Pathology Services Handbook

Hospital Sungai Buloh 2020

Pathology Services
Handbook

Hospital Sungai Buloh 2020

Foreword

This handbook, prepared by the Pathology Department gives
pre–analytical information and guidance to laboratory service
users when requesting tests and includes details of services
provided, laboratory contact details and opening hrs, details
of tests requirements, instructions for sample collection and
request form information as well as outsourcing samples to
other institutions. In this new edition, many tests have been
updated and as a designated covid–19 hospital, new tests
requirement related to covid–19 specimen is added. Thank
you to the department commitment in ensuring the
Pathology Handbook updated and always relevant to serve
as a reference for clinicians and laboratory staff.

Kind Regards,

Dr Kuldip Kaur A/P Prem Singh
Hospital Director
Hospital Sungai Buloh

Preface

Pathology take pride in providing superior quality pathology
service to the medical profession. In the light of this, we
always strive to ensure our service users were well informed
of the preanalytical requirements for the tests offered. This
new edition of Pathology Handbook has added new tests,
specimen handling requirement for infectious diseases,
reviewed test schedule and turnaround time, and easy
format to ease user navigation. Though this handbook is
mainly for clinicians, it is also relevant for lab members
and trainees who needs to know the preanalytical
requirements as well as quick reference for tests. We
welcome your feedback regarding this publication and
please feel free to contact the laboratory with comments or
criticism. We hope that you will find this user–friendly
reference guide very useful.

Kind Regards,

Dr Afifah Hj Hasan
Senior Consultant Pathologist &
Head of Pathology Department
Hospital Sungai Buloh

Contents

General Information

Our Location
Scope of Service
Outsourced Institutions
Operating Hrs
Complaints, Concerns & Compliments
Type of Request
Specimen Registration
Specimen Collection
Unmanaged Specimen
Specimen Transportation
Sending High Risk Samples
Specimen Reception & Rejection
Result Reporting & Tracing
Critical Result Notification Limits
Lab Directory
Requesting Test During LIS Downtime
Chemical Pathology

Introduction
Analytical/biological factors affecting the performance of tests
Measurement of Uncertainty
Specimen Collection Chart
List of Tests (in–house) and Reference Interval
Therapeutic Drug Monitoring (TDM) Range
List of Tests (outsource)
Type of Request Forms
Patient Information Sheet for Glucose Tolerance Test (GTT)
Patient Instructions for the Collection of Mid–Stream Urine
Patient Instructions for the Collection of 24–Hour Urine
Medical Microbiology

Introduction
List of Tests (in–house)
List of Tests (outsource)
Haematology

Introduction
List of Tests (in–house)
List of Tests (outsource)

Blood Transfusion Unit
Introduction
List of Tests (in–house)
List of Tests (outsource)

Histopathology & Cytology (outsourced)
Introduction
List of Tests (in–house)
List of Tests (outsource)

PLEASE NOTE: Information is subject to change without notice. For latest and
most up–to–date information, always refer online at http://www.

Abbreviation

TAT Turn Around Time
TDM Therapeutic drug Monitoring
LIS Lab Information System
HIS Hospital Information System
CRA Central Receiving Area
CA Clinical Access

Our Location

Department of Pathology, Hospital Sungai Buloh provides medical laboratory
diagnostic and consultation services to the entire clinical services in the
hospital and external health facilities. The Department is located at Level 1,
Block B of the hospital, next to the Radiology Department.

All specimens in our lab were received at the Central Receiving Area (CRA)
which serves as the common centralized counter for the department, except
for Blood Transfusion services, where they have a separate reception
counter adjacent to the CRA. In CRA we checks, barcodes, sorts and
process all specimens before they are sent to specific laboratories for
analysis. Here, we also supply special containers or preservatives for certain
tests.

Scope of Service

The scope of services offered including those that were outsourced are
listed as follows:

Unit Scope of Services
Medical Microbiology
Chemical Pathology Serology, Virology, Immunology, Bacteriology,
Parasitology and Mycology
Haematology
Transfusion Medicine Routine Chemistry, Endocrine & Metabolic, Cardiac
Histopathology & Markers, Tumour Markers, TDM, Toxicology, Drug of
Cytology Abuse, Dynamic Function Test, Special Proteins and
Proteomics

General Haematology and Haemostasis

Supply of blood products and components.
Immunohematology tests will be outsourced to PDN

Outsourced to Hospital Selayang, Hospital Kuala Lumpur,
IMR and UiTM Sungai Buloh

Outsource/Referral Labs

Where tests cannot be performed in–house, we outsource the tests to various
referral labs. Please refer to respective unit section for the list of tests
outsourced. The labs were selected based on certain criteria to ensure quality
is maintained. The list of our referral labs include:

a. Institute of Medical Research (IMR)
b. Hospital Kuala Lumpur (HKL)
c. Pusat Darah Negara (PDN)
d. Hospital Putrajaya
e. Hospital Selayang
f. Hospital Ampang
g. Chemistry Department of Malaysia
h. UiTM Sg Buloh
i. Makmal Kesihatan Awam Kebangsaan (MKAK) Sungai Buloh

Operating Hours

Internal specimens 8:00 am – 4:30 pm (for all tests offered)
Monday to Friday After office hours tests only – Refer to Section
Saturday Type of Request
Sunday & Public Holidays
8:00 am – 4:30 pm (for all tests offered)
External specimens Urgent tests only – Refer to Section Type of
Monday to Friday Request
Saturday
Sunday & Public Holidays

Complaints, Concerns &
Compliments

Users wishing to raise a concern, make a complaint or compliment the
department are encouraged to contact the Quality Manager or Head of Unit
to discuss further. Please refer to the Lab Directory section for contact
details.

Type of Request

The scope of tests were grouped into 4 categories as follows:

Tests offered Tests offered Tests by batches / Tests by
as urgent appointment
after office hour schedule

MICROBIOLOGY

• AFB stain • AFB stain • Molecular
• BFMP • BFMP • Serology
• Cryptococcal • Cryptococcal
Refer to Section
antigen antigen Microbiology

• CSF Bacterial • CSF Bacterial

antigen antigen

• Microfilaria (Blood • Microfilaria (Blood

film) film)

• Stool for ova & cyst • Stool for ova & cyst
• Stool for • Stool for

microscopy microscopy

examination examination

• Infective screening • All culture &

(Needle Stick Injury sensitivity

case)

• Merscov–PCR

CHEMICAL PATHOLOGY

• BUSE • BUSE • FSH, LH,
• Creatinine • Creatinine
• Bilirubin • Serum Bilirubin Progesterone,
• ALT • ALT Oestradiol,
• ALP • ALP Testosterone
• AST • AST (Tuesday)
• LDH • LDH
• Amylase • Amylase • Tumour markers

