HOSPITAL BAHAGIA ULU KINTA(Kementerian Kesihatan Malaysia)PATHOLOGY SERVICESLABORATORY USER MANUALVersion No: 0101/01/2026
Document Revision HistoryDate Version Description of Revision
CONTENTTable of contents PageMessage from Hospital Director 1Message from Head of Unit 2Editorial Committee Members 3Introduction Unit Of Patology 4Vision, Mission & Objective 4Customer Charter 4List Of Contacts 5Scope of service 5Service Hours 5Pathology test Request Intsruction 6STAT / Urgent Test Service 6Guide for specimen collection 7Retention of sample 7Rejection of Requests 8Porterage/Specimen Transportation 9Clean up spills of blood or body fluids during Transportation 10Protection Of Personal Information 10Supply Of Containers 10Results/Reports 11Web Based Registry 11List of Urgent Test 11Critical Results Notification 12Blood Collection Procedure (WHO Guidelines On Drawing Blood: Best Practices In Phlebotomy, 2010) 14Comments, Compliments & Complaints 17Oral Request 17Test Ordering During LIS Downtime (Contigency Plan) 18General factor effecting Blood Collection 19
Table of contents PageType of container and order of Draw 23General Workflow for Handling of specimen in Unit Pathology 29Chemical Pathology 34Haematology 39Microbiology 42Referral service 46• Test Available at Unit Pathology HBUK 47• Test Available at other KKM Facility 53
Page 1 of 115MESSAGE FROM HOSPITAL DIRECTORPathology services play a vital role in supporting clinicians in the diagnosis, management, and prognosis of diseases.Advances in technology, together with rapid progress in medical research, require pathology services to continuously adapt and remain aligned with current developments. In this regard, the Comprehensive Hospital Cluster policy provide a structured framework to support the achievement of the Vision and Mission of the Ministry of Health Malaysia.I would like to extend my congratulations to the Pathology Unit and the working committee for their dedication and commitment in the development of the 1st Edition of the User Manual of the Pathology Unit, Hospital Bahagia Ulu Kinta.Dr Ian Lloyd AnthonyHospital DirectorHospital Bahagia Ulu Kinta
Page 2 of 115MESSAGE FROM THE HEAD OF UNITIt is my pleasure to present the first edition of the User Manual for the Pathology Unit at Hospital Bahagia Ulu Kinta. This manual has been developed to provide a clear and comprehensive guide to the laboratory services, processes, and quality standards that underpin patient care and clinical decision-making.Pathology services are integral in assisting clinicians with the diagnosis, management, and prognosis of diseases. With ongoing advancements in medical technology and research, it is essential that our services continue to evolve to meet the needs of both patients and healthcare professionals.This manual outlines the policies, procedures, and standards followed by the Pathology Unit in alignment with MS ISO 15189:2022 and the Malaysian Society for Quality in Health (MSQH) Standards. It is designed to support laboratory staff, clinicians, and stakeholders in ensuring safe, accurate, and timely diagnostic services.I would like to extend my sincere appreciation to the Pathology Unit team and working committee for their commitment and dedication in preparing this first edition of the User Manual. Their hard work reflects our shared goal of maintaining excellence, professionalism, and continuous improvement in all aspects of laboratory services.We hope this manual serves as a valuable reference and practical guide to support the delivery of high-quality pathology services for the benefit of our patients and the community.Dr Yong Chee KeatHead of Unit PathologyHospital Bahagia Ulu Kinta
Page 3 of 115EDITORIAL COMMITTEE MEMBERSAdvisorDr Yong Chee KeatCoordinatorTs. Shashi Kumar a/l VijayakumarContributorsChemical Pathology• Pn Noraziah Binti Mohd Nazri• Pn Khairun Nisa Binti MuslimHematology• En Ahmad Zamri Bin Kasim• Pn Siti Nurlina Binti Abu SamahMedical Microbiology• Pn Norsyafiqah Izura Binti Mohd Idrus• Pn Rosliza Binti Othman
Page 4 of 115INTRODUCTION UNIT OF PATHOLOGYThe Unit of Pathology is an integral part of Hospital Bahagia Ulu Kinta. The Unit is headed by a Senior Medical Officer. The workforce comprises one (1) Scientific Officer and six (6) Medical Laboratory Technologists.The Unit of Pathology, Hospital Bahagia Ulu Kinta, is actively involved in the Perak Cluster Hospital concept as part of its preparation towards achieving MS ISO 15189 accreditation. The laboratory provides screening, diagnostic and consultative services, including training and clinical research activities, in the following disciplines:• Chemical Pathology• Haematology• Medical MicrobiologyIn addition, the Unit of Pathology, Hospital Bahagia Ulu Kinta, serves as the referral centre for HbA1c screening and diagnostic services for Hospital Raja Permaisuri Bainun Ipoh, Hospital Kampar, Hospital Batu Gajah, Hospital Sungai Siput and Hospital Sultanah Hajjah Kalsom, Cameron Highlands, Pahang.The Unit also provides Tacrolimus and Lithium testing services for the entire state of Perak and Hospital Sultanah Hajjah Kalsom, Cameron Highlands, Pahang.VISIONTo be a centre of excellence in pathology services, supporting a healthy and resilient community.MISSIONTo deliver competent, consistent, and high-quality laboratory services through a team of dedicated professionals committed to patient care, health promotion, and continuous learning.OBJECTIVE• Provide accurate and reliable laboratory results within defined turnaround times.• Offer a comprehensive range of tests and consultations to support patient management.• Continuously improve service quality through quality improvement initiatives.CUSTOMER CHARTERThe Unit of Pathology, Hospital Bahagia Ulu Kinta, is committed to delivering high-quality and customer-focused laboratory services by striving to:• Provide friendly and professional service, aiming for zero customer complaints.• Offer clear and comprehensive explanations of laboratory tests to clients when required, with customer satisfaction monitored annually at the main laboratory counter.
Page 5 of 115• Give immediate attention to urgent tests, ensuring results are communicated within the turnaround time established under the National Indicator Approach (NIA).• Perform all laboratory work effectively, efficiently, and professionally, targeting zero incidents within the laboratory.LIST OF CONTACTSExtBilik Pegawai Sains 5953Bilik JTMP Kanan 5954Makmal Utama 5956SCOPE OF SERVICEThe scope of services offered including those outsourced are listed asfollows:Unit Scope of ServicesMedical Microbiology Bacteriology and ParasitologyChemical Pathology Routine Chemistry, HbA1c, Tacrolimus and LithiumHaematology Haemostasis, General HaematologySERVICE HOURS• Non-Urgent Specimens: All non-urgent specimens must be delivered to the Specimen Reception Counter at least 30 minutes before closing time.• Office Hours: Monday – Friday: 8:00 am – 5:00 pm• After Office Hours (Urgent/STAT Tests Only):o Monday – Friday: Standby on-call serviceo Saturday, Sunday & Public Holidays: Standby on-call serviceNote: Only urgent or STAT tests are accepted outside office hours.Turnaround Time (TAT)The Unit ensures that all urgent and routine test results are reported within the expected TAT as defined in the unit’s quality objectives and monitored under the National Indicator Approach (NIA).
