PATOLOGI KIMIA - moh.gov.myhkl.moh.gov.my/content/patologi/Chemical Pathology Unit.pdf · Enquiry of results can be made to Unit Patologi Kimia by telephone (ext 5284). Enquiry for

PATOLOGI KIMIA

Head of Unit : Dr Nur Shafini Binti Che Rahim

Phone : +60326155555 ext 5630

1. INTRODUCTION

The Chemical Pathology Unit provides diagnostic and consultative services to Hospital

Kuala Lumpur for patient management. It also serves as referral centre for all the

hospitals in Malaysia. Our services cover analysis and interpretation of biochemical

changes in body fluids for diagnostics, monitoring and screening of diseases.

2. SERVICES

Chemical Pathology Unit offers specialized biochemical testing. The list of services

includes:

i. Endocrine

Thyroid Function Test, Fertility Test, Serum and Urinary Cortisol,

Catecholamines, Extended Hormone (Dehydroepiandrosterone sulphate

(DHEAS), Insulin, C-peptide, Growth Hormone, Adrenocorticotrophic Hormone

(ACTH), Intact Parathyroid Hormone (IPTH))

ii. Metabolic

HbA1c, Homocysteine

iii. Protein and Proteomic

Serum and Urine Protein Electrophoresis, Special Protein (Alpha 1 anti-trypsin,

haptoglobin, transferrin, caeruloplasmin, IgG, IgA, Ig M

iv. Hematological Biochemistry

v. Toxicology.

Requests are made as either single test or multiple tests in a dynamic function tests.

3. SERVICE HOURS

Operating hours : 7.30 am – 5.30 pm (Monday – Friday)

URGENT request: Appointment should be made by contacting Pathologist,Medical

Officer and Section in-charge. The request form should be signed or countersigned by

requesting Specialist.

4. REQUEST FORMS

Request forms for all tests are PERPAT 301 form.

5. SAMPLE COLLECTION

5.1 BLOOD

Most of tests in chemical Pathology require serum sample that need to be collected in

plain tube. Special requirement needed for certain tests:

For HbA1c test require whole blood sample that need to be collected in EDTA

tube. Request less than 2 months from previous result will be rejected.

For morning serum cortisol: between 8 to 10 am; for midnight serum cortisol:

between 10 to 12 pm.

For fertility test: Progesterone collected at day 21 menstrual cycle, estradiol, FSH

and LH is collected at day 2 to 5 of menstrual cycle.

Certain tests required to be sending in ice such as ACTH.

Serum and Urine Protein Electrophoresis should be send as paired sample for

better interpretation of tests results

5.2 URINE 24 hours Urine Collection

Most quantitative assays are performed on urine specimen collected over 24 hours. The

24 hours timing allows for circadian rhythmic changes in excretion at certain time of day.

Procedure of collection:

The 24 hours urine bottle which contains appropriate preservative for the

required test is available at the Stor Integrasi, Jabatan Patologi. Urine bottle will

be provided on request, with the accompanying request form or note.

On the day of collection, the first urine voided must be thrown away. Time of first

urine voided is the start of the timing for the 24 hour collection.

Collect the second and subsequent voided urine for 24 hour from the timed start

into the 24 hour urine bottle.

For male patient, it is advisable NOT to void the urine directly into the 24 hour

urine bottle. This is to avoid possible chemical burns.

At the end of 24-hours, the last urine voided is collected. For best result,

refrigerate if possible.

Label the bottle as directed and send immediately to the laboratory.

eg. of tests: 24-hours urine cortisol and 24-hours urine catecholamine

24-hours Urine Catecholamines

Please refer to procedure 24 hour urine collection to collect urine for 24hr urine

catecholamines.

For adult minimum 500 mls of urine should be collected. For paediatric samples

urine creatinine will be run for every request.

Please note that, preservative 10 mls of 25% HCl is added into the bottle to

preserve the analytes. It is important for the requesting physician to advise the

patient NOT to discard the preservative.

