LHB2017

FOREWORD
I am pleased to introduce this 4th edition of the Laboratory Handbook which provides an
updated directory of the extensive range of diagnostic tests offered by the various units in the
Department of Pathology Hospital Melaka.
The vast plethora of diagnostic tests of various complexity that are available today reflect the
increasingly crucial role of pathology have in patient management and outcome. We strive to deliver
quality and accurate test results to clinicians for prompt and comprehensive patient care.
Tremendous efforts are made towards continuous improvement in our turnaround time of our
laboratory tests to meet the expectations of our clients.
This fourth edition of the Laboratory Handbook is the result of a detailed review process on
all the tests that are available in the Department of Pathology. It is my sincere hope that this
guidebook will be useful to our clients and that they will refer to the information given in their daily
practice.
A close working relationship between our clients and the laboratory personnel will ultimately
benefit the patients. I gratefully acknowledge the effort and help of the individuals who contributed
in reviewing and compiling this Laboratory Handbook.
DR. CHIA KAM PIK

Consultant Pathologist &
Head of Department
Department of Pathology
Hospital Melaka
EDITORIAL COMMITTEE
Advisor : Dr. Chia Kam Pik
Coordinator : Dr. Hasmah Binti Hashim
Secretary : Pn. Noor Hafizah Yacob
UNIT REPRESENTATIVES
Administration : Dr. Mazny Binti Abu Bakar

Main Counter : Tn. Haji Roslan Bin Mokhtar @Alias
Chemical Pathology : Dr. Ana Daliela Masiman
: Pn. Tan Li Ching
Medical Microbiology : Dr. Suhaila Baharuddin
: Pn. Norzamawati Binti Sarzaman (Microbiology)
: Pn. Ummul Haninah Ali (Serology)
: Pn. Marliza Binti Kamarolzaman (Serology)
Hematology : Dr. Raudhawati Osman
: Dr. Wan Aswani Bt Wan Yusof
: Dr. Azlinda Abu Bakar
: Pn. Norhernani Binti Lukman
Anatomic Pathology : Dr. Faizah Ahmad
: Pn. Lau Sian Kai
Transfusion Services : Dr. Nor Amiza Mat Amin
: Pn. Hamizah Binti Mansor
Photographer / Design /
: En. Othman Bin Suboh
Special Task
: En. Mohd Fadzlyasraf Bin Shaari
: Dr. Muhammad Azzuhry Mohd Ali
Contents
DEPARTMENT TELEPHONE DIRECTORY ...................................................................... 1
INTRODUCTION .................................................................................................................. 2
VISION ................................................................................................................................... 2
MISSION ................................................................................................................................ 2
OBJECTIVES ......................................................................................................................... 2
SCOPE OF SERVICE ............................................................................................................ 2
CLIENT CHARTER ............................................................................................................... 3
WORK FLOW ........................................................................................................................ 4
SERVICE HOURS ................................................................................................................. 5
24 HOURS SERVICES .......................................................................................................... 5
STAT/URGENT TEST SERVICE. ........................................................................................ 6
Definition: ........................................................................................................................... 6
Urgent Requests: ................................................................................................................. 6
LISTS OF URGENT TESTS AND THE LABORATORY TURN AROUND TIME
(LTAT) .................................................................................................................................... 7
PRE ANALYTICAL REQUIREMENTS............................................................................... 8
A. REQUEST FORM .................................................................................................... 8
B. SAMPLES / SPECIMENS / TYPE OF CONTAINERS.......................................... 8
C. LABORATORY REQUIREMENTS ....................................................................... 8
D. ‘BORANG PENGHANTARAN DAN PENERIMAAN SPESIMEN’.................... 9
E. GUIDE FOR SPECIMENS COLLECTION ............................................................ 9
F. REJECTION CRITERIA ....................................................................................... 10
CHEMICAL PATHOLOGY ................................................................................................ 13
A. INTRODUCTION .................................................................................................. 13
B. SERVICES ............................................................................................................. 13
C. REQUEST FORM .................................................................................................. 13
D. SPECIMEN COLLECTION AND HANDLING................................................... 13
E. TYPE OF CONTAINERS .................................................................................... 200
MEDICAL MICROBIOLOGY .......................................................................................... 233
A. INTRODUCTION ................................................................................................ 233
B. SERVICES ........................................................................................................... 233
C. REQUEST FORM ................................................................................................ 233
D. SPECIMEN COLLECTION AND HANDLING................................................. 244
SEROLOGY ....................................................................................................................... 433
A. INTRODUCTION ................................................................................................ 433
B. SERVICES ........................................................................................................... 433
C. REQUEST FORM ................................................................................................ 444
HAEMATOLOGY ............................................................................................................... 57
A. INTRODUCTION .................................................................................................. 57
B. SERVICES ............................................................................................................. 57
C. REQUEST FORM .................................................................................................. 57
E. TYPE OF CONTAINERS ...................................................................................... 59
ANATOMICAL PATHOLOGY ........................................................................................ 622
A. INTRODUCTION ................................................................................................ 622
HISTOPATHOLOGY ........................................................................................................ 622
B. SERVICES ........................................................................................................... 622
C. REQUEST FORM ................................................................................................ 622
CYTOPATHOLOGY ......................................................................................................... 666
B. SERVICES ........................................................................................................... 666
C. REQUEST FORM ................................................................................................ 666
E. TYPE OF CONTAINERS ...................................................................................... 69
BLOOD TRANSFUSION SERVICES .............................................................................. 711
A. INTRODUCTION ................................................................................................ 711
B. SERVICES ........................................................................................................... 711
C. REQUEST FORM ................................................................................................ 711
GUIDE FOR TESTS / SPECIMEN CONTAINERS AND TURN-AROUND TIME .......... 733
CHEMICAL PATHOLOGY
IN HOUSE ...................................................................................................................... 744
REFERRAL .................................................................................................................... 822
MICROBIOLOGY
IN HOUSE .................................................................................................................... 1044
REFERRAL .................................................................................................................. 1111
SEROLOGY
IN HOUSE .................................................................................................................... 1177
REFERRAL .................................................................................................................. 1222
HAEMATOLOGY
IN HOUSE .................................................................................................................... 1411
REFERRAL .................................................................................................................. 1444
ANATOMICAL PATHOLOGY
IN HOUSE .................................................................................................................... 1544
REFERRAL ................................................................................................................ 15757
BLOOD TRANSFUSION SERVICES (IN HOUSE) ........................................................ 15959
REFERENCE RANGES
CHEMICAL PATHOLOGY ........................................................................................ 1622
HAEMATOLOGY ....................................................................................................... 1722
REQUEST FORMS .............................................................................................................. 1800
Appendix 1 .................................................................................................................... 1844
Appendix 2 .................................................................................................................... 1855
Appendix 3…………………………………………………………………………… 186
Appendix 4 (page 1).................................................................................................... 18787
Appendix 4 (page 2).................................................................................................... 18888
Appendix 5 (page 1).................................................................................................... 18989
Appendix 5 (page 2)...................................................................................................... 1900
Appendix 5 (page 3)...................................................................................................... 1911
Appendix 6 .................................................................................................................... 1922
Appendix 7 (page 1)...................................................................................................... 1933
Appendix 7 (page 2)...................................................................................................... 1944
Appendix 7 (page 3)...................................................................................................... 1955
Appendix 8 ...................................................................................................................... 196
Appendix 9 ...................................................................................................................... 197
Appendix 10 .................................................................................................................... 198
Appendix 11 .................................................................................................................... 199
Appendix 12 .................................................................................................................. 1990
Appendix 13 .................................................................................................................. 2001
Appendix 14 .................................................................................................................. 2012
Appendix 15 .................................................................................................................. 2023
Appendix 16 .................................................................................................................. 2034
Appendix 17 .................................................................................................................. 2045
Appendix 18a ................................................................................................................ 2056
Appendix 18b .............................................................................................................. 20607
Appendix 19a .............................................................................................................. 20708
Appendix 19b .............................................................................................................. 20809
Appendix 19c ................................................................................................................ 2090
Appendix 20 .................................................................................................................. 2101
Appendix 21 .................................................................................................................. 2112
Appendix 22 .................................................................................................................. 2123
Appendix 23 .................................................................................................................. 2134
Appendix 24 .................................................................................................................. 2145
Appendix 25 (page 1).................................................................................................. 21516
Appendix 25 (page 2).................................................................................................. 21617
Appendix 26 ................................................................................................................ 21718
Appendix 27 (page 1).................................................................................................. 21919
Appendix 27 (page 2).................................................................................................... 2200
Appendix 28 .................................................................................................................. 2211
Appendix 29 .................................................................................................................. 2222
Appendix 30 (page 1).................................................................................................... 2233
Appendix 30 (page 2).................................................................................................... 2244
Appendix 31 .................................................................................................................. 2255
Appendix 32a .............................................................................................................. 22626
Appendix 32b…………………………………………………………………………..227
Appendix 33 ................................................................................................................ 22828
Appendix 34 (page 1).................................................................................................. 22929
Appendix 34 (page 2).................................................................................................... 2300
Appendix 35 .................................................................................................................. 2311
Appendix 36 .................................................................................................................. 2322
DEPARTMENT TELEPHONE DIRECTORY:
The various units in this department can be contacted from out-side hospital by dialing 289 follow by
the unit extension numbers. (289 XXXX); Fax Number: 06-2812148
Dr. Chia Kam Pik (Senior Consultant Pathologist & Head of Department) 2882
Administrative Office Anatomic Pathology

Dr. Mazny Abu Bakar Dr. Faizah Ahmad
2864 2853
(Laboratory Manager) (Head of Unit))
Clerk 2851 Dr. Hasmah Hashim 2854
En Othman Suboh 2864 Dr. Najah Momin 2854
Main Specimen Reception Counter Dr. Diyana Abdullah 2853

Hj Roslan bin Mokhtar @Alias
2888 Histology Medical Officer 2858
(Head of Unit)
Main Counter 2886
Lau Sian Kai 2864
(Pneumatic Tube Number) (7258)
Blood Transfusion Service Histology Laboratory 2875
Dr. Nor Amiza Mat Amin
2852 Cytology Laboratory 2876
(Head of Unit)
Dr. Norazlina Hamzah 2852 Medical Microbiology Unit
Dr. Suhaila Baharuddin
Blood Bank Medical Officers 2869 / 2859 2862
(Head of Unit)
Hamizah Mansor 2861 Dr. Lim Bee Bee 2862
Akmal Rais B Ridzuan 2865 Nasrudin Muslim 2855
Blood Donation Officer (PRO) 2873 Norzamawati Sarzaman 2860
Blood Bank Senior MLT 2865 Scientific Officers (Micro / Sero) 2863
Blood Bank Laboratory 2874 Senior MLT 2867
Blood Donation Room 2870 Microbiology Laboratory 2879
Blood Bank Registration Counter 2871 / 2872 TB Laboratory 2880
Haematology Serology Laboratory 2881
Dr. Raudhawati Osman (Head of Unit) 2857 Chemical Pathology Unit

Dr. Wan Aswani Wan Yusof Dr. Ana Daliela Masiman
2857 2856
(Head of Unit)
Dr. Azlinda Abu Bakar 2857 Halila A.Rahim 2885
Medical Officer 2859 Noor Aishah Mohd Dawi 2885