Page 6 of 115PATHOLOGY TEST REQUEST INSTRUCTIONSAll laboratory requests must be submitted using the appropriate PER-PAT 301 Pathology Request Form. Each request form must include the following information:• Full name of the patient• I/C number or hospital registration number• Patient sex• Patient location (ward or clinic)• Destination for the report• Requesting Medical Officer’s name and signature• Test(s) requested• Relevant clinical details, including medication, fasting status, or other pertinent information• Date and time of specimen collectionSample and Test Details:• Identify the sample type and test requirements clearly, particularly for Anatomical Pathology and Microbiology. For example, use specific descriptions such as “Abscess – right leg” rather than a general term like “wound swab”.• When ordering tests, note that certain terms are not tests:o MSU refers to a type of urine collectiono DNA is only part of a test requestSubmission Instructions:• Ensure the completed forms are folded and placed in a plastic sleeve or attached to the biohazard bag.• Patient details and requested tests must be clearly visible for laboratory staff.STAT / URGENT TEST REQUESTSDefinition:A test should be classified as URGENT when the result is required for immediate patient management, and any delay in reporting could potentially result in patient morbidity or mortality.
Page 7 of 115Procedure for Urgent Requests:• Use the red-colored PER-PAT 301 request form for all urgent tests.• Urgent specimens must be delivered to the laboratory immediately, within 15 minutes of collection.• Tests not marked as urgent will be processed as routine samples.GUIDE FOR SPECIMEN COLLECTIONAll blood specimen tubes should be labeled immediately after collection at the patient’s bedside with:• date of collection• test requested • registration number• patient’s name• All specimens are to be sent to the reception counter in the Unit of Pathology.RETENTION OF SAMPLESSafe disposal of materials used in collection according Guidelines on Retention of Pathology Records and Materials, (Version2/2022).
Page 8 of 115REJECTION OF REQUESTSEvery sample, along with the request forms, will be scrutinized to make sure it is appropriate for analysis. The laboratory reserves the right to refuse a specimen under any of the following conditions:General Rejection CriteriaSpecimen Rejection ProcedureIn-House Specimens:• Wards will be informed immediately by phone when a specimen is rejected.• All rejections must be documented in the Pathology Rejection Form.• Rejection information must also be entered into the Laboratory Information System (LIS).Type No. Rejection CriteriaRequest form1 No name and no identification number2 No ward/clinic/hospital name3 No test name4 Form reused (detail illegible)5 No cop dan signature of test requesting doctor6 No clinical summary7 No date and time of specimen taken8 No signature of specialist (special test)9 Usage of wrong formSpecimen label 10 No label / label not complete11 Information on container and request form not tallySpecimen not suitable for test12 Wrong container13 Spesimen haemolysed14 Blood clotted15 Volume of sampel insufficient16 Specimen leaking17 Specimen not sealed18 Specimen degenerated19 Wrong specimen20 Container expiredOthers22 Test repeatedly requested23 Test that not process after office hours24 Test not indicated25 Test that not performed in the unit26 Form that share many test27 Urine sample stored in same plastic with non-urinesample28 Sampel not received with request form
Page 9 of 115Referral Specimens (e.g., HbA1c, Lithium, Tacrolimus):• The requesting laboratory will be notified promptly of any specimen rejection.Rejection Criteria By Specific SectionPORTERAGE/SPECIMEN TRANSPORTATIONa) IN-HOUSEPorters from wards or clinics will send the specimens to the main Pathology lab. It is requested that in order to facilitate the received of specimens, wards arrange the specimen carrier bags according to the dispatch book lists. Haphazard arrangement of bags will consume a lot of time in checking. Acknowledgement of received will be made on the dispatch book.b) REFFERAL TEST Section No. Rejection CriteriaChemical Pathology1 Medicolegal sample is not sealed2 Unable to analyze the sample due to high viscosity3The sample is not suitable for testing because the temperature was not maintained optimally during transportation to the laboratory (blood gases, ammonia & lactate).4HbA1c request less than 3 months or 90 days from previous result.5 Non urine sample for urine sample.Hematology7Over/underfilling for coagulation tests may lead to an incorrect anticoagulant ratio8 No clinical history and diagnosis for FBP9Specimens received in the laboratory for more than 4 hours after blood collection – for FBC, Retic, Coagulation & ESR test.Microbiology10Specimen in wrong container: The sample was collected in an incorrect tube, such as a sample meant for a different type of test.11Incorrect timing for repeat samples: To avoid confusion between treatment effects and active infection, labs typically have rules for the minimum time between repeat tests. For instance, a specimen may be rejected if it is sent too soon after a previous test, such as within 12 or 24 hours.12 Inappropriate specimen: Use of an unsuitable or compromised specimen for the test13 Specimen received after working hours (AFB smear test)14 Using non-sterile container for culture15 Culture sample in formalin16 Pooled 24 hour sputum, urine, or feces for AFB cultures.
