Histopathology laboratory.
A full clinical history must be supplied
Kidney Biopsies are sent to Saskatoon City Hospital for testing.
Pediatric (0-16 yr) cases are sent to Winnipeg Health Sciences
Centre for testing.
AUTOPSIES
1.
CORONER'S AUTOPSIES:

“Warrant for Post-Mortem or Other Examination” (Form C) must
be completed by the coroner. This form is provided by the coroner.

A coroner’s autopsy differs from a hospital autopsy in that the
coroner’s order to perform an autopsy constitutes a legal consent and
does not require the consent of the decedent’s family.
The coroner should be notified in all cases of death due to:
 Homicide
 Suicide
 Accident
 Unusual circumstances which require investigation falling under the
general category of “misadventure”
NOTE: A Coroner should be called in those cases in which death is due
to so-called “natural conditions” such as infection, renal failure,
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
Page 4 of 7
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pneumonia, etc., when those conditions are thought to be a consequence of
an injury even when death occurs months or years following the initial
incident.
In doubtful cases it is advisable to discuss the case with the Coroner.
2.
3.
HOSPITAL AUTOPSIES:

All hospital autopsies require a completed and signed “Consent for
Autopsy” (Form RQHR 064) before an autopsy can be performed.
For the order of those who may give legal consent for a hospital
autopsy - see list below

The request for autopsy shall be made by the attending or consulting
physician or his designate. A resident or house physician may request
an autopsy after consulting with the attending or consulting physician.

Nursing or Admitting personnel may obtain and witness the consent
signature. If consent/permission is sought by telephone, the person
obtaining permission and a witness to the telephone conversation
must both sign the “Consent for Autopsy” (RQHR 064) form.

There are no legal requirements making a hospital autopsy mandatory.
COURTESY AUTOPSIES:


A request must be made to the Director or pathologist on call. The
following documentation is required:
 Valid consent from the legal next of kin. It is acceptable to
use their own form or the “Consent for Autopsy” (Form
RQHR 064) will be provided.
 Adequate legible or type-written clinical history (must not be
photocopy of hospital chart)
 Referring agency to pay for transportation
Courtesy autopsies are performed Monday through Friday subject to
time constraints. They are not performed on weekends/holidays except
in rare instances.
THE FOLLOWING MAY GIVE CONSENT FOR AUTOPSY:




4.3
The Coroner
The legal next of kin (in certain circumstances the executor or person lawfully
in possession of the body). See list below.
In the case of common-law relationship, the Pathologist must contact Risk
Management (766-4979) for verification.
Please refer to the following procedure - RHD Procedure No: 1.1.7 (Page 13)
4.3 Consent to Autopsy.
Consent to Autopsy
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
Page 5 of 7
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The attending physician is responsible for ensuring that the individual providing
the consent is aware of the nature, purpose, and effect of the consent. A Medical
Resident may be appointed by the attending physician to explain the nature,
purpose, and effect of the autopsy to the substitute decision maker or person
lawfully in possession of the body.
An autopsy requires a written consent using the Consent for Autopsy Form. When
obtaining consent, the next-of-kin who may authorize autopsy are listed in order
below. All except the spouse must be at least eighteen years of age:






spouse (unless living separate immediately prior to the death or illness)
children of the person
either parent
brother or sister
any other next-of-kin
the person lawfully in possession of the body other than the RHD, the
Minister of Justice, or a funeral director
When permission is obtained from a person other than the person or persons listed
on the hierarchical list, the reasons should be documented on the health record.
When the extent of autopsy is not indicated on the consent form, authorization for
the complete autopsy is assumed.
Under those circumstances which warrant a coroner’s investigation, no
autopsy shall be performed unless and until authorized by the coroner.
The completed “Consent for Autopsy” form and patient chart are to accompany the body
to the Laboratory. The patient chart and “Consent for Autopsy” form must be left in the
“Autopsy Permission Box” by the accession area at RGH or in the “Autopsy Permission
Box” on the wall at Pasqua.
Note: Under no circumstances should the “Consent for Autopsy” form and patient chart
be sent to Health Records.
References

4.3 Consent to Autopsy - Page 13 of RHD Procedure No: 1.1.7 (this can be
found on the RQHR Intranet)
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author D. McHardy, MLT
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
Page 6 of 7
Last printed 5/6/2013 8:14 AM
LABHistOP1000 Histopathology Clinical Support Services Man
Laboratory Services Regina QuAppelle Health Region
LABHistOP1000.3.3 Histopathology Clinical Support Services Manual
Page 7 of 7
Last printed 5/6/2013 8:14 AM
Subject/Title: LABMicOP7204 MICROBIOLOGY LABORATORY
SERVICES
Last Approved Time: 4/15/2010 11:03:52 AM
Revision: 2
Approving Authority:Medical Microbiologist
Contact for Interpretation: Microbiology
Phone: (306) 766-4481
Current Version on Print Date
Policy
Process Control
Purpose
This procedure provides information on the hours of operation and the scope of services
provided by the Microbiology laboratory. It also provides guidelines for the collection
and transportation of specimens for Microbiology.
Hours of Operation
Technical staff is available Monday to Friday, 0645 to 0000 hours.
Saturday and Sunday technical staff is available 0745 to 1615 hours.
Outside these hours, technical staff is on call.
Scope of Service
Bacteriology: - Bacterial culture
- Organism identification
- Drug susceptibility testing
Mycobacteriology (Microscopy only. Culture will be sent to the Provincial Laboratory)
Mycology
Parasitology
Virology (Limited viral screens are performed on In Patient specimens. All specimens are
referred to the Provincial Laboratory for viral cultures)
Clostridium difficile cytotoxin testing
Trichomonas culture
LABMicOP7204 MICROBIOLOGY LABORATORY SERVICES
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 3
Last printed 4/15/2010 11:03 AM
Procedure
Step
Action
Complete a Microbiology
1
requisition.
Additional Information
These are white or blue in colour. The white
requisition is used by the Hospitals and Nursing
Homes. The blue requisition is used by the
community laboratories.
Each form has a set of perforated numbers at the
bottom. Removal of the tape enables the numbers
to be firmly affixed to each specimen submitted
for bacteriological examination. In the case of
swabs, the labels should be applied along the
length of the tube. Each number sticker must have
name, MRN/HSN, specimen type and date filled
in.
The appropriate spaces at the top half of the
requisition should be filled in by the Nursing Unit
or Clinic, with all the pertinent information
requested, including the diagnosis and antibiotic
therapy. This information is important in the
correct identification of the specimen, and also in
determining the culture method to be used.
2
Collect specimen and
transport specimens to
laboratory.
Refer to Appendix 1 for Specimen Containers for
Microbiology.
Refer to Appendix 2 for Microbiology Collection
and Test Compendium.
Refer to Table 1 for the Criteria for Rejection of
Microbiology Specimens.
Procedure notes
All specimens and containers should be considered contaminated. Biohazard bags are not
necessary for transport of specimens; however, personal protective equipment must be
used. ie. Gloves. Gross contamination of specimen containers must be removed prior to
transport (wipe visible contamination from specimen container with cotton ball soaked in
0.5% hypochloride solution or use an alcohol swab).
Page 2 of 3
Last printed 4/15/2010 11:03 AM
Reporting Results
A direct gram smear will be performed and reported on all appropriate specimens. These
results will be sent to the appropriate ward when results have been completed. STAT
gram smears will be performed and results called within 30 minutes.
When a specimen culture yields a pathogenic organism, the organism will be reported
along with a list of antibiotics to which the organism is susceptible with standard adult
dosage. Dosage adjustments must be made for other age groups, and for patients with
underlying disease. eg. renal failure.
Qualitative tests such as Clostridium difficile cytotoxin testing will be reported as
“positive” or “negative”.
Each individual test on a Microbiology report will be flagged as an “interim” or a “final”
report.
When results fall within ranges identified as “Critical”, Laboratory staff will telephone
results to the nurse on the unit concerned or to the physician, or in the case of out-patient
or referred in specimens to the clinic or physician’s office. Refer to Microbiology Critical
Values.
Related documents
LABMicOP7202.T.1 Criteria for Rejection of Microbiology Specimens
LABMicOP8000.A.3 Microbiology Critical Values
Appendixes
LABMicOP7204.A.1 Specimen Containers for Microbiology
LABMicOP7204.A.2 Microbiology Collection and Testing Compendium
LABMicOP7204.T.1 Criteria for Rejection of Microbiology Specimens
Revision History
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Author
Carol Barth, MLT.
Page 3 of 3
Last printed 4/15/2010 11:03 AM
Specimen Containers for Microbiology
Used for transport
of sterile tissue as
well as skin and nail
scrapings and hair
for fungal culture.
Supply stored at 4°C
Swabs
Transport
Stool
A
B
C
A) SAF - Parasites (O&P)
B) Sterile container without preservative - CD toxin, Viral
C) Cary Blair w/indicator - Routine Culture (C&S)
Urine
Urine culture container with Boric
Acid preservative minimum fill 5ml.
Blood Cultures
A
e-Swab is used for all routine
specimens when aerobic and/or
anaerobic organisms are suspected
including Neisseria gonorrhea,
Trichomonas and Candida species.
B
C
Cultures
A) FA- Plus - Aerobic
B) FN- Plus - Anaerobic
C) PF- Plus - Pediatric
**Vials for Mycobacterium available from Microbiology
**For Complete instructions on Specimen collection and Transportation / Storage refer to the Microbiology compendium.
6914-15-MMS-ddh
Viral Transport
Sterile Container
RQHR Microbiology Test Compendium
The Regina Qu’Appelle Health Region (RQHR) Division of Microbiology, within the Department of
Laboratory Medicine provides amalgamated service to all patients and providers within RQHR.
The laboratory is staffed 24 hours a day, 365 days per year, with medical consultation available 24/7.
Contact us:
Laboratory Services, Microbiology
Regina General Hospital
1440 – 14 Ave
Regina, SK
S4P 0W5
Phone: 306-766-4481
Fax: 306-766-4640
The Medical Microbiologist on-call can be reached through the hospital switchboards at 306-766-4444
or 306-766-2222.
General Specimen Collection and Submission Requirements
All specimens must be labeled and submitted with a completed requisition (see Laboratory Services
Manual - General Information for further details). Specimens may be rejected if:
they are improperly labeled or not accompanied by a completed requisition
submitted in inappropriate container, received in leaking or otherwise compromised container
Insufficient quantity of specimen, inappropriate specimen type for test requested, duplicate
specimens, or if integrity of specimen has been compromised (e.g. lack of temperature control,
delays in transit)
Whenever possible, specimens for microbiologic detection should be collected before antibiotics are
given. Care must be taken to avoid contamination of specimens with organisms of the normal flora or
environment.
Specimens should be delivered to the laboratory soon after they are collected. Delays in transport can
lead to incorrect, invalid, or misleading results. The date and time of specimen collection should be
recorded on the requisition in order to identify these delays and aid in results interpretation.
Providing relevant clinical information will ensure specimens are processed and reported appropriately.
This compendium describes routine testing performed. For special requests or additional information,
please contact the Microbiology laboratory or Medical Microbiologist on-call.
Last revised October 2015
Compendium of Tests
TEST ON REQUISITION
BLOOD & STERILE FLUIDS
Blood Cultures
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
[See LABMicOP7021
Collection of Blood Cultures
procedure for details]
Bottles are incubated on an
automated instrument with
continuous monitoring until
growth is detected, or for 5
days if negative.
Positive gram stains are
considered CRITICAL RESULTS
and are phoned to submitting
location immediately upon
detection 24 hours per day.
Once growth is detected,
Gram stain is performed STAT
and bottles are sub-cultured.
Identification and
susceptibility results are
usually available 24 – 48
hours after organism is
isolated.
Adult blood culture bottles
must be filled to the
appropriate volume in order
to achieve optimal dilution of
ingredients. Over-filling or
under-filling bottles will
reduce the sensitivity of
detection.
Adults (≥16 years) set:
1 aerobic + 1 anaerobic
bottle; 8 – 10 mL each
Child (1 – 15 years) set:
Collect approximately 1mL
per year of age total. Divide
total volume into multiple
bottles as indicated.
1 – 4 years: 1 pediatric bottle
5 – 8 years: 2 pediatric bottles
9 – 15 years: 1 pediatric + 1
aerobic adult bottle
Infant (0 – 12 months) set:
1 pediatric bottle (1 – 2 mL)
For all adult collections, 2 sets
collected from 2 separate sites
will always be performed. One
set should always be collected
from a peripheral venipuncture.
Label sites of collection.
Reports of no growth are sent
at 24 hours and 5 days, if
applicable.
Label bottles and provide
information on requisition to
identify the source of each
blood culture set (e.g. sets
labeled #1, #2; requisition
indicates #1 venipuncture, #2
PICC line).
Pediatric blood cultures will
be drawn as a single set
unless specifically ordered as
2 sets. Pediatric blood
cultures will not include
anaerobic culture bottles
unless specifically requested.
Transport at room temperature,
as soon as possible and <24
hours. Do not freeze or
refrigerate.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
CSF (Cerebrospinal fluid)
Lumbar puncture
Extraventricular drain
Indwelling shunt
Collect using sterile technique
into sterile screw capped
containers.
Gram stain and culture for
bacteria and yeast is
performed routinely. Cultures
are incubated for 7 days.
Positive gram stains are
considered CRITICAL RESULTS
and are phoned to submitting
location immediately upon
detection 24 hours per day.
Avoid sending first tube
collected for microbiology
testing due to increased risk
of specimen contamination.
Minimum volumes:
Bacterial/yeast culture ≥1 mL
Fungal culture ≥2 mL
Transport at room
temperature, as soon as
possible and <2 hours. Do not
freeze or refrigerate.
Sterile Fluids
Pleural fluid
Peritoneal fluid
Pericardial fluid
Synovial fluid
Bone marrow
Collect using sterile technique
into sterile screw capped
container.
Alternatively, collect 2 mL
into a sterile screw capped
container for Gram stain
preparation, then inoculate
aerobic and anaerobic blood
culture bottles with 6 – 8 mL
each.
Transport at room
temperature, as soon as
possible and <24 hours. Do
not freeze or refrigerate.
Filamentous fungal cultures
performed if ordered on
requisition. Cultures are
incubated for 4 weeks.
All CSF specimens requesting
filamentous fungal culture
will have a qualitative
Cryptococcal Antigen lateral
flow assay (CrAg LFA)
performed. Positive
specimens will undergo semiquantitative titration.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 7 days.
Identification and
susceptibility results are
usually available 24 – 48
hours after organism is
isolated.
Reports of no growth are sent
at 24 and 72 hours, if
applicable.
Positive gram stains are
considered CRITICAL RESULTS
and are phoned to submitting
location immediately upon
detection 24 hours per day.
If ordering additional testing
from reference laboratory,
ensure adequate volume is
submitted: ≥2 mL for
Mycobacterial culture, ≥1mL
for viral isolation, and
approximately 1mL per
additional special request
Swabs of sterile fluid are
inappropriate specimens. This
significantly compromises the
sensitivity of organism
detection.
Filamentous fungal cultures
performed if ordered on
requisition. Cultures are
incubated for 4 weeks.
Reports of no growth are sent
at 24 and 72 hours, if
applicable. Specimens
submitted in blood culture
bottles will have negative
Specimens submitted in blood reports sent at 24 hours and 5
culture bottles are incubated days.
on an automated instrument
with continuous monitoring
until growth is detected, or
for 5 days if negative.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Intravascular Catheter tip
Disinfect surrounding skin
before removal. Aseptically
remove catheter and cut 1-2”
of distal end into sterile
container.
Intravascular catheter tips are
processed by a semiquantitative roll method, and
incubated aerobically. If
neonate or TPN, culture for
Malassezia spp. is performed.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
Submit intravascular catheter
tips only if there are signs of
infection.
If an intravascular line
infection is suspected, blood
cultures should be collected
simultaneously. Collect 1 set
from suspected intravascular
line before removal, and
collect 1 set from a peripheral
venipuncture. Label sites of
collection.
CSF shunt and peritoneal
dialysis catheter tips are
flushed and vortexed with
broth, which is then cultured
semi-quantitatively.
Reports of no growth are sent
at 24 and 96 hours, if
applicable.
Tips from Foley catheters,
chest tubes, and other drains
are not accepted.
Cultures are incubated
aerobically for 4 days.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
WOUNDS/SURGICAL
Superficial wound swab
Clean wound thoroughly
before swabbing affected
areas. Avoid touching
surrounding skin.
Use liquid-based E-swab
collection system (preferred)
or M-40 Transystem swabs.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Gram stain and culture for
aerobic bacteria and yeast is
performed routinely. Cultures
are incubated for 48 hours.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
Reports of no growth are sent
at 24 and 48 hours, if
applicable.
If aspiration of wound is
possible, this is preferred as it
will more accurately identify
pathogens and minimize
isolation of colonizing organisms.
Note: swabs from decubitus
ulcers and pressure sores cannot
distinguish infecting pathogens
from colonizing organisms and
are not routinely processed.
Please submit tissue or aspirate
specimens.
Note: swabs are not appropriate
for isolation of filamentous fungi
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Deep wound swab
Clean wound thoroughly
before swabbing affected
areas. Avoid touching
surrounding skin.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 72 hours.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
If aspiration of wound or
tissue biopsy is possible, this
will be preferred as it will
more accurately identify
pathogens and minimize
isolation of colonizing
organisms.
Use liquid-based E-swab
collection system (preferred)
or M-40 Transystem swabs.
Reports of no growth are sent
at 24 and 72 hours, if
applicable.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Note: swabs from decubitus
ulcers and pressure sores
cannot distinguish infecting
pathogens from colonizing
organisms and are not
routinely processed. Please
submit tissue or aspirate
specimens.
Note: swabs are not
appropriate for isolation of
filamentous fungi
Aspirate/fluid/drainage
Clean and decontaminate
surface before collecting
specimen. Aspirate ≥1 mL of
specimen using sterile
technique.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 72 hours.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
Specimen can be submitted
to lab in a sterile screw
capped container, or in
capped syringe with needle
removed.
Filamentous fungal cultures
performed if ordered on
requisition. Cultures are
incubated for 4 weeks.
Reports of no growth are sent
at 24 and 72 hours, if
applicable.
Transport at room temperature,
as soon as possible. If delay is
anticipated, keep specimen at
4°C.
If Actinomycosis is suspected,
please indicate under
‘Other/Special Requests’.
Cultures will be incubated for
10 days.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
Tissue/biopsy
Collect using sterile
technique, into sterile screw
capped container. You may
add a small amount of sterile
saline to keep tissue from
drying out.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 7 days.
Positive gram stains are
considered CRITICAL RESULTS
and are phoned to submitting
location immediately upon
detection 24 hours per day.
Filamentous fungal cultures
performed if ordered on
requisition. Cultures are
incubated for 4 weeks.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Bone Chip
Collect using sterile
technique, and place into
sterile screw capped
container.
Bone bank products may be
directly placed into tube of
Thioglycollate broth.
Transport at room
temperature, as soon as
possible. Do not freeze or
refrigerate.
If Actinomycosis is suspected,
please indicate under
‘Other/Special Requests’.
Cultures will be incubated for
10 days.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 7 days.
Bone bank products are
incubated in submitted
Thioglycollate broth for 7
days.
NOTES
Reports of no growth are sent
at 24 hours and 7 days, if
applicable.
Positive gram stains or
detection of growth from
bone bank specimens are
considered CRITICAL RESULTS
and are phoned to submitting
location immediately upon
detection 24 hours per day.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
Reports of no growth are sent
at 24 hours and 7 days, if
applicable.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Foreign body/implant
Collect using sterile
technique, and place into
sterile screw capped
container.
Gram stain and culture for
aerobic and anaerobic
bacteria, and yeast is
performed routinely. Cultures
are incubated for 7 days.
Identification and
susceptibility results are
usually available 24 – 48
hours after an organism is
isolated.
For unusual specimens or
special requests, contact the
Microbiologist on-call before
submitting to laboratory.
Transport at room
temperature, as soon as
possible. Do not freeze or
refrigerate.
ARO SCREENS
MRSA
(Methicillin-Resistant
Staphylococcus aureus)
Nares: insert into nostril 2-3
cm and roll swab 5 times.
Insert same swab into second
nostril and repeat.
Groin: roll swab from top to
bottom of inguinal area 5
times. Repeat using same
swab on opposite side.
Use liquid-based E-swab
collection system (preferred)
or M-40 Transystem swabs.
Reports of no growth are sent
at 24 hours and 7 days, if
applicable.
Real Time Polymerase Chain
Reaction (RT-PCR) testing
performed routinely. Newly
identified colonization is
confirmed with culture.
Turnaround time ≤24 hours.
Newly identified colonization
confirmation available at 72
hours.
Inpatient wards and Infection
Control notified immediately
of new positive results. New
positive cases are reported to
Public Health.
Submit screens from nares,
groins, invasive devices in
place ≥1 month (e.g.
tracheostomy, catheters), and
open wounds. Only 1
requisition per patient is
needed for all MRSA
screening specimens.
Repeat specimens received
<7 days after a negative
screen or <30 days after a
positive screen will not be
processed.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
VRE
(Vancomycin-Resistant
Enterococcus)
Rectal swab: insert into
rectum 2-3 cm and rotate 5
times
Chromogenic screening
cultures are performed
routinely
Turnaround time 48 – 72
hours.
Repeat specimens received
<7 days after a negative
screen or <30 days after a
positive screen will not be
processed.
Inpatient wards and Infection
Control notified immediately
of new positive results. New
positive cases are reported to
Public Health.
Use liquid-based E-swab
collection system (preferred)
or M-40 Transystem swabs.
Stool: collect 1g (~size of a
hazelnut) of freshly passed
stool into sterile container
with no preservative (White
top).
ESBL/CRE
(Extended Spectrum BetaLactamase / Carbapenemase
Resistant Enterobacteriaceae)
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Rectal swab: insert into
rectum 2-3 cm and rotate 5
times
Use liquid-based E-swab
collection system (preferred) or
M-40 Transystem swabs.
Stool: collect 1g (~size of a
hazelnut) of freshly passed stool
into sterile container with no
preservative (White top).
Chromogenic screening
cultures are performed
routinely
Turnaround time 48 – 72
hours.
Inpatient wards and Infection
Control notified immediately
of new positive results. New
positive cases are reported to
Public Health.
Repeat specimens received
<7 days after a negative
screen or <30 days after a
positive screen will not be
processed.
Transport at room temperature,
as soon as possible. If delay is
anticipated, keep specimen at
4°C.
Last revised October 2015
TEST ON REQUISITION
URINE
C&S only if positive urinalysis
or
C&S
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Midstream: hold labia apart
(female) or retract foreskin
(male), begin voiding and
discard first several mL urine.
Without stopping flow of
urine, collect 5 – 10mL
midstream specimen into
wide-mouth sterile container.
Urinalysis screening
performed.
Urinalysis results will be
reported within 24 hours.
If urinalysis is positive for
leukocyte esterase (LE) or
nitrites, specimen will
undergo quantitative culture
for uropathogenic bacteria.
Cultures are incubated 24-48
hours.
If specimen is cultured,
organism identification is
usually available 24 – 48
hours after it is isolated.
If submitting urine for
diagnosis of urinary tract
infection (UTI), please order
“C&S only if positive
urinalysis”. A negative
urinalysis has high specificity
to rule out UTI. If urinalysis is
positive for nitrites or
leukocyte esterase culture
will be performed routinely.
Straight Catheter: thoroughly
clean urethral area with mild
soap and water. Aseptically
insert catheter into bladder.
Discard initial several mL
urine, collect 5 – 10 mL.
Indwelling Catheter: disinfect
catheter collection port with
70% alcohol. Use needle and
syringe to aseptically collect 5
– 10 mL of urine.
Supra-pubic aspirate or
Cystoscopy collection: collect
5 – 10 mL using aseptic
technique.
Transfer urine into tube
containing Boric acid
preservative and fill to
indicator line. Sterile
containers may be submitted
if processed <2 hours after
collection.
If urinalysis is negative, this
predicts the absence of a
urinary tract infection.
Specimen will not be
cultured.
If C&S is ordered, urine will be
cultured without a urinalysis
performed.
Reports of no growth are sent
at 24 hours, if applicable.
Urine from pregnant women
or individuals undergoing GU
surgery/manipulation should
order a regular urine C&S to
ensure appropriate
processing.
Urine collected or received in
non-sterile containers is
unacceptable for culture.
Catheter bags are not suitable
for culture. Specimens
collected in pediatric urine
bags should be aseptically
transferred into sterile
container and tube containing
Boric acid preservative.
Repeat specimens received
within 3 days will not be
processed.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Culture for Salmonella spp.,
Shigella spp., Campylobacter
spp., Shiga toxin producing
E.coli (STEC), Aeromonas spp.,
and Pleisiomonas spp.
performed routinely.
Cultures are incubated 72
hours.
Organism identification is
usually available 24 – 48
hours after it is isolated.
Repeat specimens received
within 5 days will not be
processed.
If ordering “C&S only if
positive urinalysis”, submit
urine in both sterile container
and preservative.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
STOOL
Bacterial C&S
Collect freshly passed stool
into clean, dry container.
Transfer to enteric transport
media container (Cary Blair).
Fill to line marked on
container. There should be no
contaminating material. E.g.
urine, tissue paper.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Report of no pathogens
Stool cultures are not
detected is sent at 72 hours, if performed on patients who
applicable.
have been in hospital >3 days.
Consider C.difficile testing in
hospitalized patients with
new onset diarrhea.
Susceptibility testing is not
routinely performed on
enteric pathogens from
patients without known risk
factors. If antibiotic therapy is
indicated, please contact the
Microbiology lab at 766-4481.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
NOTES
Clostridium difficile
Collect 1g (~size of a
hazelnut) of freshly passed
stool into sterile container
with no preservative. There
should be no contaminating
material. E.g. urine, tissue
paper.
All stools are initially tested
for GDH and Toxin A/B using
an enzyme immunoassay
(EIA). Specimens with
concordant results (i.e.
GDH+/Toxin+ or GDH-/Toxin-)
are reported immediately.
Specimens with discordant
results (i.e. GDH+/Toxin-)
undergo PCR testing, and
results of the PCR assay are
reported.
Turnaround time 24 hours.
The rate of asymptomatic
carriage of C.difficile in young
children is high (up to 50% <3
years; up to 74% <1 year).
Specimens from children <1
year will not be processed.
Positive results in children <3
years should be interpreted
with caution.
Transport at room
temperature, as soon as
possible. If delay is
anticipated, keep specimen at
4°C.
Repeat specimens from
patients with previously
positive C.difficile <2 weeks
will not be tested.
Formed stools are not
routinely processed. If patient
is suspected of C.difficilerelated ileus, please clearly
indicate on requisition or
contact the Microbiology lab
at 766-4481.
Giardia/Cryptosporidium
Collect freshly passed stool
into clean, dry container.
Transfer to container with
SAF preservative. Fill to line
marked on container and mix
well. There should be no
contaminating material. E.g.
urine, tissue paper.
Transport at room
temperature, as soon as
possible. Do not freeze.
Specimens are tested by
enzyme immunoassay (EIA)
for detection of Giardia or
Cryptosporidium antigens.
Positive EIA results are
confirmed with direct
microscopy.
Turnaround time 2 – 7 days
Positive reports are sent to
Public Health.
Antibiotics, mineral oil, bismuth,
kaolin, or barium will interfere
with parasite detection. Delay
specimen collection a minimum
of 7 days after administration of
these substances.
Stool for Giardia/
Cryptosporidium is not
performed on patients who have
been in hospital >3 days.
Consider C.difficile testing in
hospitalized patients with new
onset diarrhea.
Last revised October 2015
TEST ON REQUISITION
SPECIMEN COLLECTION &
TRANSPORT
TESTING PERFORMED
TURNAROUND TIME &
REPORTING
Pinworm (Scotch Tape Test)
Collection kits are available
from Laboratory Stores.
Direct microscopy is
performed routinely
Turnaround time 24 – 72
hours
Direct examination and
microscopy are performed
routinely
Specimens undergo direct
examination for evidence of
pathogenic stool parasites.
Turnaround time 24 – 72
hours
NOTES
Collect specimen from the
skin of the perianal area first
thing in the morning before
the patient has bathed or
used the toilet.
Remove screw cap with
pinworm paddle, press sticky
side to perianal area. Replace
cap with paddle and tighten
cap.
Parasite Identification
Full O&P exam
Transport at room
temperature, as soon as
possible
Transport suspected parasite
to laboratory in leak-proof,
wide mouth container.
Collect freshly passed stool
into clean, dry container.
Transfer to container with
SAF preservative. Fill to line
marked on container and mix
well. There should be no
contaminating material. E.g.
urine, tissue paper.
Transport at room
temperature, as soon as
possible. Do not freeze.
Turnaround time 7 - 14 days
Positive reports may be sent
to Public Health.
Antibiotics, mineral oil,
bismuth, kaolin, or barium
will interfere with parasite
detection. Delay specimen
collection a minimum of 7
days after administration of
these substances.
Indicate on requisition risk
factors warranting Full O&P.
Specimens submitted without
relevant history will be tested
for Giardia/Cryptosporidium
only.
Last revised October 2015
Patient Instructions for Sputum Specimen Collection
A sputum specimen collected first thing in the morning is the best
specimen. At least 5mL (1 teaspoon) of specimen is required.
1.
Label the specimen container with:
i.
The patient’s full name (last and first)
ii.
The date of collection
iii. The patient’s Provincial Health Number
2.
Gargle and rinse your mouth with water. This helps to
eliminate accumulated cells and normal bacteria that may
interfere with your test results.
3.
Inhale deeply several times and exhale with an explosive
cough. This should produce mucus from the lungs. Saliva
(spit) from the mouth is not an acceptable specimen.
4.
Cough specimen into the specimen container.
5.
Replace lid and tighten securely so sample will not leak.
6.
Transport the specimen with the requisition to the laboratory
or collection site as soon as possible. If there is a delay of
more than 2 hours in transporting, the specimen should be
refrigerated.
Notes:
• An early morning specimen, collected before eating,
drinking, or brushing teeth, is the preferred sample.
• The specimen should be collected before starting
antibiotics.
• Saliva (spit) has a clear color. This is not a suitable
specimen and will not be processed by the laboratory.
• Specimen MUST be labeled with a first and last name, and
a Provincial Health Number (HSN). If you do not have an
HSN, please label specimen with patient’s first and last
name, and date of birth.
• Some tests require more than one specimen. If multiple
specimens are requested, they must be collected first thing
in the morning for 3 consecutive days.
LABMicOP7204.A.3 Sputum COLLECTION.doc
Patient Instructions for Stool Specimen Collection
-
Prior to collecting the samples (at least 48 hours), the patient should not take
antacids (Rolaids, Tums), oily laxatives, or antidiarrheal medication (Kaopetate).
Radiology examinations using bismuth, or barium should also be avoided if ova &
parasite testing is requested.
Collect one specimen for each test requested unless otherwise instructed. Collection
of specimens from multiple days is usually not required.
1. Label the specimen container with:
i.
The patient’s full name (last and first)
ii.
The date of collection
iii.
The patient’s Provincial Health Number
2. Wash hands before beginning collection and after collection.
3. Urinate prior to stool collection, to avoid contaminating the specimen.
4. Pass stool directly into a clean, dry, wide mouth container, such as a plastic or
Styrofoam cup or plate, or other plastic container, or plastic bag, or clean
diaper.
5.
Carefully open the specimen container and place on a table or counter. If it
contains a fluid, do not discard it. This fluid is a preservative for the sample.
These fluids are poisonous and must be kept away from children. If more than 1
specimen vial is required, fill only one vial at a time and replace the lid onto the
same vial it came from.
6. Using the spoon attached to the lid of the specimen vial, add spoonfuls of stool
to each vial so that the liquid reaches the “fill line” located on the label of the
vial. If the vial does not have a “fill line”, then only add enough specimen to
half fill the container. If the specimen is runny it may be poured directly into
the specimen vial. It is important to take areas of the specimen which appear
bloody, slimy, or watery. Hard stools are not acceptable for most testing.
7.
Replace the lid and tighten securely so samples will not leak, and mix vial well.
Proceed to the next container if more than 1 vial is requested.
8.
Transport the specimen with the requisition to the laboratory or collection site
as soon as possible. If there is a delay of more than 2 hours in transporting, the
specimens for C&S and C. difficile Toxin testing must be refrigerated. Stools
for O&P should be stored at room temperature.
LABMicOP7200.A.4 Stool Collection
Patient Instructions for Midstream Urine Collection
1.
Label the specimen container with:
i.
The patient’s full name (last and first)
ii.
The date of collection
iii. The patient’s Provincial Health Number
2.
Wash hands with soap and water.
3.
Use the sterile screw-capped container provided to you
for collection. Open the container, and set the lid aside.
Do not to touch the inside or the rim of the container.
4.
Cleanse the entire genital area if you have been
provided with a towellete. Discard towellete in to waste
container. Thorough cleansing is very important in
children, but is not imperative for specimens from
female patients.
5.
Urinate a small amount of urine into the toilet. This
washes away some of the contaminating bacteria that
normally reside on the urethra.
6.
Continue urinating, then midway through move the
container into the stream of urine and fill half to two
thirds full.
7.
Replace lid and tighten securely so sample will not
leak.
8.
Wash hands with soap and water.
9.
If specimen was collected, on site, give to Clinic
personnel. If specimen was collected at home, transport
the specimen with the requisition to the laboratory or
collection site as soon as possible. If there is a delay of
more than 2 hours in transporting, the specimen should
be refrigerated.
LABMicOP7204.A.5 Urine Collection
INSTRUCTIONS FOR PINWORM COLLECTION
A.
Laboratory Instructions
Send patient home with a collection kit in a resealable bag.
Collection kit will contain:
i. A pinworm paddle
ii. An instruction sheet
iii. A requisition
B.
Patient Instructions
1.
Collect specimen in the morning before taking a bath
or going to the bathroom. (6:00am is the best time)
2.
Label the container with:
i.
The patient’s full name (last and first)
ii.
The date of collection
iii. The patient’s Provincial Health
Number
3.
Carefully remove the screw cap with the paddle
4.
The paddle has one side labeled “Sticky Side”
5.
Press the sticky side to the perianal area. The
adhesive material on the sticky side will collect any
pinworm eggs present
6.
Avoid touching the sticky side with your fingers or
hands
7.
Place the pinworm collection container back into the
resealable plastic bag. The collection kit can be stored
at room temperature, and does not need to be placed
in the refrigerator.
8.
Return the requisition and the collection kit to the
laboratory or Physician’s offices as soon as possible.
If further assistance is required, please call the
Microbiology Laboratory at (306)-766-4481.
.
Table 1:
Criteria for Rejection of Microbiology Specimens
Bronchial Washings
Rule
Exception
-
Washings are not processed for C&S, but are
processed for AFB and Fungus
Mini BAL will be processed only for tests
requested
-
C&S is done on washings
from ICU patients, or Dr.
Jones, Dr. Dewar patients.
-
C&S is done on NICU
patients, even if only 1 swab
is received.
ICU patients can have one
sputum specimen for C&S
daily.
Specimen type
Eye
-
Conjunctiva swabs are processed for C&S only
when swabs from both eyes are received.
MRSA Screens
-
Axilla swabs are not processd.
Duplicate specimens for MRSA screening
from the same patient within a 5 day period
should be approved before they are processed.
Sputum C&S
-
Sputum specimens for C&S from the same
patient within a 3 day period are not processed.
-
Stool C&S
-
Stool specimens for C&S from the same
patient within a 5 day period are not processed.
Stool specimens for C&S on patients after 3
days hospitalization are not processed.
- Additional testing may be
required if clinical conditions
indicate, but must be approved by
the Microbiologist.
Stool C. diff Toxin
-
-
More than two stool specimens for C. diff
Toxin from the same patient within a 5 day
period, if the first one is positive, are not
processed.
Formed stool specimens are not processed.
Stool O&P
-
Stool specimens for O&P on patients after 3
days hospitalization are not processed.
-
Additional testing may be
required if clinical conditions
indicate, but must be
approved by the
Microbiologist
Throat Grp A Screen
-
Throat swabs from the same patient within a
24 hour period are not processed.
-
If susceptibility testing is
required culture will be
performed on the repeat
specimen.
Tips
-
All Central Venous Line tips are processed
-
All “other” tips must be
approved before processing.
Urine C&S
-
Duplicate urine specimens on the same patient
in a 3 day period will not be processed.
-
Check previous culture result
before canceling.
VRE Screens
-
Only VRE screens from rectal swabs, or stool
will be processed. * Rectal swabs must be
stool stained to be acceptable.
-
All “other” sites must be
approved by Microbiologist
before processing.