• Calcium • Calcium (Thursday)
• Ammonia • Ammonia
• Lactate • Lactate • Iron, Transferrin,
• CSF Biochemistry • CSF Biochemistry
• hs–Troponin I • hs–Troponin I Folate, B12
• Urine Paraquat • Urine Paraquat (Wednesday &
• Acetaminophen • Acetaminophen Friday)
• Salicylate • Salicylate

Tests offered Tests offered Tests by batches / Tests by
as urgent appointment
after office hour schedule

HEMATOLOGY

• FBC • FBC • D–Dimer • Bone Marrow
• FBP • FBP • Hb Analysis
• PT • PT Aspiration
• APTT • APTT
• Fibrinogen • Fibrinogen • Bone Marrow
• D–Dimer • ESR
• G6PD Screening Trephine Biopsy

• Kleihauer test
• Mixing Test

TRANSFUSION SERVICES

• First stage • GSH • Phenotype Blood
• GXM
Crossmatch • Antibody for Thalassemia
• Identification (send
• Antibody Patient
• Identification (send to PDN)
• Rhesus Negative
to PDN)
for Elective OT

Cases

• Rare phenotype

blood (Anti–JK3,

etc.)

HISTOPATHOLOGY AND CYTOLOGY

• Unstained slides

(for special
staining, etc.)

Specimen Registration

All tests can be requested through CA (Clinical Access) in Hospital
Information System (HIS). Clinical summary and diagnosis in the clinical
comment must be clearly entered and abbreviations are discouraged.

For specimens which need to accompany by request form, all the necessary
information listed below must be filled in completely:

a. Patient’s identification data (Name, I/C or passport number, hospital
number, age and gender)

b. Relevant clinical summary and diagnosis
c. History of administration of drug, where relevant
d. Ward or clinic and hospital’s official rubber stamp
e. Name of test requested
f. Type of specimen and anatomic site of origin, where appropriate
g. Special timing of specimen collected, where indicated
h. Doctor’s name and signature

Incomplete form filling may result in delay in receiving the results

Specimen Collection

Correct containers for each specimen or test requested must be ensured at all
time. Correct labelling of all specimens is essential as per ISO15189
requirements. Patient name, hospital number and test name are the minimal
requirements on the specimen. This must be clearly written or available on the
printed barcode.
All specimen containers for each patient should be put in one biohazard
plastic bag. For test that were outsourced, the biohazard bag should be
stapled together with the accompanied request form.
Below are the examples of do’s and don’ts of labelling:

Correct

Incorrect

Unmanaged Specimen

For all tests ordered in the CA, it must be managed (specimen collection and
despatch) prior sending to the lab as unmanaged specimen could not be
recognized in the lab and therefore impossible to register in our Laboratory
Information System (LIS).

LIS system prompt on Unmanaged Samples

All these unmanaged specimens will be
retained for a certain period to allow for
the wards to manage it. After a certain
period, if the samples were still not
managed, it will be discarded as the
specimens are no longer suitable for
analysis. It is very important that the
requester in the wards and clinics to
ensure that all samples are managed
before sending to the lab.

How to Manage Samples

1. Click Place Order

2. Select Record Collection

3. Select Record Dispatch

Specimen Transportation

All specimens must be packed appropriately before sending to the laboratory.
Where indicated, use dry ice instead of wet ice. All specimens must be sent to
laboratory immediately via porter or pneumatic tube with exception for some
tests.

Tests that need to be sent manually includes:
a. Histopathology & Cytology
b. Blood C&S
c. Blood Gases
d. 24–hour urine
e. Ammonia & Lactate
f. Transfusion Reactions
g. Blood & Blood product

Sending High Risk Samples
e.g. Covid-19

Specimen Rejection Criteria

Samples that do not meet criteria will be rejected. All rejection shall be
informed by phone or via rejection slip to notify. Below is the list of rejection
criteria in each unit/test:

Rejection Criteria Chemical Haematology/ Microbiology Histology/
Pathology Transfusion Cytology
Duplicate order √
Order cancelled by doctor* √ √ √ √
Blood clotted √ √ √ √
Tube cracked while spinning* √ √ √
Delayed in sending ABG >30 mins √ √
Delayed in sending blood >2 hrs √
Delayed in sending FBC >2 hrs √ √
Delayed in sending FBP >4 hrs √
Delayed in sending PT/APTT >2 hrs √ √
Delayed in sending urine C&S >2 hrs √ √
Empty container received*
Icteric serum received √ √
Insufficient formalin √ √ √√
Insufficient sample √ √√
Specimen leakage* √
Lipemic blood received √ √
Tube broken* √ √√
Blood haemolysed √ √ √√
Mislabelling of specimen* √ √√
Mucoid specimen √ √√
Specimen not in ice* √√
Container not labelled* √ √ √√
Nonsterile container
Test requested is not stated* √ √√
Improper Smear √ √√
No request form attached* √
Salivary sputum: unsuitable for culture √ √
Unsuitable sample for culture √ √√
Unsuitable sample for analysis
Wrong container/ tube* √
Wrong transport medium √ √√

√
√
√√
√√
√

Rejection Criteria Chemical Haematology/ Microbiology Histology/
Pathology Transfusion Cytology
Wrong Request Form* √
AFB >3 Sample sent √ √ √ √
No 2 carbonized copy of request form* √ √
24–hour urine collection <500 ml √ √ √
No requesting Dr's name/not clear * √
Sample received in warm condition √ √ √√
No clinical indication √ √
No clinical history √
No patient diagnosis √ √√
Test FBP not offered after office hour √ √ √√
Test GSH not offered after office hour √ √ √√
No thin film received √ √
No thick film received √ √
Improper barcode labelling*
Cannot read barcode* √ √
CSF heavy blood stained √ √
SYSTEM House Cleaning √ √ √√
Earlier BFMP positive √ √ √√
Earlier AFB positive √ √√
pH>4 for 24 hrs urine catecholamine √ √ √√
Need separate tube* √ √
Post transfusion sample √
Test not offered * √
GSH convert to GXM √
Incorrect information √ √√
Double sticker* √
HbA1C request – less than 3 months √ √√
CD4/CD8 – less than 4 months √ √√
Urine vol for catecholamine < 750ml
Contaminated specimen √
Temporarily no reagent
No MO code √
Interface down √
Electricity interrupted √
Need separated barcode
Requested not used √
Order cancelled by clinician √
* Rejection done at the CRA √ √√

Result Reporting & Tracing

Result Reporting

All results requested via the CA can be viewed in the HIS. For outsourced
tests, results can be viewed in specific outsourced folder (to specify). For
external results, results will be printed out and send to the respective
institution by post or dispatch via porter.