Page 10 of 115Pack laboratory samples safely in a plastic leak-proof bag with an outside compartment for the laboratory request form. Placing the requisition on the outside helps avoid contamination.If there are multiple tubes, place them in a rack or padded holder to avoid breakage during transportation.CLEAN UP SPILLS OF BLOOD OR BODY FLUIDS DURING TRANSPORTATIONIf blood spillage has occurred (e.g. because of a laboratory sample breaking in the phlebotomy area or during transportation, or excessive bleeding during the procedure), clean it up. An example of a safe procedure is given below. o Put on gloves and a gown or apron if contamination or bleaching of a uniform is likely in a large spill. o Mop up liquid from large spills using paper towels, and place them into the infectious waste. o Remove as much blood as possible with wet cloths before disinfecting. o Assess the surface to see whether it will be damaged by a bleach and water solution. o For cement, metal and other surfaces that can tolerate a stronger bleach solution, flood the area with an approximately 5000 parts per million (ppm) solution of sodium hypochlorite (1:10 dilution of a 5.25% chlorine bleach to water). This is the preferred concentration for large spills. Leave the area wet for 10 minutes. Use blood spillage kit.o For surfaces that may be corroded or discoloured by a strong bleach, clean carefully to remove all visible stains. Make a weaker solution and leave it in contact for a longer period of time. For example, an approximately 525 ppm solution (1:100 dilution of 5.25% bleach) is effective. o Prepare bleach solution fresh daily and keep it in a closed container because it degrades over time and in contact with the sun.PROTECTION OF PERSONAL INFORMATIONIt is the organization policy that all results and patient details will be treated as private and confidential as stated in Akta Rahsia Rasmi 1972.SUPPLY OF SPECIMEN CONTAINERSThe laboratory shall provide new collection containers according to the number and type of specimens requested.Example:If a ward submits requests for three (3) patients requiring:• Three (3) plain tubes• Two (2) EDTA tubes• One (1) urine container
Page 11 of 115The laboratory will immediately supply the corresponding containers—three (3) plain tubes, two (2) EDTA tubes, and one (1) urine container—to the requesting ward.RESULTS/REPORTSAll critical / abnormal results will be informed within 30 minutes via telephone (please referNotification of Critical Laboratory Result in MOH Hospitals).Test result will be reported into Laboratory Information System. The clients are advised to check the system regularly.If any delay in test process due to analyzer breakdown or test suspended will be notified through HOD whatssapp group followed by an official MEMO email to hospital HOD group.Result can be access via online at Laboratory Information System(http://10.138.131.10/patologiperak/) using individual password.WEB BASED REGISTRYAll tests referred to Hospital Bahagia Ulu Kinta (HBUK) must be registered using the webbased registry system (http://10.138.101.180/ilabOnlineReg/).Specimens that are not registered in the system will be manually rejected by the laboratory.LIST OF URGET TESTUnits / Division Name of tests LTATChemical Pathology Bilirubin – total 1 hrChloride 1 hrCreatinine 1 hrGlucose 1 hrPotassium 1 hrSodium 1 hrUrea (BUN) 1 hrUrinalysis (Biochemistry) 1 hrUrine Pregnancy Test (UPT) 1 hrHematology APTT 1 hrFBC 45 minPT/INR 1 hr
Page 12 of 115CRITICAL VALUECRITICAL VALUE NOTIFICATION POLICY• Only first time critical value will be reported.• The authorised receiver shall only be: Medical Officer (MO), Medical Assistant (MA) and Nurse (SN & JM).• Result shall be reported according to the location specified on the form/ request. It is the responsibility of the requester to inform the subsequent ward where the patientwas transferred.• If location is not specified, result shall not be informed.• The first person who receives the notification shall accept and take the call eventhough the patient is not under his/her care. The same applies in the eventthe patienthas transferred to other location.• The waiting time shall be until the ringing ends. Lab shall make second attemptafter 5 to 10 minutes after the first call. Only 2 call attempts shall be made for eachnotification.ESCALATION IF UNABLE TO NOTIFYInpatient1. Critical results will be notified within 30 minutes. 2. if calls to the relevant ward are not answered for 3 times, if still no answer, the MO incharge/Oncall will be notified.3. if still no answer, from MO incharge/Oncall , The HOU Patology will be notified.Outpatients 1. Critical results will be notified within 1 hour. Results obtained after office hours will be notified to the test requestor or Oncall Medical Officer.2. if still no answer, from MO incharge/Oncall , The HOU Patology will be notified.
Page 13 of 115All critical limit results shall be informed to respective ward or clinic once the resultis ready.Refer to list below for the critical limits that shall be informed.ANALYTESLOWER CRITICAL LIMIT UPPER CRITICAL LIMITADULT PAED UNIT ADULT PAED UNITCHEMICAL PATHOLOGYPOTASSIUM <2.8 2.8 mmol/L 6.0 6.0 mmol/LSODIUM <125 125 mmol/L 155 155 mmol/LGLUCOSE 2.8 - mmol/L 20 - mmol/LAMYLASE - - - >1000 - U/LLITHIUM - - - >1.5 - mmol/LHEMATHOLOGYHAEMOGLOBIN < 6.0 < 7.0 g/dl 19.0 > 20.0 g/dlWBC - < 2.0 K/ul - > 50.0 K/ulPLATLET 20 - K/ul 1000 - K/ul HEMATOCRIT < 0.2 < 0.2 - > 0.6 > 0.4 - INR - - - >5 >5 Ratio PT - - - >2.5 - Sec APTT - - -80 sec or >2x upper reference range- Sec MICROBIOLOGYAFB SMEAR POSITIVEReference:Pekeliling KPK KKM Bil 3/2016: Penambahbaikan Malaysian Patient Safety Goals No 8: Toimprove clinical communication by implementing critical value programme.
Page 14 of 115BLOOD COLLECTION PROCEDURE (WHO GUIDELINES ON DRAWING BLOOD: BEST PRACTICES IN PHLEBOTOMY, 2010)a) Assemble equipment b) Perform hand hygiene c) Identify and prepare the patient. d) Select the site, preferable at the antecubital area (i.e the bend of the elbow).e) Apply tourniquet (about 4-5 finger widths above the venipuncture site). f) Ask the patient to form a fist so that the veins are more prominent. g) Put on well-fitting gloves. h) Disinfect the venipuncture site with 70% isopropyl alcohol for 30 seconds and allow to dry completely (around 30 SECONDS) i) Anchor the vein by holding the patient`s arm and place a thumb below the venipuncture site. j) Enter the vein swiftly at 30ºangle. k) Once sufficient blood has been collected, release the tourniquet before drawing the needle. l) Withdraw the needle gently and then give the patient a clean gauze or dry cotton-wool ball to apply to the site with gentle pressure. m) Pierce the stopper on the tube with the needle directly above the tube using slow, steady pressure. Do not press the syringe plunger because additional pressure increases the risk of hemolysis. Allow the tubes to be filled directly by the vacuum inside the vacutainer tube. n) If non-vacutainer tube being used, allow the blood to fill the collection tube by using a slow and steady pressure until the blood filled immediately after collection. o) Discard the used needle and syringe or blood-sampling device into sharp bin.p) Check the label and forms for accuracy. q) Remove gloves and perform hand hygiene.