Haematology Laboratory
2878 Scientific Officers Biochemistry 2885
(FBC / Coagulation)
Haematology Laboratory (FBP / BMA) 2877 Chemical Pathology Laboratory 2884
1
INTRODUCTION
The Department of Pathology and its laboratories are situated at level 2, of the new block.
The department can be accessed via the main entrance, as well as from the old block via the entrance
adjacent to the administrative block.
The Department is hospital-based and clinically oriented with 5 laboratories (Chemical
Pathology, Haematology, Anatomical Pathology, Medical Microbiology and Blood Transfusion
Service) and 1 main laboratory counter, concerned with testing of biological samples obtained from
patients.
VISION
The Department of Pathology will provide a comprehensive and quality diagnostic service
which is innovative, efficient, cost-effective and timely.
MISSION
We are committed to work together as a team of professionals to provide an efficient,
reliable and quality service with the latest technology towards achieving excellence in patient
healthcare in a caring and friendly environment.
OBJECTIVES
1. To provide diagnostic and consultancy services in Chemical Pathology, Haematology, Medical
Transfusion Service, Anatomic Pathology and Microbiology.
2. To ensure adequate procurement of blood and blood products for the usage of patients in all
the hospitals in the state of Melaka.
3. To provide training & supervision in clinical, technological and analytical skills for
departmental staff, trainees and personnel from other Government Hospitals, Institutes of
Higher Learning and other Government Agencies.
4. To provide consultative services concerning matters related to Pathology services.
5. To conduct and assist research and development in Pathology and other relevant clinical
areas of interest.
SCOPE OF SERVICE
The department provides the following services:
1. Chemical Pathology – routine chemistry testing, hormones, tumour markers, Drug Abuse
Testing & Urine Biochemistry.
2. Medical Microbiology – Bacteriology, Immunology / Serology, Mycology, Parasitology,
Molecular Testing & Virology.
3. Haematology – routine Haematology testing, Hemostasis, CD4 / CD8, Bone Marrow Aspirate
& Hb Analysis.
4. Anatomical Pathology – Histopathology & Cytology.
5. Blood Transfusion Service- Blood procurement through organized blood donation campaigns
and walk-in donors.
6. Fine Needle Aspiration (FNA) Clinics: FNA performed on in-patients & patients referred from
clinics.
2
CLIENT CHARTER
We are committed to provide professional, safe, caring and quality services
1. Result for Urgent (STAT) tests will be provided as follows:
* 45 minutes for FBC, BUSE and Creatinine

* 60 minutes for PT and APTT
* 72 hours for small tissue biopsy
2. No blood transfusion incident due to laboratory error.
3. All information pertaining to patients and blood donors and their test results shall be kept
confidential.
4. Ensure clean, safe and condusive laboratory facilities and environment.
If encounter any problem, please do not hesitate to contact

Head of Department / Laboratory Manager
(06-2892851)
3
WORK FLOW
Print Date & Time
Submit form.
Received Laboratory
Specimen
Check
Samples
Not
Accepted
Sent to Unit
Accepted Not
Accepted
Check
Samples
(Unit)
Accepted
Process Sample / Test
Not Accepted
Validate
Report
Print Report Correct
Dispatch Result
4
SERVICE HOURS
Administrative : Monday – Friday 8:00 am – 5:00 pm
Blood Donation : Monday – Friday 8.00 am – 5.00 pm

Saturday 11:00 am – 4:00 pm
Anatomic Pathology : Monday – Friday 8.00 am – 5.00 pm
Serology : Monday – Friday 8:00 am – 5:00 pm

: Weekend & Public Holidays 8:00 am – 2:00 pm
(standby call for Dengue IgG / IgM (ELISA), Dengue COMBO Rapid
Test, MERS CoV PCR, ZIka PCR, Leptospirosis Rapid)
Lunch services : Monday – Thursday 1.00 pm – 2.00 pm

Friday 12.15 pm – 2.45 pm
Histopathology / Cytology laboratory operate only during normal working hours.
24 HOURS SERVICES
The laboratory provides 24-hour services which include weekends & public holidays
1. Chemical Pathology
2. Haematology
3. Medical Microbiology
4. Blood Transfusion Service
5. Main Specimen Reception Counter
Afternoon shift : Monday - Thursday 2.00 pm – 9.00 pm

Friday 2.30 pm – 9.00 pm
On call 9.00 pm – 8.00 am
Sat - Sun / Public Holiday 8.00 am – 8.00 am
Pathologist, Medical Officers and Scientific Officers are available for consultation or assistance after
office hours, contactable by Hospital Telephone Operator.
5
STAT/ URGENT TEST SERVICE
Definition:
A test should be ordered URGENT when the result of the test is required for immediate patient
management and if there is a delay in treatment, this might result in patient’s morbidity & mortality.
The sample must reach the laboratory within 15 minutes.
Urgent Requests:
i) Must be justified by clinical summary, diagnosis and reason for the urgency.
ii) Usage of PINK COLORED PER PAT-301 forms.
iii) For Histopathology / Cytology request, if pink colored PER PAT-301 forms are not
available, write clearly the word “URGENT” or stamp preferably in red on the top at
the right hand corner of the request form.
iv) “URGENT” samples must be sent to the laboratory immediately either by ward /
clinic porter or by using pneumatic tube.
v) The time of specimen received at the counter must be acknowledged (print the time
by using Acro-Printer).
vi) Urgent request shall be separated from the non-urgent requests & send immediately
to the respective unit.
vii) Specimens which are not suitable for processing shall be rejected.
viii) CSF Specimen (Microbiology test) must be sent to Microbiology Unit by Medical
Officer / House Officer.
6
LISTS OF URGENT TESTS AND THE LABORATORY TURN AROUND TIME (LTAT)
UNIT TEST LTAT

Glucose 45 min
BUSE/Creatinine 45 min
Blood Gases 45 min
Amylase 45 min
Bilirubin (neonate) 45 min
CSF for Biochemistry 45 min
Chemical
Pathology Urine Biochemistry (suspected
45 min
Appendicitis / UTI)
Urine Biochemistry (Paeds ward) 45 min
Urine for Paraquat 45 min
Lactate 45 min
Ammonia 45 min
Lithium (Toxicity) 60 min
CSF Microscopy 60 min
Bacteriology
Blood For Malarial Parasites (BFMP) 4 hours
HIV Rapid 60 min
Serology
Dengue Combo 60 min
Full Blood Count 45 min
Haematology Coagulation tests - PT/APTT, D-Dimer 60 min
FBP (upon request) 72 hours
Anatomic Small biopsy
72 hours
Pathology Cytology
Uncross-match group specific 15 min
GSH convert urgent GXM 30 min
Blood
Safe O 15 min
Transfusion
Service Urgent Cross-match (2 units) – saline
30 min
phase cross-match
Urgent Full Cross-match (2 unit) 45 min
NOTIFICATION OF CRITICAL RESULTS
All critical results shall be notified to the clinicians as stipulated in “Quick Guide for
Improving Notification of Critical Laboratory Results in MOH Hospitals” (February 2010).
7
PRE ANALYTICAL REQUIREMENTS
A. REQUEST FORM
1. A standard laboratory request form i.e. PER-PAT 301 (Appendix 1) is used for all categories of
tests except otherwise stated.
2. All request forms must be filled legibly. The completed forms shall be stamped and signed by
a doctor or authorized personnel and accompanied by the properly collected specimens.
3. The following information must be provided for every request in the request form:
i) Patient’s detail:
a) Name (in capital letters), e.g. AHMAD B. ABU
b) Identity card (IC) number,
 Use new IC number for Malaysian patients (12 digits)
 For children who are using guardian’s IC Number, to write 12 digits followed by
the letter M (e.g. 730422055116M).
 Passport number should be used for non-Malaysian patient
 Police / army Identity Number can be used when necessary.
c) Sex & Age
ii) Source: Ward, Clinic and Name of Hospital / Health Centers
iii) Patient’s clinical summary
a) Relevant clinical summary
b) Relevant medications of patients
c) Diagnosis / Provisional Diagnosis (Abbreviations are discouraged)
iv) Test Details: Mark (√) at the appropriate box for the tests required. Tests which are not
listed in box, should be stated under the column OTHERS. The test required must be
written clearly (Abbreviations are discouraged).
v) Specimen:
a) Date & time of specimen collection.
b) Type of specimen & anatomic site (if relevant)
vi) Requester Detail:

a) Requester’s name clearly written
b) Signature with official stamp
B. SAMPLES / SPECIMENS / TYPE OF CONTAINERS

The samples / specimens should be collected, labelled and dispatched in appropriate
containers for the tests requested.
C. LABORATORY REQUIREMENTS
The specimen containers must be labelled with at least two identifiers (i.e. name of patient and
patient’s I.C Number) and test required.
8
D. ‘BORANG PENGHANTARAN DAN PENERIMAAN SPESIMEN’.
Samples & request forms must be sent together with 2 copies of ‘Borang Penghantaran dan
Penerimaan Spesimen, Jabatan Patologi, Hospital Melaka’
DOCUMENTATION
1. All requests must be recorded in “BORANG PENGHANTARAN DAN PENERIMAAN
SPESIMEN” Jabatan Patologi, Hospital Melaka in 2 copies.
2. Sort the specimens and tests requested according to respective units.
TRANSPORTATION OF SPECIMEN
1. The specimens should be transported to the laboratory as specified accordingly to the
type of test in appropriate time frame and according to transport requirements.
2. Monitoring of the temperature by suitable means is mandatory for certain tests.
E. GUIDE FOR SPECIMENS COLLECTION

1. Proper procedure & correct specimen container are of paramount importance in ensuring
the quality of laboratory test results.
2. A duly-filled laboratory request form must accompany every specimen submitted for
testing.
3. Before any specimen is collected, the patient identity must be verified by asking them to
state their name or by checking the patient’s wrist band (if available).
4. Needle must be removed from the syringe and transfer the blood immediately by gentle
ejection into specimen containers. Vigorous suction during collection or forceful transfer
may cause haemolysis.
5. If tube contains anticoagulants or additives, mix gently by inverting the tube 5- 10 times.
6. Specimen must be labelled immediately, at bed site, to avoid mislabeling.
7. The date & time when specimen is taken must be stated on the laboratory form; especially
for STAT / URGENT request and time-laboratory tests such as Coagulation, Microbiology
culture, Ammonia, Lactate etc.
8. Specimen container should be barcoded or labelled with patient’s name, I/C and test
requested.
9. Proper procedure of labeling specimen tube with barcode laboratory is as follow:
Please ensure
barcode label
does not cover
the whole tube.
Leave some space
to view the level
of blood in the
tube.
9
F. REJECTION CRITERIA
List of common / primary rejection criteria is as follows:
1. Leaking specimen.
2. Wrong container.
3. No specimen received for the intended test.
4. Information on request form & specimen do not tally.
5. Incomplete request form
i) Patient’s name not provided
ii) Source / location of test not provided
iii) Incomplete I/C number
iv) No Diagnosis / Provisional Diagnosis / Clinical Summary written
v) Name of test not provided / not written.
vi) No time & date of sample collection
vii) No name, signature or stamp of the requester.
6. Insufficient sample / excess volume.
7. Unsuitable specimen for analysis e.g. haemolysed blood sample.
8. Specific rejection criteria according to the Units:
(Lysed, clotted, storage changes, leaking, lipaemic, icterus, diluted, contaminated,
duplicate order, sample not suitable for analysis.)
Note:
1. The laboratory staff will fill the rejection form and a copy will be dispatched to the
requesting unit / ward / clinic / hospital through pigeon hole. Laboratory staff will also
inform (call) them. Unit with LIS system will register the sample in the system and produce
a rejection report.
2. Precious specimen e.g. CSF, tissue, paediatric sample etc, will be processed if possible. It
will be indicated in the report about the quality of the primary sample which was
unsuitable for testing or could have compromised the results.
TEST RESULTS / REPORTS

Tests with critical result will be informed via phone to the requesting doctor / personnel as soon as
the test is completed & validated.
DISPATCH OF LABORATORY RESULTS

1. Majority of the test results will be placed in the “Pigeon Hole” of the respective wards, clinics
and health centre located at the central Reception Counter in the department. The attendants
from the respective wards, clinics and health centres are required to collect them as soon as
possible.
2. Some of the laboratory results are dispatched to the respective wards via the pneumatic tube
system.
3. The following reports are dispatched by dispatch book;
i. Bone Marrow (Haematology)
ii. CD4 / CD8
iii. Histopathology
iv. Cytology (In-patient)
v. HIV (Positive cases) – in envelope.
vi. Police Medico-legal cases – in envelope.
vii. Urine for Abused Drugs – in envelope and sealed (Chem.Path)
10
REFERRED TEST
1. Tests which are not provided in-house will be referred to other hospital & referral laboratory
for analysis.
2. The specimens are sent to the referred laboratory twice a week
(Tuesday and Thursday).
3. All requests for external tests must be accompanied with relevant form. The laboratory can be
contacted for enquiries on sample collection.
11
CHEMICAL
PATHOLOGY
12
CHEMICAL PATHOLOGY
A. INTRODUCTION
The Chemical Pathology Unit, Department of Pathology, Hospital Melaka (HM) provides diagnostic
and consultative services for patient management in HM, other government hospitals and health
clinics in Melaka. It operates 24 hours daily including weekends and public holidays.
B. SERVICES
The diagnostic services are divided into:
i. Urgent Test (STAT).