Result Tracing
Any inquiry regarding result, kindly call the respective laboratory i.e. chemical
pathology, microbiology, haematology, transfusion medicine and
histopathology. Refer to the Lab Directory

Result tracing will only be entertained if the result has exceeded its TAT.
Please refer to each tests’ TAT in respective unit section

Critical Result Notification

All critical limit results shall be informed to respective ward or clinic once the
result is ready. Refer to list below for the critical limits that shall be informed.

Test Critical Limit

Lower Limit Upper Limit

ADULT

Potassium < 2.8 mmol/L > 6.0 mmol/L

Sodium < 125 mmol/L > 155 mmol/L

Calcium < 1.5 mmol/L > 3.0 mmol/L

Hemoglobin < 6.0 g/dL > 19.0 g/dL

Hematocrit < 0.2 > 0.6

Platelet < 20 X 103 / µL > 1000 X 103 / µL

PEDIATRIC

Potassium < 2.8 mmol/L > 6.0 mmol/L

Sodium < 125 mmol/L > 155 mmol/L

Calcium < 1.7 mmol/L >3.1 mmol/L

Ammonia - >100 µmol/L

Bilirubin - > 300 µmol/L

Hemoglobin < 7.0 g/dL > 20.0 g/dL

Hematocrit < 0.20 > 0.40

Platelet < 50 X 103 / µL > 1000 X 103 / µL

WBC < 2.0 X 103 / µL > 50 X 103 / µL

NEONATES

Hemoglobin < 8.0 g/dL > 22.0 g/dL

Hematocrit < 0.25 > 0.70

Reference:
Pekeliling KPK KKM Bil 3/2016: Penambahbaikan Malaysian Patient Safety Goals No
8: To improve clinical communication by implementing critical value programme

Critical Value Notification Policy

1. Only first time critical value will be reported
2. The authorised receiver shall only be:

a. Specialist
b. Medical Officer
c. Postgraduate Medical Officer
d. Nurse (SN & JM)
3. 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 patient was transferred
4. If location is not specified, result shall not be informed
5. The first person who receives the notification shall accept and take the
call even though the patient is not under his/her care. The same applies in
the event the patient has transferred to other location.
6. The waiting time shall be until the ringing ends. Lab shall make second
attempt after 5 to 10 minutes after the first call. Only 2 call attempts shall
be made for each notification

Lab Directory

Staff / Location Position / Unit Ext. Number
03–61562645
Pathology Fax Number Admin 2100 / 2103
Clerk / General Office Admin
Dr Afifah Haji Hassan Head of Department 4236
Dr Tuan Suhaila Tuan Soh Microbiologist 2130
Dr Adilahtul Bushro Microbiologist / Quality 2140
Manager (Microbiology)
Dr Nur Izati Microbiologist 2149
Dr Nur Hanani Microbiologist 2149
Dr Idimaz Hajar Microbiologist 2162
Dr Syarifah Khairul Atikah Chemical Pathologist 7020
Dr Firdaus Mashuri Haematologist / Quality 7020
Manager (Intergrated Lab)
Dr Nor Khairina Haematologist 2150
Dr Sarojini Transfusionist 2150
Medical Officers’ Room – 2141 / 2147
Scientific Officers’ Room Clinical Biochemist / 2108 / 2109 / 2110
Microbiologist (Scientist)
Senior Medical Lab 2111 / 2114 / 2115
Technologist –
Counter Receiving Area (CRA) 2121
Microbiology Lab – 2128 / 2129
Culture & Sensitivity
Chemical Pathology Lab Parasitology 2127
Mycology 2136
Haematology Lab Molecular (PCR / Viral 2131
Load)
Blood Transfusion Lab Serology / Virology 2139 / 2148
Media 2132
Outsource & HPE Routine Immuno– 2119
Chemistry & HbA1c
Routine Test & BMT 2116
FBP / MO in charge 2117
G6PD / CD4 / CD8 2152
Blood Bank Lab 2154
MO in charge 2151
MO in charge 2122

Requesting Test During LIS
Downtime

LIS Downtime is a condition where the LIS in the lab cannot be used to
perform the lab processes that was LIS–assisted. All samples will need to be
registered, barcoded, processes and validated manually. Since the processes
are laborious, only limited samples are able to be processed during downtime.
The test which can be requested during downtime is listed below.

Unit 8 a.m. – 5 p.m. 5 p.m. – 8 a.m.

Medical All tests including Saturday, Sunday and
Microbiology Public holiday

Chemical All tests • Cultures
Pathology • Serology & Virology
Note: Batch tests will still be run • NS1 Antigen
according to its schedule • Dengue rapid
• Organ transplant
Haematology • FBC • Needle Stick Injury (NSI)
• PT/APTT • BFMP
• Fibrinogen • AFB
• G6PD
• BUSE
Blood • GSH • Creatinine
Transfusion • GXM • ABG
Service • Antibody Identification • Amylase
• Lactate
Histopathology All tests • Ammonia
& Cytology • Calcium
• Bilirubin

• FBC
• PT/APTT
• Fibrinogen

Note: For other tests, kindly call
MO/Specialist to request

• GSH
• GXM
• Antibody Identification

None

LIS Downtime Procedure

After 30 mins of downtime, IT will activate Business Continuity
Plan (BCP) manual form

Send all samples using Per-Pat 301 form (3 copy);
regardless barcode has already been generated or not, with

exception for transfusion; use GXM manual form

Note:

• Send separate Per-Pat 301 form for each unit’s test
• All outsourced samples (without barcode/not registered) during

downtime are advised to hold from sending to the lab until
system recover to avoid problem

Fill up Per-Pat 301 form with all the following details:
• Patient’s identification data (Name, I/C or passport

number, hospital number, age and gender)
• Relevant clinical summary and diagnosis
• History of administration of drug, where relevant
• Ward or clinic and hospital’s official rubber stamp
• Name of test requested
• Type of specimen and anatomic site of origin, where

appropriate
• Special timing of specimen collected, where indicated
• Doctor’s name and signature
Note:
Please ensure LOCATION is specified as result will be
dispatched according to location

Collect the hard copy results at the counter
Note:

• Please expect delay in TAT as all processes were done

manually

• We do not encourage tracing during downtime as all manpower

will be mobilised for manual work processes

Chemical Pathology

Introduction

The unit offers a full service, including: General Biochemistry, Hormones,
Anaemia Profiles, Tumour Markers, HbA1C, Urine analyses, Therapeutic Drug
Monitoring, Special Protein & Immunology, hs–Troponin I and Osmometry.
List of tests and specimen requirements for each test is described in the
Chemical Pathology list of tests section.

All analytes are monitored by extensive external assurance schemes including
RIQAS and EQAS. A full programme of internal quality assurance also
operates. All reports issued to clinicians are reviewed by the chemical
pathologist, medical officers, clinical biochemist and medical lab technologists;
and clinical interpretation are provided by the chemical pathologist when
appropriate. All critical abnormal results are communicated to clinical staff.