LABMicOP7204.T.1 Criteria for Rejection of Microbiology Specimens
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 2
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Table 1:
Specimen Problem
Criteria for Rejection of Microbiology Specimens
Rule
Exception
-
Saliva, breast milk, 24 hour urine specimens,
foley catheter tips, vomitus, gastric aspirate,
and placenta swabs are all inappropriate
specimens.
(**Placenta tissue collected surgically
is acceptable for culture.)
Swabs of decubitis
ulcers, such as coccyx,
sacral, or ischial rectal.
-
Specimens from these sites are of limited value
as they are colonized by organisms which will
grow on culture but may not be the infecting
agent.
-
Multiple Specimens
-
Multiple specimens from the same patient and
the same source collected on the same day will
not be processed. (eg. Urine, stool, sputum)
-
Inappropriate
specimens
-
-
LABMicOP7204.T.1 Criteria for Rejection of Microbiology Specimens
Laboratory Services Regina Qu'Appelle Health Region
Swabs of rectal abscesses are
acceptable for culture.
A biopsy is the preferred
specimen.
Exceptions: AFB requests, blood
cultures, and specimens collected
by invasive procedures.
If multiple specimens from
similar sources (swabs) are
received, consult
Microbiologist.
Page 2 of 2
Last printed 6/17/2013 2:58 PM
Subject/Title: LABMicOP7021 Collection of Blood Cultures
Last Approved Time: 7/4/2012 7:35:06 AM
Revision: 4.1
Approving Authority:Medical Microbiologist
Contact for Interpretation: Microbiology
Phone: (306) 766-4481
Current Version on Print Date
Purpose
This procedure provides instruction for collecting blood culture specimens. Blood
cultures are critical in the diagnosis of bacteraemias and fungaemias, which are life
threatening conditions. Strict adherence to the accepted methods for collection of blood
cultures ie. timing, volumes, and numbers, are essential in the detection of pathogenic
organisms. Failure to recognize bacteraemia and fungaemia leads to delay or lack of
treatment. Also of importance is the use of aseptic technique in blood culture collection.
Failure to do so can result in a contaminated specimen, ie. false positive culture, resulting
in the inappropriate use of antibiotics.
Collection and Timing
1.
Collect blood aseptically by venipuncture.
2.
The number of blood culture bottles taken during a single venipuncture defines a
“set” of blood cultures.
3.
Optimal collection of blood cultures is as follows:
Bottles / Set
Volume / Number Timing
Bottle
of sets
1 aerobic +
8 – 10 mL
2
Adult
1 anaerobic
8 – 10 mL
(>12 yrs)
Child
Simultaneous
1 pediatric +
1 – 3 mL
2
(6 – 12 yrs)
Or 20 to 30
1 anaerobic
8 – 10 mL
minutes apart
(1 – 6 yrs)
1 pediatric
1 – 3 mL
2
1 pediatric
1 – 3 mL
1
Neonate – 1
**
yr.
**For infants and young children the volume drawn must not exceed 1% of the patient’s
total blood volume.
Reagents
Blood Culture vials
Supplies
BD Push Button Blood Collection Set,
alcohol swabs, cotton balls, Band-Aid, tourniquet,
vacutainer holder
Special Safety Precautions
Universal body substance precautions.
Refer to the Safety Manual for general safety requirements.
LABMicOP7021 Collection of Blood Cultures
Laboratory Services Regina QuAppelle Health Region
Page 1 of 3
Laboratory Services Regina Qu'Appelle Health Region
@BCL@C00BA06F.doc
Procedure
STEP
ACTION
Place required equipment within easy reach
1
Mark 8 to 10mL level on the aerobic and anaerobic vials. Mark the 1 to 3mL
2
level on the pediatric vial.
Remove flip caps from blood culture vials and clean vial tops with alcohol swab;
3
do not use iodine or disinfectants to swab rubber caps on vials.
Select vein and prepare arm using a double application of 70% alcohol starting at
4
the centre of the site and swabbing concentrically for 1 minute.
Allow the venipuncture site to dry. Do not touch the venipuncture site after
5
preparation or prior to phlebotomy. Screw a vacutainer holder onto the needle
farthest from the butterfly.
Remove sleeve from needle closest to butterfly.
6
Perform venipuncture
7
Tape tube to arm just below the butterfly
8
Insert multi sample needle into blood culture bottle. The multi sample needle
9
must be held in place in the vial.
Remove the needle from the aerobic vial and insert the needle into the anaerobic
10
vial. Remember to hold the needle in place.
Fill vial to the level you previously marked on the vial.
11
Proceed to collect required vacutainer tubes following the regular venipuncture
12
procedure.
Release tourniquet and remove needle from vial.
13
Cover puncture site with gauze/cotton, then activate the safety device.
14
Remove needle from arm and apply pressure to cotton swab on venipuncture site.
15
Place butterfly needle unit into needle disposal container by placing sharp edge of
16
both needles together and insert sharp edges first.
Time, date and initial requisition
17
Locate bar code on side of bottle. DO NOT mark it or cover it in any way.
18
Write the patient’s name on the bottle.
19
Blood cultures should not be refrigerated, but delivered to the Microbiology
20
laboratory immediately. If collected at Pasqua, leave bottles at room temperature
until they can be transported to RGH.
Procedure Notes
1.
A solitary blood culture is not acceptable except in neonates. Blood cultures from
two separate venipunctures are required. If a blood culture is required and only one
requisition is supplied, request a second requisition for the second collection. Two
sets of cultures increase the chances of detecting bacteraemias, and aids in the
differentiating contamination from true episodes of bacteraemia.
2.
Drawing blood through indwelling intravenous or intra-arterial catheters should be
avoided as they are associated with higher rates of contamination. If blood is drawn
via an indwelling catheter it must be accompanied by a culture drawn from a
peripheral venipuncture.
Page 2 of 3
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@BCL@C00BA06F.doc
3.
4.
5.
6.
7.
The volume of blood is critical because the concentration of organisms in the
majority of bacteremias is low, especially if the patient is on antimicrobial therapy.
Culture of larger volumes of blood increases the recovery of pathogens and also
decreases the time to detection.
Three blood cultures are the maximum number required to diagnose an episode of
septicemia. If bacterial endocarditis is suspected, 3 to 5 cultures may be collected
over a 48 hour period. Collect 3 cultures initially, and if these are negative at 24
hours, a further 2 may be collected. When orders for more blood cultures are
received, contact the Microbiologist.
The recommended blood to broth ratio is 1:5 to 1:10. Dilutions beyond 1:10 occur
by necessity in blood cultures of infants and small children.
Extended incubation of blood cultures from patients with suspected SBE is not
required.
Caution must be taken if you are using the BacT/Alert Blood Collection
Adapter Caps in combination with a third-party blood collection set. Some
blood collection sets have incompatible threads and the blood collection, even
when the needle is screwed all the way down, the threads do not firmly
connect, and the luer needle could back out of the adapter cap during use. To
reduce the chance of this happening, maintain control of the luer connector by
securing it between the thumb and forefinger during the venipuncture.
References
1) Isenberg, HD., Clinical Microbiology Procedure Handbook, ASM Press, 2004
2) Baron, EJ. et al, Blood Cultures IV, Cumitech, 1C, 2000.
3) Clinical and Laboratory Standards Institute (CLSI) M47-P. Principles and
Procedures for Blood Cultures ; Proposed Guidelines.
Revision History
Found in Softtech Health Lab QMS™ Document Management System
Author
Carol Barth, MLT.
Page 3 of 3
Last printed 7/4/2012
Subject/Title: LABTranOP7001.6.1 Transfusions Laboratory Service
Manual
Last Approved Time: 1/31/2013 1:45:06 PM
Revision: 6.1
Approving Authority : Medical Hematopathologist
Contact for Interpretation: Transfusion Supervisor Phone: (306) 766-4474
Current Version on Print Date
TRANSFUSIONS
I
LEGAL RESPONSIBILITY
A.
Physician/ Authorized Practitioner:
The ordering physician is responsible for using clinical judgement to
determine that the benefits to be obtained from transfusion outweigh the
risks. They are also responsible to obtain informed consent for the
transfusion and to ensure that the necessary clinical information is
available to the laboratory.
B.
Medical and/or Nursing Staff or Perfusionist:
The Medical and/or Nursing Staff or Perfusionist are responsible for
ensuring that blood administered to the patient is the blood crossmatched
for the patient, as identified by its labelling and it is administered in a safe
manner.
C.
Laboratory:
The laboratory is responsible for maintaining adequate blood product
within the limits of the national supply, maintaining satisfactory blood
storage conditions and using safe testing techniques.
II
SUPPLY OF BLOOD
Every effort will be made to supply blood at the time requested. If sufficient
advance notice is given, inability to fill an order will be unusual.
III
ORDERING BLOOD TRANSFUSIONS
A.
Blood Specimens:
The sample required for an ABO Group, Rh type and cross match
(compatibility testing) is 2 x 3mL two mauve top Vacutainer tubes.
Ensure that the patient armband is legible and affixed to the patient.
(Phlebotomy staff and technologists are instructed that a specimen must
not be taken unless these conditions are met.) In the case of unconscious
LABTranOP7001.6.1 Transfusions Laboratory Service Manual
Laboratory Services Regina QuAppelle Health Region
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patients who have not yet been identified, an unidentified number is
assigned; it is vital that the armband bearing this identification is not
removed prematurely. Patients who are leaving the hospital and returning
for transfusion (i.e. pre-surgical, outpatients and patient transfers) must be
identified by a red armband attached at the time of collection. This
armband must be affixed to the patient when they return for transfusion.
Confirm the patient's identity by checking
- first and last name
- medical record number and
- date of birth
on the wristband against the requisition before taking the specimen. Label
the specimen tubes with the patient's first and last name, hospital
identification number, red armband number, date of birth and the date of
collection.
Technologists are instructed to reject specimens that are inadequately
labelled or unsatisfactory in quality or amount.
Specimens are stored for 35 days and may be used up to 14 days for
crossmatch providing the patient has not been pregnant or transfused in
the last three months. Specimens from patients who have been pregnant
or transfused within the last three months samples may be used up to 96
hours. Neonatal specimens may be used for up to 4 months from the date
of birth, regardless of previous transfusions.
If more than 96 hours have elapsed since a transfusion, a new specimen
must be sent for further crossmatching in case new clinically significant
allo-antibodies have developed.
B.
Blood Transfusion Requisition:
The information requested on the form is essential in aiding the laboratory
staff. The following must be given:
1)
The name and date of birth of the patient
2)
Medical Record Number
3)
Patient location
4)
Date of order
5)
Blood Product type and amount required
6)
Diagnosis
7)
Date of surgery or transfusion if applicable
8)
History of previous transfusions, blood group, antibodies and
pregnancy
9)
Ordering physician
Technologists are instructed not to accept incomplete or illegible requisitions.
C.
Blood Products Transferred with Out of Town Patients:
All transported blood products that arrive in the hospital must be left in the
sealed container, and delivered immediately to the Transfusions
Department. Breaking the seal will result in wastage of transported
products.
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IV
ISSUE OF BLOOD
When the testing has been completed a computer-generated report is printed on
the Unit. The report contains the patient's ABO and Rh type and results of the
antibody screen. Affix this form to the patient's chart.
When the blood is required, present a slip of paper indicating the patient's first
and last name, hospital identification number, date of birth and the type of blood
product required to the Transfusion technologist. If the patient’s has a red
armband, the unique identification number is required. In order to maintain the
integrity of the blood product, only one unit of blood will be issued at a time
except in circumstances where the product will be infused quickly.
A two part pink tag is attached to the donor unit containing the patient name,
donor unit number, patient and donor blood group and compatibility status. The
technologist performs a verbal check with the portering personnel for transport to
the ward. The porter name is recorded and the person receiving the product and
the technologist sign the crossmatch tag.
V
PATIENT NOTIFICATION
All patients who receive human blood products are given a “Notification of the
Administration of Blood and Blood Products” form. This form is given with the
first product transfused in each patient stay. Upon discharge the nurse must
review this information with the patient and have the patient sign the form.
VI
BLOOD INFUSION
All transfused patients must have provided informed consent prior to transfusion.
The patient shall be informed with a description of the blood component, the
associated and benefits, including life-threatening risks and alternatives to
transfusion. This consent shall be documented on the patient Health Record chart.
1. Check the information on the pink crossmatch tags, and Blood Bank Report.
Check that the patient's name, medical record number, date of birth and ABO
Group and Rh. Check that the donor ABO Group, Rh and unit number on the
pink tag is the same as on the label of the blood pack. Sign with date and time
the white and pink tags to indicate that the information has been verified.
Remove the pink copy of the crossmatch tag and attach to the chart. NOTE:
Do not remove the white tag from the unit until the infusion is complete.
NOTE: It is not necessary to verify the unit numbers against the
Blood Bank Report.
2. Check the identity of the patient carefully by comparing the wristband with
the white tag of the blood pack. Check the patient's first name, last name,
medical record number and date of birth. This must be done in full. Failure to
do this is the major cause of transfusion accidents.
3. Check the patient vital signs as per the nursing protocol
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4. Transfusions must be started within 30 minutes of product issue. Return units
to Transfusions if unable to hang immediately. Do not put blood in nursing
unit refrigerator.
5. Infusion rate is as prescribed by physician / authorized practitioner.
6. Infusion must be completed within 4 hours of blood issue.
7. Infuse blood slowly during the first 15 minutes as the signs of a severe
transfusion reactions often appear early in the transfusion.
8.
Blood must be warmed using approved blood warming apparatus only.
Serious hemolysis may occur with over-warming.
9. Do not add any medication to the blood product.
10. For additional information on the administration of blood and blood products,
see the Circulars of Information found in on the Intranet.
11. Return all empty blood bags (used, unused, partially used) to the laboratory
the same day. Package each empty pack individually in a plastic bag with the
tag outside of the bag and secure with tape or a twist tie. DO NOT leave
needles attached. If there is blood left in bag, please close off the port before
placing in plastic bag to prevent leakage while being transported to the lab.
12. Certain wards do not return the blood pack to the lab unless there is a
transfusion reaction. Remove the white tag at the completion of the
transfusion and return to the lab. All empty bags must be kept on the ward for
4 hours post transfusion prior to discard.
VII
CANCELING BLOOD
To assist the Laboratory in making the most efficient use of the donor blood
inventory, notify the Laboratory immediately when blood is no longer required
for a patient.
VIII
SHORTAGES OF BLOOD
Due to variation in supply and demand, shortages of blood occur from time to
time. One consequence of this may be an acute shortage of a particular group
(most commonly O Rh Negative). It may be necessary on occasion to issue blood
of a different group than the patient. This will be done based on established
protocols, or in consultation with the Transfusion Medicine Physician.
IX
EMERGENT AND ROUTINE TRANSFUSIONS
A.
EMERGENT Transfusions:
An emergent request for transfusion should be made when blood is
required to preserve life.
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In such situations, uncrossmatched O Negative blood, or uncrossmatched
blood of the patient's group, may be issued on the responsibility of the
ordering physician. Group-specific blood takes a short time
(approximately 10 minutes) to obtain and is preferred to O Negative blood
(due to limited supply).
“STAT” crossmatch requests will be processed as soon as possible.
Note: Refer to the General Lab section for a complete list of turnaround
times
B.
ROUTINE Transfusions:
Requests for blood should, whenever possible, be made before 1400 hours
on the day before the blood is needed. Elective transfusions should not be
requested on evenings or nights to ensure adequate ward staff is available
to properly observe the patient and manage any adverse reactions.
X
CONFIRMATORY BLOOD GROUP
A second blood group test will be requested and collected on all non-emergent
patients who do not have a historical blood group on file.
The confirmatory blood group protocol was implemented as a risk reduction
system. Patient misidentification occurs at sample collection in approximately
one out of every 1,000 samples.
XI
CROSSMATCHES FOR SURGERY
Patients who are likely to need transfusion during surgery should have their blood
group determined and screened for antibodies prior to surgery.
XII
CORD BLOOD
All newly delivered infants have a specimen of umbilical cord blood taken as
soon after delivery as possible from the placental end of the cut cord. Draw the
specimen into 1 x 7 mL red top tube (clotted blood) and 1 x 3 mL mauve top tube
(EDTA anticoagulant). Label the tubes clearly with the infant's surname and
medical record number. If infant and mother’s surnames are different, label tubes
with both names. Send the sample with a properly completed maternal requisition
to the Transfusion Laboratory. Laboratory testing will be performed if required.
If the baby has a positive Direct Antiglobulin Test, additional testing will be
performed as indicated.
XIII
EXCHANGE TRANSFUSION
Exchange transfusion is used as a treatment for severe hyperbilirubinemia
secondary to hemolytic disease of the newborn. Removing the infant's plasma
both reduces the load of bilirubin and the amount of unbound antibody.
Antibody-coated cells, whose destruction would further raise the bilirubin load,
are removed and replaced with red cells compatible with the maternal antibody.
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Specialized blood products are required for neonatal transfusions.
XIV
NEONATAL TRANSFUSION
The Transfusion Laboratory aliquots a unit of packed cells for small volume
transfusions. This unit will be used until outdate for the assigned baby.
XV AUTOLOGOUS AND DIRECTED DONATIONS
Canadian Blood Services will collect units of blood for a patient’s own use if
requested by the attending physician. These units are specially labeled and can
only be used for the donor. The patient will bring a portion of the autologous
label and a letter for the ward explaining that autologous units are available along
with a letter explaining the process to the ward on admission. Place the green tags
on the Health Records chart along with the letter. The patient’s own blood must
be used prior to any other units.
Canadian Blood Service also operates a directed donation program for parents
donating to children under the age of 17. Please contact the Transfusions Lab for
information on this program.
XVI
BLOOD REQUIRED FOR LABORATORY TESTS
Test requested
Group and Rh Only
(including confirmatory blood group)
Specimen required
1 x 4 mL mauve
Antibody Screen
Cross match
Group and Reserve Serum
2 x 4 mL mauve
Direct Antiglobulin Test
1 x 4 mL mauve
Cold Agglutinin testing
2 x 6 mL red top
1 x 4mL mauve top
(must be maintained at 37°C)
1 x 6mL red
1 x 4mL mauve
Cord Blood Testing
Vacutainer Key
RED
MAUVE
No anticoagulant for clotted blood. Do not use the serum separator
tubes (SST)
EDTA Anticoagulant
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XVII ADVERSE EFFECTS OF TRANSFUSION
Notify the Physician and report all adverse reactions to the laboratory
immediately. Return the unit of blood to the Transfusion department as soon as
possible accompanied by the tag. The back of the tag should be completed with
all pertinent information.
1.
Febrile Non-Hemolytic Reaction
A febrile reaction is suspected if the patient has one of more of the following; a
fever (>38°C and a change of ≥ 1°C from pretransfusion value), chills, sensation
of cold or rigors. These signs and symptoms may be observed during the
transfusion or within 4-6 hours of its completion without any other apparent
cause.
A fever can have many causes unrelated to blood transfusion; therefore, a blood
transfusion is not necessarily discontinued if a fever develops. Most febrile
transfusion reactions are mild and may be treated or prevented by the
administration of antipyretics such as acetaminophen prior to the transfusion.
Severe febrile symptoms may indicate a more serious reaction, such as acute
hemolytic reaction or bacterial contamination.
2.
Allergic Reactions - Minor
Symptoms include transient urticarial or other skin rash with pruritus associated
with the transfusion. This may be associated with fever.
The cause of urticaria is thought to be a reaction to a soluble antigen in the donor
plasma. Mild urticaria is usually harmless and should be treated with
antihistamines. It is not necessary to discontinue the transfusion as long as
serious symptoms (below) are not present.
3.
Allergic Reactions – Severe/Anaphylactic
Signs and symptoms of a severe allergic reaction can include rash greater than 2/3
BSA, respiratory symptoms (tightness in throat, cough, hoarseness, dyspnea,
wheeze, hypoxemia) and unstable vital signs (hypotension, tachycardia). The
reaction may progress to respiratory failure and circulatory collapse.
Anaphylactic reactions occur in individuals who are IgA deficient and who have
developed antibodies to IgA. These antibodies react with IgA in transfused
plasma. It should be noted that it is possible for reactions to occur even during
the first transfusion.
Stop the transfusion immediately, keep the I.V. open with normal saline to allow
for the administration of medications as ordered by the physician.
4.
Hemolytic Transfusion Reactions
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Signs and symptoms include fever, chills, nausea, hypotension, chest or back
pain, shock, generalized bleeding, hemoglobinuria, oliguria or anuria within 24
hours of the receipt of the transfusion.
Hemolytic transfusion reactions are caused by the intravascular destruction of red
blood cells. This usually follows the transfusion of ABO incompatible blood
given to a patient that has been improperly identified. Hemolytic reactions may
also occur following the transfusion of blood that has outdated, is bacterially
contaminated or that has been damaged by freezing or heating.
Action to take if an Acute Hemolytic Transfusion Reaction is suspected:
a)
b)
c)
d)
e)
f)
g)
h)
i)
Stop transfusion and maintain the IV line with normal saline.
Check patient’s vital signs and commence oxygen if required.
Notify physician and the laboratory immediately and request an
investigation.
Check patient identification against blood and sign on the back of the pink
tag to confirm that the clerical check was done.
Note the nature and severity of the reaction on the back of the pink tag.
Send the remaining donor blood to the laboratory for investigation.
Collect the first urine passed following the reaction. Send to the
laboratory for a routine urinalysis and free hemoglobin.
Monitor the urine output.
Have a post reaction serum bilirubin done.
Treatment of a hemolytic reaction is determined by the specific symptoms. Treat
hypotension with fluid replacement. Induce and maintain urinary flow by fluid
replacement and diuretics. Dialysis may be required. If the patient has symptoms
of a hemostatic disorder laboratory tests will determine if platelets or specific
coagulation factors should be given.
5.
Delayed Hemolytic Transfusion Reaction
Delayed Hemolytic Transfusion reactions may occur 3 days to 2 weeks after
transfusion. The patient typically presents with hemolytic anemia (low
haemoglobin, high bilirubin, reticulocytosis, spherocytosis, high LDH), a positive
antibody screen, and a positive direct antiglobulin test (i.e., DAT, Coombs’ test).
Most are benign, but life-threatening hemolysis with severe anemia and renal
failure may occur. Notify physician and Transfusion Laboratory immediately.
6.
Bacterial Contamination- Acute reaction
Despite the observance of aseptic technique during collection and processing, the
possibility of bacterial contamination (usually by normal skin flora) still exists.
This contamination does not usually cause clinical problems because the products
are stored at temperatures that inhibit bacterial growth. However, when the
storage or administration of a blood product does not meet accepted standards,
proliferation of bacteria may occur and cause serious harm to the patient.
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Symptoms of a reaction include high fever, hypotension, shock, hemoglobinuria,
DIC and renal failure. Stop the transfusion immediately and notify the
Transfusion Laboratory. Send the product to the laboratory for Gram stain and
culture. Blood cultures on the patient are also recommended to help establish that
the blood product was the cause of any infection.
Treatment includes supportive care, including appropriate antibiotics.
7.
Disease Transmission – Delayed reaction
Infectious diseases may be transmitted in spite of careful selection of donors and
testing of blood. Donor selection criteria are designed to screen out individuals
who are at high risk for viral infections, including HIV, hepatitis B and C, and
HTLV. Testing is also performed on all units prior to release. For a complete
listing of tests, see the Canadian Blood Services Circular of Information.
9.
Circulatory Overload
Pulmonary edema may develop rapidly in a patient who has received too much or
too rapid an intravenous infusion, particularly in patients with renal failure, heart
failure or severe chronic anemia. The symptoms include dyspnea, cyanosis,
orthopnea, severe headache, hypertension or congestive heart failure during or
soon after the receipt of a transfusion
Be circumspect in transfusing such patients. It is wise to limit the patient to no
more than 2 units of packed cells per 24 hours, watching carefully for signs of
heart failure.
If circulatory overload occurs, treat with elevation of head of the bed, diuretics,
etc.
12.
Transfusion Associated Graft Versus Host Disease (TA-GVHD)
Blood products are routinely irradiated to prevent GVHD for high risk
populations. TA-GVHD is extremely rare and most commonly occurs in
immunocompromised recipients who do not receive irradiated blood products.
Symptoms of TA-GVHD include fever, skin rash (which often starts on the
palms, the soles of the feet and the ear lobes), elevated liver enzymes (ALT and
AST, Alkaline phosphatase) and bilirubin, pancytopenia and diarrhea. The
reaction is very severe and results in death in over 90% of the cases.
13.
Transfusion Related Acute Lung Injury
TRALI is suspected if the recipient experiences acute pulmonary edema in the
absence of cardiac failure within 6 hours of the receipt of a transfusion.
Symptoms include dyspnea, cyanosis, chills, fever and hypotension.
Page 9 of 10
Last printed 1/31/2013 1:45 PM
14.
Other Complications
Other rare adverse events such as iron overload, Post Transfusion Purpura,
hypotensive reactions and Aseptic Meningitis have been associated with
transfusion. The Transfusion Medicine Physician on call should be contacted if
any of these are suspected.
XVIII PRODUCT INFORMATION
Information on blood and blood products can be found in Appendix A of this
procedure, the Canadian Blood Services Circular of Information (a copy is found
with this manual) and package inserts from the fractionated blood products. The
Clinical Guide to Transfusion supplied by Canadian Blood Services and the
Bloody Easy book sponsored by Ontario are both excellent, informative books
available for information on transfusion medicine. Additional information can be
obtained from the technologists in the Transfusions Department, or the
Transfusion Medicine physician on call.
References
1. American Association of Blood Banks, Technical Manual, 16th ed., 2008
2. Canadian Society for Transfusion Medicine Standards for Hospital
Transfusion Services Version 3- February 2011
3. Canadian Blood Services Circular of Information
4. Public Health Agency of Canada Adverse Event Definitions User’s Manual
Version 3.0 November 2007
5. Clinical Guide to Transfusion, fourth edition, CBS, July 2006.
Related Documents
1.
2.
3.
4.
Appendix A – Blood Product Insert – LABTranOP7001W1.1
Turn Around Time – LABTranOP7001W2.1
Transfusions Critical Values – LABTranOP7001W3.1
Laboratory Service Manual – General Information
Revision History
Refer to Document Control Log
Author: Renee Masters-Guest MLT
Judy Hoff ART, MLT
Paula Van Vliet ART, MLT
Page 10 of 10
Last printed 1/31/2013 1:45 PM
Subject/Title: LABTranOP7011 Use of the Typenex Red Arm Band
System
Last Approved Time: 6/27/2012 8:39:23 AM
Revision: 2.2
Approving Authority : Medical Hematopathologist
Contact for Interpretation: Transfusion Supervisor Phone: (306) 766-4474
Current Version on Print Date
Purpose
This procedure provides instruction for use of Typenex stickers on red armbands and
RQHR bar-coded armbands for continuity of patient identification.
Sample Information
Typenex armbands ensure the continuity of identification for patients who require blood
group and antibody screen and are not staying in the hospital such as surgical assessment
patients, outpatient transfusions or patients being transferred to another facility for
diagnostic procedures.
RQHR bar-coded arm bands are given to patients on hospital admission through
Emergency, Day Surgery or direct ward admission.
Cardiac surgery or angioplasty patients must have 2 armbands, one applied to each arm.
The Transfusion requisition may be marked as either one of the following: OHS, CAD,
CABG, AVR, MVR, Heart surgery, Angio, Bentalls procedure or PTCA.
Supplies





Completed Transfusion Requisition with the following information:
o First and last name
o Date of birth
o MRN or HSN
o Patient location
o Order date
o Product required
o Diagnosis
o Transfusion and/or pregnancy history
o Surgery or transfusion date
o Ordering physician
Red number sheets with barcode
Typenex arm bands, cardboard inserts/or
RQHR bar-coded patient arm bands
2 mauve EDTA tubes
LABTranOP7011 Use of the Typenex Red Arm Band System
Laboratory Services Regina QuAppelle Health Region
Page 1 of 4
Last printed 6/27/2012 8:39 AM
Special Safety Precautions
Refer to the Safety Manual for general safety requirements.
Note
Two arm band processes are used within the RQHR for patient identification dependant
on patient location, the Typenex red arm band and the RQHR bar-coded arm band.
Procedure for Red Typenex arm bands
STEP
1.
2.
3.
4.
5.
6.
7.
9.
10.
11.
ACTION
If the patient is wearing an armband with a red number, STOP and
phone Transfusions to verify the need for a crossmatch or directions on
how to proceed.
On the cardboard insert, write legibly or attach a label prepared by LIS,
which contains the following information:
 First and last name
 date of birth
 MRN or HSN if available
Insert the cardboard into the red plastic armband. Seal the open end of
the card slot.
Remove the long sticker from the right side of the red number sheet and
wrap it around that end of the Typenex arm band covering the card slot.
Securely fasten the red armband to the patient’s arm. In the case of
cardiac surgery / angioplasty patients please fasten the red armband to
both arms. See Sample Information for a list of diagnosis.
Perform collection as per LABPhlbOP7017 Protocol for Performing a
Venipuncture
Attach one red sticker to:
 Each properly labeled blood sample making sure not to cover the
patient identification or the barcode.
 Transfusion requisition
Explain to the patient the importance of leaving the band on. If it is
removed for any reason:
 The sample will have to be redrawn
 The surgery or procedure may be delayed
Attach the additional stickers to the requisition.
When accessioning the sample in the LIS ensure that the Typenex (red)
number is entered.
Procedure for RQHR bar-coded arm bands
1.
If the patient is wearing a armband with a red number, STOP and phone
Transfusions to verify the need for a cross match or directions on how
to proceed
Page 2 of 4
Last printed 6/27/2012 8:39 AM
2.
The RQHR barcoded band is printed with patient’s admitting
information and barcodes on the waterproof arm band.
Remove the long sticker from the right side of the red number sheet and
wrap it around the right side of the arm band away from the barcodes,
making sure the red number is on the same side as patient’s information.
Securely fasten the RQHR armband to the patient’s arm. In the case of
cardiac surgery / angioplasty patients please fasten an armband to both
arms, a red armband can be used for the second band. See Sample
Information for a list of diagnosis.
Perform collection as per LABPhlbOP7017 Protocol for Performing a
Venipuncture.
Attach one red sticker to:
 Each properly labeled blood sample making sure not to cover the
patient identification or the barcode.
 Transfusion requisition
Explain to the patient the importance of leaving the band on. If it is
removed for any reason:
 The sample will have to be redrawn
 The surgery or procedure may be delayed
3.
4.
5.
6.
7.
8.
9.
Attach the additional stickers to the requisition.
When accessioning the sample in the LIS ensure that the Typenex (red)
number is entered.
NOTE
Once the patient has been admitted they can be identified using regular hospital armband
procedure.
The Typenex red number is unique and the same number cannot be used twice. If an
error occurs, attach another armband and discard the other numbers.
ISSUING BLOOD PRODUCTS USING TYPENEX SYSTEM
The following information must be supplied by the ward prior to issue of blood products:
A) patient’s name (last and first)
B) date of birth
C) Typenex red identification number (i.e. RHK7732)
NOTE
-
If the Typenex number is not supplied, the blood product CANNOT be issued.
Typenex system is not required for re-crossmatch once the patient has been admitted.
Page 3 of 4
Last printed 6/27/2012 8:39 AM
References
1. CSTM Standards for Hospital Transfusion Services Version 3 February 2011
#5.2.2.2
2. CSA Z902.10 Blood and Blood Components #10.2.4
Related documents
LABTranOP7011J1 Typenex Label Position
LABPhlbOP7017 Protocol for Performing a Venipuncture
Revision History
Found in SoftTech Health Lab QMS™ Document Management System
Author
Paula Van Vliet MLT, ART
Judy Hoff MLT, ART
Page 4 of 4
Last printed 6/27/2012 8:39 AM
APPENDIX
LABTranOP7001W4 Canadian Blood Services Circular of Information
The Circular of Information provided by Canadian Blood Services provides information
about blood products such as component composition, packaging, storage and handling,
indications, warnings and precautions, adverse events, dose and administration etc.
The table below provides a list of the contents of the Circular of Information.
February 2011 Edition (English Versions)
Red blood cells LR SAGM added
PDF
Pooled platelets LR CPD, apheresis platelets
PDF
June 2011 Edition (English Versions)
Plasma components (FFPA, FP CPD, Cryosupernatant CPD,
Cryoprecipitate CPD)
PDF
Visit the Canadian Blood Services website for the current
version of this document by using the following link:
http://www.bloodservices.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/page/
E_COI
LABTranOP7001W4.1.1 CBS Circular of Information
Laboratory Services Regina Qu'Appelle Health Region
Page 1 of 1
Last printed 8/1/2012
This compendium is the responsibility of Regulatory Affairs, Lab Services. All revisions to this document must go through Regulatory Affairs.
Note: Occasionally specimen collection (type of specimen, type of container required, etc.) and specimen transport instructions may change following the print date of
this handbook. Therefore, it is recommended that the use of the LIS “Ctrl-T” key function be performed in Order Entry, prior to specimen collection.
** For serological evidence, two blood specimens are desirable whenever possible. The first should be collected
within 5 days of onset, the second collected 5 -10 days later. Separate the serum from the clot and send only cell-free serum to avoid the danger of hemolysis of the
clot. It is essential that the clinical history accompany the specimens for serological investigations in order to select the appropriate viral antigens for testing.
Microbiology tests (complete Micro testing available in Lab Services Manual).
Tests referred to Saskatchewan Disease Control Laboratory (SDCL) previously Provincial Laboratories (*) must be recorded on the appropriate SDCL Requisition.
Effective date: June 12, 2015
Test Name
Highlighted information denotes changes for this version
Specimen Container Volume
Specimen Requirements Reference Range
**5 Disease
Blood
See Parvovirus B19.
*ACE
Blood
*ACE
CSF
th
1 Red
2 mL
serum
0.5 mL
Aliquot + freeze ASAP.
Freeze
Acetaminophen
Blood
(Tylenol)
N.B. Treatment
chart
should be consulted
before beginning
therapy.
1 SST or
1 Green
1 mL
serum or
plasma
*Acetazolamide
Blood
2 Red
*Acetone
(Quantitative)
Blood
1 Grey
3 mL
Aliquot
serum
3 mL whole Do not use alcohol swab.
blood
Do not open tube. Record
time of collection on tube
and requisition.
Acetone
(Qualitative)
Blood
1 SST or
1 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL
serum or
plasma
Units
Peak Concentration: 66-199
Toxic Levels:
Hours after ingestion:
4 hr: 1325
16 hr: 150
8 hr: 600
20 hr. 75
12 hr: 300
Hepatic damage may occur if >790
at 4 hr
Do not use alcohol swab.
Do not open tube.
μmol/L
Normal: negative <0.34
mmol/L
Occupational exposure: <0.34-1.72
Ketoacidosis: 1.72-12.04
Panic value: >8
Toxic: >3.40
Negative
Testing Site
LIS Code
SDCL - Hamilton
TAT: 3 weeks
SDCL - Hamilton
ACE
Chem - RGH & PH
ACECF
ACET
SDCL - Mayo
AZOLA
SDCL
Routine = 24 hr
Emergency = 2 hr
ACETO
Chem - RGH & PH
KETON
2
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Acetylcholine
Receptor Antibodies
Blood
Units
Testing Site
LIS Code
1 SST
1 mL
serum
Frozen
Aliquot and freeze serum.
Ship frozen.
SDCL - Hamilton
ABACR
*Acetylcholinesterase Blood
Pre-arrange with
SDCL
4 Mauve
3 mL EDTA
whole
blood & 3
mL plasma
Stable for only 48 hr.
Store and send COLD.
Send Hematocrit result
with specimen.
SDCL - Toronto
ACHOL
Acid Elution
(Kleihauer)
Blood
1 Mauve
Acid Glycerol
Lysis Test
Blood
*Acid Phosphatase
*ACTH
Blood
Note: Patient does
not need to be fasting
*ACTH Stimulation
Test
(Cortrosyn) (Rapid
Screen)
Activated Protein C
(APC)
*Acyclovir
Blood
Can use
same tube
as CBC
1 Mauve or 0.5 mL
Green
whole
blood
1 Mauve
(chilled)
2 mL
plasma
1-SST at 3 1 mL
separate
serum for
times
each
collection
Hematology - RGH KLEIH
Refrigerate ASAP after
Sperocytosis = <150 seconds. At
collection.
least 60% lysis
Collect Monday-Friday
occurs before scan
only.
is leveled.
Keep cool and send to
Normal = >150 seconds. Scan
Special Chem within 12
should level off before
hours.
60% lysis occurs.
Not available
Collect on ice between
0-11
0800 and 1000. Collect at
any time for
endocrinologists
Mohammed and Mann.
Return to lab immediately.
Spin and separate within
15 minutes. Freeze and
send frozen. Submit as
separate sample.