Instruction on patient preparation and specimen collection

Abstain from bananas, coffee, pineapple and walnuts one day prior to and

during the 24 hour urine collection.

Certain drugs alter the metabolism of catecholamines. It is advisable to stop

such medication at least 5 days prior to urine sampling i.e Alpha2 agonists,

Calcium channel blockers, ACE inhibitors, Bromocriptine, Methyldopa,

Monoamine oxidase inhibitors, Alpha blockers and Beta blockers,

Phenothiazines and Tricylic antidepressants.

Please advice patient to avoid stress, exercise, smoking and pain prior to and

during urine collection.

24-hours Urine Cortisol

Please refer to procedure 24 hour urine collection to collect urine for 24hr

urine cortisol.

Minimum of 500 mls of urine should be collected.

6. RECEIPT OF SPECIMEN

Specimens will be received at the main counter (Pre-analytical Unit).

7. REPORTING OF RESULTS

Results will be validated by Chemical Pathologist/Medical Officer/Scientific Officer

according to the test. Test results will be ready according to promised Laboratory

turnaround time (please refer to Section List of Tests).

Current reference intervals will be provided for all results. These may be subject to

variation differentiated by age and sex where important / available.

Reports are dispatched to the respective pigeon hole or posted via mail for referral

external samples.

8. ENQUIRY OF RESULTS

Enquiry of results can be made to Unit Patologi Kimia by telephone (ext 5284). Enquiry

for result from external customer can be made via tracing letters.

9. SERVICES AFTER OFFICE HOURS

If test needed after working hours, consultation and agreement from Chemical

Pathologist/ Medical Officer in charged are required.

10. PROTOCOLS FOR INVESTIGATION OF ENDOCRINE DISORDERS

The protocols listed below are only as guide and are subjected to changes according to

clinician requirement. These protocols are mainly for adult.

10.1 PITUITARY DISORDERS

Assessment of Anterior pituitary Hormone

1. Pituitary Hormone Insufficiency

Anterior pituitary hormones include Growth Hormone (GH), Prolactin, Thyroid

Stimulating Hormone (TSH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone

(LH) and Adrenocorticotrophic Hormone (ACTH). Main abnormalities to look for are

Corticotroph deficiency, Thyrotroph deficiency, Gonadotroph deficiency or Somatotroph

deficiency.

Assessment of Anterior Pituitary Reserve

a) Initial assessment

Morning serum Cortisol and ACTH or Short Synachten Test

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH

Testosterone for man

Estradiol for woman

b) Combine Anterior Pituitary Stimulation Test (Insulin Stress Test +

Gonadotrophin Stimulation Test)

Procedures:

Fast the patient overnight.

Insert intravenous catheter or intravenous line.

Rest patient for 30 minutes. Take samples for glucose, growth hormone,

cortisol, LH, FSH and TSH (as baseline investigation).

Give insulin 0.1-0.15 unit/kg body weight, 200µg TRH and GnRH 100ug

intravenously.

Collect samples into plain tubes and Glucose tubes and label as follows:

Time Tests Tube

0 min (basal) Glucose

Cortisol, GH, LH,

FSH,TSH

Glucose tube

1 plain tube

15 min Glucose Glucose tube

20 min FSH, LH, TSH 1 plain tube

30 min Glucose

Cortisol, GH, LH

Glucose tube

1 plain tube

45 min Glucose ( if patient

become

clinically/biochemically

(glucose < 2.2 mmol/L)

hypoglycaemic

Glucose tube

60 min Glucose

Cortisol, GH, LH,

Glucose tube

1 plain tube

FSH,TSH

90 min Glucose,

cortisol, GH

Glucose tube

1 plain tube

120 min Glucose,

cortisol, GH

Glucose tube

1 plain tube

* GH-Growth hormone, LH-Luteinizing hormone, FSH- Follicular stimulating

hormone, TSH – Thyroid Stimulating Hormone

Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,

Mosby, 2008, pg 140.

Label specimens according to sampling time.

Send all samples after test is completed to main counter, Pathology

Department.