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Page 17 of 115COMMENTS, COMPLIMENTS & COMPLAINTSUsers wishing to raise a complaint or provide a feedback to the department may do so by scanning the QR code below and fill up the details:ORAL REQUESTThe laboratory does not allow oral request of additional test on the same primary sample. Addition of test only allowed in certain special cases with approval of scientific officer. The verbal request of addition must be followed by request form on the same day
Page 18 of 115TEST ORDERING DURING LIS DOWNTIME (CONTIGENCY PLAN)The laboratory will notify the requester when an examination is delayed that could compromise patient care through WhatsApp/telephone/letter. The contingency plan for Laboratory Information System (LIS) breakdown is as below (extracted from Quality Procedure Contigency Plan, HBUK/PATHQP/18). The reference ranges for tests offered during LIS offline is listed in Appendix 1.No PerkaraTanggungjawabwaktu pejabat waktu on callII LIS OFFLINE1 Selepas LIS offline 1 jam (kes dari Jabatan Kecemasan, 10 min), aktifkan pelan kontigensi:Makluman2 Maklumkan kepada Ketua Unit berkenaan LIS offline JTMP JTMP on call3 Maklumkan kepada ward penghantaran permohonan ujian yang URGENT semua permohonan ujian mesti berserta dengan borang permohonan PER-PAT 301KU JTMP on call6 Gunapakai label barkod ‘pre-printed’ khas untuk LIS offline (1 sampel/ 1 borang permohonan/ 1 rekod maklumat )JTMP JTMP on call7 Order ujian secara manual pada mesin menggunakan 2 identifier: nombor barkod dan no. KP pesakit JTMP JTMP on call8 Cetakkan 2 salinan keputusan ujian dari printer mesin JTMP JTMP on call9 Kepilkan satu salinan cetakan keputusan ujian dari mesin bersam-sama dengan Borang PER-PAT-301 JTMP JTMP on call10 Tandakan pada borang Maklumat permohonan ujian bagi keputusan ujian yang telah siapJTMP JTMP on call11 Despatchkan keputusan ujian ke dalam pegion hole mengikut lokasi di kaunter JTMP JTMP on call12 Anggota petugas JTMP standby call dipanggil sekiranya sampel melebihi 40diterima JTMP kanan JTMP kanan
Page 19 of 115GENERAL FACTORS AFFECTING BLOOD COLLECTIONThe following should be taken into account during sample collection:a) After food intake glucose, cholesterol, triglycerides, iron, inorganic phosphate and amino acids are present in elevated concentration in blood.b) If the patient is moved from recumbent to an upright position, the concentration of corpuscular and macromolecular substances such as leucocytes, erythrocytes, haemoglobin, hematocrit, total protein, enzymes, lipoprotein and protein bound ions (e.g.calcium, iron) increase up to 10%.c) Some drugs may affect the test performed.d) Substantial diurnal variations can be observed in the case of some analytes, e.g.hormones(epinephrine, aldosterone, corticotropin, cortisol, norepinephrine, prolactin, somatotropin, testosterone), electrolyte excretion in urine, serum haemoglobin and iron.e) If possible, sample collection should always take place under standardized conditions, i.e. when the patient in the same position.PROCEDURE FOR BLOOD COLLECTION1. Venepuncturea) Blood should be drawn from a large, firm vein in an area that is free from skin lesions or evidence of infection.b) Inspect both of arms to select the best choice and remove any tight fitting sleeved clothing, if possible, or to roll up loose sleeves.c) Veins in the ante-cubital fossa should be used and no more than one venepuncture should be performed on each arm. d) The vein selected should have sufficient diameter, be turgid and have adequate tissue support for the retention of the venepuncture needle through the entire procedure for the withdrawal of blood.e) Clean the venepuncture site by using the swabs containing 70% isopropyl alcohol (commonly used) to provide maximum assurance of a sterile unit of blood.f) A dry syringe must be used and the blood should always be drawn with minimum stasis, since prolonged stasis will cause movement of water and small molecules from the vein into the interstitial fluid, with a consequent rise in the concentration of large molecules such as protein constituents and calcium.g) The venipuncture requires two separate thrusts of the needle and the skin is swiftly pierced with the needle at and angle of approximately 45o.h) For the second thrust, the needle is lowered until it is almost parallel to the skin before carefully entering the vein.i) When the appropriate amount has been collected, gently remove the needle and apply a sterile swab and pressure to the venepuncture site and the blood run gently(to avoid haemolysis) into the sample tube, which must be adequatley and correctly labeled.j) Check the patient numbers or codes on the sample tube and the request form. k) Finally, make sure venipuncture site is not bleeding and apply a plaster.l) When plasma is required, the blood is mixed thoroughly with the anticoagulant by repeated gentle inversion (no vigorous shaking) of the tube.
Page 20 of 115Note:❖ A blood sample for analysis should never be taken from the arm into which an intravenous drip is running (Not in IV line), nor from that into which a substance being estimated has recently been injected, e.g. bromosulphthalein.❖ Local anoxia will cause leakage of potassium from cells into plasma, an effect that is increased by exercise of the forearm muscles.❖ Assessment of Sample Materials for Chemical Pathology Laboratory.▪ Haemolysis:Determination of potasium, magnesium, LDH and AST is not possible even in slightly haemolitic serum. Considerable haemolysis also affects other tests. If haemolysis is observed, then a fresh sample must be requested.▪ Lipemic:Lipemic sera may interfere with photometric determinations.❖ Stability of the specimens is understood to be the capability of a sample materials to retain the initial value of a measured quantity for a defined period wi thin specified limits from the patient preparation, specimen collection and handling of specimen prior to analysis of the specimen. Example, during the transportation of whole blood for 3 to 4 hours at room temperature, the concentration of potassium rises from 4.2 mmol/L to 4.6 mmol/L.❖ For certain tests (such as coagulation tests, BUSE, CSF etc.), it is recomended whole blood specimen should be sent as soon as possible (ASAP). a) Sample identification i. The tube containing the blood/specimen should be fully identified by confirming the patient’s name and identification number. This can be done by asking the patient or relatives or checking patient’s notes.ii. Avoid pasting labels over barcode of containers.Note:❖ Never label samples from 2 or more patient’s at the same time. ❖ Avoid pre-labelling specimen containers to avoid mixed up of specimens.2. Blood C&S specimena) Take the patient's blood aseptically.b) Adults: inoculate 8 – 10 ml of blood into Bactec Plus Anaerobic mediumc) Children: Inoculate 3-5 ml of blood into Paeds Plus/F mediumd) Do not stick any stickers on the culture bottle barcodes. The section is for laboratory use.e) Do not refrigerate blood culture specimens.f) Record the date and time of specimen collection on the form.g) Place in Biohazard plastic and DO NOT mix with other specimens.h) Send to the laboratory as soon as possible with the application form.