The laboratory has expertise to advise users concerning the selection and
installation of instruments for point of care testing. The laboratory manages
POCT through the Hospital POCT Committee. Quality Performance
monitoring (IQC and EQA) and audit is conducted by the lab regularly.

Analytical / biological factors affecting the
performance of tests

There are many factors which may cause an interference in the performance
of a test including physiological aspects such as age and sex of the patient,
whether patient is supine or erect, fasting or non–fasting. In general reference
ranges will allow for these factors. The table below indicates some common
analytical factors which can cause an interference, but the list is by no means
exhaustive.

List of factors affecting tests results

Factors Precautions
Hemolysis
Avoid shaking blood tubes which may cause trauma to
the red cells (for tubes containing anti-coagulant, gently
invert the tubes 3 times immediately on collection).

Never inject a syringe needle into the vacutainer to
empty the syringe.

Avoid extremes of temperature.

Contamination Hemolysis badly affects, potassium, folate,
bilirubin, AST, ALT, LDH, CK, Mg, PO4

Avoid taking blood from the arm where an IV infusion
has been set up, which can cause a dilution effect of
most analytes also depending on the infusion may
increase glucose, sodium and potassium levels.

Venous Constriction Avoid decanting blood from one tube to another. Blood
Icterus requiring K+EDTA preservative must be taken after
samples for Chemistry tests (serum separator tubes,
SST). K+EDTA will badly affect potassium, calcium,
ALP

Avoid a tourniquet where possible or at least keep its
use to a minimum. Constriction can badly affect
calcium, lactate, electrolytes, proteins

Icterus can badly affect Creatinine, Cholesterol,
Ammonia, Triglycerides

Lipaemia Lipaemia can badly affect sodium, Ammonia, ALT,
AST, Salicylate

Drugs It is not possible to list all the drugs that may cause
interference in analysis. Advice can be
obtained from the Clinical laboratory staff if required

Delay in transit of specimens Delays in transit can cause significant changes in

(more than 4 hr) analyte concentrations. The most commonly affected

analyte is potassium, but others could also be affected

Incorrect specimen received Ensure the correct blood collecting tube is used to take
the sample.

Uncertainty of Measurements

Biochemical tests are subject to a degree of uncertainty in their measurement.
This may be due to a variety of factors including:

• Biological variation within individuals
• Analytical measurement imprecision
• Pre–analytical factors

Please contact the Chemical Pathology Unit if you wish to know or discuss the
uncertainty values for each analyte measured in the laboratory

Collection Chart – Chemical Pathology

Tube / Container Sample/Tube Common Use Special
Adult Description Instruction
Clinical Chemistry: Mix sample gently
Paeds Serum / Routine Biochemistry 8 – 10 times
SST Gel analysis.
Then stand for 15
Special Protein & mins before
Immunology: centrifuging
C3, C4, hs–CRP, RF,
ASOT

Anaemia Profiles:
Iron, Transferrin,
Ferritin & Folate, B12

Hs–Trop I
Tumour Markers
Hormones

Adult Whole blood / HbA1c (Glycosylated Mix sample gently

K2EDTA Haemoglobin) 8 – 10 times

Paeds

Stopper Colour Tube Common Use Special
Instruction
Adult Description Mix well gently.

Plasma / Sodium Clinical Chemistry: Please specify if
fasting or non–
fluoride Glucose testing, GTT fasting and any
glucose load given
to patient.

Paeds

Heparinised Blood Gases Mix Well.
syringe
Please send
samples in slurry
ice water

24 hr urine 24 hr urine chemistries Additives will be
sterile container added by lab staff
depending on the
test requested

Bijou sterile CSF biochemistry and Please ensure cap
bottle
body fluids is tight and secure

biochemistry

Stopper Colour Tube Common Use Special
Description Instruction
Urine and other body
Sterile urine fluids biochemistry Please ensure cap
container is tight and secure

Dried blood spot NA NA

List of Test (in–house) & Reference Interval

Test Sample TAT Reference Interval Remarks
Container
Run once a
Acetaminophen Plain tube 2 hrs Therapeutic level week
4 hrs 9.98 – 19.95 ug/mL
Alanine Transaminases Plain tube / Toxic level (Thursday)
>15 ug/mL Send in ice

10 – 49 U/L

(ALT/ SGPT) Heparinised

Albumin Plain tube / 4 hrs 32 – 48 g/L
Heparinised

Albumin to Creatinine Spot urine in 4 hrs < 3.4 mg/mmol
ratio, strip Sterile urine 4 hrs 46 – 116 U/L
container
Alkaline phosphatase
(ALP) Plain tube /
Heparinised

Alpha Fetoprotein Plain tube 5 < 8.1 ng/mL
(AFP) working
EDTA
Ammonia days
Plain tube / 60 11 – 32 μmol/L for adults
Amylase, serum Heparinised mins
Sterile urine 4 hrs 30 – 118 U/L
Amylase, urine container
(Diastase) 4 hrs ≤ 650 U/L

Anti–streptolysin ‘O’ Plain tube / 4 hrs Children (preschool)
Titre (ASOT) Heparinised ≤100.0 IU/mL

Children (school age)
≤ 250.0 IU/mL

Adults
≤ 200.0 IU/mL

Aspartate Plain tube/ 4 hrs 34 U/L
Transaminase Heparinised
(AST/ SGOT)
Plain tube 60 Non–pregnant females
Beta HCG mins 1.5 – 4.2 mIU/mL
(Quantitative)

Bilirubin, direct Plain tube / 4 hrs ≤ 5 μmol/L
Bilirubin, total Heparinised
4 hrs 0 – 1 day
Plain tube / <137 μmol/L
Heparinised 1 – 2 days
<205 μmol/L
3 – 5 days

Test Sample TAT Reference Interval Remarks
Container
<274 μmol/L Send in
> 5 days – 60 years slurry ice
5 – 21 μmol/L
60 – 90 years Run once a
3 –19 μmol/L week
>90 years
3 – 15 μmol/L (Thursday)
Run once a
Blood Gases (Arterial / Heparinised 60 pH
mins 7.35 – 7.45 week
Venous) syringe (Thursday)
pCO2 Run once a
35 – 45 mmHg
week
Base Excess (Thursday)
–2.0 – +2.0 mmol/L

Actual Bicarbonate
22.0 – 28.0 mmol/L

Total CO2
22.0 – 28.0 mmol/L

pO2
80 – 100 mmHg

Oxygen Saturation
95.0 – 98.0 %

Body fluids Sterile urine 4 hrs Reference interval for
biochemistry container body fluids are not
(pleural / peritoneal / available
synovial)
Plain tube 4 hrs 2.08 – 2.65 mmol/L
Calcium, serum