Notes:

Plasma glucose level must fall below 2.2 mmol/L and/or clinical signs and

symptoms of hypoglycaemia (sweating, tachycardia etc) must be observed.

Additional intravenous insulin may be given if this does not occur by 30 min

and sampling should be prolonged by another 30 min.

Physician should be in attendance throughout the tests and 50% i.v. dextrose

should be kept by bed side if severe hypoglycemia is documented.

Giving glucose for severe hypoglycemia does not invalidate the test results.

Test is contraindicated for patient with seizure, IHD or cardiovascular

insufficiency and in young children.

Normal ECG is mandatory.

c) Insulin Stress Test

Procedures:

Similar as Combine Anterior Pituitary Stimulation Test but without GnRH

injection.

Blood samples are taken at 0 minute (basal), 30 minutes and 60 minutes

after insulin injection for glucose, cortisol and growth hormone (GH) as

follows:

Time Tests Tube

0 min (basal) Glucose Cortisol, GH

Glucose tube 1 plain tube

30 min Glucose Cortisol, GH


60 min Glucose Cortisol, GH



Send all samples after test is completed to main counter, Pathology

Department.

d) Gonadotrophin- Releasing Hormones Stimulation Test

Procedures:

Collect samples into plain tubes for LH and FSH (basal sample).

Give 100 ug GnRH.

Collect samples into plain tubes at 15 minutes, 30 minutes, 60 minutes and

90 minutes after GnRH injection for Luteinizing Hormone (LH) and Follicular

Stimulating Hormone (FSH).

Time Tests Tube

0 min (basal) FSH, LH 1 plain tube

15 min FSH, LH 1 plain tube





Send all samples to main counter Pathology Department

2. Pituitary surgery assessment

a) Pre-operative assessment

Morning serum cortisol

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH


Estradiol for woman

b) Post-operative assessment (2-4 days after surgery)

Steroid coverage with hydrocortisone is administered immediately before,

during and after surgery.

If adrenal function was normal before surgery, hydrocortisone is stopped on

second or third post-operative day.

24 hours after stopping – take morning blood for cortisol

c) Follow up assessment ( one month after surgery)

FT4


Estradiol for woman

Cortisol and ACTH at 9.00 am and Short Synacthen test, even if function is

subnormal after surgery. ACTH deficiency after surgery is often transient.

After pituitary irradiation, patient should be evaluated at least once per year with

measurement of FT4, estradiol (if female), testosterone (if male), FSH, LH, prolactin,

cortisol, ACTH and Short Synacthen Test.

3. Acromegaly

a) Screening and biochemical diagnosis

2 tests must be done to attain biochemical diagnosis of active acromegaly.

Measure IGF 1 level according to age-adjusted reference.

Perform oral glucose tolerance test with 75g oral glucose after at least 8

hours of overnight fasting.

Active acromegaly is indicated by elevated IGF 1 and failure of GH to be

suppressed below 1 ng/ml.

GH may not be suppressed in poorly controlled diabetes mellitus, severe

illness, chronic liver disease and chronic kidney disease.

b) Other biochemical tests

Serum prolactin

ACTH and cortisol (morning sample)

TFT

LH, FSH, testosterone (male), estradiol (female) – morning sample

Fasting serum lipids

RP, uric acid

LFT, calcium, phosphate

Urine FEME

Assessment of Posterior Pituitary Hormone

Posterior pituitary secretes vasopressin (ADH) and oxytocin. These hormones are

synthesized in hypothalamus and pass down nerve axons into the posterior pituitary

and released into the circulation.