ii. Routine Tests – all tests that are offered during office hours
(please refer to the test list).
iii. Specialized Tests - Iron Studies (Iron, TIBC and Ferritin), Special Protein
(C-Reactive Protein), HbA1c, Hormone and Tumour Marker.
iv. Screening and Confirmation testing for Drug of Abuse (Opiates and Cannabinoids).
C. REQUEST FORM
i. All requests must be made using the PER-PAT 301 Form except for Drug of Abuse (DOA)
request and cord blood screening test.
ii. Borang Permintaan Ujian Pengesahan Dadah dalam Air Kencing - PER(LABORATORY)-SS-
301A/UPD 1 (Pindaan) should be used for any DOA request (Police or Monitoring cases).
a. Clinical case: 3 copies of request form required.
b. Police case: 2 copies of request form required.
iii. National Congenital Hypothyroidism Screening form – to be used for Cord Blood TSH
Screening form.
D. SPECIMEN COLLECTION AND HANDLING
i. Clinical chemistry and immunochemistry assays in this laboratory are performed on serum
plain tube. The anticoagulant used for blood glucose and lactate are Sodium Fluoride /
Disodium EDTA or Potassium Oxalate + Sodium Fluoride while anticoagulant used for
blood HbA1c and Ammonia are K2 EDTA.
ii. A minimal tourniquet pressure should be applied in performing venesection to avoid

forcing free fluid out of the distal capillaries resulting in haemoconcentration and spurious
elevation of protein and protein-bound substances e.g Calcium and T4.
iii. Many patients requiring clinical chemistry investigations are receiving intravenous
infusion. Venesection done proximal to the infusion site will cause contamination. This will
result in a wrong representation of the actual concentration of the analytes.
13
iv. Do not mix blood sample from different containers. Certain containers e.g. KF+Na2 EDTA
or K2 EDTA tubes contain Potassium salts and chelating agents which will cause error in
the result for Potassium and Calcium analysis.
E. TYPE OF SPECIMENS
i) Blood Gas Analysis

Arterial blood has been widely recommended
Procedure:
a) Flush the 1 ml syringe with heparin. Excess heparin may dilute the specimen and
cause hemolysis.
b) After drawing the blood, expel any air bubble in the syringe immediately to avoid gas
exchange with the atmosphere.
c) Remove the needle by using the Sharp-bin and cap the syringe immediately with a
stopper (e.g. Combi-red). Do not recap the needle or sent the syringe with needle to
the laboratory to avoid needle prick injury for the ward staff as well as the
laboratory staff.
d) Place the syringe into ice-water (not ice cube) and send the specimen to the
laboratory immediately.
ii) 24-hour Urine Collection

Note: Complete 24-hour urine collection is of utmost important as incomplete collection will
cause erroneous result.
Procedure:
a) Request the suitable 24-hour urine container from the laboratory.
b) On the day of collection, the first urine voided (e.g. at 6.00 am) must be discarded.
Time of first urine voided is the onset for the 24-hour collection. Record the date and
time of collection on the container.
c) Thereafter, all urine should be collected and refrigerated during the 24-hour period.
d) The patient has to empty the bladder at the same time (e.g. at 6.00 am) the next
morning and must be put into the container.
e) Send the urine container to the laboratory.
Precautions
1. Urine should be passed into a separate container at each voiding and then emptied into a
larger container to complete the specimen. This two-step procedure prevents the danger
of patient splashing him or herself with the preservative (e.g. acid) in the container.
2. If the patient has a bowel movement during the collection period, precautions should be
taken to prevent faecal contamination.
14
iii) Modified Glucose Tolerance Test (MGTT)
Procedure:
a) Fast the patient overnight (at least 10 hours). Drinking plain water is permitted.
b) Prepare 75 gm glucose in 250-300 ml of water. (For children, use 1.75 g/kg body
weight to a maximum of 75 g.)
c) Collect a Fasting Blood Sugar sample and label as ‘FBS’.
d) Instruct the patient to drink the glucose and the solution must be finished within 5
minutes.
e) One hour after taking the glucose solution, take another blood sugar sample and
label as ‘1hr’.
f) After another 1 hour, take another blood sugar sample and label as ‘2hr’.
g) Indicate the barcode label on the form as ‘FBS’, ‘1hr’ & ‘2hr’ accordingly matching the
barcode label of the specimen containers.
iv) Ammonia
 Samples from HM
Procedure:
a) Call laboratory prior sending the sample.
b) Upon approval from laboratory, collect the sample using K2 EDTA tube and state the
time of sampling in PER-PAT 301 Form.
c) Tubes should be filled completely and tightly capped at all times.
d) Place immediately on ice pack.
e) Send immediately to the Chemical Pathology laboratory.
 Samples from other hospitals
Procedure:
b) Upon approval from laboratory, collect the sample using K2 EDTA tube and state the
time of sampling in PER-PAT 301 Form
c) Centrifuge within 15 minutes of collecting the sample and separate the plasma.
d) Transport in ice pack as soon as possible to the Chemical Pathology laboratory.
v) Lactate
 Samples from HM
Procedure:
b) Upon approval from laboratory, collect the sample using Sodium Fluoride / Disodium
EDTA or Potassium Oxalate + Sodium Fluoride tube and state the time of sampling in
PER-PAT 301 Form.
15
c) Tubes should be filled completely and tightly capped at all times.
d) Place immediately on ice pack.
e) Send immediately to the Chemical Pathology laboratory.
 Samples from other hospitals
Procedure:
b) Upon approval from laboratory, collect the sample using Sodium Fluoride / Disodium
EDTA or Potassium Oxalate + Sodium Fluoride tube and state the time of sampling in
PER-PAT 301 Form.
c) Centrifuge within 15 minutes of collecting the sample and separate the plasma.
d) Transport in ice pack as soon as possible to the Chemical Pathology laboratory.
vi) Drug of Abuse (DOA)

Sample collection must follow the “Garis Panduan bagi Ujian Pengesanan Penyalahgunaan
Dadah dan Air Kencing – Surat Pekeliling Ketua Pengarah Kesihatan Malaysia bil 6/2002”.
Procedure:
a) Specimen collection must be properly supervised. Collection site must have suitable
toilet facilities and free from soap, dispenser or cleaning agent.
b) The urine volume should be at least 30 ml.
c) The person supervising the collection should stand close enough and able to see it
genuinely passing out from the donor to avoid any attempt in falsifying the
specimen.
d) The urine bottle must be securely capped and sealed with sealing wax.
e) Bottle is labeled in front of the donor with the following information:
 Donor’s name
 Identity card number
 Date and time of collection
 Signature of supervising officer
 Drug suspected.
vii) Rapid Adrenocorticotropic Hormone also known as Cosyntropin Test or Synacthen Test
Procedure:
a) Take blood sample for baseline cortisol level (8.00 am).
b) Give 250 µg cosyntropin (synthetic ACTH) intramuscularly or intravenously.
c) Take blood samples for cortisol at 8.30 am and 9.00 am after injection for cortisol
level.
Time Tests Tube

8.00 am (basal) Cortisol 1 plain tube
8.30 am Cortisol 1 plain tube
9.00 am Cortisol 1 plain tube
16
viii) Overnight Low Dose Dexamethasone Suppression Test
Procedure:
a) Give 1 mg dexamethasone orally between 11.00 pm to 12.00 pm.
b) Complete the request form with clinical summary.
c) Collect blood at 8.00 am the next morning for determination of serum cortisol and
send to main counter Pathology Department.
ix) Low Dose Dexamethasone Suppression Test
Procedure:
a) Collect blood for serum cortisol (basal) at 9.00 am on the 1st day of test. Immediately
after sampling, give 0.5 mg dexamethasone orally every 6 hours for 2 days (8 times).
b) Collect blood for serum cortisol at 9.00 am on day 3 (6 hours after the last dose of 0.5
mg dexamethasone) and send to the main counter Pathology Department.
c) Ensure the times are followed strictly and with full compliance.
Day 1 Day 2 Day 3
Sample taken for serum 9.00 am (basal) - 9.00 am

cortisol
9.00 am 3.00 am 3.00 am (last dose)
Drug given: 3.00 pm 9.00 am -

0.5mg dexamethasone
every 6 hours (8 times)
9.00 pm 3.00 pm -
- 9.00 pm -
x) High Dose Dexamethasone Suppression Test

Procedure:
a) Day 1: Collect blood at 9.00 am and 12.00 pm for cortisol level.
b) Day 2: Give 2.0 mg dexamethasone orally every 6 hours starting on day 2 and
continue for 8 doses.
c) Day 5: Collect blood at 9.00 am and 12.00 pm for cortisol level.
17
Day 1 Day 2 Day 3 Day 4 Day 5
Sample taken for 9.00 am and - - - 9.00 am and

serum cortisol 12.00 pm 12.00 pm
Drug given: 2.0mg 9.00 am 3.00 am 3.00 am

dexamethasone
every 6 hours (8
times) 3.00 pm 9.00 am -
- -
9.00 pm 3.00 pm -
- 9.00 pm -
xi) Renin and Aldosterone

1. Patient Preparation
a. Drugs to avoid: *spironolactone, ACE inhibitors, ARB, beta-blockers, cyclic progestogens,
estrogens and licorice.
b. Drugs that do not interfere with the renin-aldosterone axis include: Prazosin, verapamil and
terazosin.
c. Subject should be normally hydrated and has an adequate oral intake of sodium.
d. Avoid hypokalaemia as it suppresses aldosterone secretion. Give potassium replacement (Slow
K+ tablets) sufficient to raise plasma potassium > 4.0 mmol/L. Replacement should be stopped
on the day of the test.
* Spironolactone must be stopped for 6 weeks to be certain that any elevation in plasma renin
activity is not due to its inhibition of aldosterone.
Ideally all interfering drugs should be stopped but if this is impractical, the best pragmatic
approach is to stop ACE inhibitors, beta-blockers for 2 weeks and to avoid Ca-channel blockers
on the day of the test.
2. Sample Collection
a. Potassium EDTA (K2 EDTA) tube for renin.
b. Potassium EDTA (K2 EDTA) tube for aldosterone (Please use different tubes for Renin and
Aldosterone).
c. Blood samples should be sent rapidly to the laboratory within 30 minutes at room
temperature.
d. Fill up the PER-PAT 301 form.
e. Patient’s clinical history and drug history are MANDATORY.
f. Test should be requested by Specialist / Endocrine Specialist only.
g. Please record patient’s posture whether supine or upright.
18
i. Supine sample
Sample taken in the early morning before the subject arises (if feasible)
ii. Upright sample
Subject should be upright for ≥ 2 hours prior to sampling
h. Sample should be taken between 8 am - 10 am
xii) 24 Hours Urine Collection for Urine Catecholamine

1. Patient Preparation
a. Some food can elevate the concentration of catecholamine in urine, thus avoid these following
food a few days before urine collection for catecholamines:
i. All types of beverages that contain caffeine such as coffee, tea and cocoa.
ii. All types of food that contain chocolate and cocoa.
iii. All types of citrus fruits such as lime, lemon and orange.
iv. All types of food that contain vanilla (as flavor enhancer).
b. Stop treatment using medication such as alpha-methyldopa, salicylates, lithium, tetracycline,
erythromycin, aminophylline and insulin, at least 48 hours before urine collection.
c. Avoid activity or factor that can influence test result, for instance, stress and vigorous exercise.
a. Collect 24-hour urine in a specially prepared urine container that can be requested from
laboratory. This special urine container contains 10 mL of hydrochloric acid (25% 1M HCL).
Please take special care when handling the urine container to avoid spillage.
b. On the 1st day of collection, the first urine voided must be discarded. Time of first urine
voided is the onset for the 24-hour collection. Record the date and time of collection on the
container.
c. Thereafter, all urine should be collected until the end of the 24-hour period. Refrigerate urine
collected during the 24-hour period.
d. Urine should be passed into a separate container at each voiding and then emptied into a
larger container to complete the specimen. This two-step procedure prevents the danger of
patient splashing him or herself with the preservative (e.g. acid) in the container.
e. If the patient has a bowel movement during the collection period, precautions should be
taken to prevent faecal contamination.
f. After the collection period has been completed, properly label the container with barcode
label, state the collection time and collection period to enable calculation. Send the collected
urine to laboratory immediately for processing.
xiii) Pyruvate
a. Request 4 ml of 8% perchloride acid tube from laboratory.
b. Draw 2 ml of blood and dispense into cold tube containing 4 ml of 8% perchloride acid.
c. Cap the tube and mix gently until entire solution turns brown.
d. Immediately place in ice box and send to the laboratory.
19
F. TYPE OF CONTAINERS
Specimen
No Specimen Container Test Specimen Additive
volume
1. Plain tube BUSE; RP; LFT; FSL; CE; Blood None Clot 4.0 ml (Adult);
Amylase; Magnesium; Activator 0.5ml (Paeds)
Iron / TIBC;
Osmolality;
Hormones; Tumour
markers
2. Sodium Fluoride / Disodium Glucose; Lactate Blood Potassium 2.5ml (Adult);