Calcium, urine 24 hr 24 hr urine 4 hrs 2.50 – 7.50 mmol/day
container

Cancer Antigen Plain tube 5 <35 U/mL
(CA125) working

days

Carbamazepine Plain tube 60 Therapeutic level
without gel mins 16.9 – 50.8 μmol/L

Carbohydrate Antigen Plain tube 5 <37 U/mL
(CA19–9) working

days

Carcinoembryonic Plain tube 5 <5 ng/mL
Antigen (CEA) working
24 hr urine
Chloride, 24 hr urine container days
Plain tube 4 hrs 110 – 250 mmol/day
Chloride, serum
4 hrs 98 – 107 mmol/L

Cholesterol, total Plain tube 4 hrs Risk level
Desirable

Test Sample TAT Reference Interval Remarks
Container Concurrent

Complement C3 Plain tube 4 hrs < 5.2 mmol/L
Borderline
Complement C4 Plain tube 4 hrs 5.2 – 6.1 mmol/L
Cortisol, serum Plain tube 4 hrs High
4 hrs ≥ 6.2 mmol/L
Cortisol, urine 24 hr 24 hr urine
container Newborns
C–Reactive protein, Plain tube 0.60 – 1.10 g/L
high sensitive 3 months
Creatine kinase (CK) Plain tube 0.70 – 1.20 g/L
6 months
0.70 – 1.40 g/L

0.12 – 0.36 g/L

Morning (7 – 9 a.m.)
145.4 – 619.4 nmol/L
Afternoon (3 – 5 p.m.)
94.9 – 462.4 nmol/L

57.7 – 806.8 nmol/day

4 hrs <1.0 mg/dL

Creatinine Plain tube / 4 hrs Males
Heparinised 4 hrs 46 – 171 U/L
4 hrs
Females
34 – 145 U/L

Males
62 – 115 μmol/L

Females
49 – 90 μmol/L

Creatinine clearance 24 hr urine 4 hrs Males
Creatinine, urine 24 hr container & 8.4 – 22 mmol/day
Plain tube 60
mins Females
24 hr urine 5.3 – 15.9 mmol/day
container
0.08 – 0.32 g/L
CSF Protein Sterile urine
CSF Chloride container / 60 116 – 130 mmol/L
CSF Glucose Bijou mins
container
60 Adult
Sterile urine
container /
Bijou
container

Sterile urine

Test Sample TAT Reference Interval Remarks
Container
CSF Lactate Random
Estradiol container / mins 2.2 – 3.9 mmol/L Blood Sugar
Bijou (RBS) test
container Infant / child
3.3 – 4.4 mmol/L Run once a
week
Fluoride 60 1.2 – 2.1 mmol/L
Oxalate mins (Tuesday)

Plain tube 5 Adult Reference Interval
working

days Female

Follicular Phase
71.6 – 529.2 pmol/L

Luteal Phase
240.8 – 786.1 pmol/L

Mid luteal phase
234.5 – 1309.1 pmol/L
Post–menopausal
ND – 118.2 pmol/L

Male

ND – 146.1 pmol/L

Pediatric Reference
Interval

Female

2 – 3 years
<43.3 – 106.8 pmol/L
4 – 9 years
<43.3 – 160.3 pmol/L
10 – 11 years
<43.3 – 644.5 pmol/L
12 – 21 years
59.1 – 874.6 pmol/L

Male

2 – 3 years
<43.3 – 188.6 pmol/L
4 – 9 years
<43.3 – 97.1 pmol/L
10 – 13 years
<43.3 – 134.4 pmol/L
14 – 21 years
<43.3 – 179.5 pmol/L

Test Sample TAT Reference Interval Remarks
Ferritin Container
Run twice a
Folate Plain tube 4 hrs Males week
22 – 322 ng/mL
Follicle–stimulating (Wednesday
hormone (FSH) Females & Friday)
10 – 291 ng/mL
Run once a
Plain tube 3 Deficient week
working 0.79 – 7.63 nmol/L
(Tuesday)
days Indeterminate
7.64 – 12.19 nmol/L

Normal
12.19 – 46.4 nmol/L

Plain tube 5 Adult Reference Interval
working

days Female

Follicular phase
2.5 – 10.2 IU/L

Mid cycle Peak
3.4 – 33.4 IU/L

Luteal phase
1.5 – 9.1 IU/L

Pregnant

<0.3 IU/L
Post–Menopausal
23.0 – 116.3 IU/L

Male

13 – 70 years
1.4 – 18.1 IU/L

Pediatric Reference
Interval

Female

2 – 3 years
1.3 – 5.0 IU/L
4 – 9 years

0.5 – 5.0 IU/L
10 – 11 years
1.4 – 9.3 IU/L
12 – 21 years

2.2 – 10.1 IU/L

Male

2 – 3 years
<0.3 – 1.3 IU/L

Test Sample TAT Reference Interval Remarks
Gentamicin Container
4 hrs 4 – 9 years
Plain tube 0.4 – 2.0 IU/L
10 – 13 years
0.4 – 4.6 IU/L
14 – 21 years
1.4 – 7.5 IU/L

Peak level
8.64 – 21.6 μmol/L

Globulins, qualitative Plain tube 4 hrs

Glucose tolerance test Fluoride Fasting Please mix
Oxalate <6.1 mmol/L well
2 hours post prandial
<7.8 mmol/L Please mix
well
Glucose, 2 hr post Fluoride 4 hrs <7.8 mmol/L
prandial Oxalate Please mix
well
Glucose, fasting Fluoride 4 hrs <6.1 mmol/L
Oxalate Please mix
well
Glucose, random Fluoride 4 hrs <11.1 mmol/L
Oxalate Run twice a
Adults week
4.1 – 5.9 mmol/L
Newborn (Wednesday
2.2 – 3.3 mmol/L & Friday)
Newborn (1 day)
2.8 – 4.4 mmol/L Send in ice
Child
3.3 – 5.6 mmol/L

Glucose, urine 4 hrs < 2.8 mmol/day

Hemoglobin A1c EDTA 5 Normal

working < 5.6 %
days Prediabetes
5.6 – 6.2 %
Diabetes
> 6.3 %

High density lipoprotein Plain tube 4 hrs <1.03 mmol/L
cholesterol (HDL-C)

Iron Plain tube 3 Male
working 11.6 – 31.3 μmol/L
Lactate Plain tube /
Dehydrogenase Heparinised days Female
Lactate, plasma Fluoride 9.0 – 30.4 μmol/L

4 hrs 120 – 246 U/L

60 0.50 – 2.20 mmol/L

Test Sample TAT Reference Interval Remarks
Container mins

Oxalate

Low density lipoprotein Plain tube 4 hrs <3.0 mmol/L
cholesterol (LDL–C)
5 Adult Reference Interval Run once a
Luteinising Hormone Plain tube week
(LH) working
(Tuesday)
days Female