Page 21 of 1153. Fasting Blood Specimena) For Fasting Blood Specimen, blood should be collected after an overnight fasting for at least 8 hours with no intake of food or drinks except water.b) Fasting Glucose is example of test that requires fasting blood.c) Patients do not need to fast for lipid profile. Fasting lipid profile should be considered or preferred: I. If the non-fasting TG is 4.5 mmol/L samples II. Following recovery form hypertriglyceridemic pancreatitis III. In cases of familial hyperlipidemia/hypertriglyceridemia IV. When initiating medication(s) that may cause hypertriglyceridemia (e.g., steroids, anti-retroviral therapy). 4. Virological Test Specimen (Influenza/HINI and Covid-19)a) Identify the specimen involved and collect the desired specimen such as blood, urine or throat swab according to the correct collection container.specimen ContainerThroat Swab Plain Swab with VTMb) Inform the laboratory to take the VTM specimen container and sterile swab.c) Use the test application form reserved by the reference laboratory (refer to the reference laboratory test application form attachment)d) Record the date and time of specimen collection on the forme) Place in Biohazard plastic and DO NOT mix with other specimens.f) Send to the laboratory as soon as possible with 2 copies of the application form.5. Stool Ova & Cyst (FEME) and Stool for Occult Blooda) Take a stool sample into the stool container using the scoop available on the collection container.b) The specimen should preferably be in the quantity of 1/3 of the stool container.c) Record the date and time of specimen collection on the form.d) Place in Biohazard plastic and DO NOT mix with other specimens.e) Send to the laboratory as soon as possible with the application form.6. Stool for Culture & Sensitivity (C&S)a) Take a stool sample using a sterile swab from the Carry Blair Transport Medium and insert the smear into the gel in the collection container.b) Record the date and time of specimen collection on the form.c) Place in Biohazard plastic and DO NOT mix with other specimens.d) Send to the laboratory as soon as possible with the application form.7. Microscopic Sputum (DSSM)a) Take 3 Specimens within a week of application.b) Use the TBIS 20C form.
Page 22 of 115c) Take a sputum specimen using a sterile container.d) Instruct the patient to gargle before taking the specimen in the early morning Breathe in several times and cough forcefully and collect the sputum specimen. Avoid taking saliva samples.e) Avoid exposure to sunlight to prevent the microorganisms inside from being destroyed and not being able to be diagnosed accurately.f) Record the date and time of specimen collection on the request form.g) Place in Biohazard plastic and DO NOT mix with other specimens.h) Send to the laboratory as soon as possible with the application form.8. MTB C&S (BACTEC), LPA, Gene Expert and MTB PCR Testa) Use the TBIS 20C form for the test to detect Acid Fast Bacilli (AFB) and for the MTB C&S test.b) Take the specimen using a screw capped sterile universal container.c) Instruct the patient to gargle before taking the specimen in the early morning. Breathe in several times and cough vigorously and collect the sputum specimen. Avoid taking saliva samples.d) Put the specimen into biohazard plastic and send it to the laboratory immediately. Avoid exposure to sunlight to prevent the microorganisms inside from being destroyed and not being able to be diagnosed accurately.e) Record the date and time of specimen collection on the form.f) Place in Biohazard plastic and DO NOT mix with other specimens.g) Send to the laboratory as soon as possible with the application form.h) For the MTB Gene Xpert test, the form must be completed with the clinical history, diagnosis and signature of the treating Physician. Also make sure the sample volume is 3-5 mL.9. 24 hour Urine Specimena) Choose a suitable collection container (Picture)b) Urinate early in the morning and start collecting middlestream and afterwards. Record the date and start time of specimen collection on the container, Example: 15/01/2022, 6.00amc) Collect urine for the next 24 hours. If the patient wants to defecate, the bladder must be emptied first to avoid urine loss and feces contaminating the collected urine.d) Stop collection and collect urine the next morning, exactly 24 hours.e) Label the urine container clearly with the name of Patient, RN, ward,f) date, time of collection and test ordered.10.Random Urine Specimena) Choose a suitable collection container which is a screw capped sterile universal container.b) A good specimen is to obtain mid stream urine. The patient needs to remove the initial urine specimen first and collect the next specimen. Close the lid tightly and place insidec) Plastic biohazard. Send the completed application form to the laboratory.Picture : 24-hour urine specimen container
Page 23 of 115TYPES OF CONTAINER AND ORDER OF DRAWOrder of draw in phlebotomy is a system of collecting more than one tube of blood at the same time from a patient while reducing instances of cross-contamination. Contamination may occur when the syringe contacts microorganisms, additives or blood mixed withadditives in previous test tubes. [CLSI (formerly NCCLS)Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture;ApprovedStandard – Sixth Edition is as followed: SST Gel Tube Sodium Citrate Tube 1 2 3 4 5 6 7 C/S Bottle Plain Tube Lithium Heparin TubeK2 EDTA TubeNAF Oxalate Tube
Page 24 of 115Tubes Type and Order Volume of Spesimen & Collection Instructions Common Tests1. Blood Cultures Blood/Body FluidVolume: Adults 8-10mL &Paediatric/neonates 1-5mLMix the spesimen with gentle agitation.Store at Room Temperature.Microbiology: Culture & Sensitivity*If using winged blood collection set. then the Aerobic bottle should be filled first to prevent transfer of air in the device into anaerobic bottle.If using a needle andsyringe, inoculate the anaerobic bottle first to avoid antry of air.If amount of blood drawn is less then recommended volume, then approximately 10mLof blood should be inoculated into the aerobic bottle first.2. Sodium Citrate (BLUE) Correct volume critical.See marker level on tube.• Mixing test & Factor Assay: Fresh venous blood: 2 tubes• Factor Inhibitor Assays & Lupus anticoagulant: 5 tubesNote: INVERT tube GENTLY 6-8 times after collection.Haematology: PT/PTT/INR, Thrombin Time, Fibrinogen (plasma), D-Dimer, Mixing Test, Factor Assay (VIII & IX), Factor Inhibitor Assay (VIII & IX),Lupus Anticoagulant (Single Test).3. Serum Separator Tube (YELLOW)Volume: 3-5 mLNote: INVERT tube GENTLY 6-8 times after collection.Routine Chemistry: RP, LFT, Albumin, Amylase, Calcium, Lipid Profile, Creatinine clearance, GGT, Iron studies, LDH, Magnesium, Osmolality, Phosphate, Trop I,
Page 25 of 115Tubes Type and Order Volume of Spesimen & Collection Instructions Common TestsUric Acid, IgG/A/M/E, C3C4Special Chemistry: Cortisol, Estradiol, FSH, LH, Progesterone Prolactin, Ferritin, B12, Folate, TFT, Testosterone, Tumour Markers.TDM: ALL tests except Tacrolimus & Cyclosporine.Serology: Rheumatoid Factor, ANA, ASOT, VDRL, Anti-dsDNA, ENA Anti-CCPInfectious Diseases;Dengue ELISA, HBs Ag, mAnti HCV, HIV 1/2Ab ELISA, HAV IgG, HAV IgM, HBcIgM, HBc Total IgG, Anti HBe, HBe Ag, Anti HBs, HBs Ag comfirmatory (neutralization test) HCV Antigen, HCVAb Serodia (PA)HCV LIA, HIV AbSerodia (PA), HIV ½ LIA, Rapid Leptospiral IgM, RPR, TPPA, TORCHES, EBV Ab, Mycoplasma pneumoniae Ab, Leptospiral IgM.