Collect cortisol before
injection and at 30 and 60
minutes after injection.
pmol/L
Special Chem RGH
AGLT
SDCL
TAT – 7 days
ACTH
SDCL
TAT = 3 days
Order
Timed
Cortisols
SDCL - California
ACYCL
See Hypercoag
Blood
1 SST
2 mL
serum
Acylcarnitine (for
Blood
PKU Card
NICU)
*ADH
Blood
2 Mauve or 3 mL
Anti-Diuretic
2 Green
plasma
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Aliquot and freeze
Collect in pre-chilled tubes,
on ice. Aliquot and freeze
SDCL – Toronto
TAT = 4 weeks
Print Date: June 12, 2015
ADH
3
Test Name
Hormone
(Vasopressin)
Water Deprivation
Test
To measure basal
level, collect after 12
hr fast with patient in
Recumbent position
for 1 hr prior to
collection.
*Adenosine
Deaminase
*Adenovirus
*Adrenal Antibodies
Adrenal tissue Ab
Specimen Container Volume
(chilled
tubes)
Blood or
CSF or
Fluid
1 SST
Nasopharyngeal
Aspirate,
Washes
Throat
Blood
1 SST
Units
Testing Site
LIS Code
SDCL - Mayo
ADEAM
immediately. Must be
frozen within 24 hr.
Cannot be refrozen.
Aliquot plasma equally into
2 pre-chilled plastic vials.
1 mL
serum or
CSF or
fluid
(min. 0.5
ml)
Aliquot. Must Be Frozen.
Specimen must be
received with 7 days of
collection.
See Respiratory Virus
Isolation or Detection.
1 mL
serum
frozen
*Adrenalin
AFP
AGBMA (AntiGlomerular
Capillary Basement
Membrane
Antibodies)
ALA
Albumin
Blood
Blood
1 SST
Albumin
Alcohol, Ethyl
Fluid
Blood
1 Red
1 mL fluid
1 SST or
1 mL
1 Green or serum or
Blood
Specimen Requirements Reference Range
See Throat Virus Isolation
or Detection.
Freeze and send frozen.
SDCL – Hospital in ABAD
Common
TAT = 3 weeks
See Catecholamines
See Alpha-fetoprotein
1 SST
1 mL
serum
Immunology - RGH AGBMS
See Aminolevulinic Acid
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL
serum
< 1 yr. 32-48
1 – 2 yrs. 37-57
2 – 3 yrs. 33-58
> 3 yrs 35-50
None available
Do not open tube.
g/L
Chem - RGH & PH
ALB
g/L
Chem - RGH & PH
Chem - RGH & PH
ALBFL
ALC
Print Date: June 12, 2015
4
Test Name
Specimen Container Volume
1 Grey
*Aldosterone
Blood
*Aldosterone
24 hr Urine 24 hr Urine 10 mL
container
aliquot
Alkaline Phosphatase Blood
(ALP)
1 SST or
1 Green
2 mL
plasma
1 mL
serum or
plasma
Alkaline Phosphatase Fluid
(ALP)
Alkaline Phosphatase Blood
Fractionation
(Isoenzymes)
Testing will be
performed only on
specimens with
elevated alkaline
phosphatase.
*Allergy Test (RAST) Blood
(Food screen or
inhalant screen)
Please fill out
special
sheet
Alpha-1-Antitrypsin
Blood
1 SST
2 mL
serum
1 SST
100 µL
serum per
test
1 SST
1 mL
serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Testing Site
LIS Code
plasma
*Aldolase
1 EDTA
Specimen Requirements Reference Range
No longer available.
Recommend CK
Aliquot and freeze.
Requires separate aliquot
when ordered with other
tests. If ordered with Renin
can be the same specimen
and requisition.
Keep cool during
15-70
collection. Freeze aliquot.
Record collection data and
24 hr volume on
requisition.
<30 d: 76-300
1-23 mo: 112-396
2-11 yr: 90-300
12-14 yr (F): 40-270
12-14 yr (M): 76-400
15-17 yr (F): 32-200
15-17 yr (M): 63-270
Adult (>17 yr): 40-135
No Longer Available
None available
ALDOL
pmol/L
SDCL
ALDOS
nmol/d
SDCL – Hamilton
TAT = 4 weeks
ALDOU
U/L
Chemistry - RGH & ALP
PH
ALPFL
Heat stable fraction:
<20% implies bone source
>25% and <55% implies liver
and/or intestinal source
100 µL is required for each
test ordered. Special
sheet must accompany
specimen.
0.91-3.07
g/L
Special Chem RGH
APISO
SDCL - Saskatoon
TAT = 2 weeks
RAST
Immunology - RGH A1AT
Print Date: June 12, 2015
5
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Alpha-1-Antitrypsin
Feces
Special
24 hour
container
feces
from Mayo collection
*Alpha-1-Antitrypsin
Phenotyping
Only done if
alpha-1-antitrypsin
is low.
*Alpha-2Macroglobulin
Alpha-Fetoprotein
(AFP)
Tumour Marker
*Alpha-Fetoprotein
(AFP)
Blood
1 SST
1 mL
serum
Blood
1 SST
Blood
1 SST
1 mL
serum
1 mL
serum
Amniotic
Fld.
1 mL
Amniotic
Fluid
1 mL
amniotic
fluid
1 SST
1 mL
serum
3 Sodium
or Lithium
Heparin
10 mL
whole
blood
3 Sodium
or Lithium
Heparin
10 mL
whole
blood
*Alpha-Fetoprotein
Blood
(AFP)
Maternal Screen
Fill out special form
with all relevant
info.
*Alpha Galactosidase Blood
*Alpha Glucosidase
Blood
*Alpha-Hydroxy
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Testing Site
LIS Code
Freeze
SDCL
TAT = 7 days
ATTRF
Freeze serum within 24 hr
of collection. Send copy of
the alpha-1-antitrypsin
results with specimen.
SDCL - Toronto
A1PHT
SDCL - Hamilton
A2MAC
Chemistry - RGH
AFPO
Refrigerate at 2-8º C and
transport on ice packs,
within 24 hr of collection.
Complete Maternal Serum
Screen requisition.
Accurate gestational age
and all relevant information
needed for interpretation of
results.
SDCL
TAT = 1 day
AFMAT
SDCL
MSS
Send whole blood. Keep
at room temperature.
Refer ASAP. Collected
Mon-Thurs early morning.
Must be at SDCL same
morning. (Sample must be
received by Saskatoon
within 24 hrs of collection)
Send whole blood. Keep
at room temperature.
Refer ASAP. Collected
Mon-Thurs early morning.
Must be at SDCL same
morning. (Sample must be
received by Saskatoon
within 24 hrs of collection
See 17-
SDCL - Saskatoon
ALGAL
0-9
Units
μg/L
SDCL – Saskatoon ALGLU
Print Date: June 12, 2015
6
Test Name
Specimen Container Volume
Progesterone
*Alprazolam (Xanax)
Blood
1 Red
ALT
Blood
1 SST or
Green
ALT
*Aluminum
Fluid
Blood
Urine
Amikacin (Amikin)
Blood
Trough and Peak
NOTE: Record pre
or post along with
exact date and time
of last doses and
exact date and time
of collection
*Amino Acid
Blood
Chromatography
(Can be done micro 2 small green. Spin
and freeze plasma.)
*Amino Acid
Units
Testing Site
LIS Code
Therapeutic: 2-120
nmol/L
SDCL
ALPRA
4 - 55
U/L
Chem - RGH & PH
ALT
No Longer Available
None available
Separate plasma from red
cells ASAP. Put plasma or
serum in polypropylene
tube. Indicate on
requisition that specimen
is EDTA plasma.
Place in polypropylene
container. Record on
requisition: collection
date, total 24 hr volume if
submitted or random urine.
U/L
Chem - RGH & PH
SDCL – Toronto
TAT = 10 days
ALTFL
ALUM
SDCL – Toronto
TAT = 10 days
ALUMU
Trough – usually drawn ½
hr before drug is
administered.
Peak – usually drawn 1 hr
after drug is administered,
but physician may vary.
Daily – 6 to 14 hrs after
dose.
Separate ASAP, freeze
mg/L
Chemistry- RGH
AMIPR
(trough)
AMIP
(peak)
AMIKN
(random)
SDCL - Saskatoon
AACID
SDCL - Saskatoon
AARUR
hydroxyprogesterone
1 mL
serum
1 mL
serum or
plasma
3 mL
1 – 7 mL
Royal Blue plasma
EDTA)
BD368381
*Aluminum
Specimen Requirements Reference Range
Urine
24-hr urine
container
acidwashed or
random
urine
collected in
acidwashed
container.
1 EDTA
10-15 mL
aliquot of
24 hr urine
or 10-15
mL of
random
urine
1 GREEN
(preferred)
or 1 EDTA
(full)
NICU: 2
mL venous
blood in
pediatric
green top
Random or
1 mL
plasma
NICU: 0.6
mL plasma
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL
plasma
10 mL urine Freeze. Record collection
Trough: 1-8
Peak: 20-30
Toxic Trough: > 10
Toxic Peak: > 30
Print Date: June 12, 2015
7
Test Name
Chromatography
State collection
period
Aminolevulinic Acid
(ALA)
State collection
period
Specimen Container Volume
Urine
24 hr
urine.
Aliquot.
24 hr
brown
urine
container
20 mL
aliquot of
24 hr urine
in dark
container or
wrap in tin
foil
Specimen Requirements Reference Range
date 24 hr volume if
submitted or random urine
on requisition.
Collect into brown bottle.
0-45
Freeze aliquot ASAP in
dark container or wrap in
tin foil
Aminophylline
(Theophylline)
Blood
*Amiodarone
(Cordarone)
Collect trough
specimen prior to
administration of
next dose) dose.
*Amitriptyline (Elavil)
Blood
2 SST
3 mL serum
Blood
2 Red or
Green
4 mL serum Do not use SST tubes
or plasma
Ammonia
Blood
1 Green
(full)
2 mL
Place specimen on ice
heparinized immediately after
plasma
collection and bring ASAP
to lab. Patient not to
clench hand during
collection. Outpatient
collections to come to
RGH or PH.
If shipping freeze plasma
aliquot and send on dry
ice.
10 mL
Keep specimen in the dark
amniotic
at all times.
fluid
3 mL serum Aliquot.
Amniotic Fluid Scan
Amniotic
(A450)
Fluid
(OD Rise)
*Amoebasis Serology Blood
Units
μmol/d
Testing Site
LIS Code
TAT = 1 week
(random)
AA24
(24 hr)
ALA24
Special Chem RGH
See Theophylline
1 SST
(Entamoeba)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Therapeutic:
Minimum: 220-600
Maximum: 650-1100
Toxic: >1700
12-47
nmol/L
μmol/L
SDCL – Toronto
TAT = 2 weeks
AMIOD
SDCL
TAT:Emerg = 4 hr
Routine = 3
days
Chem - RGH & PH
AMIT
AMMO
Special Chem RGH
A450
SDCL - Montreal
TAT = 4 weeks
AMOES
Print Date: June 12, 2015
8
Test Name
Specimen Container Volume
*Amoxapine
(Asendin)
Blood
2 Red or
2 Green
4 mL serum Do not use SST tubes
or plasma
*Amphetamines
Urine
AMA (AntiMitochondrial
Antibodies)
Amylase
Amylase
Amylase
Blood
Plastic
urine
container
1 SST
20 mL
NOTE: Blood unsuitable.
random
Refrigerate samples.
urine
1 mL serum
1 SST
Blood
Fluid
Urine
Specimen Requirements Reference Range
Therapeutic: 600-1200
Toxic: >1200 – but CNS effects
including seizures,
convulsions, lethargy and
coma are important
indicators
Negative
Units
Testing Site
LIS Code
nmol/L
SDCL
TAT: Emerg = 4 hr
Routine = 3
days
AMOXA
SDCL
TAT = 2 days
AMPH
Immunology - RGH AMAS
Amylase Isoenzymes Blood
1 SST
1 mL serum
1 mL fluid
5 mL urine 24 hr urine amylase no
longer available.
1 mL serum No Longer Available
ANA or ANF
(Anti-Nuclear
Antibody or AntiNuclear Factor)
*Anafranil
(Clomipramine)
*ANCA
Blood
1 SST
1 mL serum No hemolysis
Immunology - RGH ANA
Blood
2 Red
4 mL serum
SDCL
CLOMI
1 SST or
1 Green
See Anti-Neutrophil
Cytoplasmic Antibodies
See Testosterone
1 mL serum Record date/time of
or plasma collection on tube and
requisition. Aliquot and
freeze. Must have own
specimen and req.
SDCL
TAT = 14 days
ADION
*Androgen
*Androstenedione
Blood
(A2) Draw in AM
preferred but can be
done at other times.
Random
*Angiotensin I
*Angiotensin
Converting Enzyme
*ANNA-1
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
20-110
None available
32-641
U/L
U/L
U/L
Total: 20-110
Pancreatic: 43-67
Salivary: 38-56
U/L
%
%
Infants and children:
Decreased from 10.1 during the
first week to 1.7 in prepuberty
At puberty: 0.3-8.4
Female:
Normal: 1.6-9.4
Menopausal: <3.5
Male: 2.0-9.4
nmol/L
Chem - RGH & PH
Chem - RGH & PH
Chem - RGH & PH
See Renin
See ACE
See Anti-Hu
Print Date: June 12, 2015
AMYL
AMYFL
AMYRA
(random)
9
Test Name
*Anti-Adrenal
Antibodies
*CC1 Esterase
Inhibitor
Anticardiolipin and
(Anticardiolipin
Antibodies to
Nonspecific Antigen)
*Anti-Centromere
Antibodies
*Anti-Chlamydia
pnemoniae
*Anti-Cyclic
Citrullinated Peptide
(Anti-CCP)
*Anti-Diuretic
Hormone
Anti-DNA or dsDNA
(Anti-Nucleic Acid)
Performed only if
ANA screen positive
*Anti-DNASE B
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Immunology-RGH
CENTR
SDCL
CCPAB
See Adrenal Antibodies
See C1 Esterase Inhibitor
Blood
3 Blue and
1 Red
Blood
1 SST
See LUPWS
1 mL serum
Blood
Blood
See Chlamydophilia
pneumoniae IgM and IgG.
1 SST
1 mL serum
Only done if ANCA screen is
positive.
See ADH
Blood
1 SST
1 mL serum RHD specimens only
Immunology - RGH DSDNA
Blood
1 SST
SDCL - MAYO
ABDNS
*Anti-Endomysial
Antibodies
*Anti-GAD65
Blood
1 SST
SDCL
ABEND
*Anti-Gastric
Antibodies (Anti GP
Cell Ab)
Anti-Glomerular
Capillary Basement
Membrane Antibody
(AGCBM Ab)
*Anti-Gliadin Antibody
(Identifies IgA & IgG)
Anti-Glutamic
Decarboxylase Ab
*Anti-Gluten
Antibodies
Blood
1 SST
0.5 mL
Refrigerate – preferred
serum
(Can be frozen).
1 mL serum Keep specimen cool.
Send on ice packs.
See Anti-Glutamic
Decarboxylase Ab
2 mL serum Send last B12 result with
specimen
SDCL - Saskatoon
ABGA
Blood
1 SST
1 mL serum
Immunology - RGH AGBMS
Blood
1 SST
1 mL serum
Blood
1 SST
2 mL serum Separate immediately and
Freeze
Order Celiac Disease
Profile and write on req.
SDCL
TAT = 3 weeks
SDCL-Toronto
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
ABGLI
ABGAD
CDP
Print Date: June 12, 2015
10
Test Name
Specimen Container Volume
*Anti-HAV IgM and/or
IgG Hepatitis A
*Anti-HAV – Total Ab
*Anti-HBc
*Anti-Hbe
Blood
1 SST
Blood
Blood
Blood
1 SST
1 SST
1 SST
*Anti-HBs
*Anti-HCV
*Anti-HDV
Only done if HBV
positive
*Anti-HEV
*Anti-HFV
*Anti-HGV
*Anti-Histone
*Anti-Hu (ANNA-1)
Blood
Blood
Blood
Blood
Blood
Blood
Blood
Blood
Testing Site
LIS Code
2 mL serum
SDCL
HEAAB
SDCL
SDCL
SDCL - test done
weekly
HEATO
HEBCO
HEBEB
1 SST
1 SST
1 SST
2 mL serum
2 mL serum
2 mL serum Performed on patients with Negative
history of being HbsAg
positive
2 mL serum
2 mL serum
2 mL serum
SDCL
SDCL
SDCL
HEBAB
HECAB
HEDAB
1 SST
1 SST
1 SST
1 SST
1 SST
2 mL serum
2 mL serum
2 mL serum
1 mL serum Freeze
1 mL serum Freeze ASAP
HEEAB
HEFAG
HEGAB
HISAB
HU
Blood
1 SST
See Insulin Antibodies
1 mL serum Separate and freeze ASAP
*Anti-Intrinsic Factor
Ab
Blood
2 SST
3 mL serum Avoid administration of
B12 for 48 h before
collection
SDCL
SDCL
SDCL
SDCL - Ontario
SDCL – Mitogen
Diagnostics,
Calgary
SDCL
SDCL – Toronto
TAT = 3 weeks
SDCL
Anti-Jo-1
Anti-La
*Anti-Liver & AntiKidney Ab (Anti-KLM
or Anti-LKM)
*Anti-Mag Assay
(Anti-Myelin
Associated
Glycoprotein Assay)
*Anti-Microsomal
Blood
1 SST
2 mL serum
SDCL
ABJO
Blood
1 SST
See Anti-SSB
2 mL serum Keep cool. Send on ice
pack.
SDCL - Toronto
ABKLM
Blood
1 RED
SDCL
AMAG
SDCL
ABMIC
*Anti-Insulin Ab
*Anti-Islet Cell Ab
*Anti-Mitochondrial
Specimen Requirements Reference Range
1 mL serum Patient should be fasting.
Freeze serum
See Anti-Thyroid
Peroxidase
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum
Units
ABINS
ABISC
ABINF
Immunology - RGH AMAS
Print Date: June 12, 2015
11
Test Name
Specimen Container Volume
Ab (AMA)
*Anti-Mullerian
Hormone
*Anti-Musk
Blood
1 SST
1 mL serum Send frozen
Blood
1 RED
Do not use
SST
1 SST
See spec.
requirement
1 SST
1 SST
2 mL serum Freeze.
Must be approved (SDCL
787-3131 ext 4)
1 mL serum
2mL serum Separate ASAP in aliquot.
Must specify perinuclear or
cytoplasmic staining.
2 mL serum If ANCA positive a p-ANCA
2 mL serum will be performed.
1 SST
1 mL serum
*Anti-Myocardial
*Anti-Neutrophil
Cytoplasmic (ANCA)
Blood
Blood
p-ANCA
c-ANCA
Syn: Vasculitis Panel
or Vasculitis Screen
Anti-Nuclear Ab
*Anti-Ovarian Ab
Anti-Pancreatic Islet
Ab
*Anti-Parietal Cell Ab
Anti-Phospholipid Ab
Blood
Blood
*Anti-Reticulin Ab
Blood
*Anti-Ri
Blood
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL – Hospital in MULLH
Commons,Toronto
SDCL – California MUSKA
SDCL - Toronto
ABMYO
SDCL – Saskatoon
PANCA
CANCA
See ANA
Blood
SDCL - Toronto
ABOVA
See Anti-Islet Cell Ab
Anti-RNP
Blood
Performed only if
ANA screen is
positive
Anti-Ro
Anti-Scleroderma-70 Blood
Ab
(Anti-Scl-70)
Performed only if
ANA screen positive
Anti-Skeletal Ab
1 SST
2 mL serum
3 Blue & 1 4 mL
Order as LUPWS. Double
Red
plasma
spin plasma and separate
2 mL serum into 4 tubes, freeze all
plasma and serum tubes.
1 SST
1 mL serum Aliquot & send specimen
on ice packs
1 SST
1 mL serum Freeze ASAP
SDCL
ABPAR
Special Coag
Hematology - RGH
SDCL - Toronto
ABRET
1 SST
1 mL serum RHD only
SDCL – Mitogen
RI
Diagnostics,
Calgary
Immunology - RGH RNPSM
1 SST
See Anti-SSA
1 mL serum RHD only
Immunology - RGH SCL70
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Anti-Striated Muscle
Print Date: June 12, 2015
12
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Ab
*Anti-Skin Ab
Blood
1 SST
1 mL serum
SDCL - Saskatoon ABSKI
TAT = 2 weeks
Immunology - RGH ASMAS
Anti-Smooth Muscle
Ab (ASMA)
*Anti-Sperm Ab
Anti-SSA Ab
Anti-SSB Ab (Anti-La)
Anti-Smith Ab (SM)
Performed only if
ANA Screen
positive
*Anti-Streptolysin
Blood
1 SST
1 mL serum
Blood
Blood
1 Red
1 SST
2 mL serum Freeze
2 mL serum RHD only
SDCL - Mayo Lab ABSPE
Immunology – RGH SSA
SSB
SM
Blood
1 SST
2 mL serum
SDCL
ASLT
*Anti-Striated Muscle
Ab
*Anti-Techoic Acid
Anti-Thrombin III
Blood
1 SST
2 ml serum
SDCL - Toronto
ABSTM
*Anti-Thyroglobulin
Blood
1 SST
2 mL serum
*Anti-Thyroid
Microsomal
*Anti-Thyroid
Peroxidase
Anti-Thyrotropin Ab
Blood
1 SST
1 mL serum
Special Coag
Hematology - RGH
SDCL
ABTHY
TAT = 2-3 days
SDCL
ABMIC
Blood
1 SST
1 mL serum
SDCL
PEROX
SDCL
ABTTG
SDCL – Mitogen
Diagnostics,
Calgary
YO
(ASO)
(Streptozyme)
See Techoic Acid.
See Hypercoag (order as
HCOAG)
Anti-Topoisomerase
AntiBlood
Transglutaminase Ab
Anti-Trypsin
Anti - Xa
*Anti-Yo (Purkinje
Cyto Ab)
Blood
<100
IU/mL
See Thyrotropin Binding
Inhibitory Immunoglobulin
See Anti-SCL-70
1 SST
See Alpha-1-Antitrypsin
See Heparin Assay
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Freeze ASAP
Print Date: June 12, 2015
13
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Apolipoprotein A1
Collect after 14 hr
fast
*Apolipoprotein B
Not required to be
fasting.
*Apo-E Lipoprotein
Must be fasting 14
hr.
A letter submitted
by the ordering
physician outliniing
the reason for
requesting this test
must accompany
the sample.
APT (Alkaline
Denaturation Test)
Bring to lab ASAP
Blood
1 Mauve
1 mL
plasma
Blood
1 Mauve
1 mL
plasma
Blood
4 Mauve
*Arbovirus Serology
Feces,
vomitus or
gastric
content
Blood
*Arsenic
Blood
For non-dietary
exposure within 48
hr
*Arsenic
Urine
Information on
patient's diet should
be included
1 SST
Testing Site
LIS Code
Separate from cells within
4 hr of collection
SDCL – Toronto
APOA1
Separate from cells within
4 hr of collection. Freeze
and send frozen
Minimum of Separate within 4 hrs of
6 mL EDTA collection. Store and ship
plasma
at 4 degrees.
SDCL – Toronto
APOLI
SDCL
APOLE
1 g or 1 mL Give to Chemistry ASAP
Chemistry - RGH
APT
2 mL serum
SDCL
ARBOS
No substitute is acceptable
*24 hr urine is specimen of
choice.
SDCL - Edmonton
ARSB
24 hr urine is specimen of
choice. For non-dietary
exposure within 48 hr,
send EDTA whole blood.
Send in polypropylene
container. Record
collection date, 24 hr
volume if submitted or
random urine on req.
Room Temp
Collect Mon-Fri mornings
only. Send to SDCL ASAP
See Salicylate
Protect from light with foil 45-85
or use light sensitive
SDCL – Toronto
TAT = 3 weeks
ARSU
SDCL - Saskatoon
ARYLS
SDCL
TAT = 3 days
VITAC
Whole
1 – 7 mL
Royal Blue blood
EDTA)
Units
BD368381
24 hr or
random
urine
container
acidwashed
1 mL of 24
hr urine or
10 mL
random
urine
*Arylsulfatase A
Blood
1 Na
Heparin
(Full)
3 mL
Whole
Blood
ASA
*Ascorbic Acid
(Vitamin C)
Blood
1 SST
1 mL
serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
μmol/L
Print Date: June 12, 2015
14
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL
AMOXA
Chem - RGH & PH
AST
SDCL - Edmonton
TAT = 3 weeks
ASPGS
LOR
HEBAG
aliquot tube.
Separate and freeze
immediately. Send frozen
on dry ice.
*Asendin
(Amoxapine)
ASMA
*ASO
Blood
2 Red or
2 Green
4 mL serum
or plasma
Blood
AST (SGOT)
Blood
1 SST
1 mL serum
*Aspergillus Serology Blood
1 SST
3 mL serum
Anti-Smooth Muscle Ab
See Anti-Streptolysin
(ASO).
<6 mo: 63-81
6 mo-5 yr: 46-63
>5 yr: 5-35
(Farmer’s Lung,
Galactomannin)
Atenolol
(Ternormen, Tenolin)
*Ativan (Lorazepam) Blood
*Australian Antigen
Blood
(HBsAg)
*Auto Antibodies
Blood
Test Not Available
2 Red
1 SST
5 mL serum
1 mL serum
SDCL
SDCL
1 Mauve
Full
Transfusions - RGH *DANT
*Auto Immune Muscle
Disease Profile
*Aventyl
(Nortriptyline)
B12
B12 & Folates (RBC)
Note: If B12 or RBC
folate decreased,
serum folate reflexed.
*B12 Binding Protein
*Babesiosis Serology
Blood
1 SST &
1 Mauve
Blood
1 SST
*Bacterial Meningitis
Blood
1 RED
Blood
2 Red
Blood
Blood
Tubes must be labelled
with name, DOB, and PHN
or MRN
1 mL serum Freeze within 4 hours of
Includes Jo1, Mi2, PL-7, PL-12,
collection
PM/Scl, Ku, Ro52, SRP.
4 mL serum Do not use SST
See Vitamin B12
1 ml serum Needs hematocrit run in
& 1 mL
Hematology first
whole
blood
See Transcobalamine
3 mL serum Aliquot.
SDCL to Calgary
AIMDP
SDCL
NORTR
Chemistry - RGH
B12FO
SDCL – Montreal
TAT = 4 weeks
BABES
Special Chem -
BARBQ
See Encephalitis
(Bacterial).
(Hemophilus influenzae, CSF
Neisseria meningitidis,
Strept. pneumoniae)
*Barbiturates
U/L
1 Red or
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
3 mL serum Do not use Seraclear -
See individual tests for reference
Print Date: June 12, 2015
15
Test Name
Specimen Container Volume
2 Green
(full)
NOT SST
*Barbiturate (Urine
Drug Screen)
*Bartonella henselae
Urine
(random)
Blood
1 SST
or plasma
Specimen Requirements Reference Range
Units
ranges
RGH
Refrigerate sample
Negative
SDCL
TAT = 2 days
SDCL – Winnipeg BARTS
TAT = 3 weeks
Immunology - RGH IFEU
2 mL serum
Bence Jones Protein
Urine or
Blood
24 hr urine 100 mL of
or 1 SST
24 hr urine
or 1 mL
serum
*Benzitropine
(Cogentin)
*Benzodiazepines
Blood
2 Red
4 mL serum
Urine
Random
20 mL urine Refrigerate
Blood
1 Red
1 mL serum Refrigerate
Blood
Urine
1 SST
1 mL serum
Blood
1 SST
Beta 2
(B2) Transferrin
Bilirubin
Fluid
Blood
1 SST or
1 Green
LIS Code
false positive
(Cat Scratch Fever)
*Beta 2 Glycoprotein1
AB
Beta 2 Microglobulin
Beta 2 Microglobulin
Beta-Hydroxbutyrate
Bicarbonate
*Bile Acid
Concentration
(Bile Acid Assay)
Testing Site
24 hr urine collection is
preferred
Record Collection Time,
Date and Volume on req.
Rural sites: Send aliquot
frozen
Not available
See B-OH Butyric Acid
See CO2
2 mL serum Aliquot & Freeze
Preferred: Collect after
overnight fast or
postprandial.
(will accept non-fasting
specimens )
0.5 mL
Freeze in plastic. Must be
frozen before shipping.
1 mL serum
Negative
0-3.4
Cord: 18-52
Direct: 0-9
Total: 2-20
mg/L
µmol/L
SDCL
BENZI
SDCL
TAT = 2 days
SDCL to Mayo
BENZO
B2GLY
Immunology - RGH B2MGB
SDCL - Edmonton
BCONC
SDCL – referred
out - Mayo
Chem - RGH & PH
B2TFE
BILCD
(cord)
BILTD
(total and
direct)
BILIT
(total)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
16
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Bilirubin – Neonate
Blood
1 Microcontainer
Bilirubin
*Biotinidase
Fluid
Blood
ß-hCG (Qualitative)
(Pregnancy Test)
State pregnancy
test on req
ß-hCG (Quantitative)
Tumour Marker
ß-hCG (Quantitative)
Maternal Screen
Fill out special form
with all relevant
information
*ß-OH-Butyric Acid
Urine or
Blood
1 mL fluid
1 SST or
2 mL serum Freeze ASAP
1 Green
or plasma
Random or 1 mL urine
1 SST
or 1 mL
serum
0.2 mL
Protect from light
serum or
heparinized
plasma
Full term:
24 hr: 36-104
48 hr: 103-120
3-5 d: 68-103
Premature:
24 hr: 17-103
48 hr: 103-137
3-5 d: 171-205
None available
0-6
Units
Testing Site
LIS Code
µmol/L
Chem - RGH
BILIN
µmol/L
Chem - RGH & PH
SDCL to Winnipeg
BILFL
BIOTD
Chem - RGH & PH
Chemistry - RGH
PREGU
(urine)
SPREG
(serum)
BHCGR
Blood
1 SST
2 mL serum
Blood
1 SST
2 mL serum Accurate gestation age
needed
SDCL
MSS
Blood
1 SST
1 mL serum Freeze ASAP
BOHBU
*BK Virus – Plasma
PCR
Blood
1 Mauve
*BK Virus
CSF BK Virus PCR
CSF
*BK Virus
Urine BK Virus PCR
Urine
SDCL - Toronto
Hospital in
Comons
SDLC – Toronto
Hospitals in
Common
SDLC – Toronto
Hospitals in
Common
SDCL –Toronto
Hospitals in
Common
*Blastomycosis
Serology
Bleeding Time
Must be approved
by Hematologist
Bleeding Disorder
Blood
SDCL - Edmonton
TAT = 3 weeks
Hem - RGH & PH
BLASS
2 mL EDTA Freeze plasma ASAP.
plasma
If specimen thaws , it is
unsuitable for analysis.
Sterile leak 1 mL CSF Freeze CSF ASAP.
proof tube
If specimen thaws , it is
unsuitable for analysis.
Sterile
20 ml urine Freeze urine ASAP.
plastic
(random)
If specimen thaws , it is
urine
unsuitable for analysis.
container.
1 SST
3 mL serum
Done on patient's arm by
Hematology Tech
Blood
IU/L
3 Blue
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
4 mL
Double spin plasma and
2-9.5
Minute
Spec. Coag.
Print Date: June 12, 2015
BKVIR
BKVIC
BKVIU
BT
BLDWS
17
Test Name
Specimen Container Volume
Investigation
(BLDWS)
Blood Culture
Fungal
Blood
Blood Culture
Pediatric
Blood Culture
Routine
Blood
*Blood Culture
TB (Mycobacterium)
Blood Culture
Blood/Bone
Marrow
Blood Gases
Blood Gases
Blood Gases
Blood
Dialysis
Fluid
Arterial
(full)
citrated
plasma
Aerobic
and
Anaerobic
Vials
Pediatric
Vial
Aerobic
and
Anaerobic
Vials
Myco/FLytic vial
8-10 mL
blood/vial
Syringe
(electrolyte
balanced
dry
heparin)
Units
Testing Site
LIS Code
separate into 4 tubes.
Freeze and send frozen on
dry ice.
Transport to Microbiology
Lab immediately and place
in BacTAlert.
Hem – RGH & PH
2-4 mL
blood/vial
8-10 mL
blood/vial
A single blood culture is
acceptable for infants.
Transport to Microbiology
Lab immediately and place
in BacTAlert.
Microbiology - RGH BCUL
1-5 mL
blood/vial
Send at room temp ASAP.
Do not refrigerate or freeze
See Microbiology
Compendium
Anaerobic technique.
PH <2 mo: 7.30-7.47
Brought to lab ASAP.
2 mo-2 yr: 7.34-7.46
>2 yr: 7.35-7.45
pCO2 < 2mo: 27-40
2 mo-2 yr: 26-41
2yr: 33-45
pO2 < 2 mo: 55-80
2 mo-2 yr: 65-100
>2 yr: 75-100
HCO3 <2 yr: 16-24
>2 yr: 22-26
Base Excess <2 mo: -10 - -2
2 mo-2 yr: -4-2
>2 y: -2.5-2.5
O2 Saturation: 95-98
1.5 mL
(adults)
0.6 mL
(neonates)
Cord
Arterial
Syringe
(lithium or
sodium
heparin)
1.5 mL
Cord
Venous
Syringe
(lithium or
sodium
1.5 mL
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Anaerobic technique.
Brought to lab ASAP.
Microbiology - RGH BCUL
Microbiology - RGH BCUL
pH …….…7.23-7.33
pCO2 …….…. 41-58
pO2 ……….… 12-24
HCO3 …….… 20-25
Base Excess
pH …7.30-7.40
pCO2 …33-44
pO2 … 23-35
SDCL.
TB/BC
Microbiology - RGH
Chem - RGH & PH
BGA
Chem - RGH & PH
BGCA
Chemi - RGH & PH
BGCV
mmHg
mmHg
mmol/L
mmol/L
%
mmHg
mmHg
mmol/L
mmol/L
mmHg
mmHg
Print Date: June 12, 2015
18
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
heparin)
Blood Gases
Blood Gases
Blood Gases
Micro
Venous
Venous
Blood Group
Blood
Blood Parasite for
______
Blood
BNP
Blood
(N-Terminal Pro Brain
Natriuetic Peptide)
Capillary
tubes
Electrolyte
balanced
heparin
Syringe
2 x 125µL
Anaerobic technique.
Brought to lab in ice water
ASAP.
pH …….…7.32-7.42
pCO2 ………. 40-50
pO2 ………… 25-47
HCO3 …….… 22-29
Base Excess
1 FULL
Anaerobic technique. .
pH …….…7.32-7.42
Green
Place on ice and deliver to pCO2 ………. 40-50
Vacutainer
Chemistry lab within 15
HCO3 …….… 22-29
minutes.
Base Excess
1 Mauve
Tubes must be labelled
with full name, DOB, MRN
OR HSN
1 Mauve
Can use same tube as
CBC, enter name of
parasite in LIS
1 EDTA
1 mL
Remove plasma from cells
ASAP and run immediately
400uL- 1
or Freeze.
full EDTA
Stability: 4 hrs at room
microtainer temp or 24 hrs frozen.
For Neonatals can be
collected using EDTA
microtainers.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Anaerobic technique. No
ice required if brought to
lab ASAP.
HCO3 … 16-24
Base Excess
pH <2 mo: 7.30-7.47
2 mo-2 yr: 7.34-7.46
>2 yr: 7.35-7.45
pCO2 < 2 mo: 27-40
2 mo-2 yr: 26-41
>2yr: 33-45
pO2 <2 mo: 55-80
2 mo-2 yr: 65-100
>2 yr: 75-100
HCO3 <2 yr: 16-24
>2 yr: 22-26
Base Excess <2 mo: -10 - -2
2 mo-2 yr: -4-2
>2 y: 2.5-2.5
O2 Saturation 95-98
Units
Testing Site
LIS Code
Chem - RGH & PH
BGM
Chem - RGH & PH
BGV
Chem - RGH & PH
BGVVA
Transfusions
*BLGR
mmol/L
mmol/L
mmHg
mmHg
mmol/L
mmol/L
%
mmHg
mmHg
mmol/L
mmol/L
mmHg
mmol/L
mmol/L
Hematology - RGH BLPA
Chemistry – RGH
Print Date: June 12, 2015
BNPA
19
Test Name
Specimen Container Volume
NT-Pro BNP
Blood
1 SST
(For Cancer Patients/
Allan Blair Patients
only)
EDTA
Body Fluids
Pleural,
(counts)
Peritoneal
Dialysate,
Pericardial
and
Synovial
Fluids
Bone Donor
(Initial Testing)
Blood
Bone Donor
(6 Month Testing)
Bone Specific ALP
*Bordetella pertussis
(Whooping Cough)
Blood
Blood
Nasopharyngeal
*Brucella Antibodies
*BSE
*Butazoldin
(Phenylbutazone)
C&S
Blood
CSF
Blood
1 mL
Frozen.