Follicular phase
1.9 – 12.5 IU/L

Mid cycle Peak
8.7 – 76.3 IU/L

Luteal phase
0.5 – 16.9 IU/L

Pregnant
<0.1 – 1.5 IU/L
Post–Menopausal
7.9 – 53.8 IU/L

Male

20 – 70 years
1.5 – 9.3 IU/L
>70 years
3.1 – 34.6 IU/L
Children
<0.1 – 6.0 IU/L

Pediatric Reference
Interval

Female

2 – 3 years
<0.07 IU/L
4 – 9 years
< 0.07 – 0.2 IU/L
10 – 12 years
<0.07 – 11.8 IU/L
13 – 21 years
1.0 – 52.2 IU/L

Male

2 – 3 years
<0.07 IU/L
10 – 13 years
<0.07 – 2.9 IU/L

Test Sample TAT Reference Interval Remarks
Container
Magnesium 14 – 21 years Run once a
Magnesium, 24 hr Plain tube / 1.0 – 7.1 IU/L week
Urine Heparinised
Osmolality, serum 24 hr urine 4 hrs 0.66 – 1.07 mmol/L (Tuesday)
Osmolality, urine container
Paraquat, urine Plain tube 4 hrs 0.99 – 10.45 mmol/day
pH, urine Sterile urine
Phenytoin container / 4 hrs 270 – 295 mOsm/kg
Sterile urine 4 hrs 300 – 900 mOsm/kg
container
Sterile urine 4 hrs Negative
container
Plain tube 60 4.5 – 7.5
mins
Peak level
4 hrs 39.6 – 79.2 μmol/L

Phosphate Inorganic Plain tube / 4 hrs 0.78 – 1.65 mmol/L
Heparinised
Phosphate Inorganic, 24 hr urine 4 hrs 12.9 – 42.0 mmol/day
24 hr urine container (on restricted diet)
Potassium Plain tube/
Heparinised 2 hrs 3.5 – 5.1 mmol/L
Potassium, spot urine Sterile urine
container 2 hrs
Potassium, urine 24 hr 24 hr urine
container/ 2 hrs 25 – 125 mmol/day
Procalcitonin Plain tube
60 < 0.05 ng/mL
Progesterone Plain tube mins

5 Males
working

days 0.89 – 3.88 nmol/L

Females

12 years
<0.67 – 5.53 nmol/L
13 – 21 years
<0.67 – 39.43 nmol/L

Follicular Phase
ND – 4.45 nmol/L

Luteal Phase
10.62 – 81.28 nmol/L

Mid luteal phase

Test Sample TAT Reference Interval Remarks
Prolactin Container
14.12 – 89.14 nmol/L
Post–menopausal
ND – 2.32 nmol/L

Pregnant

Plain tube 1st trimester Run once a
35.68 – 286.2 nmol/L week
2nd trimester
81.25 – 284.29 nmol/L (Tuesday)
3rd trimester
153.91 – 1343.55 nmol/L

5 Adult Reference Interval

working

days Females

Non pregnant
59 – 619 mIU/L

Pregnant
206 – 4420 mIU/L
Post–menopausal
36 – 430 mIU/L

Males
45 – 375 mIU/L

Pediatric Reference
Interval

Females
2 – 3 years
65.7 – 332.8 mIU/L
4 – 9 years

66.6 – 334.1 mIU/L
10 – 16 years
75.0 – 386.7 mIU/L
17 – 21 years

89.9 – 489.7 mIU/L

Males
2 – 3 years

76.3 – 606.3 mIU/L
4 – 9 years
95.4 – 382.2 mIU/L
10 – 16 years
67.8 – 284.9 mIU/L

17 – 21 years
115.1 – 326.7 mIU/L

Test Sample TAT Reference Interval Remarks
Container
Run once a
Prostate Specific Plain tube 5 <4 ng/mL week
Antigen, total working
(Thursday)
days

Protein total, serum Plain tube / 4 hrs 57 – 82 g/L
Heparinised

Protein, 24 hr urine 24 hr urine 4 hrs 0.01 – 0.14 g/L
container
At rest
0.05 – 0.08 g/day
After intense exercise
0.25 g/day

Rheumatoid factor (RF) Plain tube / 4 hrs < 14 IU/mL
Heparinised

Salicylate Plain tube 4 hrs Toxic level
>300 mg/L

Sodium Plain tube / 4 hrs 136 – 145 mmol/L
Sodium, spot urine Heparinised
Sodium, 24 hr urine
Testosterone Sterile urine 20 mmol/L
container

24 hr urine 4 hrs 40 – 220 mmol/L/24 hr
container

Plain tube 5 Adult Reference Interval Run once a
week
working
(Tuesday)
days Male
21 – 49 years
5.72 – 26.14 nmol/L
50 – 89 years
3.00 – 27.35 nmol/L

Female
Pre–menopause

0.42 – 2.06 nmol/L
Post–menopause
<0.24 – 1.70 nmol/L

Pediatric Reference
Interval

Males
2 – 10 years
<0.24 – 0.90 nmol/L

11 years
<0.24 – 11.85 nmol/L

12 years

Test Sample TAT Reference Interval Remarks
Container
<0.24 – 19.52 nmol/L
13 years
0.32 – 19.53 nmol/L
14 years
0.81 – 25.76 nmol/L
15 years
5.00 – 29.20 nmol/L
16 – 20 years
4.10 – 32.92 nmol/L

Thyroid Stimulating Plain tube Females
Hormone (TSH) 2 – 10 years
<0.24 – 3.76 nmol/L
Thyroxine, free (FT4) Plain tube 11 – 15 years
<0.24 – 1.68 nmol/L
16 – 20 years
0.61 – 1.75 nmol/L

24 hrs 1 – 23 months
0.87 – 6.15 mIU/L
2 – 12 years
0.67 – 4.16 mIU/L
13 – 20 years
0.48 – 4.17 mIU/L

24 hrs Infants 1 – 23 month
12.1 – 18.6 pmol/L
Children 2 – 12 years
11.1 – 18.1 pmol/L
Adult: 13 – 20 years
10.7 – 18.4 pmol/L

Transferrin Plain tube 3 Males Run twice a
working 2.15 – 3.65 g/L week

days Females (Wednesday
2.50 – 3.80 g/L & Friday)

Triglycerides, total Plain tube 4 hrs Normal

1.70 mmol/L

Borderline high
1.70 – 2.25 mmol/L

High
2.26 – 5.64 mmol/L

Very high
≥2.26 – 5.64 mmol/L

Tri–Iodothyronine free Plain tube 24 hrs Adult
(FT3) 3.5 – 6.5 pmol/L

Infants 1 – 23 months
5.1 – 8.0 pmol/L
Children 2 – 12 years
5.1 – 7.4 pmol/L

Test Sample TAT Reference Interval Remarks
Troponin I, Container
high–sensitive Run twice a
Plain tube 60 Female week
Urea mins < 38.64 pg/mL
Urea, 24 hr urine Male (Wednesday
Uric Acid < 53.53 pg/mL & Friday)