Page 26 of 115Tubes Type and Order Volume of Spesimen & Collection Instructions Common Tests4. EDTA (PURPLE) Volume: 2.5 - 3 mL❖ Ammonia: Adult (2.5mL), paeds(1mL),(in ice bath❖ IPT: BMA/venous blood (3-5mL)❖ Molecular test-HIV RNA Viral load, HBV Viral load (PCR): 3 tubes (2.5mL in each)❖ Blood Grouping/Antibody Screening/Identification/ Coomb’s Test/GSH/Red Cell Phenotyping/Anti-D Titre/ GXM/ Transfusion Reaction Investigation: 2.5mL+Plain Tube(5mL)Note: INVERT tube GENTLY 6-8 times after collectionBlood Bank: Blood Grouping-ABO & Rh(D), Antibody Screening /Identification, Coomb’s Test. GSH, Red Cell Phenotyping, Anti-D Titre, GXM, Transfusion Reaction Investigation.Haematology: FBC, Reticulocytes count, PBF, Immunophenotyping, CD4/CD8, Hb analysis, G6PD, DNA Analysis.Biochemistry: HBA1C, Ammonia,Blood Ketone, IPTH.Serology: HIV RNA Viral load(PCR), HBV Viral Load (PCR), HCV Viral Load.5. Fluoride/Oxalate (GREY)Volume: 2.5 mLNote; INVERT tube GENTLY 6-8 times after collectionBiochemistry: Glucose, GlucoseTolerance Test,Lactate (send in ice)
Page 27 of 115Tubes Type and Order Volume of Spesimen & Collection Instructions Common Tests6. ESR(BLACK) Correct volume critical. See marker level on tubeNote: INVERT tube GENTLY 6-8 times after collectionHaematology: ESR7. Universal Sterile ContainerVolume: 60 mL Culture & sensitivity1. Urine C/S 2. Sputum C/S3. Sputum AFB C/S4. Body Fluid C/S• Pleural Fluid• Peritoneal Fluid• Synovial FluidRoutine Test1. Urine FEME2. Urine Paraquat3. Urine Pregnancy Test4. Sputum Spot5. Sputum AFB Direct Smear9. 24 hours Urine ContainerVolume: min 750 mL 24 hours Urine forCalcium, Chloride,Creatinine, Phosphate,Protein, Potassium, Sodium, Urea, Uric Acid, Glucose, Cathecolamine
Page 28 of 115Tubes Type and Order Volume of Spesimen & Collection Instructions Common Tests10. Stuart Transport Medium Culture & sensitivity1. Pus C/S2. Swab C/S3. HVS C/S12. Viral Transport Medium Test (virology)1. H1N12. HRMD3. COVID 19
Page 29 of 115GENERAL WORKFLOW FOR HANDLING OF SPECIMEN IN UNIT PATHOLOGYReview/ Validate result/reportResult not acceptableResult View Online Update rejection information into Laboratory Information System (LIS)Urgent requestFill up rejection formSend specimen to respective sectionReceive request at the counterDetermine urgencySort specimenCheck specimenRegister requestAnalyze/ProcessInform ward if necessary and record detailsRecord in file/ LISRefer to rejection criteriaRepeat analysis/ processSend direct to section
CHEMICAL PATHOLOGYCHEMICAL PATHOLOGY
Page 34 of 115INTRODUCTIONThe Chemical Pathology section of the Pathology Unit provides diagnostic services to support patient management. FACTORS TO BE CONSIDERED FOR MORE MEANINGFUL INTERPRETATION OF BIOCHEMISTRY RESULTS.1. General ConsiderationsMany factors other than disease can influence the values of constituents in body fluids. These include:1. Long-term physiological factors: race, sex, age, diet, geographical location, and environment.2. Short-term physiological factors: physical activity, recent food intake, and time of specimen collection.3. Specimen handling and processing: conditions between collection and analysis.4. Analytical method and laboratory performance: including calibration, method precision, and quality control.2. Short-Term Physiological Influences• Posture changes: Moving from lying to standing can increase non-filterable blood elements (e.g., proteins, lipoproteins) by up to 13% after 15 minutes. The reverse occurs when lying down, but more gradually.• Cyclical variations: Constituents such as cortisol, iron, and TSH follow daily cycles. Specimens should ideally be collected between 8:00 am and 10:00 am. For example, serum iron can vary up to 50% between 8:00 am and 2:00 pm.• Meals: Food intake may influence results for up to 12 hours. A high-protein diet can increase plasma urea, uric acid, and phosphorus. High-fat meals can cause lipaemia, affecting triglycerides, alkaline phosphatase, and other analytes.• Fluid intake: Even a single glass of water can significantly affect results if blood is drawn within two hours.• Fasting requirements: Certain tests, such as triglycerides, phosphate, uric acid, and glucose, must be performed on fasting specimens or with knowledge of the timing of the last meal (e.g., fasting blood sugar, pre-prandial, or 2-hour post-prandial sugar).
Page 35 of 115Factors Affecting Test Results and PrecautionsFactor Precautions / NotesHemolysis Avoid shaking tubes; gently invert anticoagulant tubes 3 times immediately. Do not transfer blood from syringe to vacutainer using needle. Avoid extremes of temperature. Hemolysis affects potassium, folate, bilirubin, AST, ALT, LDH, CK, Mg, PO₄.Contamination Avoid drawing blood from an arm with IV infusion. Do not decant blood between tubes. Collect K₂EDTA samples after serum samples. Contamination affects potassium, calcium, ALP, glucose, sodium.Venous ConstrictionMinimise tourniquet use. Prolonged constriction affects calcium, lactate, electrolytes, and proteins.Icterus High bilirubin can interfere with creatinine, cholesterol, ammonia, and triglycerides assays.Lipaemia Affects sodium, ammonia, ALT, AST, salicylate, and other analytes.Drugs Drug interference is variable. Consult clinical laboratory staff for advice if needed.Specimen transit delays (>4 hours)Delays can alter analyte concentrations, especially potassium.Incorrect specimen typeUse the correct collection tube for each test to avoid analytical errors.