3-5 mL
All fluids must be in lab
Dialysate normal range:
within 4 hr from the time of
WBC 0.0-0.1 x 109/L
collection
Pleural, synovial fluids normal
range: clear, pale, yellow
WBC:
Pleural: 0-1.0 x 109/L
Synovial: 0.02 x 109/L
RBC:
0 x 1012/L
Diff:
<25% neutrophils
Peritoneal fluid normal range:
clear, pale, yellow
WBC: 0-300 per mm3 (<0.3 x 109/L)
RBC: 0-1012/L
Diff: - <75 neutrophils per mm3
(<25%)
Tubes must be labelled
with full name, DOB and
MRN or PHN
No longer performed
2 SST and
1 Red top
2 EDTA
2 SST and
1 Red top
1 SST
1 mL
*Borrelia borgdorferi
1 SST
2 Red
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Frozen
See Pertussis.
*Nasopharyngeal
Pertussis (Culture and
PCR)
See Lyme Disease Total
IgM and IgG Serology.
3 mL serum Aliquot and freeze.
See Creutzfeld Jakob
Disease.
4 mL serum
Units
WBC x
109/L
RBC x
1012/L
Diff - %
Testing Site
LIS Code
SDCL to Hospitals
in Common,
Toronto
NTBNP
Hematology- RGH
& PH
Specific to
each fluid
Mt Sinai, Toronto,
Ontario
BDINI
SDCL /RGH
Transfusions
SDCL/Toronto
BD6M
OSTAS
PERTU
SDCL
BRUCS
SDCL
PHEBZ
See Micro Section
Print Date: June 12, 2015
20
Test Name
Specimen Container Volume
*C1
Blood
A *C1 Esterase
Inhibitor level is done
first to see if C1
function is sent away.
*C1 Esterase Inhibitor Blood
Fasting preferred
Testing Site
LIS Code
SDCL - Denver
C1
SDCL
TAT = 2-3 days
C1EST
SDCL-Toronto
C1QAB
1 mL serum Refrigerated.
SDCL – MAYO
C1QLV
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at –70º C within 2 hr
of collection.
0.5 mL
Freeze. Send on dry ice.
serum
1 mL serum
C3: 0.74-1.85
C4: 0.16-0.44
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 mL
Aliquot and freeze at -70º
plasma
C within 2 hr of collection.
SDCL –National
Jewish Reference
Centre
C2
SDCL – MAYO
C2LEV
1 Red
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 SST
2 mL serum Allow to clot for no more
0.21-0.39
than an hr. Aliquot and
freeze at –70º C within 24
hours of collection.
1 mL serum Separate and freeze within
60 minutes of collection
*C1Q Immune
Complex Antibody
Blood
1 Red
*C1q Level
Blood
*C2 Functional test
Blood
1 RED
( can use
SST but
not
preferred)
1 Red
*C2 Level
Blood
1 RED
C3, C4 (Complement) Blood
1 SST
*C5 Level
Request C5F if
Functional test is
required
*C5 Function
Blood
1 Red
Blood
1 Red
Blood
1 EDTA
Blood
1 Red
*C6 Level
Request C6F if
Functional test is
required
*C6 Function
Specimen Requirements Reference Range
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
Units
g/L
g/L
Immunology - RGH C3C4
SDCL - MAYO
C5
SDCL – MAYO
C5F
SDCL – National
Jewish Health,
Denver
C6
SDCL – MAYO
C6F
Print Date: June 12, 2015
21
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*C7 Level
Request C7F if
Functional test is
required
*C7 Function
Blood
1 EDTA
1 mL
plasma
Aliquot and freeze at -70º
C within 2 hr of collection.
Blood
1 Red
Blood
1 EDTA
Blood
1 Red
*C8 Level
Request C8F if
Functional test is
required
*C8 Function
Testing Site
LIS Code
SDCL - National
Jewish Health,
Denver
C7
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 mL
Aliquot and freeze at -70º
plasma
C within 2 hr of collection.
SDCL – MAYO
C7F
SDCL - National
Jewish Health,
Denver
C8
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 mL
Aliquot and freeze at -70º
plasma
C within 2 hr of collection.
SDCL – MAYO
C8F
SDCL – National
Jewish Health,
Denver
C9
1 mL serum Allow to clot for no more
than an hr. Aliquot and
freeze at -70º C within 2 hr
of collection.
1 mL serum Send frozen
or 1 mL
plasma
(EDTA)
1 mL serum
0-35
See Carbohydrate Antigen
1 mL serum Aliquot & Freeze
SDCL – MAYO
C9F
SDCL – Toronto
TAT = 2 weeks
CA15
Chemistry - RGH
CA15
SDCL - Mayo Lab
CA27
SDCL - Toronto
CADMB
*C9 Level
Request C9F if
Functional test is
required
*C9 Function
Blood
1 EDTA
Blood
1 Red
*CA15-3
Blood
1 SST or
1 Mauve
CA 125
*CA19-9
*CA27-29
Blood
1 SST
Blood
*Cadmium (Blood)
Blood
1 SST preferred
RED is
acceptable
7 mL whole
1 – 7 mL
Royal Blue blood
EDTA)
Units
BD368381
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
22
Test Name
Specimen Container Volume
*Cadmium (Urine)
Urine
*CAE
Blood
24 hr or
random
acidwashed
container
1 Red
*Calcitonin
Collect after 14 hr
fast
Calcium
Blood
1 SST
Blood
1 SST
Calcium
Calcium
State collection
period
Calcium – ionized
*Calculi
Fluid
Urine
Calculus
either
passedor
surgically
removed
(renal,
bladder,
ureter,
biliary
or
prostatic)
Prefer 24
hr
Send
calculi
in a dry,
sealed,
clearly
marked
container
*C-ANCA
*Cannabinoids
(Cannabis)
Urine
Random
urine
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
10 mL
aliquot of
urine in
polypropyle
ne vial
2 mL serum
Collect in acid-washed
container. Record
collection date, 24 hr
volume if submitted or
random urine.
Remove serum from cells
within 2 hr of collection freeze. Must arrive at
SDCL frozen.
2 mL serum Aliquot & freeze. Record
fasting serum on
requisition.
1 mL serum
≥60
0-10days=1.90-2.60
>10days =2.14-2.66
None available
Intake 200n mg/d: 0.3-4.5
Intake 200-600 mg/d: 1.3-5.0
Intake 1 g/d: <7.5
1 mL serum No Longer Available
10 mL urine Acidify before analyzing
Indicate on Requisition if
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
See Ionized Calcium
Send calculi in a dry,
Descriptive report
sealed, clearly marked
container
See Anti-Neutrophil
Cytoplasmic Ab (PR3)
20 mL urine Keep cool
Negative
Units
Testing Site
LIS Code
SDCL – Toronto
TAT = 3 weeks
CADMU
SDCL - done
weekly
CAE
SDCL - Toronto
CALCI
mmol/L
Chem - RGH & PH
CA
mmol/L
mmol/d
Chem - RGH & PH
Chem - RGH & PH
CAE
units
CAUR
(random)
CA24
(24 hr)
SDCL
TAT = 7 days
STONE
SDCL
TAT = 3 days
CANNA
Print Date: June 12, 2015
23
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Carbamazepine
(Tegretol)
See TDM section for
ideal sampling times
*Carbohydrate
Antigen
Ca 19-9
*Carbohydrate
Deficient Transferrin
Carbon Monoxide
(Carboxy
Hemoglobin)
Blood
1 EDTA
1 mL
plasma
Collect 0-1 hr before
dose.
μmol/L
Chemistry - RGH
CARBA
Blood
1 SST
1 mL
Aliquot
SDCL - Toronto
TAT = 3 weeks
CA19
Blood
1 SST
1 mL serum Aliquot and Freeze
SDCL - California
CDTRF
Blood
1 small
5 mL whole Do not open tube
Green (full) blood
%
Chem - RGH & PH
COHBA
Carcinoembryonic
Antigen
(CEA)
Carcinoembryonic
Antigen
Cardiac Antibodies
*Cardizem (Diltiazem)
Collect immediately
before next oral
dose
*Carnitine (Total &
Free)
Acylcarnitine – PKU
card
Blood
1 SST
g/L
Chemistry - RGH
CEA
Chemistry – RGH
CEAFL
SDCL
TAT = 5 days
CARDI
Freeze. Avoid hemolysis.
Separate plasma from
cells.
SDCL
CARNS
*Carnitine
Freeze
SDCL (ABC Lab Saskatoon)
CARNU
SDCL
TAT = 7 days
CAROT
Fluid
1 mL
1 mL
Therapeutic: 17-50
Toxic: ≥63
(Earliest time for first TDM is one
week)
Non-smoker: <2
Smokers: 2-5
Heavy Smokers: 5-9
Toxic: >20
Fatal: >50
0-5
See Anti-Myocardial Ab
Blood
2 Red
3 mL serum
Blood
1 Red or
1 Green
Urine
Random
24 hr if
1 mL
plasma or
serum (200
L for
babies
5 mL urine
quantitative
*Carotene
Blood
results
required
results
required
1 SST
*Cat Scratch Disease Blood
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2 mL serum Keep in dark
See Bartonella henselae
(Cat Scratch Fever).
Print Date: June 12, 2015
24
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Catecholamines
(Free)
Blood
2 Mauve
(EDTA)
Plasma – Adrenalin,
Noradrenalin,
Epinephrine,
Norepinephrine
Collect after pt. has
been at rest in a supine
position for 30 min. No
smoking, tea or coffee
during procedure.
Immediately
place
specimen
on ice after
collection.
*Catecholamines Urine
Urine
(includes epinephrine
& nonepinephrine)
24 hr
urine
CBC
Blood
CBC for Hemodialysis Blood
1 Mauve
1 Mauve
CBC for Neonates
Micro
sample
EDTA
1 SST
Blood
CCU Panel (renal,
Blood
liver, glucose, Ca,
Mg, PO4, uric acid,
CK, AST, LD)
NB: Pasqua Hospital
does not include LD
*CD4\CD8
Blood
(CBC must be done
with test)
Weekdays only
1 Mauve
CEA
*Celiac Disease
Profile
Blood
1 SST
*Cell Markers
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
350 uL
minimum
Testing Site
LIS Code
Not recommended
because of pulsatile
variation in levels of
peripheral blood. Have
urine done first. Separate
and freeze immediately.
Send on dry ice.
SDCL – Hamilton
TAT = 10 days
CATEP
Refrigerate during
collection. Adjust pH to 2-4
with HCL or freeze.
Pediatric - include weight.
State 24 hr volume.
SDCL
TAT = 7 days
CATEU
Please order CBCK for
post-dialysis or unknown
dialysis and CBCP for PreHemodialysis patients
For C-NC and C-2D
Units
Hem - RGH & PH
CBC
Hematology - RGH CBCK
CBCP
Hematology - RGH CBCNC
Chem - RGH & PH
Send before 1400 hr - Att'n
Flow Cytometry specimen
must be processed within
24 hr of collection. Keep
at room temperature.
See Carcinoembryonic
Antigen
Includes Gliadine Ab
IgA/IgG and tissue
transglutaminase Ab
See Flow Cytometry
CCURG
CCUPH
Hematology - RGH CD4 + 8
SDCL - Toronto
TAT = 3 weeks
Print Date: June 12, 2015
CDP
25
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
*Ceruloplasmin
(CER)
Blood
Aliquot. Refrigerate.
Transport on ice packs
within 24 hr.
mg/L
SDCL
TAT = 2-3 days
CERUL
1 SST
*CH 50 (will do CH
100)
*CH 100
2 mL
serum.
200-600
SDCL
**Chickenpox
Blood
**Chlamydophila
Blood
pneumoniae IgM and
IgG
1 SST
Replaced with
Complement Activation E
(CAE)
See Varicella Zoster.
3 mL serum IgM and IgG performed
simultaneously on all
specimens.
SDCL
CH100
SDCL
CHLAS
1 mL (BAL) Freeze and ship ASAP to
or
SDCL.
lung biopsy Documentation must
include clinical background
leading to suspicion of
C.pneumoniae in the
patient.
See Psittacosis Serology.
SDCL - Winnipeg
CHLPP
SDCL
CHLOC
SDCL
CHLGC
SDCL
TAT = 3 days
CHLHY
(Anti-Chlamydia
pneumoniae,
C. pneumoniae,
TWAR)
*Chlamydophila
pneumoniae PCR
Bronchioalveolar
lavage
(BAL) or
lung biopsy
*Chlamydophilia
psittaci
*Chlamydia
trachomatis Culture
Blood
*Chlamydia
trachomatis
Urine Chlamydia and
GC (NAAT)
*Chloralhydrate
(Noctec)
(Trichloroethanol)
Sterile
screwcapped
container
Cervical,
Urethral,
Rectal,
Oral,
Eye,
Respiratory
(neonatal)
Urine
Universal
Transport
Medium
APTIMA
Blood
1 Red
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
20 -30 mL
first catch
void uine in
collection
cup
2 mL serum
Using provided disposable
pipette, add 2 mL of urine
specimen to APTIMA tube.
Urine level must be
between black fill lines.
Do not use SST. Record Therapeutic: 9-90
time of collection on tube
(expressed as Trichlorethanol)
and req.
mol/L
Print Date: June 12, 2015
26
Test Name
Specimen Container Volume
*Chloramphenicol
(Chloromycetin)
Blood
1 SST
1 mL serum Collect trough level
specimen before the next
dose is administered.
Collect peak level (postdose) specimen 60-90
minutes after drug
infusion. Submit separate
requisition for both trough
and peak specimen.
*Chlordiazepoxide
(Librium)
Blood
1 Red
2 mL serum Do not use SST
Chloride
Blood
1 SST or
1 Green or
Syringe
with
electrolyte
dry heparin
Chloride
Chloride
Chloride
Chloride
CSF
Fluid
Sweat
Urine
*Chloropropamide
(one of the Sulfonyl
ureas)
*Chlorpromazine
(Largactil)
*Chlorpromazine
*Cholecalciferol
Blood
Blood
Specimen Requirements Reference Range
1 mL serum
or 1.5 mL
whole
blood for
adults or
0.6 mL for
neonates in
a syringe
1 mL CSF No Longer Available
1 mL fluid
No Longer Available
See Sweat Chloride
Random or 10 mL
Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
2 Green
2 mL
Aliquot and freeze
plasma
2 Red
Urine
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
4 mL serum
Units
Testing Site
LIS Code
SDCL – Toronto
CHLAM
CHLOZ
Therapeutic: 2-17
Toxic: >33
mol/L
Serum: 98-110
Whole blood: 98-106
mmol/L
SDCL
TAT: Emerg = 4 hr
Routine = 3
days
Chem - RGH & PH
120-130
None available
mmol/L
mmolL
Chemistry - RGH
Chem - RGH & PH
<14 yr: 50-170
>14 yr: 150-250
mmolL
Chemistry - RGH
CLURA
CL24
SDCL
CHPRO
SDCL
TAT: Emerg = 4 hr
Routine = 3
days
CHLOP
0.1-2.0
mol/L
See Phenothiazines
See Vitamin D 25 Hydroxy
Print Date: June 12, 2015
CL
(Serum)
ABLCL
(whole
blood)
27
Test Name
Specimen Container Volume
Cholesterol
Blood
Cholesterol
Cholinesterase,
Pseudo
(if ordered with
Dibucaine #)
Fluid
Blood
*Cholinesterase,
Pseudo
(no Dibucaine #)
Note: Baseline
specimen
(30-60 days before
the pesticide spray
season) is highly
recommended.
Chorionic
Gonadotropins
*Chromium
Blood
1 SST
1 SST
1 SST
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
mmol/L
Chemistry - RGH
CHOL
mmol/L
Chem - RGH & PH
Special Chem RGH
CHOFL
PSDIN
SDCL
TAT = 2 days
PCHOL
Separate ASAP into
polypropylene tube.
Indicate on requisition that
specimen is lithium
heparin plasma.
SDCL - Toronto
TAT = 3 weeks
CHROM
Record on req. collection
date and 24 hr volume.
SDCL - Toronto
TAT = 3 weeks
1 mL serum
<30 yr: 3.2-4.6
30-65 yr: 3.8-5.2
>65 yr: 4.2-6.2
1 mL fluid
None available
1 mL serum Separate serum as soon
Dibucaine No: 78-89
as possible
Fluoride No: 62-71
Cholinesterase:
Female: 150-330
Male: 200-350
1 mL serum Separate from cells ASAP. 7-19
Refrigerate. Transport ice
packs within 24 hr of
collection.
U/L
U/L
U/mL
See ß-hCG
Blood
3 mL
1 – 7 mL
Royal Blue plasma
EDTA)
BD368381)
*Chromium
Urine
24 hr urine 10 mL
in acidaliquot
washed
container
*Chromogranine-A
Blood
1 EDTA
(Mauve)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL EDTA Freeze
plasma
SDCL – Hospital in CHRGA
Commons
Print Date: June 12, 2015
28
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Chromosome Studies Blood
(Whole Blood)
Collect specimen
Monday to Thursday
mornings only.
Diagnosis must be
stated on req.
1 Green
(Sodium
Heparin,
not
Lithium)
3-4 mL
Keep at room temperature
(adult)
at all times. Must be at
whole
RGH by noon.
blood
heparinized
1-2 mL
(newborn)
Chromosome Studies Bone
(Bone Marrow)
Marrow
Collect specimen
Monday to Thursday
mornings only.
Diagnosis must be
stated on req.
Bone
marrow
put in
RPMI
Bone
Marrow
Transport
Media.
Two
containers
of media
2 - 15 mL
Sterile
falcon
centrifuge
tubes
2 mL bone
marrows
aspirate
Chromosome Studies Amniotic
(Amniocentesis)
Fluid
Collect specimen
Monday to Thursday
mornings only
Chromosome Studies
for Molecular Testing
DNA
Chylomicrons
Citrate
Patient's age is
required. State
collection period.
Blood
Urine
*CJD
CSF
CK (CPK)
Blood
15-20 mL
amniotic
fluid
Units
Testing Site
LIS Code
RGH will send to
BLCHR
Royal Columbian
Hospital, New
Westminster
-New Leukemia
children to Calgary
Lab Services
-JAKS2 and
BCRAB to BC
Cancer Agency
RGH will sent to BC
-Royal Columbia
(Temporarily)
BMCRS
Vancouver, BC
Keep at room temperature.
Must be at RGH by noon.
Keep at room temperature
at all times. Transport the
same day.
Occasionally
BC Cancer
BMCHR
RGH will send to
Royal Columbian
Hospital, New
Westminster
AMCHR
See Molecular testing
1 SST
24 hr urine 10 mL
aliquot of
24 hr urine
mmol/d
SDCL to U of A
CITRU
1 SST
U/L
Chem - RGH & PH
CKS
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen to Chemistry
Refrigerate during
Lower limit of normal at age 20 is
collection. Send frozen.
0.78 and increases at rate of 0.037
Record 24 hr volume.(If
for each year
collected with oxalate send
sep req and specimen.)
See Creutzfeld Jakob
Disease.
1 mL serum
Male: 55-170
Female: 30-135
Print Date: June 12, 2015
29
Test Name
Specimen Container Volume
CK-MB Screen
CK-MB Mass
Blood
(Total CK available
only – not MB)
*Clobazam (Frisium) Blood
Includes N-desmethyl
clobazam
*Clomipramine
Blood
(Anafranil)
Units
Testing Site
LIS Code
Chemistry - RGH
MASS
nmol/L
SDCL
TAT = 3 days
CLOBA
nmol/L
SDCL
TAT: Emerg = 4 hr
CLOMI
nmol/L
SDCL
TAT = 3 days
CLONZ
nmol/L
SDCL
CLOZA
No longer available
MB and MBRI
NO LONGER AVAILABLE
2 Red
4 mL serum
2 Red
4 mL serum Do not use SST. Record
time of collection on tube
and req.
4 mL serum Do not use SST. Record
or 4 mL
time of collection on tube
plasma
and req.
4 mL serum Do not use SST. Record Therapeutic: 300-2100
or 4 mL
time of collection on tube
Toxic: >4000
plasma
and req.
No longer available
ORDER: CMV Viral Load
Whole
blood
1 mL
Freeze and ship ASAP to
SDCL
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
*Clonazepam
(Rivotril)
Blood
2 Red or
2 Green
*Clozaril (Clozapine)
Blood
2 Red or
2 Green
*CMV - Antigenemia
*CMV - Buffy Coat
Blood
2 Mauve
*CMV – CSF
PCR
**CMV IgM
Cytomegalovirus IgM
Serology
* *CMV IgG
Cytomegalovirus IgG
Serology
*CMV
Urine CMV Isolation
or Detection
*CMV – Viral Load
CSF
Blood
Sterile
container
1 SST
Blood
1 SST
Urine
Sterile
urine
container
1 Mauve
Blood
Specimen Requirements Reference Range
Clobazam: 150-1000
N-desmethylclobazam: 280014000
16-630 (up to 1500 for nonresponders)
Toxic: >1700
Therapeutic: 60-220
Toxic: >230
CMV/A
SDCL
CMV/B
SDCL to RUH,
Saskatoon
SDCL
CMV/C
CMVMS
2 mL serum Convalescent
(Immune status)
SDCL
CMVIS
20 mL urine
(random)
SDCL
CMV/U
Whole
blood
SDCL- Saskatoon
CMVVL
SDCL - Toronto
COBAL
Ship on Ice. Collect in AM
and must be at SDCL by
(CMV PCR)
noon Monday – Thursday.
If unable to reach SDCL by
noon aliquot plasma and
refrigerate. Notify referral
desk: 787-3131.
*Cobalt
Urine
Random or 10 mL urine Wash container with
24 hr urine
500 mL of a 10% sol'n of
Provide collection
container
nitric acid. Rinse the
date and DOB
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
30
Test Name
Specimen Container Volume
*Cocaine
Urine
*Coccidioidomycosis
Serology
*Codeine
*Codeine
Cold Agglutinins
Blood
Blood
Urine
Blood
acidwashed
Random.
Tightly
sealed
container
1 SST
1 Red
Random
1 Mauve +
1 Red
clotted at
37º C
Specimen Requirements Reference Range
container twice with
deionized water.
20 mL urine Blood unsuitable.
Refrigerate.
Units
Negative
3 mL serum
50 mL urine
3 mL whole Centrifuge and separate
blood and 4 serum. Label tubes with
mL serum first and last name, MRN
or HSN and DOB.
See CAE
*Complement
Activation E
Complete Blood
Count
Coombs
Blood
1 Mauve
Congentin
*Copper (Plasma)
Blood
Blood
2 Red
4 mL serum
2 mL EDTA Separate ASAP into
1 – 7 mL
polypropylene tube.
Royal Blue plasma
Indicate on requisition that
EDTA)
BD368381
specimen is EDTA plasma.
DO NOT FREEZE
*Copper (Urine)
Urine
24 hr or
random
urine in
acidwashed
container
Testing Site
LIS Code
SDCL
TAT = 2 days
COCAI
SDCL - Edmonton
TAT = 3 weeks
SDCL
SDCL
Transfusions - RGH
COCCS
CODS
CODU
*COLA
See CBC
Coproporphyrin
*Cordarone
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Label tubes with first and
last name, MRN or HSN
and DOB
7 mL of 24
hr or
random
urine in
acidwashed
container
Send in polypropylene
container. Record 24 hr
volume if submitted or
random urine and
collection date on req.
Negative
0-3 m: 1.4-7.2
3-6 m: 3.9-17.3
6-12 m: 7.9-20.1
1-13 yr: 12.6-19.0
13-Adult (Female): 9-27
13-Adult (Male): 11-22
Transfusions - RGH *DANT
mol/L
SDCL
SDCL
TAT = 2 weeks
CONGE
COPS
SDCL - Toronto
TAT = 3 weeks
COPU
See Porphyrins
See Amodarone
Print Date: June 12, 2015
31
Test Name
Specimen Container Volume
*Core Antigen
Correction Studies
Blood
*Corticosteroids
Blood
1 SST or
1 Green
*Cortisol (Saliva)
Saliva
*Cortisol (Serum)
Blood
*Cortisol Urine Free
Urine
Doctor’s office must
contact SDCL 787-3197
for collection kit and
instructions
1 SST
1 mL serum Critical - record time of
collection.
(250 L –
neonates) Cannot be capillary
specimen.
24 hr urine 10 mL of 24 Record volume
hr urine
1 SST
*C-Peptide (must be
fasting)
Testing Site
LIS Code
SDCL
HEBCO
SDCL
COSTE
SDCL
CORSA
(AM) 0800 h: 138-690
nmol/L
(PM) 1600 h: approximately half of
AM values
SDCL
TAT = 3 days
CORTR
Adult: 25-146
nmol/d
SDCL
TAT = 7 days
CORTU
298-1324
pmol/L
SDCL
TAT = 7 days
CPEP
Chemistry - RGH
CRPA
Chemistry - RGH
CRPHS
See Bleeding Disorder
Investigation (BLDWS)
2 mL serum
or plasma
See ACTH Stimulation
Blood
Blood
See Rickettsial Serology.
**C. pneumoniae
Blood
C-Reactive Protein
(CRP)
Blood
1 SST
1 mL serum Avoid hemolysis. Note
fasting sample on req.
Freeze within 2-3 hrs of
collection. Submit as
separate samples.
See Chlamydophilia
pneumoniae IgM and IgG.
1 mL
CRP (high sensitivity) Blood
1 SST
1 mL serum
Creamatocrit
Units
1 mL serum
CosyntropinStim.
*Coxiella burnetii
Specimen Requirements Reference Range
1 SST
Milk
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL
No Longer Available
human milk
CRP Reference Range
mg/L
0 - 8 mg/L
>10 mg/L -infection or inflammation
hsCRP - Risk of cardiovascular
mg/L
disease:
Low risk - < 1.0 mg/L
Average risk - 1.0 - 3.0 mg/L
High risk - >3.0 mg/L
Special Chem RGH
Print Date: June 12, 2015
32
Test Name
Creatine Kinase
Creatinine
Creatinine
Creatinine
State collection
period
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
mol/L
Chem- RGH & PH
CREAT
mol/L
mmol/d
Chem - RGH & PH CREFL
Chem – RGH & PH CRURA
(random)
CRE24
(24 hr)
Chem - RGH & PH CC24C
See CK
Blood
1 SST
Fluid
Urine
1 mL fluid
Random or 2 mL urine
24 hr urine
Creatinine Clearance Urine and
Blood
(State patient's
height (cm) & weight
(kg) and collection
period)
1 ml serum
24 hr urine 10 mL of
and 1 SST 24 hr urine
and 1 mL
serum
*Creutzfeld Jakob
CSF
Disease
CSF Creutzfeld Jakob
Disease
(BSE, CJD)
Cross Match
Blood
(Requires diagnosis
and reason for
transfusion)
Sterile leak 2 - 3 mL
proof tube
Cryofibrinogen
Blood
2 Blue
Cryoglobulin
Blood
1 Red
2 Mauve
Adult: 60-130
Pediatric Ranges:
0 – 5 yrs 20-60
6 – 12 yrs 30-70
13 – 14 yrs 40-85
None available
Record 24 hr urine volume 24 hr: 7.1-18.0
Record 24 hr urine
volume. Needs a serum
specimen, patient's height
in cm and weight in kg.
Rural sites: Send aliquot
frozen.
Freeze CSF ASAP.
If specimen thaws, it is
unsuitable for analysis.
Needs a Typenex # on
out-patient. Requires
patient armband (full
name, Typenex # or MRN
and DOB). Label tubes
with full name, DOB and
MRN or PHN and
Typenex#.
5 mL
Collect and keep at 37º C
plasma
until spun
2 mL serum RGH and PAS - Collect
and keep at 37º C, clot in
37º C waterbath.
Children(<14yrs)
40-108 mL/min /1.73m2
mL/min
(corrected)
CC24A
(actual)
Male: 84-125 mL/min /1.73m2
Female: 76 -114 mL/min/1.73m2
SDCL - Winnipeg
CJDC
Transfusions - RGH *GSM
Immunology - RGH CRYOF
Immunology - RGH CRYGL
GDML and Rural labs –
Clot at 37º C, send serum
to RGH ASAP
Cryptococcal Antigen Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
0.5 mL
MICRO - RGH
Print Date: June 12, 2015
CRYPB
33
Test Name
*Cryptococcal
Antigen
CSF Cell Count
CSF Cell Count for
Cancer Clinic
Specimen Container Volume
CSF
CSF
1 sterile
tube
1 sterile
tube
serum
0.5 mL
CSF
1 mL CSF
CSF
1 sterile
tube
1 mL CSF
*Cyanide
Blood
1 Mauve
*Cyclic AMP
Provisional
diagnosis for
interpretation
required. Fasting
overnight.
*Cyclobenzapine
Cyclosporine
Blood &
Urine
1 Mauve
(full) and
Random
urine
Blood
Blood
1 Red
1 Mauve
3 mL whole
blood
2 mL
plasma
EDTA and
10 mL
random
fresh urine
2 mL serum
2mL whole
blood
Culture & Sensitivity
*Cutaneous
Immunofluorescence
Antibodies
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Units
Requires 0.5 mL
Specimen must be in lab
within a half hour from the
time of collection. If
sharing same tube, cell
count should be done first.
Specimen must be in lab
within a half hour from the
time of collection. If
sharing same tube, cell
count should.
be done first.
See Micro Section
See Anti-Skin Ab
LIS Code
Microbiology - RGH CRYPC
WBC: (Adults) 0-5
WBC: (Neonates) 0-30
RBC: 0
X 106/L
Hem - RGH & PH
FLCSF
WBC: (Adults) 0-5
WBC: (Neonates) 0-30
RBC: 0
X 106/L
Hem - RGH & PH
ABCSF
Normal: <0.2
Toxic: 2.0
g/mL
SDCL - Mayo Labs CYAN
Acidify urine with a few
drops of 6N HCL. Freeze
specimens and send on
dry ice.
Collect prior to AM dose
Testing Site
Ranges:
Introduction phase up to 3 months
post transplant:
Kidney 150-225 g/L
Liver 225-300 g/L
Heart 250-350 g/L
Maintenance after 3 months post
transplant:
Kidney 100-150 g/L
Liver 100-150 g/L
Heart 125-175 g/L
g/L
SDCL - Hamilton
CAMPS
(serum)
CAMPU
(urine)
SDCL
Chemistry - RGH
CYCLB
CYCLO
Print Date: June 12, 2015
34
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Cystic Fibrosis DNA
Analysis
Check out
Blood
2 Mauve
(adult)
1 Mauve
(child)
*Cysticercosis
Serology
Cystine
Blood
1 SST
Blood
1 Green
2 mL
plasma
Aliquot & freeze
*Cystine
Urine
Random
Urine
Container
5 mL
Freeze
**Cytomegalovirus
IgM Serology
(CMV IgM)
**Cytomegalovirus
IgG Serology
(CMV IgG)
*Cytomegalovirus
Blood
1 SST
Blood
1 SST
10 mL
(adult)
whole
blood
5 mL (child)
whole
blood
3 mL serum
Testing Site
LIS Code
Keep at room temperature
at all times. Must be at
RGH by noon.
Variety of places
DNACF
Aliquot.
SDCL - Edmonton
TAT = 4 weeks
SDCL- Saskatoon
TAT = 1 week
CYSTI
CYSTP
SDCL- Saskatoon
TAT = 1 week
CYSTU
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
SDCL
CMVMS
2 mL serum Convalescent
(Immune status)
SDCL
CMVIS
SDCL
CMV/U
Transfusions RGH
Saskatoon
SDCL
SESTD
Blood
See CMV.
*Cytomegalovirus
Urine
Urine CMV Isolation
or Detection
*Cytotoxic Antibodies Blood
Sterile
20 mL urine
urine
(random)
container
1 Red (full) 10 mL
blood
*Dalmane
(Flurazepam)
*Darvon
D-Dimer
Blood
2 Red
4 mL serum
Blood
Blood
2 Red
1 Blue
(full)
4 mL serum
1 mL
Can use same tube as PT <500
plasma
and APTT.
Must be Double-spun and
sent frozen if referred in.
1 mL serum Centrifuge immediately,
or plasma protect from light. Freeze.
*7-dehydrocholesterol Blood
(Smith-Lemli-Opitz
Screen)
Units
1 Red or
1 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
g/mL
FLURA
SDCL
DARVO
Hematology - RGH DDIM
SDCL - Toronto
Print Date: June 12, 2015
7DHYC
35
Test Name
Specimen Container Volume
*Dehydroepiandrosterone
Blood
1 SST
1 mL serum
(DHEA-S)
*Demoral
*Dengue Fever
Serology
Blood
Blood
1 Red
1 SST
3 mL serum
2 mL serum
*11 Deoxycortisol
Blood
1 SST or
1 EDTA
*11
Deoxycorticosterone
Blood
1SST or
1 RED
1 mL serum Specimen must be frozen
or plasma
Frozen
1 mL serum Specimen must be frozen
Frozen
*Depakane (Valproic
Acid)
Blood
*Desipramine
(Norpramin)
Blood
*Desmythylcolbazam
*Desyrel (Trazodone) Blood
*Dexamethasone
Suppression Test
(DST)
*DHEA-SO4
(DHEAS)
Specimen Requirements Reference Range
Female: 0.9-12.0
Male: 2.2-15.0
Units
Testing Site
LIS Code
g/mL
SDCL
TAT = 3 days
DHEAS
SDCL
SDCL to National
Micro Lab,
Winnipeg
SDCL - Hamilton
DEMER
DENFS
11DEO
SDCL- Mayo Clinic 11DCS
See Valproic Acid
2 Red
4 mL serum Do not use SST. Record
time of collection on tube
and req.
Minimum: 150-470
Maximum: 600-1100
Toxic: >1700
nmol/L
SDCL
DESI
TAT: Emerg = 4 hr
Routine = 3
days
See Clobazam
2 Red
4 mL serum
SDCL
TRAZO
See Lab Service Manual
for instructions
*Diazepam (Valium)
Blood
2 Red
Dibucaine Number
*Digitoxin
Blood
1 Red
See
Dehydroepiandrosterone
Sulfate
4 mL serum Do not use SST. Record
time of collection on tube
Therapeutic: 350-900
Toxic: >3500
nmol/L
SDCL
DIAZ
TAT: Emerg = 4 hr
Routine = 3
days
See Cholinesterase
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum
SDCL
Print Date: June 12, 2015
DITOX
36
Test Name
Specimen Container Volume
Digoxin (Digitalis)
Blood
Collect 0-1 hr before
next dose; no earlier
than 6 hr after last
dose.
See TDM section for
ideal sampling times
*1,25 Dihydroxy
Vitamin D
Dilantin (Phenytoin)
Blood
1 EDTA if
sending to
RGH
Or
1 SST for
ANHH
*Dilantin - Free
1 Red
*Diltiazem
Dilute Russell Viper
Venom Time
(DRVVT)
*Diphenhydramine
(Gravol)
*Diphenylhydantoin
*Diphtheria Antitoxin
Direct Antiglobulin
Test
(DAT/Coombs)
Direct
Immunofluorescence
Blood
Blood
Blood
Specimen Requirements Reference Range
1 mL
plasma
Therapeutic & potentially toxic:
2.6-3.2
Therapeutic: 1.0-2.6
Therapeutic & potentially
suboptimal:
0.6-1.9
N.B. Potassium status may
modify Digoxin Toxicity
Or
1 mL serum
Units
Testing Site
nmol/L
Chem – RGH & PH DIG
Chem - ANHH
See Vitamin D1,25
Dihydroxy
See Phenytoin
2 mL serum Do not collect in SST.
Freeze.
SDCL
See Cardizem
Test is part of LUPWS, see
LUPWS
3 Blue
(full) and 1
Red
2 Red
4 mL serum Do not use SST. Record
time of collection on tube
and req.
Blood
1 Red
Blood
1 Mauve
Therapeutic: 40-430
Toxic: >2000
nmol/L
See Dilantin
2 mL serum Aliquot serum.
Capital Health Requisiton
Label tube with first and
last name, HSN or MRN
FRPTN
Special Coag Hem
- RGH
Negative
Tissue
biopsies
*Disopyramide
Blood
(Rhythmadon)
Collect immediately
before nest oral
dose for trough
concentration. Peak
occurs 2-3 hr after
last dose
LIS Code
SDCL
DIPH
TAT: Emerg = 4 hr
Routine = 3
days
SDCL- Edmonton
TAT = 3 weeks
DIPAT
Transfusions RGH
*DANT
Histology - PH
2 Red or
3 mL serum Do not use SST
2 Green or or 3 mL
2 Mauve
plasma
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Venous: 9-15
Arterial: 8.2-9.4
mol/L
SDCL
TAT = 1 day
Print Date: June 12, 2015
DISOP
37
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
D-Lactate
Add DNA testing
Blood
1 Grey
1 mL
fluoride
plasma
Separate immediately.