1. Diabetes Insipidus (DI)

Lack of ADH caused by pituitary/hypothalamic disease (cranial DI) or failure

of kidney to respond to ADH (nephrogenic DI)

Presented with polyuria –urine volume >3 L/day

common causes of polyuria such as diabetes mellitus , hypokalemia ,

hypercalcemia and diuretic therapy have been excluded

Measure serum and urine osmolality and sodium

If serum osmolality ≥ 295 mOsm/kg, urine osmolality is < 300 mOsm/kg and

sodium ≥145 mmol/l - Diagnosis of Diabetes Insipidus is unlikely and not for

Fluid Deprivation test

If diagnosis is in doubt; perform Fluid Deprivation test

a) Protocol for Fluid Deprivation Test

Procedure

Allow fluids overnight before test and give light breakfast with no fluid; no

smoking permitted

Weigh patient

Allow no fluid for 8hours; patient must be under constant supervision

Every 2 hours

- Weigh patient (stop test is weight falls by > 5% initial body weight)

- Measure urine volume and osmolality

- Measure plasma osmolality ( stop test if osmolality >300 )

After 8 hours

- Allow patient to drink ( no more than twice urine volume of period of fluid

deprivation, to avoid acute hyponatraemia) and give 2 µg desmopressin i.m

Measure urine osmolality every 4 hours for further 16 hours

Interpretation:

Algorithm for the investigation of polyuria.

Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,

Mosby, 2008, pg 152

Urine osmolality (mmol/kg) after:

8 h fluid

deprivation

desmopressin

<300 >750

<300 <300

>750 >750

300-750 <750

Cranial diabetes insipidus

Nephrogenic

diabetes insipidus

Primary polydipsia

Non-diagnostic

polyuria measure: blood glucose

plasma creatinine potassium

calcium

abnormal diagnosis

normal

fluid deprivation

test

10.2 ADRENAL DISORDERS

Disorders of Adrenal Cortex

1. Adrenal hypofunction (Addison’s Disease)

a.Short Synacthen Test/Cosyntropin Test

High index of suspicion is required to diagnose adrenal insufficiency.

Indications for screening:

– Unexplained hyponatremia.

– Prolonged corticosteroid or traditional medication ingestion.

– Bilateral adrenal mass.

Screening is by doing short synacthen test.

Procedure:

Take blood sample for baseline cortisol level (0 minutes).

Give 250ug cosyntropin (synthetic ACTH) intramuscularly or intravenously.

Take samples at 30 minutes and 60 minutes after injection for cortisol level.

Time Tests Tube

0 min (basal) Cortisol 1 plain tube

30 min Cortisol 1 plain tube

60 min Cortisol 1 plain tube

Interpretation:

Normal response is cortisol peak is greater than 550 nmol/l.

Patient with atrophy of adrenal cortex (exogenous steroid / pituitary or

hypothalamic disease) shows slight rise in serum cortisol.

2. Adrenal Hyperfunction (Cushing’s syndrome)

Screening tests should be done in patients:

– With multiple and progressive features of Cushing syndrome

– With adrenal incidentaloma.

– After excluding exogenous steroid intake.

Screening tests are:

i. 24-hours urine free cortisol: if less than 380 nmol/day, Cushing

syndrome is excluded and if level is 3-4 times greater than upper limit

normal, suggestive of Cushing syndrome.

ii. Overnight Low Dose Dexamethasone Suppression Test (OLDDST)

Procedure:

– Give 1 mg dexamethasone orally at 2300 or 2400 hours.

– Fill up the request form complete with clinical summary and

request test mentioned above.

– Collect blood at 8.00 am the next morning for determination

of serum cortisol and send to main counter, Pathology

Department.

Interpretation: In normal subjects, serum cortisol is suppressed

to less than 50 nmol/l. Serum cortisol level of more than 50

nmol/l can also be seen in cases of stress, obesity, infection,

acute or chronic illness, alcohol abuse, severe depression, oral

contraceptive, pregnancy, estrogen therapy, failure to take

dexamethasone, or treatment with diphenylhydantoin or

phenobarbital (enhancement of dexamethasone metabolism).

iii. Low Dose Dexamethasone Suppression Test

Procedure:

– At 9.00am on 1st day of test, collect blood for serum cortisol

(basal) and request test mentioned above.

– Immediately after sampling, give 0.5mg dexamethasone orally

every 6 hrs for 2 days (8 times).

– Collect blood for serum cortisol 6 hours after last dose of 0.5mg

dexamethasone and send to main counter Pathology

Department.