EDTA or Potassium Oxalate + Oxalate + 0.5ml (Paeds)
Sodium Fluoride tube Sodium
Fluoride or
Sodium
Fluoride /
Disodium
EDTA
(Adult) (Paeds)
3. K2 EDTA tube HbA1c; Ammonia Blood K2 EDTA 2.0ml (Adult);

0.5ml (Paeds)
(Adult) (Paeds)
20
Specimen
No Specimen Container Test Specimen Additive
volume
4. Sterile Container Urine Biochemistry Urine; Nil Urine: 20 –

Body 30ml
Body Fluid: LDH, TP Fluids &
Stool Stool: Peanut
CSF Biochemistry size
Stool Occult Blood
Urine Pregnancy
5. 24-hour Urine Container 24-hour Urine for 24-hour Nil Minimal

Calcium, Chloride, Urine 750ml
Creatinine,
Phosphate, Protein,
Potassium, Sodium,
Urea, Uric Acid.
6. Plain tube Referred test Blood None Clot 4ml

Activator
21
MICROBIOLOGY
22
MEDICAL MICROBIOLOGY
A. INTRODUCTION
Medical Microbiology is an essential component in the infectious disease field and knowledge in this
area is vital to the clinical management of infections. Microbiology unit is particularly involved in
isolation or establishing the causative organisms as well as monitoring and screening of diseases.
B. SERVICES
Medical Microbiology unit provides the following services:
i. Diagnostic Microbiological services which comprise of Bacteriology, Mycology, Parasitology, TB,

Virology, Serology and Molecular (MERS CoV, Zika Virus & Hepatitis C RNA).
ii. Participation in hospital wide infection control activities related to surveillance, control and
prevention of nosocomial infections.
iii. Provision of microbiological studies of the hospital environment and sterility testing.
iv. Microbiological investigations for medico-legal cases.
C. REQUEST FORMS
i. PER PAT 301 (2 copies)
ii. TBIS 20C (Only for Direct Smear AFB, TB Culture & Sensitivity)
iii. QAP Perkhidmatan Makmal Patologi, KKM “Turnaround Time (TAT) Motion Study Of
Cerebrospinal Fluid-Bacterial Meningitis”
iv. Brucellosis Laboratory Request Form (IMR/IDRC/BACT/BRUCE/01)
23
BACTERIOLOGY LAB
1. General Specimen Collection Guidelines
i) The quality of laboratory results depends greatly on the proper collection and handling of the
specimen as well as obtaining satisfactory material for examination.
ii) The clinical specimen must be material from the actual infection site and must be collected
with minimum contamination from adjacent tissue, organs or secretions.
iii) A sufficient quantity of specimen must be obtained in order to perform the examination
required.
iv) Appropriate collection devices, specimen containers and culture media must be used to ensure
optimal recovery of microorganisms.
v) Ideally, the specimen must be collected before the commencement of antibiotic therapy.
vi) Specimens are best transported immediately to the laboratory.
vii) 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 (for outpatient).
viii) All culture & sensitivity tests requests are advised to fill up one copy of PER PAT 301 form.
2. Specific Specimen Collection Guidelines
2.1 Cerebrospinal Fluid (CSF) for culture & sensitivity (C/S), cell count, gram stain and India Ink.
*Bacterial Antigen Test will be done only when requested.
a) Disinfect the skin over the lumbar spine with 2% iodine followed by 70 % alcohol.
b) With aseptic techniques, perform a lumbar puncture and collect about 1-2 ml of CSF
directly into sterile universal container.
c) Fill up PER PAT 301 form with all tests required and EXACT time of specimen collection.
d) Fill up QAP Perkhidmatan Makmal Patologi, KKM “Turnaround Time (TAT) Motion Study of
Cerebrospinal Fluid-Bacterial Meningitis” form. Staple together with PER PAT 301 form.
e) Specimen with all forms must be sent directly to the Microbiology laboratory
immediately by either Medical Officer or House Officer after lumbar puncture
procedure has been done. It is encouraged to call laboratory before sending specimen.
f) DO NOT STORE IN A REFRIGERATOR as organisms causing meningitis are usually very
sensitive to cold.
g) Upon arrival at the laboratory, MLT will record time of specimen received to the
laboratory in the LIS system. The laboratory MLT will do the test and will inform the result
24
(cell count, gram stain & India Ink only) to the requestor in the ward by phone within 1
hour after receive the specimen in Microbiological Laboratory.
2.2 Other body fluids

Transfer pleural, pericardial and synovial fluids aspirated aseptically to a sterile universal
container and send to the laboratory without delay.
2.3 Ear Swab

a) The external meatus is cleaned with a dry swab moistened with sterile saline. Let the
site dry before sampling.
b) Pass a swab gently into the external canal and collect whatever exudate that is found
there.
c) Replace the swab in its carrier-tube and send to the laboratory immediately.
2.4 Eye Swab

a) Collect the exudate with a sterile swab.
b) Inoculate the swab into a Stuart Transport Medium and send the specimen together
with a fixed smear of the exudates to the laboratory.
25
2.5 Stool
A. Fresh stool:
a) Using a scoop, collect a small amount of stool (1/4 volume of container), taking care
to include materials containing pus, mucus or blood if present.
b) Place the stool into a sterile container, screw the cap tightly and send it immediately
to the laboratory.
B. Rectal swab:
Note: Should only be taken if a stool specimen is not available and for CRE/VRE/ESBL
carrier. It is a less satisfactory specimen than stool.
For stool clearance culture, in cases of typhoid, stool should only be sent upon
completion of therapy.
a) Insert a sterile swab deep into the anus so that the swab may come into contact with
some fecal material. A satisfactory rectal swab is one which show some fecal
staining.
b) Send the specimen to the laboratory as soon as possible. If not, dip the rectal swab
into the appropriate transport medium as below: -
Selenite Medium : specifically for Salmonella sp. / Shigella sp.
Alkaline Peptone Water : V. cholerae and other vibrios.
2.6 Blood Culture
1. Blood Culture
a) Check medium for blood culture for gross contamination before use. Bottles with
gross turbidity should be returned to the laboratory. Do not open cap of the culture
bottle.
b) Clean venipuncture site with chlorhexidine 1:200 in 70% alcohol.
Remarks: Do not touch the venipuncture site after disinfection unless the finger to be
used for palpation has been similarly disinfected.
c) Disinfect the top of the cap of culture bottle with 70% alcohol.
d) Withdraw blood with syringe and needle as indicated below:
Adults: Aerobic and anaerobic culture bottle

Volume: 8-10ml into each tubes
Paediatric: A single blood culture bottle

Volume: 1-3ml
Fungal / Use Myco F Lytic bottle

Mycobacterium: Volume: 1-5ml
26
e) Inject the blood directly into bottle through the perforation in the bottle cap. Gently
swirl to mix.
f) Send the specimen to the laboratory immediately. If delay is inevitable, keep the
blood culture at room temperature.
Notes:
 In cases where bacteremia is generally continuous e.g. endocarditis and typhoid,
up to three cultures are collected separately from different venipuncture sites
and if the condition of the patient permits at no less than hourly intervals, within
a 24-hour period.
 In intermittent bacteremia, three separate blood specimens within 24-48 hours
are taken. Each should preferably be collected just preceding the onset of fever
or chills.
 In cases where catheter-related blood stream infection suspected, blood from
lumens & peripheral site should be collected at the same time.
2.7 Bone Marrow Aspirates
For bone marrow aspirate, 1-2ml of aspirate is required and to be inoculated directly
into the bottles (Aerobic bottle). If unable to get bone marrow, trephine is acceptable
and to be collected in a sterile container.
Method of collection:
a) Before venipuncture, the skin must be carefully disinfected with chlorhexidine

1:200 in 70% alcohol.
b) Clean the tops of the bottle with 70% alcohol.
c) Inoculate the specified volume of bone marrow aspirate into each bottle.
d) Do not store the specimens in the refrigerator.
Note: In the suspicion of catheter-related bacteremia, blood drawn from both the
line and peripheral vein is indicated.
27
2.8 Respiratory specimens
A. Nasal Swab
This is only done for screening of MRSA carriage.
a) The swab needs to be moistened with sterile saline before sampling.
b) Swab both the anterior nares and insert the swab into the nose and gently
rotate against the nasal mucosa. Replace the swab in its carrier-tube and send
the specimen to the laboratory immediately.
B. Nasopharyngeal / Pernasal Swab for Bordetella pertussis PCR

a) This is especially useful for the diagnosis of whooping cough caused by Bordetella
pertussis. A special pernasal swab mounted on a soft flexible wire is used.
b) Pass the swab gently through the nostril and along the floor of the nasal cavity
into the nasopharynx, rotate it and withdraw.
c) Replace it in its carrier-tube (Charcoal transport medium) and dispatch the
specimen to the laboratory immediately.
C. Throat Swab
In the majority cases, throat swabs are obtained to recover Group A Streptococcus
(Streptococcus pyogenes) which causes pharyngitis and diphteria.
a) Insert swab carefully through the mouth with the tongue depressed.
b) Rub the swab over each tonsillar area and the posterior pharynx. Any area with
exudate should be touched.
c) Do not allow to touch tongue or lips.
d) Replace the swab in its carrier-tube immediately and send the swab to the
laboratory or store in refrigerator if it cannot be sent at once to the laboratory.
● If diphtheria is suspected:
i) Lift edge of the membrane and swab under it to search for deeply
located diphtheria organisms.
ii) Obtain at least 2 swabs and send to the laboratory immediately.
28
D. Sputum
a) Sputum is preferably collected when the patient first wakes up in the morning
after a deep cough or after a session of physiotherapy.
b) Ask the patient to cough deeply and spit directly into a sterile universal bottle.
Ensure that the expectorate is sputum and not saliva.
c) Send the specimen immediately to the laboratory. If delay is unavoidable, store it
in a refrigerator.
Note:
Send nasopharyngeal aspirate, transtracheal aspirate or lung aspirate whenever
possible or indicated. These specimens are more representative of the lower
respiratory tract and are devoid of contaminants from the mouth.
E. Bronchoalveolar Lavage (BAL) / Brushings / Biopsies

a) Place the specimen which is obtained via bronchoscopy into a sterile container.
b) Send the specimen to the laboratory immediately.
2.9 Urine
A. Midstream Urine
Male patients
a) Withdraw the prepuce and clean thoroughly the glans penis with water.
b) Pass the first part of voided urine to flush out the bacteria from urethra, then
collect the midstream portion in a sterile universal container and close it tightly.
Female patients
a) Clean the periurethral area and perineum thoroughly with water.
b) Hold the labia apart and pass the first part of voided urine.
c) Collect the midstream portion in a sterile universal container and close it tightly.
Note:
When culture for tubercle bacilli is required, collect at least 50ml of early
morning midstream urine on 3 consecutive mornings into sterile containers.
Collect 10 -
20 ml of
urine (refer
to volume
level)
29
B. Catheterized Urine
a) Catheter urine specimens should be taken by aseptic puncture of the catheter
conduit and syringe out into a sterile container.
b) Urine from collection bag is generally unsuitable for culture.
Note:
Culturing urinary catheter tips is a waste of time because the catheter tips are
invariably contaminated with urethral organisms.
C. Bladder Urine Samples

a) This is obtained via suprapubic aspiration or cystoscopically.
b) Urine is collected in a sterile container.
2.10 Tissue
a) Collect tissue specimens and aseptically transfer into a sterile container OR
b) Put tissue in Stuart Medium.
c) Do not add fluid especially formalin solution.
d) Send immediately to the laboratory.
e) If delay, store in a refrigerator.
Notes:
For anaerobic culture, specimen can be put into Thioglycolate Transport
Medium which is supplied by the laboratory.
2.11 Pus Aspirate

a) Disinfect the skin over the inflamed area with 2% iodine followed by 70% alcohol
OR with chlorhexidine 1:200 in 70% alcohol.
b) With a sterile syringe, aspirate the pus or exudates and transfer the pus into a
sterile container.
c) Transfer 1-2 ml into Thioglycolate Transport Medium (anaerobic organism).
d) Send the specimen immediately to the laboratory. DO NOT STORE IN A
REFRIGERATOR.
2.12 Genital Sample
A. High vaginal swab

a) This is suitable for the diagnosis of candidiasis and other causes of vaginitis but
NOT gonorrhoea in the female.
b) Using a sterile speculum lubricated with sterile normal saline and not antiseptic
cream, swab either from the posterior fornix or the lateral wall of the vagina.
c) Inoculate the swab into Amies transport media and send the specimen to the
laboratory as soon as possible.
B. Endocervical swab
a) This is the best specimen for the diagnosis of gonorrhoea and puerperal sepsis.
b) Under direct vision, gently compress cervix with blades of speculum and use a
rotating motion with swab, obtain exudates from the endocervical canal.
c) Inoculate the swab into Amies transport media.
30
C. Urethral discharge (Male)
a) Wipe the urethra with a sterile gauze or swab.
b) Collect the exudates with a sterile swab and inoculate into Amies transport
media.
c) If discharge cannot be obtained by ‘milking’ the urethra, use a sterile swab to
collect material from about 2 cm inside the urethra.
d) Place the swab into Amies transport media.
D. High vaginal discharge (to detect T. vaginalis, C. albicans and G. vaginalis)