Freeze.
DNA Analysis for CF
*Note: Call
Supervisor,
Accession
(4495) or
Asst Mgr,
Lab
Support
Services
(4465)
2 Mauve
(adult)
1 Mauve
(child)
10 mL
Keep at room temperature
(adult)
at all times. Must be at
whole
RGH by noon.
blood
5 mL (child)
whole
blood
Blood
1 SST
0.5 mL
serum
*DNASE-B (Anti)
*DNASE Titre
24 hr urine 10 mL of 24 Adjust pH to <2 with HCL.
hr urine
State volume and
collection date.
2 Red
3 mL serum
2,3 DPG
Blood
(Diphosphoglycerate)
*Drug Screen
Blood
Drugs to screen for
must be listed
individually.
*Drug Screen
Urine
NO LONGER AVAILABLE
4 mL serum Do not use SST. Record
or 4 mL
time of collection on tube
plasma
req.
Testing Site
LIS Code
SDCL - Hamilton
DLACS
(serum)
DLACU
(urine)
RGH will send to
DNACF
BC
Children's Hospital,
Vancouver
No Longer Available
14 days refrigerated or can
be frozen.
*Dopamine
Urine
State collection
period
*Doriden
Blood
(Glutethimide)
*Doxepine (Sinequan) Blood
2 Red or
2 Green
Units
Therapeutic:
Lower level 300-500
Maximum 800-1000
Toxic: >1700
nmol/L
SDCL to MAYO
ABDNS
SDCL - Toronto
DOPA
SDCL
DORID
SDCL
DOX
TAT: Emerg = 4 hr
Routine = 3
days
2 Red
5 mL serum
SDCL
DRUGS
Random
2-5 mL
Street drugs screened.
aliquots in See SDCL compendium
plastic
for list of drugs included.
tubes(12x7.
5mL) at
time of
collection.
If not
SDCL
DRUGU
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
38
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL - Montreal
TAT = 4 weeks
SDCL
TAT = 3 days
ECHIN
aliquotted
send
source
container.
D'Xylose
E2
*Eastern Equine
Encephalitis
**EBV
Blood
CSF
Blood
CSF
Blood
See Xylose
See Estradiol
See Encephalitis (Viral).
See Epstein-Barr Virus.
*Echinococcosis
Serology
*Effexor (Venlafaxine) Blood
1 SST
3 mL serum Aliquot.
2 Red
4 mL serum Do not use SST. Record
time of collection on tube
and req.
*Ehrlichia Serology
Blood
1 SST
2 ml serum
*Elavil (Amitriptyline)
Electrolytes (Na, K,
Cl, CO2)
Blood
Blood
2 Red
1 SST or
1 Green if
STAT
Electrolytes (Na & K)
Breast Milk Sterile
Container
5 mL serum
1.5 mL
serum or
1.5 mL
plasma
5 mL breast
milk
Electrolytes (Na & K)
Not performed on
formed stools
Feces
Stool
Container
Electrolytes (Na & K)
Electrolytes (Na & K)
Fluid
Urine
nmol/L
EFFEX
SDCL – Winnipeg ERHLS
TAT = 4 weeks
SDCL
Chem – RGH & PH HLYTE
(hospital)
PLYTE
Use Green if STAT or
patient does not clot
(Hemodialysis or OHS)
See individual tests
NOT AVAILABLE
None available
Chem - RGH & PH LYBRM
1 g feces
NOT AVAILABLE
None available
NOT AVAILABLE
1 mL fluid
Random or 100 mL
24 hr
urine
NOT AVAILABLE
None available
See individual tests for reference
ranges of 24 hr urine. None
available or random urine.
Chem - RGH & PH LYFLD
Chem - RGH & PH LYTUR
(random)
LYT24
(24 hr)
Electrophoresis
*Encephalitis
(Bacterial) – Blood
PCR
Therapeutic: 250-900
(community)
LYFEC
See specific test (I.e.
protein, hemoglobin)
Blood
1 Mauve
2 mL EDTA Refrigerate specimen. Do
whole
not freeze. Ship on ice
blood
pack.
SDCL
(Hemophilus influenzae,
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
BANTS
39
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
2 mL EDTA Separate ASAP and freeze
plasma
plasma. Ship on ice.
Plasma must be received
frozen.
Sterile leak 1 ml CSF
Freeze CSF ASAP.
proof tube.
If specimen thaws, it is
unsuitable for analysis.
SDCL – Winnipeg
ENCAS
SDCL – Winnipeg
ENCCF
1 SST
SDCL - Toronto
ABEND
Neisseria meningitidis,
Strept pneumoniae)
*Encephalitis (Viral) – Blood
Plasma PCR
(Eastern Equine,
Japanese Encephalitis)
*Encephalitis (Viral)
CSF Encephalitis
(Viral) PCR
CSF
1 Mauve
(Eastern Equine,
Japanese Encephalitis)
*Endomysial
Antibodies
(Anti-Glutenial Ab)
*Entamoeba
**Enterovirus
Serology
Eosinophils (urine)
*Epinephrine
*Epival (Valproic
Acid)
**Epstein-Barr Virus
IgM Serology
Blood
1 mL serum Keep specimen cool.
Send on ice packs.
Blood
See Amoebiasis
(Entamoeba) Serology.
No longer available.
Blood
Urine
Random
urine
ENTAS
10 mL
Hematology – RGH UREOS
See Catecholamines
See Valproic Acid)
SDCL
EPIN
Blood
1 SST
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
SDCL
EBVMS
Blood
1 SST
1 mL serum Convalescent
(Immune status)
SDCL-Saskatoon
EBVGS
CSF
Sterile leak 1 mL CSF
proof tube
SDCL
EBVC
(EBV IgM, Viral Capsid
Antigen)
**Epstein-Barr Virus
IgG Serology
(EBV IgG)
*Epstein-Barr
CSF Epstein-Barr
Virus PCR
Erythrocyte
Protoporphyrin
*Erythropoietin
(Eprex) (EPO)
Recommend
collection time 07301200 hr
ESR
Blood
1 SST or
1 Green
Blood
1 Mauve
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Freeze CSF ASAP. If
specimen thaws, it is
unsuitable for analysis.
NO LONGER AVAILABLE.
See Zinc Protoprophyrin
2 mL serum Separate from cells and
or plasma freeze ASAP. Avoid
hemolysis.
3 mL whole
SDCL
SDCL - Toronto
TAT = 3 weeks
0-20
mm/hr
Hem - RGH & PH
Print Date: June 12, 2015
ERYTH
ESR
40
Test Name
Specimen Container Volume
blood
1 mL serum Refrigerate and keep cool. Female:
assay must be done within
Follicular phase: <977
48 hr.
Mid-cycle: 433-1303
Luteal phase: 95-606
Post-menopausal: <110
Male: <205
1 mL serum
Estradiol
Blood
1 SST
*Estriole - Free
(Unconjugated)
*Esterone
Ethanol
Blood
1 SST
Blood
Blood
1 SST
1 mL serum
1Gray or
1 Green or
1 SST
Random
20 mL urine
urine
1 Red
2 mL serum
*Ethanol (Ethyl
Alcohol)
Ethchlorvynol
(Placidyl)
*Ethosuximide
(Zarontin)
Collect 0-1 hr before
dose
See TDM section for
ideal sampling times
Ethyl Alcohol
Urine
Blood
Refrigerate. Send in
tightly sealed container.
1 Red or
1 mL serum Do not use SST
1 Green or or 1 mL
1 Mauve
plasma
Blood
1 Gray
1 Green or
1 SST
1 Grey or 3 mL whole
1 Red
blood
0.5 mL
serum
1 Blue
(full)
Blood
Euglobulin Lysis
Blood
Exposure: INHOUSE
Source of Exposure
Blood
1SST
Exposed Person
Blood
2 SST &
1EDTA
1 EDTA &
2 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Testing Site
LIS Code
pmol/L
Chemistry - RGH
ESTRA
SDCL – Toronto
FREST
TAT = 2 weeks
SDCL - Hamilton
ESTRO
Chemi - RGH & PH ALC
Aliquot and freeze
Do not open tube
Blood
*Ethylene Glycol
Exposure:ASSAULT
Specimen Requirements Reference Range
Negative
Therapeutic: 283-708
Toxic: >708
mol/L
Do not open tube
Keep tube stoppered
Normal negative
Record time and date of
Panic value: >4
collection on tube and req.
Extra information
If this Exposure is due to an
depending on if staff or
assault please see the following
public must be included on ASSAULT Exposure.
the requisition (Ward to
complete)eg. copies
If Pediatric Assault order
EXPOS with a VDRL
SDCL
TAT = 2 days
SDCL
TAT = 3 days
SDCL
TAT = 1 day
URALC
ETHVY
ETHOL
Chem - RGH & PH ALC
mmol/L
SDCL
ETHGL
TAT: Emerg = 2 hr
Routine = 1
day
Hematology - RGH EUGLO
RGH
RGH
Print Date: June 12, 2015
SORCE
(source)
EXPOS
(exposed
person)
ASSLT
41
Test Name
Specimen Container Volume
Exposure: RURAL
Source of Exposure
Exposed Person
Blood
Factor Assays
Blood
3 Blue
(full)
Factor V Leiden
Blood
1 Mauve
(full)
Factor VIII Related
Antigen
Blood
3 Blue
(full)
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
RGH-Chemistry
RUSOR
(source)
RUEXP
exposed
BLDWS
1 SST (for
either)
*Farmer’s Lung
Blood
Fat Content of Breast
Milk
Fat in Feces
Feces
6 mL
citrated
plasma
4.5 mL
whole
blood
EDTA
6 mL
citrated
plasma
Test is part of BLDWS
(see BLDWS)
Special Coag
Hematology - RGH
See Hypercoag
Special Coag
HCOAG
Hematology - RGH
?
Saskatoon
Special Coag
Hematology - RGH
Test is part of BLDWS
(see BLDWS)
See Aspergillus Serology.
See Creamatocrit
Containers
available
from SDCL
only.
No longer available at
RGH.
Sent out by SDCL with
prior approval from Dr.
Lehotay.
FCFAT
*Fatty Acids (Free
Fatty Acids)
Collect Fasting
*Fatty Acids (Very
Long Chain)
Blood
1 SST
1 mL serum Freeze serum
SDCL
FFA
Blood
2 Red or
2 Mauve
SDCL- Saskatoon
FALC
*Fecal Elastase
*Feldene
*FEP (Free
Erythrocyte
Protoporphyrin)
*Fenoprofen (Nalfon)
Ferritin
Stool
Blood
Blood
1 Red
1 Mauve
(full)
2 mL serum Send frozen - 2 mL
or plasma minimum
(Neonate - 0.5 mL
minimum)
5g
Frozen
2 mL serum
5 mL whole Keep in dark. Do not spin.
blood
SDCL – Calgary
SDCL
SDCL
FELAS
FELDE
TEP
1 Red
1 SST
2 mL serum
1 mL serum
SDCL
Chemistry - RGH
FENOP
FER
Blood
Blood
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
0m-12 m: 9 - 72
1 yr – 5 yr: 3 – 127
6 yr – 10 yr: 9 – 185
11 yr – 14 yr: 6 – 216
g/L
Print Date: June 12, 2015
42
Test Name
Specimen Container Volume
Fetal Hemoglobin
Blood
Fetal Lung Maturity
Amniotic
Fluid
Fibrinogen
Anticoagulant status
must be provided on
req.
Blood
Fibrinogen
Degradation
Products
*Fifth Disease
*Filariasis Serology
1 Mauve
Specimen Requirements Reference Range
15 yr – 20 yr: 5 – 207
> 20 yr Female: 10-200
> 20 yr Male: 30-300
<1 m: 55-85
1 m-6 m: 0-30
6 m-12 m: 0-20
12 m-18 m: 0-10
18 m-5 yr: 0-3
>5 yr: 0-1
3 mL whole
blood
Units
Testing Site
LIS Code
%
Special Chem RGH
HBF
g/L
Hem - RGH & PH
FIB
SDCL – Montreal
TAT = 4 weeks
FILAR
SDCL - May Lab
FLECA
See Lamellar Body Count
1 Blue
(full)
1 mL
citrated
plasma
Can be same tube if PT
and APTT are ordered
2-4
3.5-4.5 (maternity patients)
Rural labs: doublespin and
freeze if specimen not at
RGH within 4 hrs.
Order D-Dimer instead
Blood
Blood
FK506
Flecainide
Blood
(Tambocor)
Collect 0-1 hr before
dose for trough.
Peak occurs 2-3 hr
after last dose.
1 SST
2 Red or
2 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Parvovirus B19.
3 mL serum Aliquot.
See Tacrolimus
3 mL serum Separate from cells within Toxic: >1
or plasma 2 hr of collection. Send on
ice packs or frozen.
g/mL
Print Date: June 12, 2015
43
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Flow Cytometry
(CBC must be done
with test)
Blood,
Bone
Marrow,
Tissue,
Body Fluid,
FNA
Test done Monday-Friday.
Specimen must be
received within 24 hr and
processed within 48 hr.
Keep blood and bone
marrow specimens at room
temperature. Tissue, FNA
and body fluids must be
refrigerated.
Flow Cytometry for
PNH
Blood
Blood and
Bone
Marrow
(sodium
heparin)
Tissue,
FNA and
Body
Fluids
(RPMI
media)
1 full ACD
(yellow)
tube
10 mL ACD Store and transport at
whole
room temp (18-22 ◦C)
blood
Collect Monday-Thursday
mornings only.
1.8 mL
Must be at RGH lab by
Sodium
noon.
Citrate for Specimen must be sent
Newborns out the same day as
collection
Flow Cytometry
FNA, Blody Do not add
RPMI media (RGH – flow
fridge, PH – cyto fridge)
(Saskatoon)
Fluid,
formalin.
Deliver to
(CBC must be done Tissue
lab immedwith test)
iately
(RGH/PH)
to be
placed in
RPMI
media
*FLU Test for Severe NasoUniversal
Specimen must be
Respiratory Illness
pharyngeal Transport
accompanied with RQHR
,
Medium
Microbiology Requisition
Aspirate,
and/or Severe Respiratory
Washings
Illness and Pandemic
Influenza Requisition.
*Fluoxetine (Prozac) Blood
2 Red
4 mL serum Do not use SST. Record Therapeutic: 16-1600
time of collection on tube
and req.
*Fluconazole (AntiBlood
1 SST or
2 mL serum Frozen
fungal drug)
RED
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Testing Site
LIS Code
Hematology - RGH FLOWG
nmol/L
RGH to Calgary
PNHRF
Saskatoon (RUH)
(CBC done in
Hematology)
FLOWC
SDCL
FLU-R
SDCL
TAT = 3 days
FLUOX
SDCL to Edmonton FLUCZ
Print Date: June 12, 2015
44
Test Name
*Fluphenazine
(Moditen)
*Flurazepam
(Dalmane)
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
nmol/L
SDCL
TAT = 3 days
FLURA
See Phenothiazines
Blood
2 Red
4 mL serum Do not use SST. Record
time of collection on tube
and req.
*Fluoride
Blood
2 mL serum Draw blood into vacutainer
and then remove rubber
stopper immediately.
Aliquot with plastic pipette
SDCL - California
FLUOR
*Fluoride
Urine
1 Red
Avoid
contact
with
rubber
stopper
Random
SDCL - California
FLUOU
*Flucytosine
Blood
20 mL urine Do not collect in glass
container
1 mL serum
or plasma
SDCL - Toronto
FLUCY
*Fluvoxamine
Folic Acid, Red Cell
Blood
Folic Acid and
Blood
Vitamin B12
NOTE: RBC folate
done. If either B12 or
RBC folate is
decreased, serum
folate is done.
Follicle Stimulating
Hormone
*Follitropin
Fragile X
Blood
Chromosome
1 Red or
1 Green
See Luvox
1 Mauve
1 mL whole Needs hematocrit run in
blood
Hematology first
1 SST and 1 mL serum Give EDTA tube to
1 Mauve
& 1 mL
Hematology first. Needs
whole
to have hematocrit run.
blood
Therapeutic: 250-640
408.6-1389.8
nmol/L
Chemistry - RGH
RCFOL
RBC folate: 408.6-1389.8
Serum folate: 7.9-36.6
B12:
Deficient: <116
Borderline: 116-138
Normal: 138-781
nmol/L
Chemistry - RGH
B12FO
BC Children's
Hospital,
Vancouver
FRAGX
pmol/L
See FSH
**Francisella Acute
Serology
(Tularemia)
Blood
2 Mauve
and
2 Green
(Na
Heparin)
1 SST
**Francisella Conval
Serology
(Tularemia)
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See FSH
Keep at room temperature.
Collect Monday through
Thursday. Specimen
must be at RGH by noon.
Whole
blood (do
not spin)
3 mL serum Submit acute and
convalscent sera for
diagnosis.
SDCL – Winnipeg
TAT = 4 weeks
FRAAS
3 mL serum Submit acute and
convalscent sera for
diagnosis.
SDCL – Winnipeg
TAT = 4 weeks
FRACS
Print Date: June 12, 2015
45
Test Name
Specimen Container Volume
*Free Androgen Index Blood
(Calculated from sex
hormone, binding
globulin and total
testosterone assays)
1 SST
*Free Carnitine
Blood
1 SST or
1 Green
*Free Cortisol
Urine
*Free Iron (Nontransferrin bound)
Blood
Free Light Chains
(Kappa, Lambda)
Blood
Free Light Chains
(Kappa, Lambda)
Urine
Free PSA
Done if PSA >4 and
</=10
*Free-T3
*Free-T4
*Free Testosterone
*Frisium (Clobazam)
*Fructosamine
Fructose in Semen
Specimen Requirements Reference Range
1 mL serum
1 mL serum
or 1 mL
plasma
24 hr Urine 10 mL of 24
hr urine
collection
1 Red
1 SST
collected,
remove
serum from
cells ASAP
1 SST
2 mL serum
Avoid hemolysis.
Separate from cells.
Freeze. Send on dry ice.
Record volume.
Refrigerate.
Replaces Free Testosterone
Male: 14.8-94.8
Female:
Normal cycling: 0-8.5
Oral contraceptives: 0-3.4
Postmenopausal (untreated): 06.6
Hirsute: 1.7-20.6
Adult: 18-63
<12 yr: 16-51
Adult: 25-146
Free Kappa:3.3-19.4
Free Lambda:5.7-26.3
Ratio: 0.26-1.65
Units
Testing Site
LIS Code
SDCL
TAT = 5 days
FAI
mol/L
SDCL
TAT = 10 days
CARNS
nmol/d
SDCL
TAT = 7 days
CORTU
SDCL
FREFE
Immunology-RGH
FRLCI
mg/L
Immunology-RGH
NO LONGER AVAILABLE
DO NOT ORDER
Blood
Blood
Blood
Blood
1 SST
1 SST
2 mL serum
2 mL serum
2.6-5.7
9-19
pmol/L
pmol/L
Chemistry - RGH
Chemistry - RGH
See Testosterone
2 Red
Semen
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
3 ml serum
1 mL
semen
SDCL
See Glycosylated Proteinj
UNAVAILABLE
Special Chem RGH
Print Date: June 12, 2015
FRT3
FRT4
FTEST
CLOBA
FRUCT
46
Test Name
Specimen Container Volume
FSH
Blood
1 SST
*FTI (Free Thyroxine
Index)
*Fungal Serology
Blood
*Gabapentin
*Galactomannin
Galactose
Blood
Blood
Galactose
Urine
Random
Galactose-1Phosphate
Blood
1 Sodium
Heparin
Galactose-1Phosphate
Uridyl Transferase
(GAL-PUT)
Gamma Glutamyl
Transferase (GGT)
Gamma Hydroxy
Butyric Acid
Gamma Hydroxy
Butyric Acid
*Gastric Antibody
Blood
1 EDTA
Blood
1 Red or
1 Green
1 mL serum Keep cool. Do not freeze.
Calculation from free T4
and TBG
Must indicate requested
test on requisition. See:
Aspergillus
Blastomycosis
Coccidioidomycosis
Cryptococcal Antigen
Histoplasmosis
Sporotricosis
See Neurontin
See Aspergillus Serology.
1 mL serum Separate from cells and
or 1 mL
freeze
plasma
10 mL urine Frozen
FSH
Male: 13-70 yr: 1.4-18.1
Females:
Follicular: 2.5-10.2
Mid-cycle: 3.4-33.4
Luteal: 1.5-9.1
Pregnant: <0.3
Postmenopausal: 23-116.3
Units
Testing Site
LIS Code
IU/L
Chemistry - RGH
FSHA
SDCL
<1.11 at 60 minutes after galactose mmol/L
feed
Special Chem RGH
GALSE
0.0-0.8
3.3 for neonates
Special Chem RGH
SDCL to
Diagnostics
Services of
Manitoba
SDCL to
Diagnostics
Services of
Manitoba
Chem - RGH & PH
GALUR
GGT
SDCL
GHBAU
SDCL
GHBAS
mmolL
4 mL whole Collect on ice.
blood
Freeze whole blood in
plastic vial ASAP. Send
frozen to SDCL
4 mL whole Refrigerate
blood
1 SST
1 mL serum
Urine
Random
4 mL urine
Blood
1 RED
(NO SST)
2.0 mL
serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Female: 12-43
Male: 15-73
Frozen. Collect ASAP after
suspected ingestion
Frozen.
Urine preferred.
See Anti-Gastric Antibody
U/L
Print Date: June 12, 2015
GALPH
GALPU
47
Test Name
Specimen Container Volume
*Gastrin
Collect fasting
(10 hr minimum)
Blood
*GC
Urine
Blood
Testing Site
LIS Code
1 mL serum Centrifuge in the cold
ASAP. Freeze serum
immediately. Submit a
separate sample. Note
fasting serum on req.
Avoid hemolysis. Send on
dry ice.
See Neisseria
gonorrhoeae.
See HCV Genotyping
See Hemochromatosis
0-100
ng/L
SDCL
TAT = 14 days
GAST
1 EDTA
1.0 mL
plasma
Trough: 0.0-2.0
Peak: 5.0-10.0
Toxic: >=15.0 for post
> 2.0 for pre
mg/L
Chemistry - RGH
GENT
GENPR
(trough)
GENPO
(peak)
1 SST
1 mL serum Taken 1 hr after drink
3.6-7.8
mmol/L
Chemistry - RGH
GL50G
1 SST for
each
sample
1 mL serum Specimens (fasting, 1 hr
and 2 hr after drink)
See section on glucose tolerances
for interpretation
Chemistry - RGH
GTTGE
GGT
*Gliadin Antibody
*Glucagon
Patient must be
fasting.
Units
1 RED
Genotyping for HCV
Genotyping for
Hemochromatosis
Gentamycin Trough
Blood
Peak
NOTE: Record
exact date and time
of last dose and
exact date and time
of collection
See TDM section for
ideal sampling times.
Gestational 50 g
Blood
Screen
Gestational Glucose Blood
Tolerance (75 g drink)
Specimen Requirements Reference Range
2 Mauve
(EDTA)
prechilled
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2- 5 mL
EDTA
plasma
2 mL
minimum.
Trough – usually drawn ½
hr before drug is
administered.
Peak – usually drawn 1 hr
after drug is administered,
but physician may vary.
Daily – 6 to 14 hrs after
dose.
See Gamma Glutamyl
Transferase
Anti-Gliadin Ab
Place tubes on ice
immediately after
collection for at least 10
minutes. Spin in
refrigerated centrifuge and
Freeze plasma.
Unsuitable for analysis if
specimen thaws.
SDCL – Minnesota GLUCA
Print Date: June 12, 2015
48
Test Name
Specimen Container Volume
Glucose
Blood
`
Glucose
CSF
NB – Plasma
glucose should be
measured
simultaneously with
CSF glucose
Glucose
Fluid
Glucose Tolerance
Blood
1 SST or
1 Green or
syringe
with
electrolyte
balanced
dry heparin
Specimen Requirements Reference Range
mmol/L
0.5 mL
CSF
2.7-4.2
mmol/L
None available
See section on glucose tolerances
for interpretation
mmol/L
Urine
Random
Glucose (Urine)
State collection
period 24hr
Urine
24 hr
1 mL urine
1 Mauve
2 mL whole For Newborn - 1 EDTA
<1 mo: 11.3 – 21.3
blood
microtainer.
>1 mo: 4.6 – 13.5
EDTA
NO LONGER AVAILABLE
1 Red
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Chem - RGH & PH GLU
GLUCR
(random)
GLUFA
(fasting)
GLUPC
(2 hr PC)
ABLGL
(Whole
Blood)
Chem - RGH & PH GLUCF
Fasting: 3.6-6.1
Random: <11.1
Whole blood: 3.9-5.8
Glucose(Urine)
Glucose-6-Phosphate Blood
Dehydrogenase
(G6PD)
*Glutathione
Peroxidase
Recommended to
order
simultaneously with
Selenium
*Glutethimide
Blood
(Doriden)
Testing Site
1 mL serum
or plasma
or 1.5 mL
whole
blood for
adults or
0.6 mL for
neonates in
a syringe
1 mL fluid
0.5 mL
serum from
each
collection
10 mL urine
1 SST for
each
collection
Units
3 mL serum
2 hr (F, 2h)
5 hr (F, 0.5h, 1h, 1.5h, 2h,
3h, 4h, 5h)
Gestational (F, 1h, 2h)
Will be performed as part
of routine urinalysis.
LIS Code
Chem - RGH & PH GLUFL
Chem - RGH & PH GTT2H
GTT5H
GTTGE
Chem - RGH & PH
NO LONGER AVAILABLE
U/gm Hb Special Chem RGH
G6PHD
SDCL - Toronto
GLUTA
SDCL
DORID
Print Date: June 12, 2015
49
Test Name
Specimen Container Volume
*Gluten Sensitive
1 SST
Glycerol Lysis Time
*Glycol (Ethlene)
See Acid Glycerol Lysis
1 Grey
3 mL whole Do not use alcohol swab
blood
1 Mauve
1 mL whole Refrigerate
blood
EDTA. Or
Capillary –
200 L
whole
blood
EDTA
1 SST or
1 mL serum Avoid hemolysis
1 Green or or plasma
1 Mauve
*Glycosylated
Blood
Hemoglobin
(A1CHB)
(For monitoring
control of diabetics)
*Glycosylated Protein Blood
Fasting not required
*GM1 Ganglioside Ab Blood
1 Red
2 - 1mL
serum
aliquots.
*Gold
Gonococcal
Blood
*GQ1b IgG
Blood
(Autoimmune
Neurological Disease
Profile)
*Gravol
Blood
(Diphenylhydramine)
Units
See Endomysial
Antibodies
Freeze.
*Glyburide (one of the Blood
Sulfonyl Ureas)
Blood
1 mL
serum
Specimen Requirements Reference Range
Allow specimen to clot at
room temp. for 3 hr. Spin,
separate and freeze
immediately.
NO LONGER AVAILABLE
Canadian Diabetes Association
Guidelines:
Ideal non-diabetic: < 6.0% normal
Optimal diabetic: < 7.0% target
goal
Suboptimal diabetic: 7.0-8.4%
action may be required
Inadequate: >8.4 action required
Up to 285
mol/L
Testing Site
LIS Code
SDCL – Specialty
labs
GLYBU
SDCL
ETHGL
Special Chem RGH
A1CHB
SDCL
TAT = 2 days
GLYPR
SDCL – Toronto
GM1AB
(If ordered GM2
see NEURP)
No longer available.
GONOS
1 RED
1 mL serum Frozen within 60 minutes
of collection
SDCL –Calgary
2 SST
4 mL serum
SDCL
DIPH
TAT: Emerg = 4 hr
Routine = 3
days
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
GQ1b
50
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Group & Screen
Blood
Needs a Typenex # on
outpatient. Requires
patient armband (full
name, Typenex # or MRN
and DOB). Label tubes
with full name, DOB and
MRN or PRN and
Typenex#.
Freeze and submit a
separate sample
2 Mauve
*Growth Hormone
Blood
1 SST
Collect fasting or as
specified by
physician
*H1N1
Nasopharyngeal
,
Aspirate,
Washings
*Halcion (Triazolam) Blood
2 Red
*Haldol (Haloperidol), Blood
(Novoperidol),
(Apo-Haloperidol),
(Peridol)
Collect trough
before next dose is
administered
Ham's Test
Blood
*Hantavirus Serology Blood
1 Green
2 mL
0.06-5.0
Units
g/L
LIS Code
Transfusions RGH
*GSM
SDCL
TAT = 7 days
GROWH
SDCL
TRIAZ
SDCL - Toronto
HALDO
See FLU test for Severe
Respiratory Illness.
4 mL
1 mL
plasma
Separate ASAP. Freeze.
2 Red and 4 mL serum Usually ordered with
1 Mauve
& 2 mL
Sucrose Lysis Test
whole
blood
EDTA
1 SST
2 mL serum
Hematology - RGH HAMSU
SDCL – Winnipeg
TAT = 3 weeks
SDCL – Winnipeg
TAT = 3 weeks
(Sin Nombre Virus)
*Hantavirus
CSF Hantavirus
Serology
Testing Site
CSF
Sterile leak 2 mL CSF
proof tube.
Blood
1 SST
Also send serum for
Hantavirus Serology.
HANTA
HANTC
(Sin Nombre Virus)
Haptoglobin
HAV
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum
0.53-2.37
g/L
Immunology - RGH HAPTO
See Hepatitis A
Print Date: June 12, 2015
51
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
HBA1C
Blood
1 Mauve
Refrigerate (for monitoring 4-6 (Non-Diabetic)
control of diabetics)
%
Special Chem RGH
*HBV-DNA
Blood
2 Mauve
Blood
2 Mauve
4 mL
plasma
Blood
1 SST
2 mL serum
1 Mauve
Anti-Myocardial Ab
2 mL whole Order as CBC
blood
EDTA
HCG
*HCV Genotype
Patient should be
HepC positive before
ordering this test
HDL-Cholesterol
Collect fasting
*Heart Muscle Ab
Hematocrit
Blood
*Heavy Metals
Do not order as
such. Req must
state specific test(s)
(Lead, Copper,
Mercury)
**Helicobacter pylori Blood
Ab Serology
1 mL whole
blood
EDTA.
CapillaRY –
5 L whole
blood
placed in a
tube
containing
processing
reagent.
2 – 1.5 mL
EDTA
plasma
Freeze aliquots –send as
dangerous goods.
See β-hCG
Remove plasma ASAP.
Freeze and ship on dry
ice. Split plasma equally
between 2 vials.
0.90-2.40
d0-3 mo: 0.44-0.64
3-12 mo: 0.32-0.44
1-3 yr: 0.36-0.44
4-12 yr: 0.37-0.45
Female: 0.37-0.47
Male: 0.4-0.5
mmol./L
LIS Code
HBA1C
SDCL- Winnipeg
HBDNA
SDCL
TAT = 3 weeks
HCGEN
Chemistry – RGH
& PH
LIPID
Hem - RGH & PH
HCT
SDCL
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2-5 mL
serum
Requires only a single
serum sample. Specimen
must be frozen if not
received at RGH within 48
hrs.
Chemistry - RGH
Print Date: June 12, 2015
HPYLS
52
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Helicobacter pylori
Titre
Blood
Titre - No longer available.
Hemochromatosis
Blood
Must have clinical info
and family history on
req. Usually ordered
by Dr.
Devaraj.**MUST have
approval before
collection.
Hemoglobin
Blood
Hemoglobinopathy
Study
(Hemoglobin
Electrophoresis, Iron
Studies, CBC)
Hemoglobin F
3 Mauve
1 Mauve
Collect Mon, Tues, Wed,
Thurs mornings only.
Specimen must be kept at
room temp at all times.
Specimen
must be received at RGH
lab by noon and ready for
FED-EX pickup at 1400 h
2 mL whole Order as CBC
blood
EDTA
1 Mauve
(full)
1 SST
5 mL whole
blood
EDTA and
1 mL serum
Blood
1 Mauve
Hemoglobin in
Plasma
Blood
1 Mauve
Hemosiderin
Urine
Random
Heparin Assays
Anticoagulant status
& type of heparin
used must be
provided on the
requisition. Must be
approved by
Dr. Devaraj
Heparin Induced
Thrombocytopenia
(HITT)
Blood
1 Blue
(full)
1 mL whole
blood
EDTA
2 mL EDTA Centrifuge immediately
plasma
and take plasma off into a
new tube
10 mL
urine
1 mL
Must be drawn 4 – 6 hrs
citrated
post dose.
plasma
Must be double-spun and
sent frozen
Blood
1 Red
2- 1mL
aliquots of
serum
If sending, specimen must
arrive frozen
Testing Site
LIS Code
HPYLT
Whole
blood
EDTA
Blood
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
d0-3 mo; 135-195
4-12 mo: 96-126
1 –3 yr: 110-130
4-6 yr: 120-140
7-12 yr: 115-145
Female: 120-160
Male: 140-180
HbF (adult): 0-1
HBA2: 1.8-3.5
Winnipeg Health
Sciences Centre
HEMOC
g/L
Hem - RGH & PH
HGB
% op
total Hb
Special Chem RGH
HGBWS
Special Chem RGH
HBF
Special Chem RGH
PLHB
See Fetal Hemoglobin
0-70
mg/L
Hematology - RGH URHEM
U/mL
Hematology - RGH HEPAR
Special Coag –
RGH
Print Date: June 12, 2015
HITT
53
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
*Hepatitis A-IgM, IgG
Blood
Antibody
*Hepatitis A - Total
Blood
Antibody
*Hepatitis B –
Blood
Genotyping
1 SST
2 mL serum
SDCL
HEAAB
1 SST
2 mL serum
SDCL
HEATO
1 SST
2 – 1.5 mL
serum
Not frozen
SDCL-Winnipeg
HBGEN
*Hepatitis B – Viral
Load
Blood
2 EDTA
Blood
1 SST
SDCLImmunoserology
Dept.
SDCL
HBVVL
*Hepatitis B Surface
Antibody (HBsAb)
2 – 1.5 mL Freeze, ship on dry ice
aliquots
and send as Dangerous
plasma
goods.
1 ml serum
HEBAB
*Hepatitis B Surface
Antigen (HBsAg)
Blood
1 SST
2 mL serum
SDCL
HEBAG
*Hepatitis B Core
*Hepatitis Be
Antibody
*Hepatitis Be Antigen
*Hepatitis C Antibody
*Hepatitis C Antigen
Hepatitis C
Genotyping
Blood
Blood
1 SST
1 SST
2 mL serum
2 mL serum
SDCL
SDCL
HEBCO
HEBEB
Blood
Blood
Blood
Blood
1 SST
1 SST
1 SST
1 Mauve
2 mL serum
2 mL serum
2 mL serum
SDCL
SDCL
SDCL
SDCL
HEBEG
HECAB
HECAG
HCGEN
Hepatitis C PCR
Blood
2 Mauve
4 mL
plasma
(EDTA)
*Hepatitis C Viral
Load
Blood
2 Mauve
4 mL
plasma
EDTA
*Hepatitis D
Only done if HBV
positive
*Hepatitis E
*Hepatitis F
Blood
1 SST
2 mL serum
SDCL
HEDAB
Blood
Blood
1 SST
1 SST
2 mL serum
2 mL serum
SDCL - Winnipeg
SDCL
HEEAB
HEFAB
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Separate plasma within 6
hr of collection. Freeze
and send on dry ice.
Separate plasma within 6
hr of collection. Split
plasma equally between 2
vials. Freeze and send on
dry ice.
Separate plasma within 6
hr of collection. Split
plasma equally between 2
vials. Freeze and send on
dry ice. Send as
Dangerous goods.
SDCL
PCR
Test performed 2-3
times per week
SDCL
HCVVL
Test performed 1-2
times per month
Print Date: June 12, 2015
54
Test Name
Specimen Container Volume
*Hepatitis G
*Hepatitis Screen
*Heroin
*Herpes Simplex
CSF Herpes Simplex
Virus PCR
*Herpes Simplex
Herpes Simplex Virus
IgM Serology
*Herpes Simplex
Virus IgG Serology
Blood
Blood
Urine
CSF
1 SST
1 SST
Random
Sterile leak
proof tube.
Lesion
Blood
Blood
1 SST
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
2 mL serum
2 mL serum Includes HAV, HBV & HCV
20 mL urine
2 mL CSF Freeze CSF ASAP.
If specimen thaws, it is
unsuitable for analysis.
See Viral, Lesion.
No longer available.
SDCL - Winnipeg
SDCL
SDCL
SDCL
HEGAB
HESCR
HEROI
HSPCR
SDCL
HRPVC
HSPCS
2 mL serum Immune status
SDCL
HSPIS
(HSV Type 1 & 2)
**Herpes Zoster
Hexosaminidase
Level A & B or
Taysachs Test
Blood
Lesion
Blood
See Varicella Zoster.