Note:

Ensure the times are followed strictly and with full compliance.

Day 1 Day 2 Day 3

Sample taken for serum cortisol.

0900 am (basal) -

0900 am

Drug given: 0.5mg dexamethasone every 6 hours (8 times)

0900 am 0300 am 0300 am (last dose)

1500 pm 0900 am -

2100 pm 1500 pm -

- 2100 pm -

Interpretation:

In normal subjects, serum cortisol will be suppressed to <50nmol/l.

After 2 concordantly positive screening tests, localization tests are

recommended, which include:

iv. Plasma ACTH

Procedure:

– Blood should be taken together with serum cortisol at 9am.

– Keep the tube in ice water bath and send to lab for

centrifuged and frozen as soon as possible to avoid falsely

low result.

Interpretation:

– ACTH < 5 ng/L (<1 pmol/L): ACTH independent Cushing →

proceed with CT scan of adrenals.

– ACTH >15 ng/L (>3 pmol/L): ACTH dependent Cushing →

proceed with MRI pituitary/ CXR.

v. Bilateral inferior petrosal sinus sampling:

For localization of pituitary tumour (Cushing disease).

11. REFERENCES

Special Endocrinology Test Protocols for Adults ,Endocrinology Unit, Department of MedicineHospital Putrajaya, 2010

Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert, Mosby, 2008

12. CONTACT NUMBERS

Location Ext. Direct Line

Bilik Ketua Unit 5630 03-26155630

Scientific Officer Room 5611 03-26155611

Medical Officer Room 7530 03-26157530

Laboratory 5284 03-26155284

TESTS AVAILABLE AT CHEMICAL PATHOLOGY UNIT

(ACCORDING TO ALPHABETICAL ORDER)

NO TEST SPECIMEN

TYPE

CONTAINER VOLUME TAT REFERENCE RANGE REMARK

1 Adenocorticotrophic Hormone

(ACTH)

Blood

EDTA tube in

ice

3 ml 5 working

days

≤ 10.2 pmol/L Packed with ice

2 Alpha-1-antitrypsin Blood Plain tube 3 ml 5 working

days

0.9 – 2.0 g/L

3 Caeruloplasmin Blood Plain tube 3 ml 5 working

days

Male : 0.15 – 0.30 g/L

Female : 0.16 – 0.45 g/L

4 Catecholamines : Urine 24 hrs urine

container with

10mL of 25%

HCL

24 hrs urine

collection

20 working

days

Reference range for 24 hour urine

catecholamines ≥750mL :

Epinephrine : 0.5 - 20ug/24 hrs

Norepinephrine : 15.0 – 80.0ug/24 hrs

Dopamine : 64- 400ug/24 hrs

Reference range for random urine

catecholamines < 750mL

Epinephrine :

< 2 yr : < 75.0 ug/g creatinine

2 – 4 yr : < 57.0 ug/g creatinine


10 – 19 yr :< 34.0 ug/g creatinine

Norepinephrine :



5 – 9 yr: < 89.0 ug/g creatinine


Rejection criteria :

i) Inadequate urine

collection (Adult <

500 ml

ii) Urine pH > 5.

Dopamine :



5 – 9 yr: < 1048.0 ug/g creatinine


5 Cholinesterase Blood Plain tube 3 ml 1 working

day

Male and Children;

Female (≥ 40 years old) :

5320 – 12,920 U/L

Female (16 – 39 years old), not

pregnant, not taking contraceptives :

4260 – 11,250 U/L

6 Cortisol

Blood Plain tube 3 ml 3 working

days

Morning Cortisol

: 171 – 536 nmol/L

Midnight Cortisol

: 64 – 327 nmol/L

Urine 24 hrs urine

container

without

preservative

24 hrs urine

collection

5 working

days

24 hrs Urine Cortisol

: 100 – 379 nmol/24 hrs

24 hours urine

collection with

volume ≥500 ml

7 C-Peptide Blood Plain tube 3 ml 5 working

days

298 – 2350 pmol/L

8 Dehydroepiondosterone

Sulphate (DHEAS)


days

Male : 2.20 – 15.20 umol/L

Female : 0.95 – 11.70 umol/L

9

Estradiol

Blood Plain tube 3 ml

5 working

days

Female (Adult) :