Uric Acid, urine 24 hr Plain tube / 4 hrs 3.2 – 8.2 mmol/L
Valproic acid Heparinised
Vancomycin
24 hr urine 4 hrs 0.43 – 0.71 mol/24 hr
Vitamin B12 container

Plain tube / 4 hrs Male
Heparinised 220 – 547 μmol/L

Female
184 – 464 μmol/L

24 hr urine 4 hrs 1.48 – 4.43 mmol/24 hr
container

Plain tube 4 hrs Therapeutic level
346 – 693 μmol/L

Plain tube 4 hrs Peak
12.4 – 17.9 µmol/L

Trough
3.5 – 6.9 µmol/L

Plain tube 3 Normal
working 156 – 672 pmol/L

days Deficient
24 – 181 pmol/L

Note:
• All tests were run daily, otherwise specified
• Reference interval that were not based on clinical decision limit are set according

to the methodology and equipment used. Therefore, it could vary between

hospital.
• Reference interval for all outsourced test will follow the ranges specified by the

perform site/location.

Therapeutic Drug Monitoring (TDM) Range

Test Dosing umol/l mg/l

Amikacin Multiple Peak Adult 34-51 20-30
Gentamicin Dosing Paeds
Vancomycin <17 <10
Single Trough Adult 3.4-8.5 2-5
Daily Paeds 60
Dosing 102 20-30
Peak Adult 34-51 <1
Multiple Paeds <1.71 2-5
Dosing 3.4-8.5 5-10
Trough Adult 10.5-21 5-12
Single Paeds 10.5-25 <2
Daily <4.2 <1
Dosing Peak Adult <2.1 10-20
Paeds 21-42 5-12
11-25
Trough Adult <1
Paeds < 2.1
25-40
Peak Adult 17.3-27.6
Paeds

Trough Adult
Paeds

Peak

Trough Non-complicated 6.9-10.4 10-15
infection

Complicated Infection 10.4-13.8 15-20

Paediatric & neonates 6.9-13.8 10-20

Continuous Infection 10.4-17.3 15-25

Digoxin CHF 0.64-1.15 nmol/L 0.5-0.9 ng/ml
Theophylline
AF 1-2.5 nmol/L 0.8-2 ng/ml

Apnoea / Bradycardia in neonates 27.75-55.5 5-10

Valproic Acid Asthma / COAD 55.5-111 10-20
Epilepsy 347-693 50-100

Psychiatry Disorder 347-866 50-125

Phenobarbitone Epilepsy 65-172 15-40
Refractory status epilepticus
>302 (up to 431) >70 (up to 100)

Phenytoin 40-80 10-20

Carbamazepine 17-51 4-12
Pharmaceutical Service
Reference:

1. Clinical Pharmacokinetics Pharmacy Handbook,
Division, MOH, 2015

2. Basic Clinical Pharmacokinetic (Winter) 2004
3. Drug Doses, Frank Shann 16th Edition 2014
4. Drug Information Handbook 10th Edition 2003

List of Test (outsourced)

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

Adrenocorticotrophic Unit Endokrin, HKL Plain tube 3 ml 5 days PER–PAT 301
Hormone

Aldosterone Unit Endokrin, EDTA 4 ml 30 PER–PAT 301
days
Hospital Putrajaya

Alpha–1–Acid Unit Patologi Kimia, Sterile 7 days PER–PAT 301
Glycoprotein
Hospital Ampang container 3 ml

Send in ice

Alpha–1–Antitrypsin Unit of Molecular Sterile 3 ml 5 days Request Form

Diagnostics and container for Multiple

Protein (UMDP) Send in ice Myeloma and

Specialized Specific

Diagnostics Centre, Proteins

Institute for Medical

Research (IMR),

Kuala Lumpur
Tel: 03–2616 2568 /

2569 / 2540 / 2590
Fax: 03–26162533

Alpha–1–Antitrypsin– Unit of Molecular EDTA 1–2 3 Special Form
Diagnostics and Send in ice
Deficiency (2.5 ml months (IMR
(SERPINA–1) Protein (UMDP)
EDTA) Molecular
Specialized
/ DBS Diagnostic
Diagnostics Centre,
(dried Services)
Institute for Medical
blood
Research (IMR),
spot) Must have
Kuala Lumpur specialist
Tel: 03–2616 2568 /
Signature
2569 / 2540 / 2590
Fax: 03–26162533

Amino Acid (plasma) Unit Biokimia, IMR Plain tube 2 ml 15 Special Form
days (IEM Request
(for Amino acid disorders) (03–26162627 / and EDTA
Form)
2498)

Amino Acid (CSF) Unit Biokimia, IMR Sterile 1 ml 15 Special Form
(03–26162627 / container days (IEM Request
(for Amino acid disorders) Form)
2498)

Amino Acid (Urine) Unit Biokimia, IMR Plain tube 2 ml Must send
together with
plasma

15 Special Form

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

(for Amino acid disorders) (03–26162792 / days (IEM Request
2498) Form)

After
consultation
only

Amikacin Unit Patologi Kimia, Plain gel 3 ml 3 days TDM Form
Anti–Thyroglobulin Hospital Selayang tube /

24 hour
urine
container

Unit Patologi Kimia, Bijou bottle 3 ml 3 days PER–PAT 301
Hospital Selayang

Anti–thyroid Unit Patologi Kimia, Plain tube 3 ml 7 days PER–PAT 301
Peroxidase Hospital Selayang

Beta–2 Microglobulin Unit Patologi Kimia, Plain tube 3 ml / 7 days PER–PAT 301
Hospital Ampang 20 ml 5 days PER–PAT 301

Caeruloplasmin Unit Patologi Kimia, EDTA 3 ml
HKL

Cancer Antigen 15–3 Unit Toksikologi EDTA 3 ml 2 days PER–PAT 301

(CA 15–3) Klinikal, HKL

Carnitine Free & Total Unit Biokimia, IMR EDTA 2 ml 5 days PER–PAT 301
(03–26162792 /

2498)

Cholinesterase Unit Patologi Kimia, Plain tube 3 ml 2 days PER–PAT 301
Hospital Selayang

Copper Urine, 24H Unit Farmakologi & EDTA 5 ml 14 Samples must
Toksikologi, IMR 3 ml days be collected
using an
appropriate
container, free
of heavy metal
/ trace
elements

C–Peptide Unit Endokrin, HKL Plain tube 5 days PER–PAT 301

Metanephrines, 24 hr Unit Endokrin, Plain tube By
Appointment
Urine Hospital Putrajaya
– 30 PER–PAT 301
days

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

Must have
specialist
signature

Acidify with 10
ml of 6M HCl
(special
container from
lab)