See Viral, Lesion.
2 – 5 mL
Green
(adult)
2 Ped.
Green
(children)
7 mL whole
blood
HFE Studies
*HGH
*HGPRT
*HHV-6
Blood
*Histamine
Blood
1 Mauve prechilled
*Histamine
Urine
*Histoplasmosis
Serology
Blood
24 hr Urine 5 mL
aliquot of
well-mixed
urine
1 SST
3 mL serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL
plasma
(EDTA)
SDCL - Saskatoon HEXOS
See Hemochromatosis
See Growth Hormone
See Hypoxanthene
guanine phosphoribosil
transferase.
See Roseola IgM and IgG
Serology.
Collect in prechilled tube
and place on ice
immediately. Separate
ASAP. Freeze. Avoid
hemolysis.
NO LONGER DONE
SDCL - California
HISTS
SDCL - California
HISTA
SDCL – Edmonton HPLAS
TAT = 3 weeks
Print Date: June 12, 2015
55
Test Name
Specimen Container Volume
*HIV
Blood
1 SST
HIV Point of Care
(performed in-lab)
Blood
HIV – DNA- PCR
Blood
Whole
blood or
whole
blood
capillary
2 Mauve
*HIV Genotyping
Blood
2 Mauve
3-5 mL
plasma
*HIV Viral Load
(Ordered on known
anti-HIV positive
patients, seen by
infectious disease
physician)
Blood
2 or 3
Mauve
3-5 mL
plasma
HLA Typing
Blood
Varies with
testing site
HLAB27
Collection must be
booked with
Saskatoon HLA
306 655-5205
Blood
1 EDTA
tube
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Testing Site
LIS Code
1 mL serum Fill in special req. Address
of where report is to go
must be on req.
Plasma or
Lab performed only
serum
specimens
SDCL
HIV
10 mLwhole bld
SDCL-Ottawa
HIDPC
SDCL-Vancouver
HIVGT
SDCL
HIVVL
Saskatoon Lab
HLAOD
Saskatoon – St.
Pauls
HLAB2
4 mL
Specimen Requirements Reference Range
Room Temperature
DO NOT Order Fridays or
Weekends. Must be
received in Ottawa within
48 hrs. Notify SDCL at
787-8635.
Centrifuge and freeze 3-5
mL plasma in cryogenic
tube. Ship on dry ice.
Centrifuge and freeze at
–70 degrees at least 1.5
mL plasma in separate
cryogenic tubes. Ship on
dry ice. (If not enough for 2
tubes use 1 aliquot and
note on requisition.
Requires pre-booking with
testing site. Collect as per
requisition. Monday –
Thurs. Must be at RGH by
noon.
Can only be ordered by
rheumatologist or
ophthalmologist. Must be
accompanied by physician
completed Saskatoon HLA
req. Shipped Monday –
Thursday. Must be at RGH
by noon for same day
shipping.
Units
HIVPC
Print Date: June 12, 2015
56
Test Name
Specimen Container Volume
*Homocysteine in
plasma
& urine (child)
Blood or
Urine
1 Green or 2 mL
Same as amino acid.
Random
plasma
Freeze.
Urine
10 mL urine
*Homocysteine
(adults)
Blood
1 SST
Homogentisic Acid
Urine
*Homovanillic Acid
(HVA)
State collection
period
Include weight of
patient if less than 15
years
*HPV
Cervical HPV PCR
(Human
Papillomavirus)
*HSV
Urine
HTLV1, HTLV2
*Human Anti-Mouse
Antibody
*Human Growth
Hormone
**Human Herpes 6
Virus
*Human
Papillomavirus
**H. zoster, VZV
Cervical
swab
Specimen Requirements Reference Range
1 mL serum Collect on ice. Centrifuge
and separate within 1 hr.
Freeze serum.
Random
30 mL fresh Freeze
urine
24 hr Urine 25 mL
Keep refrigerated during
aliquot of
collection. Acidify to pH 224 hr urine 4 with HCL or freeze.
Record 24 hr volume and
collection
period.
Universal
Transport
Medium
Blood
CSF
Lesion
Blood
1 SST
2 mL serum
Blood
1 RED
1 mL serum Aliquot and Freeze
frozen
See Growth Hormone
Units
mol/L
Testing Site
LIS Code
SDCL
AACID
(serum)
AARUR
(urine)
HCYST
SDCL
SDCL – Saskatoon HOMAC
Adults: up to 82 mol/d
1 mo-2 yr: up to 25
2-5 yr: up to 19
5-15 yr: up to 12
mol/d
SDCL
HVA
SDCL
HPVCV
RGH, Chemistry
Lab
SDCL – Mayo
HTLV
mmol./L
creatinine
See Herpes Simplex Virus.
See Viral, Lesion.
Blood
Cervical
swab
Blood
Lesion
*Human T-Cell
Lymphotropic Virus
Antibody
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Roseola IgM and IgG
Serology.
See HPV.
Cervical HPV PCR
See Varicella Zoster.
See Viral, Lesion.
See HTLV
Print Date: June 12, 2015
HAMA
57
Test Name
Specimen Container Volume
*5
Hydroxyindoleacetic
Acid
Urine
*17 Hydroxycorticosteroids
(17 OHCS)
State collection
period
*17 HydroxyProgesterone
Collect between 8
and 10
Urine
Blood
*17
Blood
Hydroxypregnenolone
*21 Hydroxylase
Blood
Antibody
Specimen Requirements Reference Range
Keep refrigerated during
collection. Acidify to pH 24 with HCL or freeze.
Record 24 hr volume and
collection
period.
24 hr Urine 100 mL
Adjust pH to <5 with glacial
aliquot of
acetic acid or freeze.
24 hr urine Record 24 hr volume and
collection period. Provide
age and sex.
1 SST or
1 mL serum Refrigerate and transport Female:
1 Green or or plasma on ice packs within 24 hr
Oral contraceptives: 3-5.1
1 Mauve
Neonate:
or send frozen. Submit
Follicular: 0.3-3.6
separate sample to SDCL.
Luteal: 0.3-12.1
100 L
Stable for 4 days at 2-8º
Prepubertal: <1.8
Separate from cells ASAP
Menopausal: 0.3-3.6
Male: 2.2-10.9
1 RED
1 mL serum Freeze
Units
24 hr Urine 100 mL
aliquot of
24 hr urine
1 SST
*25-Hydroxy
Vitamin D
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Freeze ASAP.
frozen
Requires approval from
Jeff Eichhorst at SDCL
787-3131.
See Vitamin D 25 Hydroxy
nmol/L
Testing Site
LIS Code
SDCL
5HIPL
SDCL
CORTU
SDCL
TAT = 15 days
17HYD
SDCL to Mayo Cl.
17HYP
SDCL to Mayo Cl.
21HYD
Print Date: June 12, 2015
58
Test Name
Specimen Container Volume
Urine
Hydroxyproline
State collection
period.
About 24 hr before
and also during the
collection of the
sample, give the
patient a diet free of
collagen. A
collagen-free diet
contains no meat,
meat products, fish,
poultry, meat
extracts, soup, soup
concentrates, gravy,
pudding, ice cream,
soft candy or other
products containing
gelatin.
Hypercoag
Blood
- ATIII
- Plasminogen
- Protein C
- Protein S
- APC
- PTMUT
- FVLeiden
*Hypoxanthene
Blood
guanine
phosphoribosil
transferase
24 hr
10 mL
aliquot of
well-mixed
24 hr urine
3 Blue(full)
1 Red
(Plasma
should be
double
spun)
1 EDTA
whole bld
3 Sodium
Heparin(3
mL)
Ibuprofen
IFE
Blood
1 Red
IgA
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Freeze sample. Record
24 hr volume and
collection period. Provide
age, weight and height
<1 yr: 420-1680
1-22 yr: 190-610
22-65 yr: 40-170
>65 yr: 40-130
Units
Testing Site
2
LIS Code
Metabolic Diseases
Lab in Saskatoon
OHPRO
1 mL
Arrival at hospital within 4
plasma in 4 hr. Must be sent frozen
tubes.
and on dry ice.
1 mL serum
in 2 tubes.
Special Coag
Hematology RGH
HCOAG
Min. 3 mL
plasma and
saline
washed
RBCs
SDCL to Alberta
HGPRT
Children’s Hospital
Collection must be done at No Transfusions in the last 60 days
RGH.
Separate ASAP – Freeze
plasma.
Wash Red cells with saline
x2 and after rmoving the
last saline wash, freeze
the red cells.
2 mL serum Aliquot
See Immunofixation
Electrophoresis
1 mL serum
<3 mo: 0-0.30
3-6 mo: 0-0.50
6 mo-1 yr: 0.10-0.70
1-3 yr: 0.15-1.00
μmol/d/m
SDCL
g/L
IBUPR
Immunology - RGH IGA
Print Date: June 12, 2015
59
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL - Toronto
IGD
SDCL
IGE
SDCL
TAT = 21 days
SOMC
3-5 yr: 0.25-1.55
5-8 yr: 0.30-2.35
8-11 yr: 0.20-2.50
11-16 yr: 0.30-2.40
>16 yr: 0.87-3.94
IgD
Blood
1 SST
*IgE
Blood
1 SST
*IGF (Somatomedin
C)
Insulin-like Growth
Factor
IgG
Blood
1 SST
2 mL serum Separate serum ASAP.
Freeze
Blood
1 SST
1 mL serum
IgG Index
Blood &
CSF
*IgG Subclass
Blood
1 SST
IgM
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Freeze
frozen
State age of patient
1 mL serum
1 mL serum Both serum & CSF
1 mL CSF required
CSF IgG/serum IgG
CSF aIb/serum aIb
1 mL serum Freeze and send on ice
packs. Provide patient
age.Fasting specimen
preferred. If not, mark
requisition Non-fasting.
1 mL serum
Neonates: <1.5
Infants in 1st year of life: <15
1-5 yr: <60
6-9 yr: <90
10-15 yr: <200
Adult: <100
<1 mo: 6.00-16.30
1-3 mo: 2.10-6.20
3-6 mo: 1.35-5.75
6 mo-1 yr: 2.15-8.75
1-2 yr: 3.60-10.40
2-3 yr: 4.20-10.75
3-5 yr: 4.15-12.60
5-8 yr: 5.10-14.35
8-11 yr: 6.10-14.80
11-16 yr: 5.50-14.85
>16 yr: 5.52-17.24
0.30-0.60
IU/mL
g/L
Immunology - RGH IGG
Immunology - RGH IGIDX
SDCL - Toronto
<1 mo: 0.00-0.20
1-3 mo: 0.10-1.20
3-6 mo: 0.10-1.55
6-12 mo: 0.45-1.20
g/L
IGGSC
Immunology - RGH IGM
Print Date: June 12, 2015
60
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL - Mayo
INHBA
SDCL - Mayo
INHBB
1-2 yr: 0.40-1.95
2-3 yr: 0.45-2.05
3-5 yr: 0.50-2.25
5-8 yr: 0.40-2.30
8-11 yr: 0.40-2.50
11-16 yr: 0.45-3.00
>16 yr: 0.44-2.47
Inhibin A
Blood
1 RED
Inhibin B
Blood
1 RED
*Imipramine (Tofranil) Blood
2 Red or
2 Green
1 mL serum Frozen.
Approval required from
Jeff Eichhorst at SDCL
(787-3131) unless ordered
by Dr. C. Aspe-Lucero.
1 mL serum Frozen.
Approval required from
Jeff Eichhorst at SDCL
(787-3131) unless ordered
by Dr. C. Aspe-Lucero.
4 mL serum Aliquot. Do not use SST. Minimum: 300-500
or plasma Record time of collection
Maximum: 800-1000
on tube and req.
Toxic: 1700
See Immunofixation
Electrophoresis
Immunoelectrophoresis
Immunoelectrophoresis
Urine
Immunofixation
Blood
Electrophoresis (IFE)
24 hr Urine 50 mL urine
aliquot
1 SST
1 mL serum
nmol/L
SDCL
IMIPR
TAT: Emerg = 4 hr
Routine = 3
days
Immunology - RGH IFE
Immunology - RGH IFEU
Immunology - RGH IFE
Immunoglobulins
(Quantitative) IgA,
IgG, IgM
*Inderal
*Indocid
(Indomethacin)
*Infliximab
Blood
1 SST
1 mL serum State age
Blood
Blood
2 Red
1 Red
3 mL serum Aliquot
2 mL serum Aliquot
SDCL
SDCL
INDER
INDOM
Blood
1 RED
SDCL – Mayo Cl
INFLX
*Influenza A & B
Nasopharyngeal
2 mL serum Approval from Jeff
Frozen
Eichhorst prior to
collection (787-3131)
Freeze and send ASAP to
SDCL
See Respiratory Virus
Isolation or Detection.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See individual immunnoglobulins for
reference ranges
Immunology - RGH QIG
Print Date: June 12, 2015
61
Test Name
*Influenza Pandemic
INH
Specimen Container Volume
Aspirate,
Washes
Throat
Nasopharyngeal
Aspirate,
Washes
Blood
2 Green
(full)
Specimen Requirements Reference Range
4 mL
plasma
Aliquot
See Bleeding Disorder
Investigation
Blood
1 Blue
*Insulin
Blood
1 SST
*Insulin Antibodies
(Insulin
Receptor Antibodies)
*-Interferon
(Nabferon Inf-B Ab.)
Blood
1 SST
Blood
1 Red
*Interleukin-1 (IL-1)
Blood
1 Red
*Interleukin-6 (IL-6)
Blood
1 Red
*Intrinsic Factor
Blood
Antibodies
Avoid
administration of
B12 for 48 hr before
collection
*Insulin-like Growth
Blodd
Testing Site
LIS Code
SDCL
INH
See Throat Virus Isolation
or Detection.
See FLU test for Severe
Respiratory Illness.
Inhibitor Correction
Studies
INR
Anticoagulant
status must be
provided on req.
Units
1 mL
plasma
Draw is critical. 2.7 mL in
a 3 mL tube. Remove
plasma within 2 hr. If not
analyzed within 4 hr,
freeze.
1 mL serum Freeze serum. Avoid
250 μL
hemolysis.
neonates
Cannot be capillary
specimen
1 mL serum
2 mL serum *Needs approval from
SDCL 787-7900
Dr.Lehotay
1 mL serum Freeze @ -80 C. Send on
dry ice.
Special Coag RGH
Therapeutic range:
DVT: 2-3
Mechanical valve & recurrent P.E.:
2.5-3.5
Hem - RGH & PH
PT
Fasting
43-194 pmol/L
(6-27 μIU/mL)
SDCL
TAT = 5 days
INSUN
SDCL - Toronto
ABINS
SDCL - Mayo
SDCL – Toronto
IL1
1 mL serum Freeze @ -80 C. Send on
dry ice.
SDCL - Toronto
IL6
2 SST
3 mL serum
SDCL – Hamilton
TAT = 4 weeks
ABINF
1 SST
1 mL serum Frozen
SDCL – Toronto
IGFBP
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
62
Test Name
Factor Binding
Protein 3
*Insulin-like Growth
Factor
Ionized Calcium
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
mmol/L
Chemistry - RGH
ABLCA
(whole
bld)
IONCA
(serum)
μmol/L
Chem - RGH & PH IBIND
See IGF
Whole blood:
Hospital Sites:
<1 mo: 1.05-1.37
1 full green top or blood
>1 mo: 1.10-1.29
gas syringe – order
Serum: 1.16-1.35
ABLCA-send to lab
immediately on ice. OR 1
Tourniquet SST – order IONCA.
should not Stable at room temp for
be used.
24 hrs or at 4°C for 72 hrs.
DO NOT OPEN TUBE.
Community Sites:
1 SST-order IONCA.
Centrifuge ASAP and send
to RGH within 24 hrs. DO
NOT OPEN TUBE
1 mL serum
Iron: 7-32
TIBC: 45-80
2 mL serum Freeze serum
Blood
1 Green
(full) or
syringe
containing
electrolyte
balanced
heparin or
1 SST
Iron and Iron Binding
(TIBC)
*Islet-Cell Antibodies
(Pancreatic)
*Iso-Propanol
(Iso-Propyl Alcohol)
Blood
1 SST
Blood
1 SST
Blood
1 Grey
3 mL whole Keep tube stoppered.
blood
Refrigerate.
JC Virus PCR
CSF
Sterile
container
1 mL
JC Virus PCR
Blood
1 EDTA
2 mL
plasma
JC Virus PCR
Urine
Sterile
Container
20 mL
Random
JAKS-2
Blood
1 EDTA
Whole
blood
*Japanese
Encephalitis
*JO-1 Antibody
Kaolin clotting Time
Blood
CSF
Blood
1 SST
1 mL serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Whole
blood
1.6-2.5 mL
in syringe.
Freeze ASAP
If specimen thaws it is
unsuitable
Freeze ASAP
If specimen thaws it is
unsuitable
Freeze ASAP
If specimen thaws it is
unsuitable
Ship as per Chromosomes
Studies
*Encephalitis (Viral).
Netative
Panic value: >8
SDCL
mmol/L
ABISC
SDCL
ISOPR
TAT: 1 day
Emerg = 2 hr
SDCL – National
Microbiology Lab in
Winnipeg
SDCL – National
Microbiology Lab in
Winnipeg
SDCL – National
Microbiology Lab in
Winnipeg
BC Cancer Agency
JAKS2
SDCL - Hamilton
ABJO
See Bleeding Disorder
Print Date: June 12, 2015
JCVIC
JCVIR
JCVIU
63
Test Name
(KCT)
Karyotyping
*Keppra
*17-Ketogenic
Steroids
(17KGS)
Ketones
*Ketoprofen (Orudis)
*17-Ketosteroids
Provide age, sex
and collection
period.
Pediatric - include
patient's weight.
Specimen Container Volume
Blood
Blood
Blood
Urine
Kidney Room PreBlood
panel
(Na, K, Cl, CO2,
glucose, urea, creat,
TP, alb, Ca, PO4, Bili,
ALT, ALP)
Kidney Room PostBlood
panel
(Na, K, Cl, CO2,
glucose, urea, creat,
TP, alb, Ca, PO4)
Kleihauer
Blood
1 Red
Specimen Requirements Reference Range
Investigation
See Chromosome Studies
1 mL serum Syn: Levetiracetam
1 SST or
1 Green
0.5 mL
serum or
plasma
1 Red
2 mL serum
24 hr Urine 25 mL
aliquot of
24 hr urine
1 SST
1 mL serum
1 SST
1 mL serum
Test Discontinued
Urinary-Free Cortisol done
instead
Do not open tube
Negative
Aliquot
Refrigerate during
collection. Adjust pH to <5
with glacial acetic acid or
freeze. Record 24 hr
volume, collection period,
age and sex.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Male: 35-70
Female: 15-50
Children:
0-3 yr: 0-2
4-8 yr: 0-7
9-10 yr: 2-14
11-14 yr: 2-35 (male)
11-14 yr: 2-30 (female)
See individual tests for reference
ranges
See individual tests for reference
ranges
1 Mauve
Whole
(full)
blood
Same tube
as CBC, if
ordered
KLM
Units
μmol/d
Testing Site
LIS Code
SDCL to Mayo
KEPRA
Chem - RGH & PH
KETON
SDCL
SDCL
KETOP
17KS
Chemistry - RGH
KRPRE
Chemistry - RGH
KRPOS
Hematology - RGH KLEIH
See Anti Kidney & Anti
Liver Antibodies
Print Date: June 12, 2015
64
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Lactic Acid
Blood
Lactic Acid
CSF
Grey: Separate plasma
Plasma: 0.7-2.1
from cells within 15 min.
Whole blood: 0.5-1.6
Stable at 2-8◦C for 14 days
or may be frozen.
If Shipping freeze plasma
aliquot and send on dry
ice.
Syringe: deliver to lab
ASAP
1.10-2.20
Lactic Acid
Lactose Intolerance
Fluid
Lamellar Body Count
Amniotic
Fluid
*Lamictal
(Lamotrigne)
Collect pre-dose
*Lanoxin
*LATS (long acting
thyroid stimulator)
Blood
LD/LDH
Blood
LD/LDH
CSF
LD/LDH
LD/LDH Isoenzymes
Fluid
Blood
LDL - Cholesterol
(calculation)
Blood
1 Grey or
syringe
with
electrolyte
balanced
dry heparin
1 mL
plasma or
1.5 mL
whole
blood for
adults or
0.6 mL for
neonates in
syringe
0.5 mL
CSF
1 mL fluid
None available
Units
Testing Site
LIS Code
mmol/L Chem - RGH & PH LA
(plasma)
ABLLA
(whole
bld)
mmol/L Chem - RGH & PH LACSF
mmol/L Chem - RGH & PH LAFL
Hydrogen Breath test done
in GI Unit at Pasqua
2 mL
1 SST
/uL
2 mL serum Aliquot ASAP
Special Chemistry- LBC
RGH
SDCL Toxicology
LAMIC
See Digoxin
See Thyroid Binding
Inhibitory Immunoglobulin
1 SST
1 mL serum
0.5 mL
CSF
1 mL fluid
<6 mo: 441-564
6 mo-5 yr: 319-441
Adult: 120-245
None available
U/L
Chem - RGH & PH LDH
U/L
Chem - RGH & PH LDCSF
None available
U/L
Chem - RGH & PH LDFL
Special Chem ISOLD
RGH
Chem - RGH & PH LIPID
No Longer Available
1 SST
LE
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2 mL serum
Target LDL-C values by level of risk
*Risk: LDL-C
Very high: <2.5 mmol/L
High: <3.0 mmol/L
Moderate: <4.0 mmol/L
Low: <5.0 mmol/L
*To determine risk refer to CMAJ
2000; 162(10):1441-7
Not available. Do ANA
Print Date: June 12, 2015
65
Test Name
Specimen Container Volume
*Lead
If a concurrent assay
for zinc
protoporphyrin is
required, it must be
specified on the req.
Blood
2 mL whole
1 – 7 mL
Royal Blue blood
Ensure
EDTA)
BD368381 specimen is
well-mixed
*Lead
Urine
24 hr urine
container
acidwashed
or random
acid
washed
container
Lecithin/Sphingomyeln
Ratio (L/S Ratio)
Amniotic
Fld
7 mL of 24
hr or 7 mL
random
acidwashed
container.
Aliquot.
Specimen Requirements Reference Range
Testing Site
LIS Code
SDCL
TAT = 7-10 days
LEAD
Send in polypropylene
container. Provide 24 hr
volume and collection
date. State if 24 hr or
random urine on req.
SDCL - Toronto
TAT = 2 weeks
LEADU
See Fetal Lung Maturity
Special Chem RGH
Also send urine for
Legionella Antigen
Detection.
SDCL
LEGC
See report or SDCL Compendium
Units
*Legionella
Bronchial
*Bronchial Legionella Lavage/
Culture
Aspirate
Sterile
sputum
container
*Legionella
*Urine Legionella
Antigen Detection
Sterile
urine
container
20 mL urine Urine (first morning) or at
least 2 hrs after last
urination
SDCL
LGU
**Legionella Serology Blood
1 SST
2 mL serum Acute (onset) and
convalescent (1-3 weeks)
SDCL - Etobicoke
TAT = 3 weeks
LEGAS
**Leishmaniasis
Blood
Serology
**Leptospira IgM
Blood
Serology
Leukocyte Alkaline
Phosphatase (LAP)
CBC must be done at
the same time
1 SST
3 mL serum Aliquot.
1 SST
1 mL serum Keep cold but not frozen.
SDCL – Montreal
LEISH
TAT = 4 weeks
SDCL – Winnipeg LEPTO
TAT = 3 weeks
Hematology - RGH LAPSC
Urine
*Levetiracetam
*LH
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
NO LONGER AVAILABLE
See Keppra
See Luteinizing Hormone
Print Date: June 12, 2015
66
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Librium
Blood
*Lidocaine
(Xylocaine)
See TDM section for
ideal sampling times
Lipase
Blood
Blood
Lipase
Fluid
Lipid Profile (Chol,
Trig, HDL, LDL)
Blood
1 SST
2 mL serum Fasting specimen
*Lipoprotein
Fractionation
(Phenotyping) 14 hr
fast.
Blood
3EDTA
Collect
only
Monday
and
Tuesday
7 mL
*Lipoprotein A
Blood
1 SST
*Lipoprotein
Electrophoresis
Lithium
Blood
2 mL
Aliquot
plasma
3 mL serum Aliquot. Do not use SST.
2 Red or
2 Green or or plasma
2 Mauve
Units
1 Green
1 SST or
1 Green
1 mL serum Aliquot
or plasma
1 mL
6-21
Toxic: 25-34
Therapeutic: 114-286
Annotate type of fluid on
requisition
See individual test reference ranges
μmol/L
Testing Site
LIS Code
SDCL
LIBRI
SDCL
TAT = 3 days
LIDO
SDCL
TAT = 2 days
LIP
SDCL
LIPFL
Chem - RGH & PH LIPID
Must be fasting for 14 hrs.
Place tubes in ice water
immediately after
collection. Separate
plasma within 1 hr of
collection using 30 min.
spin. Transfer to
polypropylene vial and
send cold, not frozen.
1 mL serum Separate within 4 hr of
collection. Freeze.
SDCL
LIPFR
SDCL - Toronto
LIPOA
1 SST
1 mL serum Not Available
SDCL
LIPEL
Blood
1 SST
1 mL serum Do not collect less than 8
hrs after last dose.
See Anti Kidney & Anti
Liver Antibodies
Therapeutic: 0.5-1.3
Toxic: >2.0
Liver Panel (Hospital) Blood
(Bili, ALP, ALT, ALB)
1 SST
1 mL serum
See individual test reference ranges
Chem - RGH & PH HLIVE
Liver Panel (Clinics)
(Bili, ALP, ALT)
1 SST
1 mL serum
See individual test reference ranges
Chemistry - RGH
*Liver/Kidney Muscle
Antibodies (LKM)
Blood
*Long Acting Thyroid
Stiumlator
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
mmol/L Chemistry - RGH
See thyrotropin Binding
Inhibitor Immunoglobulin
Print Date: June 12, 2015
LI
PLIVE
67
Test Name
Specimen Container Volume
*Long-Chain Fatty
Acids (Very)
Blood
2 Red or
2 Mauve
*Lorazepam (Ativan)
Blood
2 Red
*LSD
L/S Ratio
*Ludiomil
(Maprotiline)
Urine
Random
*Luminal
Lupus Anticoagulant
Luteinizing Hormone
(LH, Lutropin)
Blood
2 Red
Blood
3 Blue
(full)
& 1 Red
Blood
1 SST
*Luteotrophic
Hormone (LTH)
Lutropin
Luvox
Specimen Requirements Reference Range
2 mL serum Aliquot and freeze
or plasma
Neonates:
0.5 mL
serum or
plasma
4 mL serum Aliquot. Record time of
Therapeutic: 560-740
collection on tube and req.
Do not use SST.
See Fetal Lung Maturity
4 mL serum Aliquot. Do not use SST.
See Phenobarb
4 mL
Double spin plasma and
plasma
separate into 4 tubes.
2 mL serum Freeze all plasma and
serum tubes.
1 mL serum
Therapeutic: 180-720
Toxic: >1800
Units
nmol/L
nmol/L
Testing Site
LIS Code
SDCL- Saskatoon
FALC
SDCL
TAT = 5 days
LOR
SDCL - Toronto
LOR
SDCL
MAPRO
TAT: Emerg = 4 hr
Routine = 3
days
Hematology - RGH LUPWS
Male:
20-70 yr: 1.5-9.3
>70 yr: 3.1-34.6
Female:
Follicular: 1.9-12.5
Mid-cycle: 8.7-76.3
Luteal: 0.5-16.9
Pregnant: <0.1-1.5
Postmenopausal: 5.0-52.3
Contraceptives: 0.7-5.6
Children: <0.1-6.0
IU/L
Chemistry - RGH
LHA
Therapeutic: 90-500
nmol/L
SDCL
TAT = 3 days
LUV
SDCL
(Indeterminate –
LYMES
See Prolactin
Blood
**Lyme Disease Total Blood
IgM and IgG Serology
2 Red or
2 Green
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Luteinizing Hormone
4 mL serum Aliquot. Do not use SST.
or 4 mL
Record time of collection
plasma
on tube and req.
2 mL serum Lyme indeterminate
specimens are referred to
Print Date: June 12, 2015
68
Test Name
Specimen Container Volume
(Borrelia burgdorferi)
1 mL
Specimen Requirements Reference Range
NML for supplemental
testing.
Freeze ASAP
Ship ASAP to SDCL
CSF
Sterile
Lymphocytotoxic
Antibodies
Macroglobulin
Macroprolactin
Blood
1 Red top
Blood
Blood
1 SST
1 SST
Magnesium
Blood
1 SST or
1 Green
Magnesium
Magnesium
State collection
period
Fluid
Urine
Malaria
Blood
Malaria PCR
Blood
*Malarial
(Plasmodium
falciparum) Serology
*Mandrax
(Methaqualone)
*Manganese
Blood
1 mL fluid
No Longer Available
None available
Random or 10 mL urine Indicate on Requisition if
24 hr: 3.00-5.00
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
1 Mauve
Whole
Can use same tube as
blood
CBC
1 Mauve
2 mL ETDA
whole
blood
1 SST
3 mL serum Aliquot.
Blood
2 Red
Blood
3 mL
1 – 7 mL
Royal Blue plasma
EDTA)
Aliquot and freeze
4 mL serum Aliquot
Aliquot ASAP into
polypropylene vial
Testing Site
NML, Winnipeg
TAT = 3 weeks)
SDCL to National
Microbiology Lab
Winnipeg
Transplant Centre
*Lyme Disease
CSF PCR
2 mL serum
2 mL serum Aliquot equally into 2
plastic tubes. Freeze
ASAP
1 mL serum
or plasma
Units
0.66-1.07 (RGH, PH)
0.70-1.10 (SEICC, ANHH)
LYMEC
SESTO
Immunology - RGH MACRG
SDCL – Hospitals MACRP
in Common,
Toronto
mmol/L Chem - RGH & PH MG
mmol/L Chem - RGH & PH
mmol/L Chem - RGH & PH MGUR
(random)
MG24
(24 hr)
Hematology - RGH MALAR
SDCL – Montreal
TAT = 4 weeks
MALRP
SDCL - Montreal
TAT = 4 weeks
MALRS
SDCL
METHQ
SDCL - Toronto
TAT = 2 weeks
MANG
BD368381
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
LIS Code
Print Date: June 12, 2015
69
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Manganese
Urine
Aliquot. Record collection
date, total 24 hr urine
volume, if submitted, or
random urine on req.
*Maprotiline
(Ludiomil)
Blood
24 hr or
random
urine
in acid
washed
container
2 Red
*Maternal Serum
Screen
(Maternal serum
screening req. must
be fully completed.
**Measles (Rubeola)
IgM Serology
**Measles (Rubeola)
IgG Serology
*Measles (Rubeola)
Nasopharyngeal or
Throat – Measles
PCR
Blood
*Measles (Rubeola)
Urine Measles PCR
Urine
Sterile
Urine
Container
->
Universal
Transport
Medium
Melanin
Urine
*Mellaril
Blood
10 mL
Therapeutic: 180-720
Toxic: >1800
1 SST
2 mL serum Random sample drawn
between 15 & 20 weeks
gestation. Optimum
is 16-17 weeks.
Includes: AFP, bHCG, Estriol,
Inhibin-A.
Also known as QUAD screen.
Blood
1 SST
Blood
1 SST
Random
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
2 mL serum Convalescent
(Immune status)
Leave swab in Universal
Transport Medium. Ship
to SDCL on ice pack or
freeze at -70C.
(Can be kept cold up to
24 hrs before specimen
must be processed.)
50 mL
Centrifuge urine at 2500xg
for 15 min. at 4C.
Resuspend the sediment
in 2 mL Universal
Transport Medium.
Freeze at -70C.
(Can be kept cold up to 24
hrs before processing.)
10 mL
Frozen
2 Red
4 mL serum Aliquot
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Testing Site
LIS Code
SDCL - Toronto
TAT = 4 weeks
4 mL serum Aliquot. Do not use SST.
Record time of collection
on tube and req.
Nasophary Swab in
ngeal or
Universal
Throat
Transport
Medium
Units
nmol/L
SDCL
MAPRO
TAT: Emerg = 4 hr
Routine = 3
days
SDCL
MSS
TAT = 1 day
SDCL
MEAMS
SDCL
MEAIS
SDCL – Winnipeg
TAT = 3 weeks
MEA/R
SDCL – Winnipeg
TAT - 3 weeks
MEA/U
SDCL- Specialty
Lab in California
SDCL
MELAU
Print Date: June 12, 2015
MELLA
70
Test Name
Specimen Container Volume
*Mercury
Blood
Specimen Requirements Reference Range
Units
7 mL whole Do not separate or freeze
1 – 7 mL
Royal Blue blood
EDTA)
Testing Site
LIS Code
SDCL - Toronto
TAT = 4 weeks
MERC
SDCL - Toronto
TAT = 2 weeks
MERCU
SDCL
TAT = 7 days
METAN
BD368381
*Mercury
Assay of whole
blood may be more
reliable and is
recommended
Metabolic Studies
*Metanephrine
(Catecholamines)
Urine
Urine
24 hr or
Random
acidwashed
plastic
container
24 hr
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
10 mL 24
hr or
random
aliquot
25 mL
aliquot
Collect in plastic container.
Record urine volume,
collection period and date.
State if 24 hr or random
urine on req.
See Amino Acids
Refrigerate during
collection. Adjust pH to 2-4
with 6N HCL or freeze.
Record volume and
collection period.
0-3 mo:
Metanephrine: 0.03-0.19
Normetanephrin: 0.26-0.85
Total Metanephrine: 0.29-1.04
4-6 mo:
Metanephrine: 0.03-0.21
Normetanephrin: 0.17-0.61
Total Metanephrine: 0.20-0.82
7-9 mo:
Metanephrine: 0.06-0.21
Normetanephrin: 0.23-0.60
Total Metanephrine: 0.29-0.81
10-12 mo:
Metanephrine: 0.04-0.51
Normetanephrin: 0.12-0.56
Total Metanephrine: 0.17-1.07
1-2 yr:
Metanephrine: 0.03-0.26
Normetanephrin: 0.18-0.65
Total Metanephrine: 0.21-0.91
2-6 yr:
Metanephrine: 0.06-0.50
Normetanephrin: 0.27-0.60
Total Metanephrine: 0.33-1.10
6-10 yr:
Metanephrine: 0.28-0.70
Normetanephrin: 0.26-0.96
μmol/d
Print Date: June 12, 2015
71
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL to MAYO
METAP
SDCL
METHS
Total Metanephrine: 0.54-1.66
10-16 yr:
Metanephrine: 0.20-1.23
Normetanephrin: 0.29-1.59
Total Metanephrine: 0.49-2.82
Adult:
Metanephrine: 0.37-1.50
Normetanephrin: 0.57-1.93
Total Metanephrine: 0.94-3.43
Metanephrine
(Plasma)
Blood
1 EDTA
Methadone
Blood
1 Red
Methadone
Urine
Random
20 mL
Negative
*Methaqualone
(Mandrax)
Blood
2 Red
Therapeutic: 2-20
μmol/L
Methemalbumin
Blood
2 SST
4 mL serum Aliquot. Do not use SST.
Record time of collection
on tube and req.
4 mL serum
0
mg/L
Methemoglobin
Blood
1 Green
1 mL whole
blood
0-2
%
Met Hemoglobin
Blood
Reductase Deficiency
1 mL
plasma
Freeze ASAP. Ship frozen,
if specimen thaws it is
unsuitable.
Collect peak 3-4 hr after
dose
1 Mauve or 0.2 mL
1 Green
whole
blood
1 Grey
3 mL whole
blood
*Methyl Alcohol
(Methanol)
Blood
Methotrexate
Blood
1 EDTA
1 mL
plasma
*Methylmalonic Acid
(Patient must be
fasting)
Blood
2 RED
3 mL serum Aliquot into plastic tube
ASAP and freeze. Send
frozen.Serum must be
separated from cells within
30 minutes.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
SDCL
TAT = 2 days
SDCL
TAT = 3 days
Special Chem RGH
Special Chem RGH
Special Chem RGH
Negative
Panic value: >15
After high dose chemotherapy:
Toxic: 24 hr post dose: >10
48 hr post dose: >1
72 hr post dose: >0.1
After regular therapy:
Toxic: >0.1
mmol/L SDCL
TAT: Routine 1
day
Emerg. 2 hr
μmol/L Chemistry - PH
SDCL –Alberta
Children’s Hosp,
Calgary.
TAT = 3 weeks
Print Date: June 12, 2015
METHQ
METHA
MTHGA
METRD
METH
MTX
MMA
72
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Methylphenidate
(Ritalin)
Urine
Random
Refrigerate
*Mexilitine (Mexitil)
Collect trough just
before next dose.