Use a plain sterile swab to collect a specimen from the vagina. ADD FEW DROPS
(1-2ml) OF STERILE PHYSIOLOGICAL SALINE onto bottom of the swab container till
the cotton swab immerse in the saline. Label and deliver to the laboratory as soon as
possible for immediate examination.
Add 1-2 ml of
sterile
physiological
saline
31
2.13 Stool for Clostridium difficile toxin
a) Collect fresh stool (approximately ¼ volume of container) in a sterile bottle.
b) Send to the laboratory immediately.
2.14 Mycobacterium (MTB): Acid-fast bacilli stains and culture
Acceptable specimen: respiratory secretions, CSF and body fluids. Swab specimens and Stool
are NOT acceptable.
a) For sputum: Collect a minimum of 3 early morning sputum / spot specimen (1
specimen per day).
b) Collect in a sterile container.
c) If blood specimen: Withdraw 1-5 ml of blood and put into Myco F Lytic Blood
Bottle.
2.15 Peritoneal dialysis effluent

A sample from the bag is obtained as follows:
a) Disinfect the port of the bag with 70% alcohol.

b) Collect at least 30ml of fluid through the disinfected area using a needle and
syringe.
c) Place the sample into a sterile container OR / AND inject 8-10 ml in each Blood
culture bottle (Aerobic and Anaerobic).
d) Send to the laboratory immediately.
Notes:
Repeat samples taken during therapy of CAPD peritonitis is discouraged
unless there is clearly no clinical response to treatment or the effluent remains
cloudy after 72 hours of the therapy.
2.16 Other swabs

Notes:
a) A ‘dry’ swab may fail to yield organisms in smear and culture.
b) Surface swabs of deeply infected lesions (e.g: sinus tracks from osteomyelitis,
pressure sores) usually grow surface contaminants like Coliforms and
Pseudomonas.
2.17 In-use test for disinfectant.

a) Aseptically, transfer 5ml of disinfectant into a sterile bottle.
b) Send immediately to the laboratory.
2.18 Spore Test (Autoclave)

a) Send Attest indicator that has gone through the autoclaving cycle together
within untreated Attest (Control) to the laboratory.
b) Ensure that both test and control Attest are from the same batch.
Note:
The same applies to spore strips of any brand.
32
2.19 Mycology Examination.
A. Skin, Nails and Hair

Clean cutaneous and scalp lesions with 70% alcohol prior to sampling as this will
improve the chances of detecting fungus on microscopic examination, as well as
reducing the likelihood of bacterial contamination of cultures. Prior cleaning is
essential if ointments, creams or powders have been applied to the lesion. Skin, nails
and hair specimen should be collected into folded squares of paper or directly onto
agar plate.
a) Skin
Material should be collected from cutaneous lesions by scraping outwards
from the margin of the lesion with the edge of a glass microscope slide or a
blunt scalpel.
b) Hair
i. Specimen from the scalp should include hair roots, the contents of
plugged follicles and skin scales.
ii. Hairs should be plucked from the scalp with forceps or the scalp is
brushed with a plastic hairbrush and collected onto an agar plate.
c) Nails
i. Nail specimens should be taken from any discolored, dystrophic or
brittle parts of the nail.
ii. Specimen should be cut as far as possible from the edge of the nail and
should include the full thickness of the nail.
B. Mouth and Vagina

i. Swabs from the buccal mucosa should be moistened with sterile water
prior to take the sample and sent in Amies transport medium.
ii. For vaginal infections, swabs should be taken from discharge in the
vagina and from the lateral vaginal walls. The swabs should be sent to
the laboratory in transport medium.
C. Ear
Scrapping of materials from the ear are to be preferred, although swabs can
also be used.
D. Ocular specimens
i. Material from patients with suspected fungal infections of the cornea
(keratomycosis) should be collected by scrapping the ulcer. The entire
base of the ulcer, as well as the edges, should be scrapped. (Swab is not
suitable for sampling corneal lesions).
ii. The material is collected directly onto agar plates for culture and to a
glass slide for microscopic examinations.
33
2.20 Blood Film for Malarial Parasites
Note: Blood for smear preparation can be obtained either by finger prick or after blood
taking for other investigations.
A. By finger prick
a) Clean a new glass slide with alcohol swab.

b) Select the third finger from the thumb (big toe can be used for infants). Clean
the finger with cotton wool soak in 70% alcohol. Dry the finger with cotton
towel.
c) With a sterile lancet, puncture the ball of the finger using quick rolling action.
d) By applying gentle pressure to the finger, express the first drop of blood and
wipe it away with dry cotton wool.
B. After blood taking from intravenous line
a) Clean a new glass slide with alcohol swab.

b) Intravenous blood taking by using syringe and needle was done with aseptic
technique.
c) Remove needle from syringe with safe disposal.
d) Put 1 drop of blood onto each glass slide (1 slide for thick film, 1 slide for
thin film).
C. How to prepare thick blood film
a) Apply gently pressure to the finger and collect a single drop of blood on the
surface of clean slide.
b) Using the corner of another glass slide as a spreader, quickly spread the
blood to make an even, thick film. The blood is spread in a circular motion
with 3-6 movements and spread over 20mm diameter.
c) Label the slide with patient’s registration number and date of collection
with grease pencil.
d) Place the blood film in a slide tray to air dry at room temperature.
34
D. How to prepare thin blood film
a) With another gentle pressure to the finger and collect a small drop of blood
on to a new slide about 5mm away from the edge of the slide.
b) Rest the blood slide on a firm, flat surface. Use another slide as a spreader.
Touch the drop of blood with a spreader and allow the blood to run along
its edge. Keep the spreader at an angle of 30-45° and in steady movement,
firmly push the spreader forward to prepare a thin smear.
c) Label the slide with patient’s registration number and date of collection
with grease pencils.
d) Place the blood film in a slide tray to air dry at room temperature.
thin
thick
2.21 Intravascular Catheters
a) Clean the skin surface in the region of the intravascular catheter with the 70% alcohol-
soaked cotton swab and withdraw the catheter using sterile forceps. After withdrawal
apply pressure to the puncture site.
b) Cut the distal 5cm of the catheter off with sterile scissors and place in a dry, sterile
container; transport to the laboratory as soon as possible.
35
2.22 Medicolegal Cases
Specific guidelines:
a) Specimen should be sealed and send directly to the Bacteriology laboratory.
b) Specimen should be sent to the laboratory by a designated personnel.
c) Chain of custody should be maintained at all times and record book should
accompany the samples.
** Sample collection of various tests should follow the guidelines as of normal microbiological
requirements and the specific headings are referred.
36
E. TYPE OF CONTAINERS
No. Tube/ Container Additives Specimen Specimen Test Frequency

volume of mixing
1. Sterile container NA Urine, sterile NA Culture & NA

body fluid, sensitivity, AFB
tissue, CSF, direct smear,
sputum, pus, Mycobacterium
stool culture &
sensitivity
2. Aerobic blood bottle NA Blood 8-10ml Blood culture & Mix with
sensitivity swirling
(Aerobic) method
DO NOT STICK
PATIENT
BARCODE ON
THE BOTTLE
BARCODE
Do not store in
the refrigerator
3. Anaerobic blood NA Blood 8-10ml Blood culture & Mix with

bottle sensitivity swirling
(Anaerobic) method
DO NOT STICK
PATIENT
BARCODE ON
THE BOTTLE
BARCODE
Do not store in
the refrigerator
37
volume of mixing
4. Paeds blood bottle NA Blood 1-3ml Blood culture & Mix with
sensitivity swirling
(Pediatric) method
DO NOT STICK
PATIENT
BARCODE ON
THE BOTTLE
BARCODE
Do not store in
the refrigerator
5. Myco F Lytic blood NA Blood 1-5ml Blood culture & Mix with
bottle sensitivity (for swirling
Tibi) method
DO NOT STICK
PATIENT
BARCODE ON
THE BOTTLE
BARCODE
Do not store in
the refrigerator
6. Charcoal Transport NA Ear swab, Eye NA Culture & NA

Medium swab, genital sensitivity
female/ male
swab, nasal
swab, pus
swab, throat
swab
38
volume of mixing
7. Amies Transport NA Ear swab, Eye NA Culture & NA

Medium swab, genital sensitivity
female/ male
swab, nasal
swab, pus
swab, throat
swab
8. Sterile container Boric Urine 10-20 ml Urine culture & NA

with boric acid acid sensitivity
(adult) (Adult)
9. Sterile container Boric Urine Up to Urine culture & NA

with boric acid (Male acid level sensitivity
Paediatric) indicated (Male
Paediatric)
10. Dacron swab NA Pernasal swab NA Bordetella NA

pertussis PCR
39
volume of mixing
11. Sterile container NA Nasopharyngeal 2ml Bordetella NA

(Falcon tube) aspirate / pertussis PCR,
Sterile body Sterile body
fluid fluid Culture &
Sensitivity
12. EDTA tube K2 EDTA Blood 2-5 ml Malaria PCR 8
5ml Blood buffy 8

coat for gram
stain
13. Stuart transport NA Ear swab, Eye NA Culture & NA

medium swab, genital sensitivity
female/ male
swab, nasal
swab, pus
swab, throat
swab
14. Plain sterile swab NA Genital female NA High vaginal NA

swab, Eye swab swab FEME,
Eye swab for
wet smear
40
volume of mixing
15. Selenite F broth Selenite Stool ¼ of Stool for NA

container Salmonella &
volume Shigella
16. Alkaline peptone Alkaline Stool ¼ of Stool for V. NA

water peptone container cholera
volume
17. Thioglycolate NA Tissue NA Tissue culture NA

transport medium & sensitivity
(anaerobic)
18. Universal sterile NA Sputum/ NA Tibi PCR NA

container Aspirate/
Tissue/ Body
fluid
41
SEROLOGY
42
SEROLOGY LABORATORY
A. INTRODUCTION
Serology is the scientific study of plasma, serum and other bodily fluids. In practice, the term usually
refers to the diagnostic identification of antibodies in the serum. Such antibodies are typically formed
in response to an infection (against a given microorganism), against other foreign proteins (in
response, for example, to a mismatched blood transfusion), or to one's own proteins (in instances of
autoimmune disease).
B. SERVICES
Serology laboratory provides the following services:
i. Virology, Serology, Immunology and Molecular testing

ii. Participation in national epidemiological activities such as dengue surveillance, Severe Acute
Respiratory Infection Surveillance (SARI) and other emerging outbreak diseases such as
leptospirosis, Influenza, MERS-CoV, Zika Virus and etc.
iii. Serological and virological investigations for medicolegal cases.
Tests required to be inform Pegawai Sains / Pakar Patologi (Mikrobiologi) on call before sending
specimens:
i. Dengue combo (rapid)
ii. Organ Transplant Cases
iii. Zika PCR
iv. MERS-CoV PCR
SERVICE HOURS:
Weekday : 8.00 am to 5.00 pm
Weekend : 8.00 am to 2.00 pm standby / call for Dengue IgG & IgM (ELISA), Dengue COMBO
Rapid Test, MERS-CoV PCR and Zika PCR.
43
C. REQUEST FORM
1. All serological tests can be requested using PER PAT 301 form except for the following tests:
No. Tests Forms Form’s No.
1. Acute Flaccid Paralysis AFP Case Investigation Form -