Page 36 of 115SPECIMEN COLLECTION AND HANDLING1. MID STREAM URINE• For random urine specimen, first voided specimen during an early morning isusually preferred for testing.• Clean groin area prior to collecting urine.• Catch mid-stream urine using 60 mL sterile container during emptying of the bladder.• Send specimen immediately to laboratory.• Never keep urine in the wad / clinic / home as urine urine samplecollected more than 2 hours will affect result reliability2. 24-HOUR URINE• Empty bladder into toilet after 6:00am on the morning of the commencement of the test (this specimen is not to be collected into the 24-Hour Sterile urine container)• Record on the 24-Hour Sterile urine container the time and date you passed theUrine.• Collect all Urine over the next 24 hrs directly into the 24-Hour Sterile urinecontainerprovided.• The 24-Hour Sterile urine container should at all times be stored in the refrigerator.3. GLUCOSE TOLERANCE TEST (GTT)Purpose of Test:• Used in the diagnosis of Diabetes MellitusPreparation for the Test:• You should have an unrestricted diet containing at least 150 g of carbohydratesperday over the three (3) days preceding the test.• You should fast (no food or energy supplying substance) for at least eight hrs prior tothe test (but no longer than 16 hrs). Water is permitted during this periodand duringthe test procedure.Test Procedure:• All tests are preferably done in the morning because of variations in sugar levelsduringthe course of the day.• On arrival, a fasting blood is collected.• Following this, you will be given a glucose (sugar) drink. You should drink all theliquidover a period of no more than five (5) mins.• Blood sample is collected after 60 mins (1 hour), and 120 mins (2 hrs) from the start of you drinking the glucose drink.
Page 37 of 115Note:• You should not have the test if you are ill or if you are known to have diabetesmellitus.• Smoking is not permitted during the fasting period and throughout the durationof thecollection procedure.• Any form of exercise (walking) during the test period should be avoided.TYPE OF CONTAINER FOR SPECIMENS IN CHEMICAL PATHOLOGYNo. Spesimen Container Test Spesimen Additive SpesimenVol.1.BUSE, RP, LFT, FSL, CE,CRP, Magnesium, UricAcid, Amylase, Iron, TIBC, Hormonal test, TumorMarkers, TDMBlood Clotactivator5.0 mL(Adult),0.5 mL (Paeds)2. Glucose Blood KF+Na2EDTA2.0 mL(Adult)3. HbA1c, IPTH, ReninAldosterone, TroponinIBlood K2 EDTA2.0 mL(Adult),0.5 mL (Paeds)4. Referred test Blood PlainTube 3 - 5 mL5.Urine, Body fluids, CSFBiochemistry, Urine forCalcium, Chloride,Creatinine, Phosphate,Protein, Potassium,Sodium, Urea, Uric Acid,GlucoseUrine,Bodyfluids Nil 20 - 30 mL
Page 38 of 115RETENTION PERIOD OF SPECIMENS AND RESULTS/REPORTS.RECORD/ MATERIAL RETENTION DURATIONRequest form accompanying specimen 1 month after issue of report/resultReport duplicates (All other reports) 7 yearsResults (hard copy or electronic equivalent)1 yearSamples1. Serum, plasma, blood, frozen urine and other frozen body fluids2. Urine and faeces3. Other body fluids (e.g. cerebrospinal fluid,pleural fluid), aspirates and swabs2 days after issue of report/result Discard after issuance of report/result1 days after issue of report/result
HAEMATOLOGYHAEMATOLOGY
Page 39 of 115INTRODUCTIONLaboratory Haematology provides routine and urgent automated blood counting, coagulation screening and ESR.DIAGNOSTIC SERVICESUrgent Tests (STAT): These are short turnaround time tests for immediate patient management as indicated by the clinician on the request form. Urgent test are offered 24 hours.Routine Tests: These are all tests that are offered during office hours (please refer to thelist).REQUEST FORMS• Request for the test is done using PER-PAT 301 form.PRE-ANALYTICAL VARIABLES IN HAEMATOLOGY TESTINGThe table below shows common factors that are known to interfere with Haematologytesting.Factors PrecautionsHemolysis • Hemolysis affects certain FBC parameters andcoagulation tests.• Allow alcohol to dry completely when it is used forskinsterilization prior to venipuncture.• Never inject a syringe needle into the vacutainer toemptythe syringe.• Samples should be mixed thoroughly but gentlyimmediately after collection. Vigorous shaking causesredcells to rupture.• Avoid extremes of temperature. Never place a blood tubedirectly on ice as this may cause hemolysis.Contamination • Avoid taking blood from the arm where an IV infusion has been set up. It can cause a dilution effect of mostanalytes.• Avoid decanting blood from one tube to another even if thetubes contain the same anticoagulant. Follow therecommended order of draw to avoid contamination. e.g. Blood requiring K+EDTA preservative must be taken after samples for coagulation tests to avoid thepossibility of falsely prolonged PT/ APTT or lowfibrinogen results.Icterus Icterus affects Coagulation tests.Lipaemia Lipaemia affects Hemoglobin, MCH, MCHC andCoagulationtests.Delay in transit ofspecimens (> 4 hours)Delays in transit affects coagulation testing and causePlatelet,RBC and WBC cell degradation.
Page 40 of 115Inadequate filling ofblood collection tubesImproper ratio of blood to anticoagulant causes prolongedPTand APTT result.Hematocrit level > 55% Improper ratio of blood to anticoagulant causes prolongedPTand APTT result. Please contact lab for furtherinformation.Improper specimenstorage/ transportSpecimens not stored or transported according torecommended temperature may cause aberrant results.e.g. CD4/CD8 Enumeration should be sent at roomtemperature not cold temperature (2 - 8 °C).SPECIMEN COLLECTION AND HANDLING• Venous blood is preferred.• To ensure consistent and accurate result, follow strictly the volume ofblood requiredby fill the blood sample to the mark on the label.• To prevent haemolysis :o Avoid vigorous mixing.o Prick the needle on the cap and allow the blood drawn into the tube.o Send the specimen to the laboratory as soon as possible.• Avoid clot formation by :o Ensuring a smooth venepuncture and steady flow of blood into the syringe.o Correct order of drawn blood.o Introducing the blood in the anticoagulated tube as soon as bloodbeen drawn.o Mix immediately by inverting the tube gently 4 - 8 times.METHOD OF COLLECTIONFull Blood Count• Specimen for FBC /FBP should be sent immediately to the laboratory to prevent storage changes.• Mix gently to ensure good anticoagulation.Coagulation Test• Good specimen collections i.e. clean venepuncture, not from indwelling catheter or arterial lines, mix well by inverting 3-4 times gently.• Correct ratio (1 part of sodium citrate to 9 part of blood) is essential. Collect 2.0 mLof blood into sodium citrate tube.• Send to the lab immediately. Time of collection must be stated. Thesample must beanalysed within 2 hours of collection.