Peak occurs 2-3 hr
after last dose.
Microalbumin
Blood
2 Red or
3 mL serum Aliquot. Do not use SST.
2 Green or or
2 Mauve
3 mL
plasma
Therapeutic: 4-11
Toxic: 11.2
Severe toxic: >34
Urine
First
10 mL urine
Morning or
random or
24 hr
Urine
First
10 mL
Morning or
random
Blood
Blood
1 Red
2 Red
Microalbumin/
Creatinine Ratio
20 mL
Microbiology Tests
*Microsomal Antibody
*Mitotane
*Moclobemide
(Menerix)
*Modetin
(Fluphenazine)
*Mogadon
(Nitrazepam)
To monitor therapy,
draw trough
specimen before
next dose is given
*Molecular Testing
(DNA)
2 mL
4 mL
Samples contaminated
with blood are not
recommended. Indicate
random or 24 hr on
sample. For 24 hr, record
volume and collection
period.
Rural sites: Send aliquot
frozen.
Samples contaminated
with blood are not
recommended.
Rural sites: Send aliquot
frozen.
See Micro Section
See Anti-Thyroid
Peroxidase
Refrigerate
Aliquot
Units
Testing Site
LIS Code
SDCL - Toronto
TAT = 7 days
RITAU
μmol/L
SDCL
TAT = 1 day
MEXIL
Random: 0-20
24 hr: 0-30
mg/L
mg/d
Chemistry - RGH
MIALB
(random)
MA24
(24 hr)
Female: 0-2.8
Male: 0-2.0
mg/mmol Chemistry - RGH
Negative
MA/C
SDCL- Mayo
SDCL
MITOT
MOCLO
SDCL - Toronto
MOG
Reference Lab
MOLEC
See Phenothiazines
Blood
1 Red or
1 Green
Blood
Varies
(check with
supervisor)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Aliquot
or plasma
Requires pathologist preapproval
Print Date: June 12, 2015
73
Test Name
Specimen Container Volume
Monotest
Blood
*Morphine
Blood
*MPO
6-MP/GTG
Blood
(Metabolite of
Azathioprine Crohn's drug)
(Thiopurine
Metabolites)
Mucopolysaccharides Urine
**Mumps IgM
Serology
1 SST or
1 EDTA
Specimen Requirements Reference Range
0.5 mL
serum
or 2 mL
whole
blood
Units
Testing Site
Hem - RGH & PH
LIS Code
MONO
SDCL
MORPH
California
6TGMP
Random or 10 mL urine Freeze. State 24 hr or
24 hr
random on req. If 24 hr,
record volume on req.
SDCL- Saskatoon
TAT = 2 weeks
MUCO
(random)
MUC24
(24 hr)
Blood
1 SST
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
SDCL
MUMMS
Blood
1 SST
2 mL serum Convalescent
(Immune status)
SDCL
MUMIS
Urine
Sterile
Urine
Container
->
Universal
Transport
Medium
50 mL
SDCL - Winnipeg
MUM/U
Blood
1 Mauve
2-3 mL
plasma
See P-ANCA
1 Mauve
top
EDTA
whole
blood
(Parotitis IgM)
**Mumps IgG
Serology
(Parotitis IgG)
*Mumps
Urine Mumps PCR
*Mycology Serology
*Mycophenlite
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Centrifuge urine at 2500xg
for 15 min. at 4C.
Resuspend the sediment
in 2 mL Universal
Transport Medium.
Freeze at -70C.
(Can be kept cold up to 24
hrs before processing.)
Must indicate requested
test on requisition. See:
Aspergillus
Blastomycosis
Coccidioidomycosis
Cryptococcal Antigen
Histoplasmosis
Sporotricosis
Spin and Freeze
SDCL-Hamilton
MYCPH
Sent Wednesdays
Print Date: June 12, 2015
74
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Mycobacterium (TB)
Blood Culture
*Mycoplasma hominis
Mycoplasma and
Ureaplasma Culture
(Ureaplasma
urealyticum,
Mycoplasma
genitalium)
Mycoplasma
pneumoniae Culture
**Mycoplasma
pneumonia (IgM)
Serology
*Myelin Basic Protein
Myoglobin
*Mysoline (Primidone)
Nabferon(INF-B)
Antibody(Beta
Interferon)
Blood/Bone
Marrow
See Blood Culture
TB (Mycobacterium).
*Nalfon
*NAPA (N-Acetyl
Procainamide)
See TDM section for
ideal sampling times
Units
Cervical,
Universal
Urethral,
Transport
Respiratory Medium
(neonatal)
Respiratory
Blood
CSF
Urine
Blood
Blood
Blood
Testing Site
LIS Code
SDCL
UREMH
No longer available.
2 mL serum If the acute is negative,
submit convalescent in 510 days.
0.5 mL
Frozen
No Longer Available
1 Red
3 mL serum Aliquot
1 Red
2 mL serum Refrigerate.Sample needs
to be collected before
treatment with interferon or
more than 24 hrs postdose
See Fenoprofen
1 Red or
1 mL serum Do not use SST
1 Green or or plasma
1 Mauve
MYCOP
1 SST
MUST BE APPROVED
Patient should not be on steroid
therapy for at least 2 wks prior to
testing.
Sum of Procainamide and NAPA
Therapeutic range: 43-129
μmol/L
SDCL
MYPMS
SDCL-Calgary
MBPCF
SDCL
SDCL to Athena
Diagnostics
MYSO
SDCL
TAT = 1 day
PROC
*Naproxen
(Naprosyn)
*Neonatal Screen
(PKU, thyroid
function)
Blood
1 Red
2 mL serum Aliquot
SDCL
NAPRO
Blood
Card
SDCL
TAT = 3 days
PKU
*Neisseria
gonorrhoeae
Urine Chlamydia and
GC (NAAT)
Urine
APTIMA
Whole
blood
applied to
lab
supplied
card
20 -30 mL
first catch
void uine in
collection
cup
SDCL
CHLGC
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Using provided disposable
pipette, add 2 mL of urine
specimen to APTIMA tube.
Urine level must be
between black fill lines.
Print Date: June 12, 2015
75
Test Name
Specimen Container Volume
*Neurological
Disease Profile
(Anti-GM1, GM2,
GM3, GD1a, GD1b,
Bt1b, GQ1b
Blood
Specimen Requirements Reference Range
1 SST
1 mL serum Freeze ASAP
*Neuromyelitis Optica Blood
Antibody
1 SST or
1 RED
1 mL serum Freeze specimen.
Frozen
*Neuron-specific
Enolase
Blood
1Red
DO NOT
USE SST
Serum
*Neurontin
(Gabapentin)
Collect 2 hr post
dose after patient
reaches steady
state
*Niacin
Blood
1 nonSST or
1 Green
Blood
2 EDTA
Nickel
Blood
3 mL serum Aliquot into polypropylene
1 – 7 mL
Royal Blue or plasma vial
EDTA)
Do not use SST
Aliquot and keep cold but
not frozen.
Send on ice packs.
1 mL serum Aliquot ASAP and freeze
or
heparinized
plasma
4 mL of
plasma
Protect from light.
Spin and Send frozen
Units
Testing Site
SDCL to Mitogen
NEURP
Diagnostics,
Calgary
(if GM1 ordered
alone see GM1ABgoes to Toronto)
SDCL-Calgary
ABNMO
SDCL-Mayo
ENONS
SDCL – Hospital in NEUR
Commons, Toronto
TAT = 2 weeks
SDCL – Minnesota NIACN
SDCL - Toronto
TAT = 2 weeks
BD368381
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
LIS Code
Print Date: June 12, 2015
NICKS
76
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Nickel
Urine
Record collection datae
and 24 hr urine volume, if
submitted, or random urine
on the req.
*Nitrazepam
Blood
(Mogadon)
To monitor therapy,
draw trough
specimen before
next dose is given
Nitro Blue
Blood
Tetrazolium (NBT)
*Nitroprusside
Therapy
*Noctec
*Noradrenalin
*Norclomipramine
*Norepinephrine
*Norovirus
Stool Norovius PCR
Stool
Random or 15 mL of 24
24 hr acid- hr or
washed
random
urine
container
1 Red or
1 Green
1 mL serum Aliquot
or plasma
Syringe
Sterile
stool
container
Collected only by
Hematology staff
Must be approved by
Hematologist
See Thiocyanate
Walnut size
stool
portion
with no viral
transport or
preservative
*Norpace
*Norpramin
*Nortryptyline
(Aventyl)
Blood
Blood
Blood
1 Red
2 Red
2 Red
*Norverapamil
Nuclear Antibodies
5-Nucleotidase
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
1 mL serum
4 mL serum
4 mL serum
See Chloralhydrate
See Catecholamines
See Clomipramine
See Catecholamines
Stool must be collected
within 48 hrs from onset of
symptoms.
When an institution
suspects an outbreak,
inform the Virology Section
at (306)787-3138 prior to
submitting specimens.
Aliquot
Aliquot
Aliquot. Do not use SST. 190-570
Record time of collection
Toxic: >1800
on tube and req.
nmol/L
Testing Site
LIS Code
SDCL - Toronto
TAT = 2 weeks
NICKU
SDCL - Toronto
NITRA
RGH
NBT
SDCL
NORPA
STLNW
SDCL
NORPA
SDCL
SDCL
NORTR
TAT: Emerg = 4 hr
Routine = 3
days
See Verapamil
See ANA
Not available.
Recommend GGT.
Print Date: June 12, 2015
77
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Occult Blood –Fecal Stool
(FIT) Inpatient and
Emerg patients
Occult Blood – Fecal Stool
(FIT) Outpatient and
Community patients
Oligoclonal Bands
CSF
Sterile
container
New Method kit - Not
previous Hemoccult cards.
Chemistry
FITIN
Kit
KIT and instructions given
to patient.
SDCL
FIT
*Oligosaccharides
*Opiates
Urine
Urine
Random
Random
2.5 mL
CSF
10 mL urine Freeze
20 mL urine Refrigerate
*Organic Acids
Organic acids in
serum are not
available
*Orudis (Ketoprofen)
Osmolality
Urine
Random
10 mL urine Freeze
Blood
Blood
1 Red
1 SST or
1 Green
Osmolality
Osmolality
Fluid
Urine
Osmolal Gap
Osmotic Fragilities
(Acid Glycerol Lysis
Test is usually done
instead)
Ostase
*Ovarian Antibodies
Blood
2 mL serum Aliquot
1 mL serum
or plasma
1 mL fluid
Random or 10 mL urine Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
1 SST or
1 mL serum Serum glucose and urea
1 Green
or plasma result required. Calculated
Osmolality - Measured
Osmolality
No Longer Available
See ACID GLYCEROL
LYSIS
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Negative
Special Chem RGH
SDCL- Saskatoon
SDCL
TAT = 2 days
SDCL- Saskatoon
TAT = 2 days
280-305
None available
300-900
OLIGO
OLISA
OPIAT
OGACU
SDCL
KETOP
mmol/kg Chem - RGH & PH OSMO
mmol/kg Chem - RGH & PH OSFL
mmol/kg Chem - RGH & PH OSMRU
(random)
OSM24
(24 hr)
0-14
mmol/kg Chem - RGH & PH OSGAP
Hematology - RGH OSMFR
See Bone Specific ALP
See Anti-Ovarian Ab
Print Date: June 12, 2015
78
Test Name
Specimen Container Volume
*Oxalate
Avoid large amounts
of vitamin C for 48 hr
prior to collection
Urine
*Oxazepam (Serax)
Blood
24 hr Urine 25 mL urine Adjust pH to 2-4 with 6N
aliquot
HCL or freeze. Record 24
hr volume on req.(If
ordered with Citrate, send
sep specimen and req)
2 Red
4 mL serum Aliquot. Do not use SST.
*Oxcarbazepine
Blood
1 Red
2 mL serum Remove serum from cells
as soon as possible.
SDCL
*P-ANCA (MPO)
Blood
1 SST
2 mL serum
SDCL - Saskatoon PANCA
TAT = 2 weeks
*Pancreatic Islet Cell
Ab
Pancretic
polypeptides (fasting)
*PAPP-A Maternal
Serum Screen
(Maternal serum
screening req. must
be fully completed.
*Paragonimus
Serology
*Parainfluenza
*Paraneoplastic
Disease Profile
(Includes: HU, YO,
RI, Amphyphysin and
PNMA-2)
Specimen Requirements Reference Range
Male: 80-490
Female: 40-320
7-14 yr: 140-420
<7: not determined
Therapeutic: 0.6-5
Units
μmol/d
Testing Site
LIS Code
SDCL
TAT = 7 days
OXU
SDCL
TAT = 3 days
OXAZE
OXCRB
See Anti-Islet Cells Ab
Blood
2 mauve
Blood
1 SST
3 mL EDTA Aliquot and freeze
plasma
2 mL serum Random sample drawn
between 11 & 14 weeks
gestation.
Blood
1 SST
3 mL serum Aliquot.
Nasopharyngeal
Aspirate,
Washes
Throat
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Includes: PAPP-A, Free bHCG,
and nuchal translucency test.
SDCL
PAPEP
SDCL
TAT = 1 day
PAPPA
SDCL – Montreal
TAT = 4 weeks
PARAG
SDCL – Mitogen
Diagnostics,
Calgary
PNPDP
See Respiratory Virus
Isolation or Detection.
See Throat Virus Isolation
or Detection.
1 mL serum Freeze and ship frozen
frozen
Includes: HU, YO, RI, Amphyphysin
and PNMA-2
Print Date: June 12, 2015
79
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Parasitology
Serology
Blood
*Parathyroid
Hormone (PTH)
Blood
1 EDTA
1 mL
EDTA
plasma
Must indicate requested
test on requisition. See:
Amoebiasis
Babesiosis
Cysticercosis
Echinococcosis
Filariasis
Leishmaniasis
Malaria PCR
Malaria (P.falciparum)
Paragonimus
Schistosomiasis
Strongyloidiasis
Toxocariasis
TORCH
Toxoplasma Antibody
Toxoplasma Total
Trichinellosis
Trypanosomiasis
Can be refrigerated up to 2 1.6 – 7.2
days.
Rural sites: Freeze plasma
*Parathyroid
Hormone (PTH)
Related Peptide
Blood
1 EDTA
2 mL
plasma
*Parietal Cell
Antibody
(Parietal Antibodies)
Blood
1 SST
**Parotitis
Blood
**Parvovirus B19 IgM Blood
Spin and freeze within 2
hrs of collection.
Unsuitable if specimen
thaws.
2 mL serum Send last B12 result with
specimen
Units
pmol/L
Testing Site
LIS Code
RGH Chemistry
PTHA
SDCL - Quebec
PTHRP
SDCL- Saskatoon ABPCA
TAT = 2 weeks
See Mumps.
1 SST
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
SDCL
PAVMS
1 SST
2 mL serum Convalescent
(Immune status)
SDCL
PAVIS
Serology
(Fifth Disease IgM)
**Parvovirus B19 IgG Blood
Serology
(Fifth Disease IgG)
*Paroxetine
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Paxil
Print Date: June 12, 2015
80
Test Name
Specimen Container Volume
Partial
Blood
Thromboplastin Time
Anticoagulant
status must
provided on req
Paul Bunnell
Blood
Paxil
Blood
*PCP
*Pemphigoid
(Pemphigous)
Antibodies
*Penicillin Allergen
Blood
Test
(Penicillin G/Penicillin
V)
*Pentazocine (Talwin)
*Pentobarbital
Blood
Pentothal
(Thiopental)
1 mL
plasma
Draw is critical. 4.5 mL in 24-36
a 5 mL tube. Remove
55-80 (therapeutic range)
plasma within 2 hr. If not
analyzed within 4 hr,
freeze.
1 Red (full)
2 Red or
4 mL serum Do not use SST. Record
2 Green
or plasma time of collection on tube
and req.
See Phencyclidine
See Anti-Skin Ab
Therapeutic: 94-188
Units
sec.
nmol/L
2 mL serum
1 Red or
2 Green
(full)
Blood
1 Red or
2 Green
(full)
NasoRegan
pharyngeal Lowe
Transport
Medium
*Pertussis
*Nasopharyngeal
Pertussis (Culture
and PCR)
(Bordetella pertussis)
(Whooping cough)
Pertussis Serology
Blood
PFA
Blood
PH
PH
1 Blue
Specimen Requirements Reference Range
1 Blue
Blood
Fluid
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Talwin
3 mL serum Do not use seraclear for
or plasma separating plasma (false
positives)
3 mL serum Do not use seraclear for
or plasma separating plasma (false
positives)
Testing Site
Hematology RGH
SDCL
SDCL
TAT = 3 days
LIS Code
APTT
PAXIL
SDCL- Saskatoon
Hpnotic: 4-22
Toxic: >44
Coma: 88-221
Hpnotic: 4-21
Toxic: >41
Coma: 124-413
μmol/L
Special Chem RGH
BARBQ
μmol/L
Special Chem RGH
BARBQ
SDCL
No longer available.
5 mL whole Approval by Hematologist
blood
required
Whole Blood “Unspun”
See Blood Gases
1 mL fluid
Specimen must be kept on None available
ice
PERTU
PERTS
Special coag RGH PFA
Chem - RGH &
PH
Print Date: June 12, 2015
PHFL
81
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Phencyclidine (PCP) Urine
Random
Urine
container
20 mL urine Refrigerate
Negative
Phenobarbital
Blood
See TDM section for
ideal sampling times
Urine
*Phenothiazines
Chlorpromazine
(Largactil)
Fluphenazine
(Moditen)
Mesoridazine
Methotrimeprazine
Perphenazine
(Trilafon)
Prochloroperazine
(Stemetil)
Promazine
(Sparine)
Thioridazine
(Mellaril)
Trifluoperazine
(Stelazine)
Trifluopromazine
(Sequil)
Trimeperazine
*Phenylalanine (PKU) Blood
1 EDTA
1 mL
plasma
64-172
Random
Urine
container
20 mL urine
Negative
*Phenytoin - Free
Blood
1 mL serum
or plasma
or whole
blood
2 Red
4 mL serum
1 EDTA if 1 mL
sending to plasma
RGH
Or
Or
1 SST for 1 mL serum
ANHH
1 Red
2 mL serum
*Philidelphia
Blood
2 EDTA
*Phenylbutazone
Blood
Phenytoin (Dilantin)
Blood
Collect 0-1 hr before
dose.
See TDM section for
ideal sampling times
1 SST or
1 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Record date and time of
1st week of life up to 360 μmol/L,
collection on tube and req. thereafter 210
Aliquot
Collect 0-1 hr before dose. Therapeutic: 40-80
Toxic: ≥119
Units
μmol/L
μmol/L
μmol/L
Testing Site
LIS Code
SDCL
TAT = 3 days
PHENC
Chemistry - RGH
PHENO
SDCL
TAT = 3 days
PHEOZ
SDCL
TAT = 2 days
PHALA
SDCL
Chem - RGH &
PH
PHEBZ
PHENY
CHEM - ANHH
Aliquot and freeze in
plastic tube. Do not use
SST.
Keep cool
SDCL
FRPTN
BC Cancer
BLPHC
Print Date: June 12, 2015
82
Test Name
Specimen Container Volume
Chromosome
Blood
Phosphorus
Fluid
Phosphorus
State collection
period
Urine
Phyantic Acid
Blood
*Placidyl
(Ethchlorvynol)
Plasma Hemoglobin
Plasminogen
Platelet
1 SST
1 mL serum
1 mL fluid
<14 yr: 1.30-2.00
>14 yr: 0.75-1.55
No Longer available
24 hr:
<14 yr: 16-26
>14 yr: 11-36
Blood
Random or 10 mL urine Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
1 Green
2 mL
Freeze plasma
plasma
1 Red
2 mL serum Aliquot
Blood
1 Mauve
2 ml
plasma
0-70
Blood
1 Mauve
Whole
blood
Platelet Aggregation
Centrifuge and remove
from cells within 30
minutes
See Hypercoag
Order CBC
Special test - notify
hematology
Platelet Antibody
1 RED
3 EDTA
Blood
Pre 1 SST
Post –
1 SST
P-Neutrophil
Cytoplasmic
Antibodies
*Polio Neutralization
Units
Testing Site
LIS Code
Must be sent to SDCL
same day as collection by
noon.
Phosphorus
**Pneumococcal
Serology
Specimen Requirements Reference Range
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Approval Required by
Hematologist and must be
pre-booked with Saskatoon
at 306 655-5205
2 ml serum Requires both pre- and
post-immunization samples
before sending out. Give
vaccination date and
clinical history.
See P-ANC
1 ml serum
mmol/L Chem - RGH &
PH
Chem - RGH &
PH
mmol/d Chem - RGH &
PH
SDCL – Hospital
in Commons
SDCL
mg/L
PHOS
PO4UR
(random)
PO424
(24 hr)
PHYTA
ETHVY
Special Chem RGH
PLHB
Hem - RGH & PH
PLT
Special Coag
Hematology RGH
Saskatoon
PLABS
SDCL – Cadham
Prov Lab,
Manitoba
TAT = 4 weeks
PNEUS
SDCL
POLNT
Print Date: June 12, 2015
83
Test Name
Test
*Polymerase Chain
Reaction (PCR) for
Hepatitis C (RNA)
*Polyomavirus –
BK Virus,
Porphobilinogen
(PBG)
Specimen Container Volume
Specimen Requirements Reference Range
Blood
Remove plasma ASAP.
Freeze and ship on dry ice.
Blood
CSF
Urine
Urine
1 Mauve
1 mL
plasma
Units
Testing Site
SDCL
LIS Code
PCR
See BK Virus.
Random
Frozen
5 mL urine
Keep urine in the dark
10 mL
plasma
Protect from light by
wrapping in tin foil. Send
plasma frozen.
Porphyrins
Blood
2 Mauve
(EDTA)
Porphyrins Fractionation
Urine
Porphyrins Screen
Urine
24 hr Urine 50 mL urine Preservative: 5 g
aliquot
Na2CO3. Freeze. Collect
in brown bottle. Wrap
aliquot in tin foil. Record
collection time and volume.
Keep refrigerated during
collection.
Random
5 - 10 mL
Collect in brown bottle and
wrap in foil. Freeze
Porphyrins
(Qualitative)
Quantitation done if
screen positive
*Porphyrins
(Quantitation)
Feces
Fecal Fat
Container
50 g of
well-mixed
feces
Feces
Fecal Fat
Container
50 g of
well-mixed
feces
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Protect from light (use dark
container or wrap in tin
foil). Must be sent in a
sealed container.
Send frozen. Protect from
light – as above.
0-9
Uroporphyrin I: 0-44
Uroporphyrin III: 0-20
Heptacarboxyl Porphyrin: 0-16
Hexacarboxyl Porphyrin: 0-2
Pentacarboxyl Porphyrin: 0-2
Coproporphyrin I: 5-90
Coproporphyrin III: 15-242
μmol/L
nmol/d
Special Chem RGH
PBG
SDCL - Toronto
TAT = 3 weeks
PORPP
SDCL
TAT = 7 days
PORPH
Special
Chemistry- RGH
PORSC
SDCL - Toronto
SDCL - Toronto
TAT = 3 weeks
Print Date: June 12, 2015
PORPS
PORPF
84
Test Name
Specimen Container Volume
Potassium (K)
Blood
1 SST or
1 Green or
Syringe
with
electrolyte
balanced
dry heparin
Potassium (plasma)
Blood
1 Green –
Lithium
Heparin
Potassium
Vitreous
Fluid only
Urine
Potassium
State collection
period
PRA (Plasma Renin
Activity)
PreAlbumin
Pregnancy Test
(hCG)
Pregnancy Test
(hCG)
1 mL serum
or plasma
or 1.5 mL
whole
blood for
adults or
0.6 mL for
neonates in
syringe
1 mL
Only order on request by
plasma
physician or instruction in
LIS.
1 mL fluid
Random or 10 mL urine Indicate on Requisition if
24 hr Urine
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
See Renin
Blood
Blood
1 SST
1 SST
1 mL serum Frozen
1 mL serum
Urine
Random
Urine
5 mL urine
*Pregnanediol
*Pregnanetriol
Prenatal Antibody
Screen (Maternal or
Paternal)
Specimen Requirements Reference Range
3.5-5.0
Units
Testing Site
mmol/L Chem - RGH &
PH
2 Mauve
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Whole
blood
Label samples with
patient’s full name and one
of the following: PHN,
MRN or DOB. Sign and
Date Req.
K
(serum)
ABLK
(whole
bld)
KHEP
None available
24 hr: 25-125
Positive/negative
Sensitivity 25 IU/L
Positive/negative
Sensitivity 25 IU/L
mmol/L Chem - RGH &
PH
mmol/d Chem - RGH &
PH
KFL
KURA
(random)
K24
(24 hr)
SDCL - Saskatoon PREAL
Chem - RGH &
SPREG
PH
Chem - RGH &
PREGU
PH
Replaced by Progesterone
No Longer Available
Blood
LIS Code
CBS
Print Date: June 12, 2015
85
Test Name
Specimen Container Volume
*Primidone (Mysoline) Blood
See TDM section for
ideal sampling times
1 Red or
1 Green
Prion Analysis
(PRNP Analysis)
Blood
3 ACD
25 mL
(yellow
Whole
glass tube) blood
*Procainamide
(Pronestyl)
See TDM section for
ideal sampling times
Performed
simultaneously with
NAPA.
*Prochlorperazine
(Stemetil)
*Progesterone
Blood
Specimen Requirements Reference Range
1 mL serum Aliquot. Do not use SST.
or plasma
Store at room temp. Do
Not Freeze. Ship at
ambient temp.
Requisiton for Prion
Diseases Program
required.
Consent form required.
1 Red or
1 mL serum Aliquot. Do not use SST.
1 Green or or plasma
1 Mauve
23-55
Toxic: >55
Units
μmol/L
Testing Site
LIS Code
SDCL
TAT = 1 day
PRIMO
SDCL - Winnipeg
PRNPA
Therapeutic: 17-43
Toxic: >43
Sum of Procainamide & NAPA: 43129
μmol/L
SDCL
TAT = 1 day
PROC
Normal Menstruating Female:
Follicular phase (preovulation):
<0.32-0.95
Luteal phase (postovulation):
3.82-50.6
Postmenopausal: <0.32-0.64
Pregnancy:
1st trimester: 8.9-468
2nd trimester: 72-303
3rd trimester: 89-771
Male: <0.32-0.64
nmol/L
Chemistry - RGH
PROGS
See Phenothiazines
Blood
1 SST
*Prograf
*Proinsulin
Patient must be
Fasting
Blood
1 EDTA
(prechilled)
Prolactin
Blood
1 SST
*Promazine (Sparine)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Avoid hemolysis
See Tacrolimus
1.5 mL
Place tubes on ice
plasma
immediately after collection
for at least 10 minutes.
Spin in refrigerated
centrifuge and Freeze
plasma.
1 mL serum Avoid hemolysis
Male: 2.6-18.1
Female: 1.2-29.9
SDCL -Minnesota PROIN
μg/L
Chemistry - RGH
See Phenothiazines
Print Date: June 12, 2015
PROLC
86
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Pronestyl
*Propafenone
(Rythmol)
Blood
Blood
1 Red
2 Red
1 mL serum
3 mL serum Aliquot
*Propoxyphene
(Darvon)
Blood
2 Red
4 mL serum Aliquot. Record time of
Therapeutic: 150-600
collection on tube and req.
Do not use SST.
4 mL serum Aliquot. Do not use SST. Therapeutic: 190-770
*Propranolol (Inderal) Blood
Peak occurs 2-3 hr
after last dose.
Collect trough level
just before the next
dose.
*Propyl Alcohol
Blood
2 Red or
2 Green or
2 Mauve
1 Grey
3 mL whole Do not use alcohol swab
blood
Prostatic Specific
Antigen (PSA)
Protein
Blood
1 SST
Blood
1 SST
1 mL serum Free PSA done if PSA >4
and =10
1 mL serum
Protein
CSF
Protein
Fluid
Protein
State collection
period
Urine
Protein/Creatinine
Ratio
Urine
Protein
Electrophoresis
Blood
0.5 mL
CSF
1 mL fluid
Random or 10 mL urine Indicate on Requisition if
24 hr Urine
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
Random
5 mL urine Samples contaminated
with blood are not
recommended
1 SST
1 mL serum
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Testing Site
LIS Code
SDCL
SDCL
TAT = 5-14 days
PRONE
PROPA
nmol/L
SDCL
TAT = 3 days
PROPO
nmol/L
SDCL
TAT = 3 days
PROPR
SDCL
TAT = 1 day
PROPY
0-4
μg/L
Chemistry - RGH
PSA
<3 mo: 46-70
3-12 mo: 45-65
1-2 yr: 54-75
2-3 yr: 53-80
>3 yr: 60-80
0.15-0.60
g/L
Chem - RGH &
PH
TP
g/L
PROCF
None available
g/L
24 hr: 0.00-0.15
g/d
Chem - RGH &
PH
Chem - RGH &
PH
Chemistry - RGH
Hypertensive Disorders of
Pregnancy: < 30mg/mmol
mg/
mmol
Chemistry – RGH
TP/C
Albumin: 30-50
Alpha1 globulin: 1-4
Alpha2 globulin: 4-8
Beta globulin: 6-11
Gamma globulin: 7-17
g/L
Immunology RGH
SPE
Print Date: June 12, 2015
TPFL
TPUR
(random)
TP24
(24 hr)
87
Test Name
Specimen Container Volume
Protein
Electrophoresis
CSF
Protein
Electrophoresis
Urine
Protein C
Protein S
Prothrombin Time
Anticoagulant
status must be
provided on the req
Protoporphyrin
(Erythrocyte)
Specimen Requirements Reference Range
1 mL CSF
CSF Albumin: 111-483
CSF IgG: 6-86
IgG/Albumin Ratio: 0.07-0.25
See Hypercoag
See Hypercoag
See INR
1 Blue
(full)
1 mL
plasma
Blood
1 Mauve
Blood
2 Red
5 mL whole DO NOT SPIN. Keep in
blood
the dark.
EDTA
4 mL serum Aliquot
See Prostatic Specific
Antigen
PseudocholinBlood
esterase
(If ordered with
Dibucaine #)
PseudocholinesBlood
terase
*Psittacosis Serology Blood
1 SST
Testing Site
Immunology RGH
IMCSF
Immunology RGH
TPEU
sec.
Hem - RGH & PH
0.30-1.80
μmol/L
RBCs
Special Chem RGH
TEP
SDCL
FLUOX
Special Chem RGH
PT
PSDIN
1 SST
1 mL serum
SDCL
1 SST
1 mL serum
SDCL – Winnipeg PSIAS
TAT = 4 weeks
*PTH
*PTH Related Peptide
See Parathyroid Hormone
See Parathyroid Hormone
Related Peptide
Blood
LIS Code
11.9-13.8
Dibucaine No: 78-89
Fluoride No: 62-71
(Chlamydophilia psittaci,
Chlamydia psittaci)
PTMUT
mg/L
24 hr Urine 50 mL urine Record 24 hr urine volume
aliquot
and collection period
Blood
*Prozac (Fluoxetine)
PSA
Units
1 Mauve
Whole
blood
See Hypercoag
*Purkinje Cyto Ab
See Anti-Yo
*Pyridoxine
*Pyruvate (Pyruvic
Acid)
NO LONGER
AVAILABLE
See Vitamin B6
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
PCHOL
88
Test Name
Specimen Container Volume
*Pyruvate Kinase
(PK)
Blood
*Q Fever
Blood
*Quinidine
See TDM section for
ideal sampling times
*Quinolinic Acid
*Rabies Serum
Serology
1 Mauve
5 mL whole Ward (NICU), will collect
blood
on newborn. Collect on
Monday and Tuesday
See Rickettsial Serology.
Blood
1 Red or
1 Green
1 mL serum Do not use SST. Aliquot.
or plasma Refrigerate.
Blood
Blood
2 Green
1 SST
*Rabies
CSF
CSF Rabies Serology
*Rapamycin
Trough specimen
must be drawn
immediately
pre-dose
*Rapid Plasma
Reagin
*RASH viral panel
Rast Test
Special sheet must
accompany
specimen
Red Cell Fragility
(Osmotic Fragility)
Acid Glycerol Lysis
Test is usually done
instead
Specimen Requirements Reference Range
Blood
Plasma
Freeze plasma
2 mL serum Aliquot ASAP and send
frozen.
Human Rabies Serology
Requisition must be
completed by ordering
physician.
Sterile leak 2 mL CSF Freeze CSF ASAP.
proof tube
If specimen thaws, it is
unsuitable for analysis.
Human Rabies Serology
Requisition must be
completed by ordering
physician.
1 Mauve
3 mL whole Refrigerate immediately.
blood
Ship on ice packs.
Therapeutic: 6-15
Toxic: >15
Units
μmol/L
Testing Site
LIS Code
SDCL - Toronto
PK
SDCL
TAT = 1 day
QUIN
SDCL- Saskatoon QUINO
SDCL - Winnipeg RABIS
TAT = 4 weeks
SDCL - Winnipeg
TAT = 4 weeks
RABIC
Chemistry-RGH
SIROS
1 mL serum To include patient
symptoms and date of
onset on requisition.
Serum
100 µL serum required for
each test ordered
SDCL
RASHP
Whole
blood
Hematology RGH
See RPR
Blood
1 SST
Blood
1 SST
Blood
1 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Check with hematology
before collection. Collect
before 1200.
SDCL- Saskatoon RAST
Print Date: June 12, 2015
OSMFR
89
Test Name
Specimen Container Volume
Reducing Substances Urine
Reducing Substances Feces
*Renal Calculus
Renal Panel (urea,
Blood
creatinine,
electrolytes)
Renin Direct
(replaces renin
activity)
Blood
Random
Random
5 mL urine
2g
1 SST
1 mL serum
2 Mauve
3 mL
room temp plasma
Neonates:
750 uL
*Respiratory Syncytial NasoVirus (RSV)
pharyngeal
Aspirate,
Washes
Throat
Reticulin Ab
Reticulocytes
Blood
1 Mauve
Specimen Requirements Reference Range
NO LONGER AVAILABLE
NO LONGER AVAILABLE
See Calculi
See individual tests for reference
ranges
Separate and Freeze
plasma ASAP.
Collect between 07001000
See Respiratory Virus
Isolation or Detection.
See Throat Virus Isolation
or Detection.
See Anti-Reticulin Ab
Can use same tube as
CBC
Rheumatoid Factor
(RA Latex, Latex
Fixation)
*Rhythmadon
Blood
1 SST
Whole
blood
1 mL serum
Blood
1 Red or
1 Green
3 mL serum Aliquot
or plasma
*Riboflavin
*Rickettsial Serology
Blood
Blood
1 SST
(Rickettsia rickettsii,
Rickettsia typhi,
Rocky Mountain Fever,
Q Fever,
Coxiella burnetii)
Ristocetin Cofactor
*Ritalin
Urine or
Blood
*Rivotril (clonazepam) Blood
Random
Urine or
2 Red
2 Red
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Vitamin B2
2 mL serum Screen includes Q Fever
(Phase I & II), Coxiella
burnetii, Rickettsia
rickettsii IgG and Rickettsia
typhi IgG specific assays.
Test is part of BLDWS
20 mL urine Urine is preferred.
Units
Testing Site
LIS Code
Chemistry - RGH
Chemistry - RGH
RDSUN
RDSFN
Chem - RGH &
PH
HRENA
(hospital)
PRENA
(PML
sites)
RENIN
SDCL
Hem – RGH & PH RETIC
Immunology RGH
RF
SDCL
RHTHY
SDCL - Winnipeg
TAT = 6 weeks
RICKT
SDCL
RITAU
SDCL
CLONZ
4 mL serum Aliquot
4 mL serum Aliquot
Print Date: June 12, 2015
90
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Rocky Mountain
Spotted Fever
**Roseola IgM & IgG
Serology
Blood
See Rickettsial Serololgy.
Blood
1 SST
Blood
1 SST
(HHV-6,
Human Herpes 6 Virus)
*RPR (VDRL)
Rapid Plasma Reagin
*RSV
(Respiratory Syncytial
Virus)
**Rubella IgM
Serology
**Rubella IgG
Serology
**Rubeolla
Russell Viper Venom
Nasopharyngeal
Aspirate,
Washes
Throat
Blood
1 SST
Blood
Blood
*Rythmodan
Blood
(Disopyramide)
*Rythmol
*Sabril
*Saccharomyces
Blood
cerevisiae antibodies
(Anti-Saccharomyces
cer)
Salicylate
Blood
See TDM section for
ideal sampling times
SARS
*SARS
Nasopharyngeal or
1 SST
2 Red
LIS Code
SDCL
VDRL
SDCL
RUBMS
SDCL
RUBIS
See Respiratory Virus
Isolation or Detection.