(AFP) (MOH, Malaysia)
2. a. Brucella Antibody Brucellosis Laboratory Request Form IMR/IDRC/BACT/BRUC

b. Brucella PCR E/01
3. Dengue Serology/ Laboratory Request Form for Dengue MKAK-BPU-

Serotyping and Flavivirus D02(rev_Nov 2015)
4 a. Enterovirus Test Borang Permohonan Ujian Makmal (MKAK/ENT/20__/__)

b. HFMD HFMD
5. HIV Drug Resistant HIV Genotyping Resistant Testing IMR/Viro/HIV/24
6. HIV PCR (DNA) Ujian Polymerase Chain Reaction (PCR) IMR/VIRUS/NARL2

untuk Human Immunodeficiency Virus
(HIV) dikalangan bayi
7. HLA Typing (Class I & II) a) Request for HLA Typing Test a) IMR/AIRC/TI/RF-2
b) Request for HLA Typing Test (Disease b) IMR/AIRC/TI/RF-3
Association)
8. HLA Crossmatching a) Request for HLA Crossmatch Test a) IMR/AIRC/TI/RF-1

(Living Donor) b) IMR/AIRC/TI/RF-5
b) Request for HLA Crossmatch Test
(Deceased Donor)
9. HLA Antibody Screening Request For HLA Antibody Screening IMR/AIRC/TI/RF-4

Test
10. H7N9 PCR Laboratory Request Form for Influenza A ANNEX 7
(H7N9) Investigations
11. Influenza-Like Illness National-Influenza Surveillance (Appendix 8) NIPP

(ILI) Diagnostic Request Form 2006
12. a. MKAK General MKAK Laboratory Request Form MKAK-BPU-U01

Request Test
b. Leptospirosis
antibody IgM (MAT)
c. Legionella serology
44
No. Tests Forms Form’s No.
13. Leptospirosis Leptospirosis Laboratory Request Form IMR/IDRC/BACT/LEPTO

(Culture & PCR) /01
14. Measles MEASLES – Borang Permohonan dan MSLF:01/2004

Keputusan Ujian Makmal
15. MERS-CoV PCR Laboratory Request Form for Novel Lampiran 3

Coronavirus Investigations
16. Panel Reactive Antibody Request for HLA Antibody Screening Test IMR/AIRC/TI/RF-4
(PRA)
17. Primary Primary Immunodeficiency Screening IMR/AIRC/PID/RF

Immunodeficiency (PID) Request Form Version 3.0
18. Zika Virus PCR Laboratory Request Form for Dengue MKAK-BPU-
and Flavivirus D02(rev_Nov 2015)
2. All samples sent to Hosp. Sungai Buloh require 3 copies of PER-Pat 301 as per requested by
Hospital Sungai Buloh.
1. Methods of blood collection:

a) Draw 3-5 ml of blood into a plain tube with / without gel (without anticoagulants).
b) Clot at ambient temperature.
c) Dispatch to the laboratory within 4 hours of collection for serum separation by
centrifugation.
Note:
 Haemolysed, icteric or lipaemic specimens invalidate certain tests.
 If such specimens are received, the samples will be rejected to assure that results
are of clinical value.
2. Cerebrospinal Fluid (CSF) for Cryptococcus, VZV PCR, CMV PCR, HSV PCR, Enterovirus,
VDRL & TPPA, Viral Study, Zika Virus PCR
a) Disinfect site with 2% chlorhexidine.
b) Insert needle with a stylet at L3-L4, L4-L5 or L5-S1 interspace. Upon reaching the
subarachnoid space, remove the stylet and collect 1 ml of fluid into sterile container.
c) Send the specimen to laboratory immediately.
45
3. Chlamydia trachomatis Immunoflourescence Test
i) Urethral specimens:
Note: Because the passage of urine may dislodge cells from the urethra, instruct the patient
to refrain from urinating for 1 hour prior to sampling.
a) Insert a small swab 2-4 cm into the urethra (rotate swab gently to aid in insertion).
b) Gently rotate the swab using enough pressure to obtain epithelial cells.
c) Allow the swab to remain inserted for 1-2 seconds.
d) Withdraw the swab and prepare slide immediately.
e) Make a circle onto a slide where a smear had been made.
ii) Cervical Specimen:

Note: The columnar epithelial cells of the cervical mucous are located just inside the cervical
opening. In some cases, the location of the transitional zone, where the stratified epithelium
ends and the columnar epithelium begins may vary. Adhering to the following procedure will
ensure that columnar epithelial cells are sampled.
a) Use a sterile swab to remove excess mucus and exudates from the endocervix (exudate or
mucus could interfere with the test). Dispose of the swab into a biohazard container.
b) Insert specimen collection device into the endocervical canal. If using a large swab, insert
about 1-1.5cm until most of the swab tips is inside the cervical opening.
c) Rotate the swab for 5-10 seconds using enough pressure to obtain epithelial cells from all
surfaces of the endocervical canal.
d) If using cytology brush, insert until more than half the bristles are inside the cervical
opening. Slowly rotate the device one full turn.
e) Withdraw the collection device avoiding contact with the vaginal surfaces.
f) Prepare direct specimen slide immediately.
g) Make a circle onto a slide where a smear had been made.
iii) Ocular specimens:

Note: If both eyes are infected, collect a sample from each eye and process as separate
specimens.
a) Pull down the lower eyelid of the patient to expose the conjunctiva.
b) Carefully remove any exudates or pus with a moist sterile swab. Discard the swab into a
biohazard container.
c) Using a small sterile swab moistened with saline, rotate gently but firmly against the
conjunctiva surface of the lower lid. Use care to avoid damaging the eye.
d) Prepare direct specimen slide immediately.
e) Make a circle onto a slide where a smear had been made.
4. EBOLA VIRUS (EVD) PCR

a) Designated clinician to inform Pathologist / MO / SO on-call on specimen collection from
PUI for EVD.
b) Fill up request forms (PER-PAT301 for tests in EVD rRT-PCR) and label containers
appropriately. Prepare dispatch list for specimen send to MKAK).
c) Wear appropriate personal protective equipment (PPE) with double gloves.
46
d) Carry only label container(s) to patient’s room / area for specimen collection. Ensure
correct patient identification.
e) Collect 4-5 ml blood in serum separator tube (provided by Serology laboratory).
f) Place the serum separator tube into a water and leak proof secondary container (hardy
plastic container) with sufficient absorbent material.
g) Wipe the external surface of the secondary container with 1% sodium hypochlorite and
allow to air dry.
h) Place the secondary container into a sturdy; leak-proof outer container (box, flask,
Styrofoam box, chiller box) containing ice. Size should not exceed 9 x 9 x 9 inches.
i) Wipe the external surface of the outer container with 1% sodium hypochlorite and allow
to air dry.
j) Inform laboratory prior to dispatch. Please check MKAK website for Officer in-charge. The
laboratory address is Unit Molekular, Makmal Kesihatan Awam Kebangsaan (MKAK), Lot
1853, Kg. Melayu, 47000 Sungai Buloh, Selangor.
5. HIV PCR DNA for babies

a) Collect 2.5 ml of baby’s blood into EDTA tube (fresh blood taken <48 hours) at birth and
at 2 weeks of life.
b) Send together with mother’s blood (2.5 ml of blood in EDTA tube; fresh blood taken <48
hours (except abandon babies).
6. HIV Drug Resistant

a) Collect 2.5 ml of blood each into 2 EDTA tubes freshly blood taking.
b) Should inform Microbiologist before sending a sample.
7. HIV RNA Viral Load

a) Collect 2.5 ml of blood each into 2 EDTA tubes.
b) Send the specimen to laboratory immediately.
c) Forms must be signed by a specialist / consultant.
8. HLA typing (Molecular Class I and II) for bone marrow and solid organ transplantation
a) An appointment is required for all the tests.
b) Please call 03-26162782 / 2581 / 2587 (IMR).
c) Collect 6 ml blood for anaemic patient and 15 ml blood for patient with TWBC < 1.5 x 103
cells / ml.
d) Patient must not have blood transfusion 3 weeks preceding blood collection.
e) Sample should be taken a day before transportation.
9. HLA Cross Matching

a) An appointment is required for all the tests.
b) Please call 03-26162782 / 2581 / 2587 (IMR).
c) Sample should be taken a day before transportation.
47
10. Nasopharyngeal specimens for Respiratory Virus Screening & MERS-CoV PCR
Note: For patients with suspected respiratory viral infection, collect an aspirate, wash or
swab specimen from the nasopharynx.
i) Nasopharyngeal Aspirate / Wash (NPA):

a) Patient has to sit comfortably and the head tilted slightly backward. Instill 1-1.5 ml of
sterile, physiological saline (pH 7.0) into one nostril.
b) Flush 3 cc syringe with 2-3 ml of saline. Insert the syringe into the nostril parallel to the
palate. Flush in and out few times. Aspirate nasopharyngeal secretions.
c) Collect specimens in falcon tube. Transport on wet ice.
d) If nasopharyngeal wash is not feasible, please do throat swab.
ii) Nasopharyngeal Swab:

a) Insert a flexible, fine shafted polyester swab into the nostril and back to the nasopharynx.
b) The swab should be slid straight into the nostril with the patient’s head held slightly back.
c) The swab is inserted following the base of the nostril towards the auditory pit and will
need to be inserted at least 5-6 cm in adults to ensure that it reaches the posterior
pharynx (do NOT use rigid shafted swabs for this sampling method – a flexible shafted
swab is essential).
d) Leave the swab in place for a few seconds. Withdraw slowly with a rotating motion. Use a
different swab for the other nostril.
e) Put the tip of swab into vial containing VTM and break off the applicator sticks. Close the
vial and seal.
48
11. Pneumocyctis carinii Pneumonia Immunofluorescence Test (PCP)
i) Induced Sputum
a) Specimen can be obtained by inhalation of hypertonic saline using ultrasonic nebulizers
for 20 minutes.
b) Collect the specimen in sterile container.
ii) Bronchial wash / Bronchoalveolar lavage (BAL)

a) Place the specimen which is obtained via bronchoscopy into a falcon tube.
b) Send the specimen to laboratory immediately since the specimen should be processed as
soon as possible after collection.
12. Primary Immunodeficiency Disease (PID) Screening

a) An appointment from IMR is required for all tests related to PID.
b) Please call 03-26162782 during office hour, and provides:
- Details of the patient and test required
- Contact details i.e. telephone number(s) and email address
c) On the date of appointment, collect all the specimens. Refer Appendix 25.
d) Label and pack all the specimens in biohazard plastic together with PID screening
request form.
e) Then, keep all specimens and form into an envelope and write full address on it (Allergy
& Immunology Research Centre, Institute for Medical Research (IMR), Jalan Pahang, KL).
Please make a note on the envelope, this specimen must be sent WITHOUT ice.
f) Send to Biochemistry laboratory, and pass it to on-call staff for recording (SPECIMENS
MUST ARRIVED BEFORE 6.00 am).
g) Samples should reach the PID laboratory, AIRC, IMR by 12 noon.
h) Blood must be processed within 24 hours of withdrawal.
13. Rectal Swab for Enterovirus & HFMD

a) Insert rectal swab 4-6 cm into rectum.
b) Roll swab against rectal mucosa, avoid excessive stool sampling.
c) Break swab off into a vial of viral transport medium. The swab must remain in the VTM.
d) Tightly recap the vial of VTM.
e) Send the specimen to laboratory immediately.
14. Vesicular lesion swab for Enterovirus & HFMD

a) Wipe vesicle with saline.
b) Disrupt vesicle & collect fluid with swab. Using the same swab, collect cells from base of
lesion.
c) Place the swab immediately into a viral transport media (VTM) and break applicator
sticks off near the tip to permit tightening of the cap.
49
15. Throat Swab for Enterovirus & HFMD
a) Put the patient in the sitting position. Ask the patient to tilt the head slightly and open
the mouth.
b) Depress the tongue with tongue depressor. Use a sweeping motion to swab the posterior
pharyngeal wall and tonsillar pillars. Have the subject say “aah” to elevate the uvula. (Use
sterile Dacron or rayon swab with plastic shaft. DO NOT use calcium alginate or cotton
swab or ones with wooden sticks).
c) Avoid swabbing the soft palate and do not touch the tongue with the swab tip. (N.B. This
procedure can induce the gag reflex).
d) Place the swab immediately into a VTM and break applicator sticks off near the tip to
permit tightening of the cap. Transport with ice.
16. Semen for Seminal Fluid Analysis

a) Collection should follow a period of sexual abstinence of 2-7 days.
b) The specimen is collected by masturbation or by coitus interrupts into a sterile container.
Note:
 Condoms, even when thoroughly washed and rinsed, contain spermicidal agents, and
must not be used. Exposure of spermatozoa to cold and heat should be avoided. Note
the date and exact time when the specimen was obtained.
 The material should be examined within 1-3 hours.
 Patient must obtain an appointment date from the Obstetrics & Gynecology Clinic (O&G
Clinic) before submitting their specimens for examination.
17. Special Test and Appointment Oriented Test