Page 41 of 115TYPE OF CONTAINER FOR SPECIMENS IN HAEMATOLGYNo. SpesimenContainer Test Spesimen Additive SpesimenVol.1.FBC, FBP,Blood K2EDTA2.0 mL(Adult)0.5 mL (Paed)2. PT, APTT, Blood 3.2% SodiumCitrate 1.8 mL3. ESR Blood 3.8% SodiumCitrate 1.8 mLRETENTION PERIOD OF SPECIMENS AND RESULTS/REPORTS.RECORD/ MATERIAL RETENTION DURATION1.1 Request form accompanying specimen1.1.1 Routine test1.1.2 Test with interpretive report1 month after issue of result3years after issue of report1.3 Blood samples 2 days after the test is done1.4 Results1.6.1 Full blood count1.6.2 Routine coagulation test (e.g., PT, INR,APTT,disseminated intravascularcoagulation)1.6.3 G6PD Screening3 years3 years7 years
MICROBIOLOGYMICROBIOLOGY
Page 42 of 115INTRODUCTIONThe main role of Microbiology Laboratory Services is to identify the aetiologic agents of diseases caused by bacteria and parasites. The laboratory also carries out urinalysis andstool microscopic examination.Microbiology laboratory also works closely with Hospital Infection Control Unit in activitiesrelated to bacterial and parasite infections in healthcare service.LIST OF SERVICESMicrobiology unit provides the following services:• Diagnostic Microbiological services which comprise of Bacteriology andTuberculosis.• Participation in hospital wide infection control activities related tosurveillance, controland prevention of nosocomial infections.• Provision of microbiological studies of the hospital environment andsterility testing.FORMSAll test request must use Borang Permohonan Ujian Perkhidmatan PatologiPER PAT 301except:• Permohonan Ujian TB TBIS 20C (Only for Direct Smear AFB, TB Culture&Sensitivity)GENERAL SPECIMEN COLLECTION GUIDELINES• The quality of laboratory results depends greatly on the propercollection and handling of the specimen as well as obtaining satisfactory material for examination.• The clinical specimen must be material from the actual infection site and must be collected with minimum contamination from adjacent tissue, organs or secretions.• A sufficient quantity of specimen must be obtained in order to perform theexamination required.• Appropriate collection devices, specimen containers and culture mediamust be usedto ensure optimal recovery of microorganisms.• Ideally, the specimen must be collected before the commencement of antibiotictherapy.• Specimens are best transported immediately to the laboratory.• If specimen collection after office hours is unavoidable, the specimen should be kept in refrigerator (not in freezer compartment) except for Blood Culture and Stool in transport media which should be stored at room temperature in the respective wards.• All culture & sensitivity tests request must fill up two copies of PER PAT301 form.
Page 43 of 115SPUTUM1. Assure patient cooperation to get an adequate specimen. Microbiology will determine the number of squamous epithelial cells present for specimen adequacy.2. Instruct the patient as follows:a. Rinse mouth with tap water to remove food particles and debris. b. Have patient breathe deeply and cough several times to achieve a deep specimen. c. Patient should expectorate into dry, sterile container. d. Tuberculosis patients should expectorate sputum in the early morning, into a sterile container with lid sealed tightly. Leaking specimens may be cancelled.e. Transport immediately at ambient temperature. f. Expectorated sputum is acceptable for bacterial, mycobacterial, and fungal cultures.g. Patients with clinical and chest x-ray findings compatible with TB should collect 3 first morningsputums (preferably on 3 separate days) for AFB culture. INDUCED SPUTUMInduced sputum is collected by Pulmonology and nursing staff on OSL-8. Induced sputum is acceptable for Legionella, PCP (on ice), fungal, and AFB testing.
Page 44 of 115TYPE OF CONTAINER FOR SPECIMENS IN MICROBIOLOGY:No. SpecimenContainer Test Specimen Additives SpecimenVolume1.Sterile ContainerAFB direct smear sputum NA NA2Plain Swab RTK Covid 19 Nasopharyngael Swab NA NARETENTION PERIOD OF SPECIMENS AND RESULTS/REPORTS.RECORD/ MATERIAL RETENTION DURATION1 Request form accompanying specimen forBacteriology, Parasitology, Virology andMycology.1 month after issue of report/result.3 Serum/plasma for serology Negative - Discard after issue ofreport/result.Positive - 7 days after issue of report/result.4 Slidesa. Wet preparationb. Stained/ Immunofluorescence slides Discard after issue of report/result.Negative- Discard after issue ofreport/result.Positive- 2 days after issue of report/result.
REFERRAL SERVICEREFERRAL SERVICE
Page 46 of 115INTRODUCTIONFor the tests which are not provided by the laboratory, referred examinations are arranged with MOH, non-MOH or private laboratories. The laboratory is responsible for facilitating the referral process according to its documented procedures. There is an established agreement for providing medical laboratory services between the laboratory and the referral laboratories. The referral laboratories are selected based on certain criteria to ensure quality is maintained. The list of referral laboratories and their transport schedule are shown below.OPERATING HOURMonday - Friday : 8.00 am - 5.00 pmTRANSPORTATION SCHEDULE TO REFERRAL CENTERS:NO TRANSPORTATION DAY LOCATION1 Monday - Friday Hospital Raja Permaisuri Bainun, IpohTRANSPORTATION SCHEDULE HANDLE BY HOSPITAL RAJA PERMAISURI BAINUN, IPOHNO TRANSPORTATION DAY LOCATION1 Monday - Friday MKA Jelapang, Ipoh; Jabatan Kimia, IpohOutside from Perak, Referral cases handle by Hospital Raja Permaisuri Bainun, Ipoh2 Mond and ThursdayHospital Kuala Lumpur, Hospital Tunku Aziza, NIH, Institut Penyelidikan Malaysia, Hospital Ampang, Pusat Darah Negara3 Tuesday Hospital Pulau Pinang4 WednesdayHospital Putrajaya, Institut Kanser Negara, MKA Sungai Buloh, Hospital Sungai Buloh dan Hospital SelayangREPORTING AND DESPATCHING OF RESULTS1. The laboratory uploads all test results into the LIS, where wards can view them through the LIS Ward Inquiry module.2. For restricted results, such as drugs of abuse and infectious disease tests (e.g. HIV), the LIS Ward Inquiry module indicates ‘Collect at Laboratory’ once the results are ready. Wards shall collect these results directly from the laboratory. RETENTION PERIOD OF SPECIMENS AND RESULTS/REPORTSThe laboratory keeps hard copies of consignment documents on file until the results are received
TESTS AVAILABLE AT UNIT PATHOLONO. TESTS SPECIMEN TYP1 Activated Partial Thromboplastin Time Plasma 2 AFB Direct Smear1. Respiratory samplSputum, tracheal aspirate,bronchoalavage 2. body fluid, cerebrofluid 3. pus aspirate,tissue,gaslavage,bone3 Alanine Transaminase (ALT) Serum 4 Albumin 24 HRs Urine 5 Albumin Serum 6 Albumin Body Fluid 7 Alkaline Phosphatase (ALP) Serum 8 Amylase 24 HRs Urine 9 Amylase Body Fluid