See Throat Virus Isolation
or Detection.
2 mL seum If acute is negative, submit
convalescent in 5-10 days.
1 mL serum Convalescent
(Immune status)
See Measles (Rubeolla).
See
DRVVT
3 mL serum Aliquot
1SST
1 mL serum
1 SST or
1 Green
1 mL serum
or plasma
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Testing Site
SDCL – Winnipeg ROSEO
TAT = 3 weeks
1 mL serum Screen includes Roseola
IgG and IgM.
Viral Exanthemata
Requisition must be
completed by ordering
physician before specimen
is forwarded.
1 mL serum
RGH
DISOP
See Propafenone
Not available
Blood
NasoUniversal
pharyngeal Transport
Units
SABRI
SDCL – Hospitals ASCA
in Common,
Toronto
Therapeutic: 1.10-2.20
Toxic: >2.3
Usually lethal: >5.0
N.B. Children are more sensitive to
the effects of salicylate
No longer available.
Phone SDCL at
(306)787-3131 to pre-
mmol/L Chem – RGH &
PH
SDCL
Print Date: June 12, 2015
SALI
SARSG
SARSR
91
Test Name
Specimen Container Volume
Throat - SARS
or
Throat
Medium
Blood
1 SST
Blood
Blood
1 SST
1 Mauve
(full)
*SBG
*Schistosomasis
Serology (Bilharzia,
Bilharziosis, Snail
Fever)
Scleroderma-70
Sedimentation Rate
with CBC
Specimen Requirements Reference Range
approve testing prior to
shipping.
See Sex Hormone Binding
Globulin
3 mL serum Aliquot.
2 mL serum
Whole
Can use same tube as
blood
CBC
Test within 8 hrs of
collection
3 mL
Separate plasma ASAP
1 – 7 mL
Send in metal-free
Royal Blue plasma
polypropylene tube
EDTA)
Selenium
Blood
*Selenium
Urine
24 hr urine 10 mL
container
*Serotonin
Patient to be on a
low tryptophan diet
for 2 days prior to
collection. Patient
to be off all drugs
for 3 days prior to
collection, if
possible. Foods
high in tryptophan
Include avocadoes,
bananas, tomatoes,
plums, eggplant,
hickory nuts,
walnuts, pineapple
and mollusks.
Blood
1 SST
Units
Testing Site
SDCL – Montreal
TAT = 4 weeks
LIS Code
SCHS
Immunology-RGH SCL70
Hematology ESR
RGH
SDCL- Toronto
TAT = 20 days
SELEN
SDCL – Mayo
TAT = 2 weeks
SELUN
SDCL - Toronto
TAT = 4 weeks
SEROS
BD368381
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2-1mL
serum
aliquots
Freeze specimen within 4
hr of completing 24 hr
collection
Centrifuge and separate
into 2 aliquots ASAP.
Freeze.
Print Date: June 12, 2015
92
Test Name
Specimen Container Volume
*Serotonin
See above diet for
restrictions
Urine
24 hr Urine
*Serpax
*Severe Respiratory
Illness
(H1N1)
Blood
2 Red
Nasopharyngeal
,
aspirate,
washings
Sex Hormone Binding Blood
1 SST
Globulin (SHBG,
SBG)
**Shingles
Blood
Lesion
Sickle Dex
Blood
1 Mauve
(Sickle Cell)
All specimens with a
Sickle Dex request
should also have Hb
electrophoresis
studies
done as well as a
CBC.
*Silver
Urine
24 hr Urine
(acidwashed
plastic
container)
*Sin Nombre Virus
Blood
CSF
*Sinequon
Blood
2 Red or
(Doxepin)
2 Green
Specimen Requirements Reference Range
Add 20 mL 6N HCL to
brown bottle before
collection. Do not use
Boric Acid. Record
volume and collection
period. Aliquot urine and
freeze.
4 mL serum Aliquot
See FLU test for Severe
Respiratory Illness.
1 mL serum
Male: 13-71
Female: 18-114
nmol/L
Testing Site
LIS Code
SDCL - Toronto
SEROU
SDCL
SERPA
SDCL
TAT = 5 days
SHBG
Hematology RGH
SICKC
SDCL
TAT = 3 weeks
SILVE
SDCL
DOX
See Varicella Zoster.
See Viral, Lesion.
2 mL whole
blood
7 mL
aliquot
Add 20 mL of 6N Nitric
Acid at start of collection
See Hantavirus.
5 mL serum
or plasma
*Siquil
(Triflupromazine)
See Phenothiazines
*Sirolimus
See Rapamycin
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Print Date: June 12, 2015
93
Test Name
Specimen Container Volume
Smith-Lemli Opitz
Screen
Sodium
Blood
Sodium
Fluid
Sodium
State collection
period
Urine
*Somatomedin-C
(IGF-1)
Blood
*Somatostatin
Blood
Units
Testing Site
LIS Code
See 7-Dehydrocholesterol
*Somatotropin
*Sominex
Specific Gravity
Blood
Fluid
Specific Gravity
Urine
1 SST or
1 Green or
Syringe
with
electrolyte
balanced
dry
heparin
1 mL serum
or plasma
or 1.5 mL
whole
blood for
adults or
0.6 mL for
neonates in
syringe
1 mL fluid
No Longer Available
Random or 10 mL urine Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
1 SST
2 mL serum Separate ASAP. Divide
specimen into two equal
aliquots and freeze.
1 EDTA
2 mL
Keep on Ice. Separate
plasma
and Freeze immediately.
2 Red
135-145
mmol/L Chem - RGH &
PH
None available
mmol/L Chem - RGH &
PH
mmol/d Chem - RGH &
PH
24 hr: 43-217
See Growth Hormone
4 mL serum Aliquot
1 mL fluid
None available
5 mL urine
1.002-1.030
*Sperm Antibodies
Spinal Fluid
*Sporotricosis
Specimen Requirements Reference Range
NA
(serum)
ABLNA
(whole
bld)
NAURA
(random)
NA24
(24 hr)
SDCL - Toronto
TAT = 2 weeks
SOMC
SDCL - California
SOSTA
SDCL
Chem - RGH &
PH
Chem - RGH &
PH
SOMIN
SGFL
SDCL –
SPORS
U/A
See Anti-Sperm
See individual tests
(glucose, protein, lactic
acid, LD, protein
electrophoresis)
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
3 mL serum
Print Date: June 12, 2015
94
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Serology
Edmonton
TAT = 3 weeks
SDCL
3 mL serum Aliquot
See Phenothiazines
See Calculi
LIS Code
*Stelazine
*Stemetil
Stones
Blood
*Streptozyme
Blood
*Strongyloidiasis
Serology
Blood
1 SST
3 mL serum Aliquot.
SDCL – Montreal
TAT – 4 weeks
STRON
*Strychnine
*Strychnine
Blood
Urine
1 RED
2 mL serum
10 mL
random
urine
SDCL
SDCL
STRYC
STRYU
Sucrose Lysis
Blood
2 Red &
1 Mauve
Hematology RGH
Special Chem RGH
HAMSU
Sugar
Chromatography
Blood
Sugar
Chromatography
Sugar
Chromatography
Feces
Random
3 g feces
Urine
Random
5 mL urine
*Sulfaethoxazole
*Sulfatide AutoBlood
Antibodies
(Sulfamethoxazole)
Blood
(Septra) (Bactrim)
Trough - just before
dose. Peak - 3-4 hr
after dose.
*Sulfonyl Ureas
2 Red
Testing Site
TRIFL
See Anti-Streptoysin
(ASO).
Usually ordered with Ham's
Test
NO LONGER available
NO LONGER Available
1 SST
Freeze if not tested within
24 hrs.
Approval required by
Dr. B.Mali 766-4493 or
Dr.T.Burton 766-4476
See Sulfonamides
2 mL serum Freeze
1 Red
1 mL serum Aliquot
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
SUCRP
Ward must state which one
(I.e. glyburide, tolbutamide,
chloropropamide). Freeze.
Therapeutic: 400-730
μmol/L
Special Chem RGH
Special Chem RGH
SUCRF
SDCL - California
ABSUL
Special Chem RGH
SULFA
SUCRU
SDCL - Etobicoke SULUR
Print Date: June 12, 2015
95
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Sulfhemoglobin with
Methemoglobin
Blood
1 Green
1 mL whole
blood
*Surmontil
(Trimipramine)
Blood
2 Red
5 mL serum Aliquot
Sweat Chloride
Sweat
Sulfhemoglobin: 0
Methemoglobin: 0-2
Book with special
chemistry at RGH
(766-4497)
*Syphilis MHA-TP
Blood
Syphilis IgG
(Treponema pallidum)
1 SST
2 mL serum
*T3 (Triiodothyronine) Blood
(Total T3)
1 SST
*T4 (Thyroxine)
(Total T4)
Blood
1 SST
Tacrolimus
State drug dosage
and time of dose
*Talwin
For suspected Talwin/
Ritalin abuse only ritalin urine screen is
done
*Tambocor
(Flecainide)
Blood
1 Mauve
1 mL serum Order after consultation
Neonate – with endocrinologist or
100 μL
SDCL consultant
biochemist
1 mL serum Order after consultation
Neonate – with endocrinologist or
100 μL
SDCL consultant
biochemist
3 mL whole Collect before dose given.
blood
Done daily Mon-Fri
Urine or
Blood
Random or 4 mL urine Aliquot. Do not use SST.
2 Red or 2 or serum or
Green
plasma
Blood
2 Red
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
3 mL serum Aliquot
Units
%
Testing Site
Special Chem RGH
SHB
METHB
SDCL
TRIM
(Sweat Chloride by Classic Method) mmol/L Special Chem RGH
Interpretation/Results:
up to and including 6 months of
age:
<=29 mmol/L CF unlikely
30 - 59 mmol/L Intermediate
>=60 mmol/L Indicative of DF
older than 6 months of age:
<40 mmol/L CF unlikely
40 - 59 mmol/L Intermediate
>60 mmol/L Indicative of CF
The result must be interpreted with
regard to the patient's
age and clinical presentation.
Non-reactive
LIS Code
SWCL3
SDCL
TAT = 2-3 days
SYPHS
0-89-2.44
nmol/L
SDCL
TAT = 3 days
TT3PL
63-151
nmol/L
SDCL
TT4PL
3.0-15.0
μg/L
Chemistry - RGH
TACRS
Serum/Plasma:
Therapeutic: 170-700
Toxic: >1500
Urine: Negative
nmol/L
SDCL
TAT = 3 days
TALWU
SDCL
FLECA
Print Date: June 12, 2015
96
Test Name
Specimen Container Volume
Tay Sachs Test
*TBII
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
See Hexoaminidase
See Thyrotropin Binding
Inhibitory Immunoglobulin
TAU protein
*TB (Mycobacterim)
Blood Culture
*TBG
Blood/Bone
Marrow
*Teichoic Acid
Blood
1 Red
All Beta 2 transferrin
See Blood Culture
TB (Mycobacterium).
See Thyroxine Binding
Globulin
1 mL serum Aliquot and freeze.
Tegretol
Tenolin (Tenormen)
*Testosterone
Blood
1 SST
1 mL serum
Therapeutic: 17-50
μmol/L
Blood
1 SST
Test not available
1 mL serum Submit as a separate
sample. Avoid hemolysis.
Male: 5.8-28
Female: 0.45-3.74
nmol/L
*Tetanus Antitoxin
Blood
2 SST
Thallium
Blood
1-10mL
GLASS
Sodium
heparin
tube
SDCL - California. TECHO
TAT = 4 weeks
Chemistry - RGH CARBA
SDCL
TAT = 14 days
TESTO
5 mL serum Capital Health Requisition
SDCL- Edmonton
TAT = 3 weeks
TETAT
7 mL whole
blood
Do not separate or freeze
SDCL - Toronto
TAT = 20 days
THALS
Use polypropylene vial.
Record collection date and
total 24 hr urine volume, if
submitted, or random on
the req.
SDCL - Toronto
TAT = 2 weeks
THALU
Chemistry - RGH
THEO
(BD366480)
Thallium
Urine
(24 hr or
random)
24 hr or
random
acidwashed
container
10 mL
Theophylline
Provide Date and
Time of Last Dose
See TDM section for
ideal sampling times
*THC
Blood
1 EDTA
1 mL
plasma
Therapeutic:
<1 mo: 28-83
>1 mo: 28-85
Toxic: ≥111
μmol/L
See Cammabompods
(Tetrahydrocannabinol)
*Thiamine
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Vitamin B1
THIAM
Print Date: June 12, 2015
97
Test Name
Specimen Container Volume
*Thiocyanate
Blood
Thiopental
Thiopurine
Methyltransferase,
RBC
1 SST
Specimen Requirements Reference Range
1 mL serum Record time of collection
on tube and req.
Normal:
Non-smoker: 0.02-0.21
Smoker: 0.05-0.21
Toxic: >1.75
Units
nmol/L
Testing Site
SDCL
TAT = 1 day
THIO
SDCL –
Diagnostic
Services of
Manitoba
THIOM
Blood
2 Red
1 Blue
(full)
1 SST
See Pentothal
5 mL whole Keep refrigerated but not
blood
frozen. Collect Tues or
Wed. morning and must be
at SDCL by noon Wed.
See Mellaril
3 mL serum Aliquot
1 mL
Same tube for PT & APTT
plasma
1 mL serum
Hematology RGH
SDCL
Blood
1 SST
2 mL serum Freeze serum aliquot
SDCL
*Thyroglobulin Level
Biospy
wash
1 RED
*Thyroid Antibodies
Blood
1 SST
2 mL serum
1 SST
See Anti-Thyroid
Peroxidase
See TSH
1 mL serum Aliquot and freeze serum.
frozen.
Indicate thyroid status of
patient including presence
of exophthalmos on req.
*Thioridazine
*Thorazine
Thrombin Time
*Thyroglobulin
Includes antithyroid
peroxidase
(microsomal Ab and
thyroglobulin
autoantibodies)
*Thyroglobulin Level
*Thyroid Peroxidase
Ab
Thyrotropin
*Thyrotropin Binding
Inhibitory
Immunoglobulin
Blood
Blood
Blood
Blood
1 EDTA
Thyroid Receptor Ab
(Thyrotropin)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Wash out FNA needle with
normal saline into the Red
top tube. Requisition
clearly marked as “saline
wash from biopsy, Attn
Debbie Caswell”
LIS Code
THIOR
THORA
TT
THYGL
THYGB
SDCL - In house THYWA
for Cancer Agency
<100
IU/mL
SDCL
TAT = 2-3 days
ABTH
SDCL - Toronto
TAT = 3 weeks
TBII
See Thyrotropin Binding
Inhibitory Immunoglobulin
Print Date: June 12, 2015
98
Test Name
Specimen Container Volume
Thyroid Stimulating
Hormone
*Thyroid Stimulating
Immunoglobulin
Thyroxine - Total
*Thyroxine - Free
*Thyroxine Binding
Globulin (TBG)
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
See TSH
See Thyrotropin Binding
Inhibitory Immunoglobulin
TSI
See T4
See Free T4
Blood
Thyroxine Stimulating
Hormone Receptor
Ab
TIBC
*Tissue
Blood
Transglutaminase
Antibody (IGA)
Tobramycin
Blood
1 SST
1 mL serum
SDCL - Toronto
TAT = 3 weeks
TBG
SDCL
TAT = 2 weeks
ABTTG
Chemistry - RGH
TOBRA
TPBPR
TOBPO
SDCL
IMIPR
SDCL
TOLBU
See Thyrotropin Binding
Inhibitory Immunoglobulin
See Iron
1 SST
1 mL serum
1 EDTA
1 mL
plasma
Trough – usually drawn ½
hr before drug is
administered.
Peak – usually drawn 1 hr
after drug is administered,
but physician may vary.
Daily – 6 to 14 hrs after
dose.
5 mL serum Aliquot
Therapeutic:
Pre: 0.0-2.0
Post: 5.0-10.0
*Tofranil
(Imipramine)
*Tolbutamide
(one of the Sulfonyl
Ureas)
*Topiramate
(Topomax)
Blood
2 Red
Blood
1 Green
Blood
1 non-SST 1 mL serum Aliquot and freeze
*ToRC screen
*TORCH
(Toxoplasma,
Rubella, CMV)
(Herpes Simplex)
*Total Carnitine
Blood
1 SST
3 mL serum If unable to collect 0.5 mL
0.5 ml
on neonates serum,
neonates
specify which tests are
most important.
Blood
1 SST or
1 Green
1 mL serum Separate from cells. Avoid Adult: 21-74
or plasma hemolysis. Freeze
<12 yr: 22-60
Total Iron Binding
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
2 mL
plasma
mg/L
Aliquot and freeze
SDCL- Hosp. In
TOPIR
Commons,Toronto
TAT = 2 weeks
SDCL
TORCH
μmol/L
SDCL
TAT = 10 days
See Iron
Print Date: June 12, 2015
CARNS
99
Test Name
Specimen Container Volume
*Toxocariasis
Blood
Serology
*Toxoplasma
Blood
Antibody
Confirmation
Serology
**Toxoplasma Total
Blood
IgM and IgG Serology
1 SST
3 mL serum Aliquot.
1 SST
3 mL serum Aliquot.
1 SST
*TPHA
*TPO
Blood
1 Red
*Transcobalamine
Blood
1 SST
Transferrin
Blood
Transferrin Blood
Isoelectric Focusing
Transglutaminase Ab
1 SST
1 SST
*Trazodone
Treponema Pallidum
*Triazolam (Halcion)
Blood
2 Red
Blood
2 Red
*Trichinellosis
Blood
Serology
*Trichloroethanol
*Triiodothyronine (T3)
1 SST
*TriiodothyronineFree
*Tricyclic Drugs
(TCA)
*Triflupromazine
Triglycerides
Collect fasting
Triglycerides
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
SDCL - Montreal
TAT = 4 weeks
SDCL - Montreal
TAT = 4 weeks
TOXOC
2 mL serum If the total antibody is
present, a specific IgM test
will be performed.
SDCL
TOXOP
2 mL serum NO LONGER AVAILABLE
See Anti-Thyroid
Peroxidase
2 mL serum Separate immediately.
Keep cool.
1 mL serum
1 mL serum Freeze
SDCL
TPHA
SDCL - Toronto
TRANS
1.80 – 3.42
See Tissue
Transglutaminase
4 mL serum Aliquot
See Syphilis
4 mL serum Aliquot
3 mL serum Aliquot.
aliquot
See Chloralhydrate
See T3
g/L
TOXIS
Chemistry - RGH TFERN
SDCL - Saskatoon TRISO
SDCL
TRAZO
SDCL
TRIAZ
SDCL - Montreal
TAT = 4 weeks
TRICS
SDCL
TRICY
See Free T3
Blood
Blood
2 Red
4 mL serum Aliquot
1 SST
See Phenothiazines
1 mL serum Fasting speicmen
0.35-1.70
mmol/L Chem - RGH &
PH
1 mL fluid
None available
mmol/L Chem - RGH &
PH
Fluid
*Trilafon
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Phenothiazines
Print Date: June 12, 2015
TRIPR
TRIG
TRFL
100
Test Name
Specimen Container Volume
*Trimipramine
(Surmontil)
Blood
Specimen Requirements Reference Range
2 Red
4 mL serum Aliquot. Do not use SST.
Triple Screen
Troponin I
Blood
1 SST
See Maternal Serum
Screen
1 mL serum Aliquot
Troponin T
(Cancer patients/
Allan Blair Patients
only)
Trypsin
Blood
1 SST
1 mL serum Frozen
Units
Testing Site
LIS Code
Therapeutic: 170-680
Toxic: >1800
nmol/L
SDCL
TRIM
TAT: Emerg = 4 hr
Routine = 3
days
<=0.02 ug/L
ug/L
Chem-RGH
TROPA
SDCL to MAYO
TTROP
Feces
NO LONGER AVAILABLE
Chemistry - RGH
TRYPS
Trypsin
*Trypanosomiasis
Serology
Fluid
Blood
1 SST
NO LONGER AVAILABLE
3 mL serum Aliquot.
Chemistry - RGH
SDCL – Montreal
TAT – 4 weeks
TRYFL
TRYPA
Tryptase
Collect 1 hr postallergic reaction
Tryptophan
TSH
Blood
1 SST
1 mL serum Aliquot and freeze
SDCL - Toronto
TTASE
Blood
1 SST
1 mL serum
100 μL
neonate
Chemistry - RGH
(SDCL does
neonate testing)
TSHSC
(screen)
TSHFU
(follow-up)
TSH with T3 and T4
Blood
1 SST
1 mL serum
600 μL
neonates
Chemistry - RGH
(SDCL does
neonate testing)
NETSH
(to SDCL)
SDCL-Toronto
TNF
See Amino Acid
*TSH Receptor Ab
0.49-4.67
mIU/L
See Thyrotropin Binding
Inhibitory Immunoglobulin
Tumor Necrosis
Factor
**TWAR
Blood
Blood
Tylenol
Tyrosine
Blood
1 Red
1 Green
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
1 mL serum Freeze at –80 C. Send on
dry ice.
See Chlamydophilia
pneumoniae IgM and IgG.
See Acetominophen
1 mL
plasma
25-200
μmol/L
SDCL- Saskatoon AACID
Print Date: June 12, 2015
101
Test Name
Specimen Container Volume
*Unconjugated Estriol
(Perfomed only as
part of Maternal
Serum Screen)
Urea
Blood
1 SST or
1 Green
Urea
Fluid
*Ureaplasma
*Mycoplasma and
Ureaplasma Culture
Cervical,
Universal
Urethral,
Transport
Respiratory Medium
(neonatal)
Urea
State collection
period
Urine
Uric Acid
Blood
Uric Acid
Fluid
Uric Acid
State collection
period
Urine
Urinalysis
Urine
Specimen Requirements Reference Range
1 ml serum
or plasma
1 mL fluid
Random or 10 mL urine Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
1 SST
1 mL serum
1 mL fluid
Random or 10 mL urine Indicate on Requisition if
24 hr
Random or 24 hr urine.
Record Collection Time,
Date and Volume (if 24 hr
).
Rural sites: Send aliquot
frozen
Random
10 mL
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
0-12 months: 1.4-6.8
1-15 yrs: 2.2-7.0
>15 yr: 3.0-7.1
None available
Units
Testing Site
LIS Code
mmol/L Chem - RGH &
PH
UREA
mmol/L Chem - RGH &
PH
SDCL
UREFL
24 hr: 250-600
mmol/L Chem - RGH &
PH
URURA
(random)
URE24
(24 hr)
Male: 200-500
Female: 145-430
None available
μmol/L
Chem - RGH &
PH
μmol/L Chem - RGH &
PH
mmol/L Chem - RGH &
PH
URIC
μmol/L
U/A
24 hr: 1.2-4.5
Glucose: negative
Bilirubin: negative
Ketones: negative
SG: 1.002-1.030
Blood: negative
PH: 5.0-8.0
Protein: negative
UBG: 3-17
Nitrite: negative
Chem - RGH &
PH
Print Date: June 12, 2015
UREMH
URAFL
URAUR
(random)
URA24
(24 hr)
102
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Leucocyte esterase: negative
*Urine Free Cortisol
(UFC)
Urobilinogen
See Free Cortisol
Urine
Random
5 mL urine
*Uroporphyrin
*Uroporphyrinogen
Synthetase
Blood
2 Green
*Valium (Diazepam)
Blood
2 Red
Valproic Acid
(Depakane, Epival)
See TDM section for
ideal sampling times
Blood
1 EDTA
*Vanadium
Urine
Vancomycin
Trough and peak
NOTE: Record
exact date and time
of last does and
exact date and time
of collection
See TDM section for
ideal sampling times
*Vanillyl Mandelic
Acid
(VMA)
State weight with
pediatric
specimens. State
collection period.
*Varicella Zoster
Blood
Random or 10 mL urine
24 hr urine
container,
acidwashed
1 EDTA
0.5 mL
plasma
Urine
Keep in dark
See Porphyrins
Protect from light by
wrapping in tin foil
10 mL
whole
blood
5 mL serum Aliquot
1 mL
plasma
Collect 0-1 hr before dose. 350-700
Significant liver enzyme elevation
and thrombocytopenia may occur at
levels >1000
μmol/L
Wash container with 500
mL of 10% solution of nitric
acid. Rinse container twice
with deionized water.
Trough - Usually drawn ½
hr before drug is
administered.
Peak - usually drawn 1 hr
after drug is administered,
but physician may vary.
24 hr Urine 25 mL urine Refrigerate during
aliquot
collection. Adjust pH 2-4
with 6N HCL or freeze.
Record volume and
collection period. Do not
over acidfy.
Lesion
Done as part of urinalysis
Chem - RGH &
PH
U/A
SDCL
TAT = 14 days
UPS
SDCL
DIAZ
Chemistry - RGH
VALPR
SDCL - Toronto
VANAD
Trough: 10.0 – 20.0
Peak: 20.0-40.0
Toxic Peak: >=60.0
Toxic Trough: >=20.0
mg/L
Chemistry - RGH
VANCO
VANPR
(trough)
VANPO
(peak)
Adult: 9-34
Children:
7-30 d: up to 0.9
30 d-6 mo: up to 1.2
7 m-10 yr: up to 0.8
μmol/d
SDCL
TAT = 3 days
VMA
μmol/
kg/day
See Viral, Lesion.
(H. Zoster, VZV,
Herpes Zoster,
Chickenpox,
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Print Date: June 12, 2015
103
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
Shingles)
**Varicella Zoster IgM Blood
Serology
1 SST
2 mL serum If acute is negative, submit
convalescent in 5-10 days.
SDCL
HZVMS
1 SST
2 mL serum Convalescent
(Immune status)
SDCL
HZVIS
2 Mauve
3 mL
plasma
(EDTA)
SDCL - Mayo
TAT = 4 weeks
VIP
SDCL
TAT = 1 week
CSFVD
(H. Zoster, VZV,
Herpes Zoster,
Chickenpox,
Shingles)
**Varicella Zoster IgG Blood
Serology
(H. Zoster, VZV,
Herpes Zoster,
Chickenpox,
Shingles)
*Vasoactive Intestinal Blood
Polypeptide (VIP)
(Collect after an
overnight fast)
*Vasopressin
*VDRL
Blood
(STS & FTA
Absorption)
*VDRL
CSF
Venlafaxine
Very Long Chain
Fatty Acids
Blood
Verapamil
Blood
Draw 1-2 hr after
last dose (peak
value)
*VIP
Blood
(Vasoactive Intestinal
Polypeptide)
Fasting specimen
*Viral
CSF Virus Isolation
( Enterovirus)
CSF
Separate from cells ASAP.
Freeze. Record fasting
plasma on req.
See ADH
SEE Syphilis
Sterile
Tube
2 Red or
2 Mauve
2 Red
2 Mauve
(prechilled)
0.5-1 mL
Refrigerate.
Non-reactive
Provide patient symptoms
and onset, recent
vaccinations on requisition
See Effexor
2 mL serum Send frozen
or plasma
500 μL
neonates
5 mL serum Aliquot and freeze
SDCL - Mayo
VERAP
3 mL
plasma
Collect on ice. Separate
ASAP and freeze. Send
on dry ice. Record fasting
plasma on req.
SDCL - Mayo
TAT = 4 weeks
VIP
Do not freeze CSF for viral
isolation.
SDCL
CSFVC
Sterile leak 2 mL CSF
proof tube.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
SDCL- Saskatoon FALC
Print Date: June 12, 2015
104
Test Name
Specimen Container Volume
*Viral
Eye swab
Eye Virus Isolation or
Detection
*Viral
Genital Lesion Virus
Isolation or Detection
(Viral Lesion, Lesion,
Herpes, Herpes
Simplex, HSV)
*Viral
Blood
Hemmorrhagic Fever
(PCR)
Universal
Transport
Medium
*Viral
Blood
Hemmorrhagic Fever
(Serology)
1 SST
1 EDTA
*Viral
Other Lesion Virus
Isolation or Detection
(Viral Lesion, Lesion,
Herpes, Chickenpox,
Shingles)
*Viral – Lesion
Lesion
Universal
Isolation or Detection swab,
Transport
aspirate or Medium
scrappings
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Units
Testing Site
SDCL
LIS Code
EYEVC
NOT AVAILABLE – see
Lesion Viral Isolation or
Detection
SDCL
Ship refrigerated on wet
ice.
Contact Microbiologist on
call at RGH
Requisition for Special
Pathogens
(NML,Winnipeg)
Ship TDG RG4
Ship centrifuged specimen
refrigerated on wet ice.
Contact Microbiologist on
call at RGH
Requisition for Special
Pathogens
(NML,Winnipeg)
Ship TDG RG4
NOT AVAILABLE - see
Lesion Viral Isolation or
Detection
Winnipeg –
National
Microbiology Lab
VHF_P
Winnipeg –
National
Microbiology Lab
VHF_S
Include specimen source,
patient symptoms and date
of onset on the requisition.
SDCL
SDCL
Print Date: June 12, 2015
LESVC
105
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*Viral
Respiratory Virus
Isolation or Detection
(Adenovirus,
Influenza A & B,
Parainfluenza,
Respiratory Syncytial
Virus-RSV,
Enterovirus)
*Viral
Stool Viral Isolation or
Detection
(Enterovirus,
Coxsackie)
NasoUniversal
pharyngeal Transport
Aspirate,
Medium
Washings
(See Viral, Throat Virus
Isolation or Detection.)
Stool
(Eastern Equine,
Japanese Encephalitis)
Walnut size (See Norovirus PCR).
stool
portion
Testing Site
LIS Code
SDCL
RESVC
SDCL
STLVC
with no viral
transport or
preservative
*Viral
Throat
Throat Virus Isolation swab
or Detection
(Adenovirus,
Influenza A & B,
Parainfluenza,
Respiratory Syncytial
Virus-RSV)
*Viral
Tissue
Tissue Virus Isolation
*Viral
Urine Viral Isolation
or Detection
**Viral Acute
Serology
**Viral Convalescent
Serology
*Viral Meningitis
Sterile
stool
container
Units
Urine
Universal
Transport
Medium
Universal
Transport
Medium
Sterile
Urine
Container
Blood
CSF
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
NO LONGER AVAILABLE
-STAT(Urgent) protocolPhone SDCL at
(306)787-3131 to prearrange testing prior to
shipping.
20 mL urine (See CMV Urine).
(random)
NOT AVAILABLE – order
specific viral serology
NOT AVAILABLE – order
specific viral serology
See Encephalitis (Viral).
SDCL
SDCL
TISVC
SDCL
URVC
SDCL
SDCL
Print Date: June 12, 2015
106
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
Viral Surveillance
Blood
3 Blue tops
2 Red tops
Require completion of
consent and questionnaire
Viscosity
Blood
1 Red
*Vitamin A
Blood
1 Red
*Vitamin B1
Blood
1 Mauve
*Vitamin B2
Blood
(Riboflavin)
Patient must fast for
12-14 hr and refrain
from alcohol for 24
hr before collection
*Vitamin B3
*Vitamin B6
Blood
(Pyridoxine)
1 GRN
Vitamin B12
Vitamin B12 &
Folates
Vitamin C
*Vitamin D1,25
Dihydroxy
*Vitamin D2
Blood
2 mL serum Send within 3 hr of
collection. Separate from
cells ASAP. Freeze.
1 mL serum Protect from light by
wrapping in tin foil.
Freeze. Transport on ice
packs within 24 hr.
4 mL whole Wrap in tin foil
blood
1 mL Hep
plasma
Protect from light.
Freeze
2 Mauve
3 mL
plasma
Not available
Freeze. Wrap in tin foil
within 5 min. of collection.
1 SST
1 mL serum
1.1-1.3
Deficient: <116
Borderline: 116-138
Normal: 138-781
Units
cps
pmol/L
Testing Site
LIS Code
Transfusions RGH
STVIR
Hematology RGH
VISCO
SDCL - Toronto
TAT = 2 weeks
VITA
SDCL - Mayo
Clinic
VITB
SDCL - MAYO
VITB2
SDCL - Toronto
VITB6
Chemistry - RGH
B12AX
SDCL - Calgary
TAT = 4 weeks
VD125
SDCL
VITD2
See B12 & folates
Blood
1 RED
Blood
1 SST
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
See Ascorbic Acid
2 mL serum Aliquot and freeze serum
If specimen thaws it is
unacceptable.
2 mL serum Aliquot and send
separately with its own
requisition
Print Date: June 12, 2015
107
Test Name
Specimen Container Volume
*Vitamin D 25
(25Hydroxy Vit D3)
Blood
1 SST
*Vitamin D 25 Hy
Blood
1 SST
droxy
*Vitamin D
(Vitamin D3)
Blood
1 SST
*Vitamin E
Blood
1 SST
Blood
1 Green
Vitamin K
*VMA
*Voriconazole
**VZV
*Water Deprivation
Test
WBC and Diff.
Blood
Lesion
Specimen Requirements Reference Range
Units
Testing Site
LIS Code
2 mL serum Aliquot and send
separately with its own
requisition
2 mL serum Aliquot and send
separately with its own
requisition
SDCL-Chemistry
TAT= 10 days
VID25
SDCL
TAT = 10days
VD25
2 mL serum Aliquot and send
separately with its own
requisition
2 mL serum Protect from light by
wrapping in tin foil. Aliquot
and freeze.
Not available.
Replacement test is
protime.
See Vanillyl Mandelic Acid
1 mL
Frozen
plasma
SDCL - Toronto
VITD3
SDCL - Toronto
TAT = 4 weeks
VITE
SDCL to Hospitals VORIC
in
Common,Toronto
See Varicella Zoster.
See Viral, Lesion.
See ADH
Blood
1 Mauve
*West Nile Virus IgM
Serology
Blood
1 SST
*West Nile Virus IgG
Serology
*West Nile Virus –
Plasma PCR
Blood
1 SST
Blood
1 Mauve
(only for
immunocompromised/
encephalitis / meningitis
patients)
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Whole
Order CBC
blood
2 mL serum Acute
Initial test for diagnosis of
suspect West Nile Virus.
2 mL serum Convalescent
Hematology RGH
SDCL
WNVAS
SDCL
WNVCS
1 mL EDTA Separate ASAP and freeze
plasma
plasma. Ship on ice.
Plasma must be received
frozen.
SDCL
WNPCR
Print Date: June 12, 2015
108
Test Name
Specimen Container Volume
Specimen Requirements Reference Range
*West Nile Virus
CSF West Nile Virus
PCR
CSF
*WNV
Blood
CSF
Freeze CSF ASAP. If
specimen thaws, it is
unsuitable for analysis.
(For symptomatic or
immunocompromised
patients.)
See West Nile Virus.
Xylose
Specimens include
fasting, and 1hr after
D-Xylose drink
Xylose
Fasting.
D-Xylose drink to be
given
*Xylocaine
(Lidocaine)
Yersina Serology
*Zarontin
(Ethosuximide)
*Zinc
Blood
2 SST
5 mL serum Freeze serum
Children at peak: >20 (0-10 yr)
Adults: at least 1.67 should be
reached after 2 hr
Urine
5 hr
collection
after drink
Adults: 21-31% excretion/5 hr
Blood
1 Red
10 mL urine Collect urine for 5 hrs post
dose, no preservative.
Record volume.
Freeze and send 10 mL.
3 mL serum Aliquot
Blood
1 Red
No longer available.
1 mL serum Aliquot
Blood
3 mL
1 – 7 mL
Royal Blue plasma
500 μL for
EDTA)
BD368381 neonates
*Zinc
Urine
24 hr or
random
urine
container
acidwashed
Sterile leak 2 mL CSF
proof tube.
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Units
Testing Site
SDCL
mmol/L SDCL to
Edmonton
SDCL to
Edmonton
LIS Code
WVPCR
XYLO
XDU
SDCL
LIDO
SDCL
ETHOL
Separate plasma ASAP.
Pour into polypropylene
tube. Indicate on req. that
specimen is sodium
heparin plasma.
SDCL - Toronto
ZNS
10 mL urine Send in polypropylene
aliquot
container. Record on the
req. the collection date,
total 24 hr urine volume, if
submitted, or random
urine.
SDCL - Toronto
TAT = 3 weeks
ZNU
Print Date: June 12, 2015
109
Test Name
Specimen Container Volume
*Zinc Protoporphyrin Blood
Recommend that lead
be ordered
simultaneously to
detect lead exposure
(may not be a good
indicator of lead
exposure in women
and children)
1 – 7 mL 10 mL
Royal Blue whole
blood
EDTA)
BD368381 500 μL for
neonates
L:\LabProcedures\DeptLIS\LABLisOP8007T1.26
Specimen Requirements Reference Range
Specimen must be
analyzed within 5 days of
collection. Suggest
ordering LEAD
Units
Testing Site
SDCL - Toronto
TAT = 2 weeks
Print Date: June 12, 2015
LIS Code
ZPORP