All special and appointment oriented tests should be discussed between the doctor and the
laboratory personnel to clarify, investigate & make an appropriate date for sending the
specimens to the laboratories that are doing the tests such as IMR, HKL, MKAK Sg. Buloh &
Hospital Sg. Buloh.
18. Stool for Acute Flaccid Paralysis (AFP)

a) Collect two (2) adult thumb size (10 mg) stool specimens, 24 hours apart, into sterile
container within a 2-week period.
b) Send the specimen to laboratory immediately.
Note: Rectal swab not encouraged. Specimen should be collected within 14 days after onset
of illness.
50
19. Vesicle fluid
a) Wipe area with sterile saline.
b) Aspirate fluid from vesicle using a sterile needle.
c) Immediately rinse the syringe in 1-2 ml of VTM.
PACKAGING AND LABELING

Basic Triple Packaging System as illustrated below is designed for the purpose of safe
transport of infectious substances and diagnostic specimens.
The system consists of three layers as follows:
1. Primary receptacle is the container (e.g. tube, vial, and bottle) that holds the specimen as
coloured in yellow. (Figure 1)
 The primary receptacle must be securely sealed and leak-proof (Screw-top tubes must
have a piece of waterproof tape around the top to prevent the top from coming loose in
transit).
 The primary receptacle must be surrounded by absorbent material capable of taking up
the entire liquid contents.
 The primary receptacle must be packed in the secondary receptacle in such a way that it
will not break.
Figure 1: Primary Packaging
51
2. Secondary packaging is the receptacle into which a primary receptacle and the absorbent and
cushioning material are placed as coloured in yellow. (Figure 2)
 The secondary packaging must be leak-proof and securely sealed.
 The secondary packaging must be placed in the outer packaging so that it does not move.
 The biohazard marking should be on the secondary receptacle and may be on the
primary receptacle.
Figure 2: Secondary Packaging
3. Itemized List of Contents

 An itemized list of contents is required. DO NOT place documents inside the secondary
container.
 The itemized list is placed OUTSIDE the secondary container.
 The laboratory request form should be placed OUTSIDE the secondary container.
52
4. Outer packaging is the receptacle where the secondary packaging with cushioning materials
is placed as coloured in yellow (Figure 3).
 The outer packaging must be rigid (effective 1-1-2016).
 The outer packaging bears the addressing information along with all required markings
and labels such as:
- The full name and address of the shipper and consignee must be on the outside
packaging.
- The outside packaging must have the name and telephone number of a person
who is knowledgeable about the contents of the shipment.
- This is important emergency information in the event an exposure occurs during
shipping.
Figure 3: Outer Packaging
53
No Specimen Container Test Specimen Additive Specimen

volume
1. Plain Tube - Routine Blood None 5 ml

serology and Clot
virology Activato
tests r
- Zika Virus
PCR
2. K2 EDTA - HIV RNA Viral Blood Spray- 2.5 ml

Load Coated
(2 tubes) K2 EDTA
- HIV PCR
- HIV Resistant
(2 tubes)
3. Lithium heparin Dihydro- Blood Lithium 2 ml

rhodamine test heparin
(DHR) for
Chronic
granulomatous
disease.
4. Sterile Universal - PCP - Urine NA NA

Container - AFP - Induced sputum
- JE PCR - Stool
- MERS-CoV - Seminal fluid
PCR - Autopsy
- Zika PCR specimen
54
volume
5. Viral Transport Medium Virology tests - Throat Swab NA NA

(VTM) and Dacron Swab (Culture /PCR) - Nasopharyngeal
Swab (NPS)
- Rectal Swab
- Vesicular Swab /
fluid
6. Sterile Container  Respiratory - Nasopharyngeal NA NA

(Falcon Tube) Virus Aspirate (NPA)
Screening - Nasopharyngeal
 MERS-CoV Wash (NPW)
PCR - ETT
 H7N9 PCR - BAL
 JE PCR - CSF
 CMV PCR
 HSV 1 & 2
PCR
 Rabies Virus
55
HAEMATOLOGY
56
HAEMATOLOGY
A. INTRODUCTION
The Haematology Unit, Department of Pathology, Hospital Melaka provides tertiary diagnostic
and consultative haematology services to Hospital Melaka, other government (district) hospitals
and health clinics in Melaka. It also serves as a training center for undergraduate, postgraduate
and Advanced Diploma courses in Haematology from local training colleges and universities.
B. SERVICES
The diagnostic services are divided into: -

(i) Urgent Tests (STAT): These are short turnaround time tests for immediate patient
management as indicated by the clinician on the request form. Urgent tests are
offered 24 hours.
(ii) Routine Tests: Offered during office hours (please refer to the tests list).
(iii) Specialized Tests: Perform only during office hours. All specialized tests require
appointment before sending the samples (please refer to the tests list).
(iv) Referred Tests: Must be sent to Haematology laboratory during office hour before
2.00 pm on Monday or Wednesday. All requests to referral laboratory must be
accompanied with 2 copies of relevant forms.
C. REQUEST FORMS
i. Request for test done in-house is using the following forms:
a. Routine haematology, routine coagulation, specialized haematology, specialized
coagulation – PER PAT 301 (1 copy)
b. Lupus anticoagulant (LA) - PDN/HA/QP-01/01 (2 copies)
ii. For tests which are referred to other hospitals:
a) Request forms are based on type of tests and referred laboratories. All request forms are
available in the Haematology laboratory upon request.
b) All requests for referred test must be sent to Haemotology laboratory during office hour
before 2.00 pm on Monday or Wednesday.
c) The specimens are sent to the referred laboratory twice a week (Tuesday and Thursday)
except public holidays.
d) All requests to referral laboratory must be accompanied with 2 copies of respective forms.
57
1. Method of collection (In-house tests)
i) Bone Marrow Aspiration:

 Call the laboratory (Ext 2868/2877) or send request form for an appointment.
 Require recent Full Blood Picture report within a week.
 For all suspected new haemato-oncology cases - to fill up request form for
Immunophenotyping, Molecular and Cytogenetic studies.
ii) Mixing study / Factor VIII / Factor IX / Factor Inhibitors

 Contact Pathologist / Medical Officer (Ext 2857/2868) for approval.
 Send to the laboratory within 2 hours of collection to avoid incorrect result.
iii) Osmotic Fragility Test (OFT)

 OFT request for paediatric cases must be accompanied with parents’ sample.
 Collect 5.0 ml blood into 1 tube of Lithium heparin and 2.0 ml blood into 1 tube
of EDTA for patient and both parents.
 Send to the laboratory immediately before 9.00 am.
iv) Kleihauer Test

 Contact Pathologist / Medical Officer (Ext 2857/2868) for approval.
 Contact laboratory for appointment.
 Collect 2.0 ml of mother’s blood in EDTA tube or up to the level marked with a
sample of cord blood as a control.
 Send to the laboratory immediately before 9.00am.
v) Lupus Anticoagulant (LA) Test

 Collect 6 x 2.0ml blood in 3.2% Trisodium citrate tubes.
 Send to the laboratory before 2.00 pm and within 2 hours of collection to avoid
incorrect result.
 Part of the plasma will be send to PDN to complete with Anti Beta-2
Glycoprotein 1 (Antiβ2GP1 antibody) and Anticardiolipin antibody.
2. Method of Collection (For Referred Tests to Referral Laboratory)
*Please refer to Haematology Referral tests list.
58
No Specimen Test Specimen Additive Specimen

Container volume
1. K2 EDTA Blood K2 EDTA 2.0ml

(Adult)
FBC, FBP, CD4/CD8,

DNA Analysis,
Hb Analysis, OFT,
Molecular Studies,
Kleihaeur, G6PD assay
2. PAED.TUBE Blood K2 EDTA 0.5 ml
and
Immunophenotyping
3. Routine Coagulation & Blood 3.2% Trisodium 2.0 ml

Specialized Citrate
Hemostasis
4. ESR Blood 3.8% of Sodium 1.2 ml

Citrated tube
5. Cytogenetic, OFT Blood Lithium Heparin 5.0 ml
59
No Specimen Test Specimen Additive Specimen
Container volume
6. Urine Haemosiderin, Urine / Sterile Container 5.0 ml

Apt Test Gastric
Lavage
7. Bone Marrow BMA / Sodium Heparin 4.0 ml

Cytogenetic Blood
8. Serum Erythropoietin Blood Plain tube 4.0 ml
60
ANATOMICAL
PATHOLOGY
61
A. INTRODUCTION
The Anatomic Pathology Laboratory provides Histopathology and Cytopathology services for Melaka.
The Histopathology unit is concerned with the diagnosis by macroscopic and microscopic
examination of tissue. The Cytopathology unit involves the morphologic study of cells.
HISTOPATHOLOGY
B. SERVICES
a. Routine HPE
b. Frozen Sections
c. Renal/ muscle/ cone biopsies
d. Immuno-histochemistry, Immuno-fluorescence and special histochemistry staining
e. Autopsy specimen
C. REQUEST FORM
(i) All specimens are to be accompanied by a completed request form (PER–PAT 301) in
duplicate.
(ii) All request forms must be filled up completely and legibly.
(iii) Patient’s biodata with relevant clinical information to be written clearly and signed by a
doctor.
(iv) Previous histopathology and cytology number is required if other tissue or cytology
specimen have been sent from the patient.
(v) Requesting doctor’s name should be legibly written down together with a contact
number as a direct contact by phone can be made if it is urgent.
(vi) The name of the doctor / specialist / consultant who does the procedure / operation is
also required for easy communication.
(vii) If an early report on any specimen is required, the form should be indicated as such.
Please indicate on the request form where the results should be dispatched.
62
1. Routine surgical specimen for HPE

(i) Specimens collected should be fixed in 10% Neutral Buffered Formalin and must be
completely immersed in adequate fixative (approximately sample: fixative ratio of 1:10).
(ii) Specimen should be sent in wide mouth receptacles to prevent traumatizing the tissue.
(iii) Solid, large tumours and large lymph nodes that are anticipated to reach the laboratory
later than 2 hours should be cut into two for proper fixation.
2. Frozen section
(i) Test requested by appointment only. The specialist requesting the Frozen Section must
communicate and discuss the case with the pathologist on-call to make the appointment
at least 1 day before test.
(ii) Fresh tissues collected for frozen section should be placed in empty container or placed
on filter paper and packed in ice.
(iii) Specimen to be sent personally by the doctor to the histology laboratory immediately
and wait for the result.
(iv) Specimen to be labeled correctly, a direct contact phone number and surgeon’s name
must be written on the request form.
(v) Make sure that the contact line is available to ensure that the result can be informed.
(vi) Result of first specimen will be informed within 30 minutes after specimen received.
3. Renal biopsies / Skin Immuno-fluorescence

(i) Test requested by appointment only.
(ii) Specimen to be sent personally to the Histopathology laboratory.
(iii) Fresh tissue should be placed on wet filtered paper to prevent tissue from drying.
4. Specialized test
Tissues requiring any specialized tests for example tissue for electron microscopy should be sent in
proper fixatives using a standardized protocol and prior discussion with the pathologist.
5. Autopsy specimen
(i) Specimen that had been grossed and put in the cassette should be sent to the laboratory
together with the request form (PER-PAT 301).
(ii) Specimen to be sent personally by the staff of Forensic Department to the laboratory.
6. General specimen handling guideline

(i) All specimens must be labeled clearly with the patient’s name, age, registration number/
identification number, type of specimen and date of collection.
(ii) All specimens should bear the same identification as that written on the request forms.
(iii) Routine specimens can be sent anytime (during office hours) to the main counter of
Department of Pathology, Hospital Melaka.
63
(iv) Specimen from the operation theatre should be sent to the laboratory by 4.30 pm on the
same working day.
(v) Specimen collected after 5.00 pm can be sent to the laboratory main counter by 9.00 am
on the next working day.
7. Special handling of frozen section request for organ transplant