Follicular phase : 45.4 - 854 pmol/L

Ovulation phase : 151 - 1461 pmol/L

Luteal Phase : 81.9 – 1251 pmol/L

Post-menopausal : < 18.4 – 505

pmol/L

Blood taking at Day

2 to Day 5 menses

Male (Adult) :

94.8 – 223 pmol/L

10 Ferritin Blood Plain tube 3.5 ml 10 working

days

Children :

< 1yr : 12 – 327 ug/L

1 – 6 yr : 4 – 67 ug/L

Male :

7 – 17 yr : 14 – 152 ug/L

> 17 yr : 30 – 400 ug/L

Female :

7 – 17 yr : 7 – 84 ug/L

> 17 yr : 13 – 150 ug/L

11 Folate Blood Plain tube 3.5 ml 10 working

days

12.0 – 43.9 nmol/L

12 Follicle Stimulating Hormone

(FSH)


days

Female : Follicular phase : 3.5 – 12.5 IU/L Ovulatory phase : 4.7 – 21.5 IU/L Luteal Phase : 1.7 – 7.7 IU/L Post-menopausal : 25.8 – 134.8 IU/L Male (Adult) :1.5 – 12.4 IU/L Children : Boys : < 5 yr : 0.2 – 2.8 IU/L 6 – 10 yr : 0.4 – 3.8 IU/L 11 – 13 yr : 0.4 – 4.6 IU/L 14 – 17 yr : 1.5 – 12.9 IU/L Girls : < 5 yr : 0.2 – 11.1 IU/L 6 – 10 yr : 0.3 – 11.1 IU/L 11 – 13 yr : 2.1 – 11.1 IU/L 14 – 17 yr : 1.6 – 17.0 IU/L

Blood taking at Day

2 to Day 5 menses

13 Free Thyroxine (FT4) Blood Plain tube 3 ml 3 working days

Children : Newborns : 11.0 – 32.0 pmol/L 6 d – 3 mth : 11.5 – 28.3 pmol/L

4 – 12 mth : 11.9 – 25.6 pmol/L 1 – 6 yr : 12.3 – 22.8 pmol/L 7 – 11 yr : 12.5 – 21.5 pmol/L 12 – 20 yr : 12.6 – 21.0 pmol/L Adults : 12.0 – 22.0 pmol/L

14 Free Triiodothyronine (FT3) Blood Plain tube 3 ml 5 working days

Children : Newborns : 2.7 – 9.7 pmol/L 6 d – 3 mth : 3.0 – 9.3 pmol/L 4 – 12 mth : 3.3 – 9.0 pmol/L 1 – 6 yr : 3.7 – 8.5 pmol/L 7 – 11 yr : 3.9 – 8.0 pmol/L 12 – 20 yr : 3.9 – 7.7 pmol/L Adults, euthyroid : 3.1 – 6.8 pmol/L