Cyclosporin A Makmal Dadah, Sterile 3 ml 5 days TDM Form
HKL container

Copper, Serum Unit Toksikologi Sterile 3.5 ml 10 PER–PAT 301
Klinikal, IMR
container days

Dehydroepiandroster Unit Endokrin, HKL Sterile 3 ml 10 PER–PAT 301

one Sulphate container days
(DHEA–S) Once a week

Diabetes mellitus Unit Autoimmune, Plain tube 5 ml 14 PER–PAT 301

Antibody test (anti– IMR days

islet, anti–GAD, Anti– (03–26162783 / Send

insulinoma) 2804 / 2781) immediately to
the lab

Digoxin Unit Patologi Kimia, Plain tube 3 ml 5 days TDM Form
Hospital Selayang

Fructosamine Unit Patologi Kimia, Plain tube 3 ml 7 days PER–PAT 301
Hospital Ampang

Gamma Glutamyl Unit Patologi Kimia, Plain tube 3 ml 5 days PER–PAT 301
Transpeptidase Hospital Selayang
(GGT)

Galactosemia Unit Biokimia, IMR Dried 3 5 days Special Form
Screening (03–26162791 / blood spot
(Total Galactose & (DBS) on circles (IEM Request
Galactose–1–Uridyl 2498) Whatman
Transferase), blood 903 Filter of DBS Form)
spot paper

Growth Hormone Unit Endokrin, HKL Plain tube 3 ml 10 PER–PAT 301
(Somatotropin) days
Unit Patologi Kimia, Plain tube Once a week
Haptoglobin HKL
3 ml 5 days PER–PAT 301

Once a week

Immunoglobulin A Makmal Protein, Plain tube 3 ml 7 days PER–PAT 301
(IgA) Hospital Ampang

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

Immunoglobulin G Makmal Protein, Plain tube 3 ml 7 days PER–PAT 301
(IgG) Hospital Ampang

Immunoglobulin M Makmal Protein, Plain tube 3 ml 7 days PER–PAT 301
(IgM) Hospital Ampang

Immunoglobulin E Unit Allergi, IMR Plain tube 0.5 ml / 5 days PER–PAT 301
(IgE) – Total (03–26162587 / 3 ml

2804 / 2789)

Immunoglobulin E Unit Allergi, IMR Plain tube 0.5 ml / 5 days PER–PAT 301
(IgE) – Specific (per– (03–26162587 / 3 ml
Send
allergen) 2804 / 2789) immediately to
the lab

Insulin Unit Patologi Kimia, Plain tube 3 ml 10 PER–PAT 301

HKL days
Once a week

Insulin–like Growth Unit Endocrine, Plain tube 3 ml 20 PER–PAT 301
Factor I (IGF–1) days
IMR Keep FROZEN
(03–26162645) or within 2–8’C
during
transportation

Inborn Error Unit Biokimia, IMR Dried 3 3 days Special Form
Metabolism (IEM) (03–26162792 / blood spot circles (IEM Request
(DBS) on of DBS Form)
screening, blood spot 2498) Whatmann
903 Filter
paper

Inborn Error Unit Biokimia, IMR Sterile 2 ml 10 Special Form
Metabolism (IEM) (03–26162796 / container days (IEM Request
Screening, Urine Form)
2498)

Lead MKAK Whole 2 ml 14 Send at
EDTA 3.5 ml days ambient
Lithium temperature
Mercury, Urine If >3hrs, keep
sample cooled
&
Protect from
freezing

Unit Patologi Kimia Plain gel 1 day PER–PAT 301
(Core Lab), HKL tube

MKAK Sterile 15 ml 4 – 6 Daily
container weeks

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

Mucopolysaccharide Unit Biokimia, IMR Sterile 5 ml 10 Special Form
(GAGs / HRE) Urine (03–26162627 / container/ days (IEM Request
1st Form)
2498) Morning
Urine
Daily (office
Methotrexate (MXT) Makmal Dadah, Plain tube 3 ml hrs)
HKL
5 days PER–PAT 301

Daily (office
hrs)

Mycophenolic acid Unit Toksikologi EDTA 3 ml 1 day TDM Form
Klinikal, HKL
Every
Thursday

Organic Acid, Urine Unit Biokimia, IMR Sterile 5 ml 5 days Special Form
container (IEM Request
Send in ice Form)
Transport
FROZEN,
easily
destroyed by
heat

Orotic Acid, Urine Unit Biokimia, IMR Sterile 5 ml 5 days Special Form

(03–26162594 / container (IEM Request

2792) Send in ice Form)

Parathyroid Hormone Unit Endokrin, HKL EDTA 3 ml 5 days PER–PAT 301

(PTH 1–84) Send in ice

Twice a week

PID Quantitation of Unit PID, Allergi & Plain tube 5 ml 10 Special Form
Immunoglobulin & and EDTA (serum) days (PID Request
Complement Immunologi, IMR Form)
(03–26162587) and
2 ml Monday–
(fresh Thursday
blood) By
appointment
(must reach
IMR before 1
pm)

Porphyrin / Unit Biokimia, IMR Sterile 5 ml 15 Special Form
porphobilinogen / (03–26162627 / container days (IEM Request
Uroporphobilinogen,
Urine 2498) Form)

Protect from
light, easily
destroyed by

Test Perform Site / Sample/ Vol TAT Forms /
Referral Lab
Container (Working Special
days) Requirement

light

Progesterone, 17–OH Unit Endokrin, IMR Plain tube 3 ml 20 PER–PAT 301
(03–26162645) days
Keep FROZEN
Protein Makmal Protein, Plain tube 3 ml / – or within 2–8’C
Electrophoresis Hospital Ampang (gel) / 20 ml during
(Serum / Urine) 24 hour transportation
urine
container PER–PAT 301

Must send
serum & urine
together

Protein Makmal Protein, Bijou bottle 1–2 ml 21 PER–PAT 301
Electrophoresis CSF Hospital Ampang days
(CSF Oligoclonal Must send CSF
Band) & Serum
together

CSF must be
FROZEN
immediately
after collection

Phenobarbital Unit Patologi Kimia, Plain tube 3 ml CSF (frozen)
Hospital Selayang and serum (at
Prostate Specific 2–8’C) must
Antigen (PSA), Free reach lab not
Renin more than 7
days after
collection

5 days TDM Form

Unit Patologi Kimia, Plain tube 3 ml – PER–PAT 301
HKL

Unit Endokrin, EDTA 3 ml 30 PER–PAT 301
3 ml days
Hospital Putrajaya Must have
specialist
signature

Sirolimus Makmal Dadah, EDTA 1 day TDM Form
Tacrolimus HKL EDTA
Theophylline Plain tube 3 ml 5 days TDM Form
Makmal Dadah,
HKL 3 ml 5 days TDM Form

Makmal Dadah,