15 Gamma Glutamyl Transferase (GGT)

Blood Plain tube 3 ml 5 working days

Male : < 60 U/L Female : < 40 U/L

16 Growth Hormone Blood Plain tube 3 ml 10 working days

Male : ≤ 3 ug/L Female : ≤ 8 ug/L

17 Haptoglobin Blood Plain tube 3 ml 5 working days

0.30 – 2.00 g/L

18 Haemoglobin A1c (HbA1c) Blood EDTA tube 3 ml 3 working days

NGSP (< 6.5 %) / IFCC (< 48 mmol/mol) - Optimal Glycaemic Control

19 Homocysteine Blood Plain tube in ice

3 ml 20 working days

< 15 umol/L Packed with ice

20 Immunoglobulin G (IgG) Blood Plain tube 3 ml 5 working days

7.0 – 16.0 g/L

21 Immunoglobulin A (IgA) Blood Plain tube 3 ml 5 working days

0.7 – 4.00 g/L

22 Immunoglobulin M (IgM) Blood Plain tube 3 ml 5 working days

0.4 – 2.3 g/L

23 Insulin Blood Plain tube 3 ml 10 working days

≤ 29.1 uIU/mL

24 Intact Parathyroid Hormone (IPTH)


1.3 – 6.8 pmol/L

25 Iron (Fe) Blood Plain tube 3 ml 10 working days

5.8 – 34.5 umol/L

26 Luteinising Hormone (LH) Blood Plain tube 3 ml 5 working days

Female : Follicular phase : 2.4 – 12.6 IU/L Ovulatory phase : 14.0 – 95.6 IU/L Luteal Phase : 1.0 – 11.4 IU/L Post-menopausal : 7.7 – 58.5 IU/L Male : 1.7 – 8.6 IU/L Children : Boys : < 1 yr : < 0.4 IU/L 1 – 5 yr : < 1.3 IU/L 6 – 10 yr : < 1.4 IU/L 11 – 13 yr : 0.1 – 7.8 IU/L 14 – 17 yr : 1.3 – 9.8 IU/L Girls : < 1 yr : < 0.4 IU/L 1 – 5 yr : < 0.5 IU/L 6 – 10 yr : < 3.1 IU/L 11 – 13 yr : < 11.9 IU/L 14 – 17 yr : 0.5 – 41.7 IU/L

Blood taking at Day

2 to Day 5 menses

27 Paraproteins / Protein electrophoresis

Blood Plain tube 3 ml

10 working days

Albumin : 53.8 – 65.2 % or 32.3 – 39.1 g/L Alpha-1- globulins : 1.1 – 3.7 % or 0.7 – 2.2 g/L Alpha-2-globulins : 8.5– 14.5 % or 5.1 – 8.7 g/L Beta globulins : 8.6 – 14.8 % or 5.2 – 8.9 g/L Gamma globulins : 9.2– 18.2 % or 5.5 – 10.9 g/L

Blood and urine

sample must be

sent together.

Urine

24 hrs urine container

or 50 ml sterile

container

5 ml

28 Progesterone Blood Plain tube 3 ml 5 working days

Female : Follicular phase : 0.6 – 4.7 nmol/L Ovulatory phase : 2.4 – 9.4 nmol/L Luteal Phase : 5.3 – 86 nmol/L Post-menopausal : 0.3 – 2.5 nmol/L Male (Adult) : 0.7 – 4.3 nmol/L

Blood taking at Day

21 of menses

29 Prolactin Blood Plain tube 3 ml 5 working days

Male : 98 – 456 mIU/L Female : 127 – 637 mIU/L

30 Testosterone Blood Plain tube 3 ml 5 working days

Female : 0.22 – 2.9 nmol/L Male : 9.9 – 27.8 nmol/L

31 Thyroid Stimulating Hormone (TSH)


Children : Newborns : 0.70 – 15.2 mIU/L 6 d – 3 mth : 0.72 -11 mIU/L 4 – 12 mth : 0.73 – 8.35 mIU/L 1 – 6 yr : 0.70 – 5.97 mIU/L 7 – 11 yr : 0.60 – 4.84 mIU/L 12 – 20 yr : 0.51 – 4.30 mIU/L Adult : 0.27 – 4.20 mIU/L

32 Transferrin Blood Plain tube 3 ml 5 working days

2.0- 3.6 g/L

33 Unsaturated Iron Binding Capacity (UIBC)


Male : 22.3 – 61.7 umol/L Female : 24.2 – 70.1 umol/L

34 Vitamin B12 Blood Plain tube 3 ml 10 working days

156 – 698 pmol/L

Documents

PATOLOGI KIMIA - moh.gov.myhkl.moh.gov.my/content/patologi/Chemical Pathology Unit.pdf · Enquiry of results can be made to Unit Patologi Kimia by telephone (ext 5284). Enquiry for