(i) Any request of frozen section for organ transplant, please contact MO / histopathologist
on-call.
(ii) Discuss the case with histopathologist on-call to fix the time for frozen section.
(iii) Doctor in-charged has to inform histopathologist before sending specimen to
Histopathology laboratory.
(iv) Label specimen correctly and fill up the request form (PER-PAT 301) completely with
surgeon’s name and contact number.
(v) Specimen to be sent personally by the doctor to the Histopathology laboratory
immediately and wait for the result.
64

volume
1. Capped tissue specimen HPE Resected tissue 10% Specimen to

container of various sizes Neutral fixative
Buffered ratio= 1:10
Formalin
2. Tissue Cassette Autopsy Grossed autopsy 10% Within

specimen specimen Neutral cassette
Buffered
Formalin
65
CYTOPATHOLOGY
B. SERVICES
(i) Gynaecological PAP Smear

(ii) Non-gynaecological smear
(iii) Fine Needle Aspiration for Cytology
C. REQUEST FORM
(i) All ‘Non-gynaecological’ and Fine Needle Aspiration Cytology specimens are to be
accompanied by a completed request form (PER–PAT 301) in duplicate.
(ii) All Gynaecological PAP smears are to be accompanied by a completed request form (PS
1/98-Pindaan 2007) in duplicate.
(iii) All request forms must be filled up completely and legibly.
(iv) Patient’s biodata with relevant clinical information to be written clearly and signed by a
doctor.
(v) Previous cytopathology and histology number is required if cytology or other tissue
specimen have been sent from the patient.
(vi) Requesting doctor’s name should be legibly written down together with a contact number as
a direct contact by phone can be made if it is urgent.
(vii) The name of the doctor / specialist / consultant who does the procedure / operation is also
required for easy communication.
(viii) If an early report on any specimen is required, the form should be indicated as such. Please
indicate on the request form where the results should be dispatched.
1. PAP Smear
(i) Specimen to be collected prior to bimanual examination.
(ii) Use an unlubricated speculum (If necessary only water may be used).
(iii) No douching or sexual intercourse prior to specimen collecting.
(iv) The end of the spatula is inserted into the cervical os and rotated through 360°.
(v) The specimen adhering to the spatula is spread evenly across a glass slide which has been
previously label in pencil or diamond pen with the patient’s name.
(vi) The slide must be spray fixed immediately or by immersion in 95% ethyl alcohol for a
minimum of 30 minutes after which it may be safely removed and stored dry at room
temperature.
(vii) Pap Smear/glass slide should be sent in a slide mailer to prevent damage.
2. Fine Needle Aspiration for Cytology (FNAC)

i) Surgeon Clinic
a) Breast Clinic:
Monday : 10.00 am - 1.00 pm
Wednesday : 10.00 am - 1.00 pm
b) Surgeon/Doctor from surgical unit will do FNAC in the Breast Clinic.
c) Consent for FNAC is the responsibility of the Surgeon/Doctor attending to the case.
66
ii) Other Clinic / Ward
a) Clinic / ward doctors / specialists requesting the FNAC must communicate and
discuss the case with the Pathologist / Cyto-technologist to make the appointment.
b) Kindly contact Ext: 2876 for an appointment.
c) FNAC clinic in the Department of Pathology will be held twice a week:
Tuesday : 10.00 am – 12.30 pm
Thursday : 10.00 am – 12.30 pm
d) Service is also provided to all other clinics (ENT, Surgical – Non-breast lesion) and
wards, by appointment only, during working hours.
e) The FNAC will be done by the pathologist / doctor in the FNAC’s room located in the
Department of Pathology.
f) Consent for FNAC is the responsibility of the pathologist / doctor attending to the
case.
iii) ‘Mobile FNAC’

a) Non-palpable lesions are done in Radiology Department by the Radiologist.
Appointment will be made through the Radiology Staff.
b) Bed-ridden patient from wards.
c) Consent for FNAC is the responsibility of the Radiologist or Ward’s Doctor attending
to the case.
3. Body fluid / CSF / Body Aspirate

i. Specimens are collected into sterile container and send to the laboratory immediately
for urgent processing.
ii. Specimen collected after 5.00 pm, must be refrigerated at 4˚C and sent to the laboratory
main counter by 9.00 am on the next working day.
iii. If the volume of body fluid is too large, a representative specimen can be sent in a sterile
container with the actual volume stated in the form.
4. Bronchial Washing and Gastric Aspirate

Specimen is collected in a sterile container and sent to the laboratory immediately for
processing.
5. Bronchial Brushing / Gastric Brushing

i. Brush should be rotated gently but rapidly on a small area of the slide and the smear is
then fixed in 95% ethyl alcohol immediately for at least 10 minute.
ii. Smears are sent to the laboratory immediately.
iii. All glass slides should be sent in a slide mailer to prevent damages.
6. Sputum
i. Morning specimen is required i.e. before breakfast after rinsing mouth with water.
ii. Deep cough specimen is required.
iii. Cough into a side mouth receptacle and dispatch immediately for processing.
iv. If there is a long delay, sputum can be collected into a container with 50% alcohol (15 –
20 ml) as fixative.
v. Three samples, if possible a few days apart, are required to eliminate false negative.
67
7. Discharge (Nipple Secretions)
i. Specimen should be collected by applying the slide directly to the nipple, followed by
immediate fixation/air-dried.
ii. All glass slides should be sent in a slide mailer to prevent damages.
8. Urine
i. A catheterized specimen is preferred.
ii. Collect random urine specimen direct into a clean container and dispatch to the
laboratory for processing.
iii. If there is a delay, collect it in an equal volume of 50% ethanol and dispatch.
Note: Use of fixative is not encouraged as it can cause changes in the specimen. It is highly
recommended that freshly collected specimen to be sent to the laboratory immediately.
9. Smears from Buccal Mucosa

i. Scrape the inside of the cheek firmly with a tongue depressor.
ii. Immediately spread the cells on a label glass slide using a single spreading motion.
iii. Immediately place the smear in 95% ethyl alcohol for fixation. Leave the smear in the
fixative and prolonged immersion is not harmful.
iv. All glass slides should be sent in a slide mailer to prevent damages.
10. General Specimen Handling Guideline

i. All specimens must be labeled clearly with the patient’s name, age, registration
number/identification number, type of specimen and date of collection.
ii. All specimens should bear the same identification as that written on the request forms.
iii. Specimen can be sent anytime (during office hours) to the main counter at Department
of Pathology, Hospital Melaka.
iv. Specimen should be sent to the laboratory by 4.30 pm on the same working day.
iv. Specimen collected after 5.00 pm, must be refrigerated at 4˚C and sent to the laboratory
main counter by 9.00 am on the next working day.
68

volume
1. Sterile container Cytology Urine; Nil Minimal -

Body Fluid; 10ml
Gastric Lavage;
Sputum;
CSF
2. Glass slide Pap Smear, Gynaecological Fixed in Smear:

Cytology and non- 95% ethyl 2/3 of slide
smear gynaecological alcohol
specimen
69
BLOOD
TRANSFUSION
SERVICES
70
BLOOD TRANSFUSION SERVICES
A. INTRODUCTION
The Blood Transfusion Service Hospital Melaka is the sole provider of blood and blood
component to Hospital Melaka as well as all district and private hospitals within the state. The Blood
Transfusion Service is responsible for collecting, processing and microbiology screening (Serology
and Nucleic Acid Testing) of all blood intended for transfusion.
B. SERVICES
The Blood Transfusion Laboratory Hospital Melaka offers a 24-hour service to provide blood and
blood components for elective and emergency transfusions of in- and out-patients.
Pre-transfusion tests offered are:
1) ABO & Rh (D) grouping
2) Red cell antibody investigation (Antibody screening/antibody identification)
3) Coomb’s test
4) Anti-D titre
5) Red cell phenotyping
6) Cross matching
The following services are also offered:

1)Investigation of all adverse transfusion reactions.
2)Investigation of discrepancy of forward and reverse grouping
3)Leucodepletion of red cells and platelets (selected patients only) by prior arrangement with
Specialist in-charge.
4)Irradiation of red cells and platelets (selected patients only) by prior arrangement with Pusat
Darah Negara.
5)Washed Red Cell (selected patients only) by prior arrangement with Specialist in-charge
Please refer to “TRANSFUSION PRACTICE GUIDELINES FOR CLINICIANS AND LABORATORY

PERSONNEL, National Blood Centre, Ministry of Health Malaysia”
C. REQUEST FORM
 Please use request form as “Appendix 36” for all the above test except for red cell
phenotyping, ABO and Rh (D) grouping, anti-D titre, Coomb’s test
 For red cell phenotyping, ABO and Rh (D) grouping, anti-D titre, Coom’b test, please use
PER- PAT 301 form (Appendix 1).
 In an event of transfusion reaction, please inform Blood Bank personnel for further
instruction.
ORDERING BLOOD FOR TRANSFUSION

To ensure patient safety,
i) The process of taking and labeling blood samples must be carried out as one process by one
person at the bedside. Only one patient at any one time till completion.
ii) The person who takes the blood sample must label the blood tube him or herself.
 For further details of blood ordering, please refer to Transfusion Practice Guidelines for
Clinical and Laboratory Personnel, National Blood Centre, Ministry of Health Malaysia
71
All patient samples must be in EDTA tube which is label appropriately. Volume of blood required for
each test is at least 2.0 ml.

volume
1. K2 EDTA GSH/GXM, ABO Blood K2 EDTA 2.0 ml

Rh D grouping,
Coomb’s test,
red cell
antibody
investigation,
anti-D titre, red
cell phenotyping
72
GUIDE FOR
TESTS/
SPECIMEN
CONTAINERS
AND TURN-
ROUND TIME
73
CHEMICAL
PATHOLOGY
(IN HOUSE)
74
NO TEST CONTAINER SPECIMEN VOLUME LTAT REMARKS / APPENDIX
1. 24hrs urine calcium 24 hr urine container 24 hr urine Min. 750 ml 1 day
2. 24hrs urine chloride 24 hr urine container 24 hr urine Min. 750 ml 1 day
3. 24hrs urine creatinine 24 hr urine container 24 hr urine Min. 750 ml 1 day
4. 24hrs urine phosphate 24 hr urine container 24 hr urine Min. 750 ml 1 day
5. 24hrs urine protein 24 hr urine container 24 hr urine Min. 750 ml 1 day
6. 24hrs urine potassium 24 hr urine container 24 hr urine Min. 750 ml 1 day
7. 24hrs urine sodium 24 hr urine container 24 hr urine Min. 750 ml 1 day
8. 24hrs urine urea 24 hr urine container 24 hr urine Min. 750 ml 1 day
9. 24hrs urine uric acid 24 hr urine container 25 hr urine Min. 750 ml 1 day
10. Alanine Amino Transferase Plain tube Blood 4.0 ml 4 hrs

(ALT/SGPT)
11. Albumin Plain tube Blood 4.0 ml 4 hrs
12. Albumin Creatinine Ratio/ Index Sterile Container Urine 20 ml 1 day 1st morning urine
13. Alkaline Phosphatase (ALP) Plain tube Blood 4.0 ml 4 hrs
14. Alpha-feto Protein (AFP) Plain tube Blood 4.0 ml 3 working days
75
15. Ammonia K2 EDTA Blood 2.5 ml STAT: 45 minutes Specimen must be sent in
Routine: 4 hrs ice.
16. Amylase Plain tube Blood 4.0 ml STAT: 45 minutes

Routine: 4 hrs
17. Aspartate Amino Transferase Plain tube Blood 4.0 ml 4 hrs

(AST/SGOT)
18. Beta Human Chorionic Plain tube Blood 4.0 ml 3 working days
Gonadotropin (B-hCG)
19. Bilirubin - Total & Direct Plain tube Blood 4.0 ml STAT: 45 minutes
Routine: 4 hrs
20. Blood Gas Analysis 1 ml syringes flushed with heparin Blood 1 ml Return to Specimen must be sent in
(pH, pCO2, pO2) attendant ice.
immediately
21. Body Fluids Biochemistry Sterile Container Body Fluid 2 ml 4 hrs

i) LDH, ii) Total Protein
22. BUSE: i) Urea, ii) Sodium, iii) Plain tube Blood 4.0 ml STAT: 45 minutes
Potassium, iv) Chloride Routine: 4 hrs
23. CA 125 Plain tube Blood 4.0 ml 3 working days
24. Calcium Plain tube Blood 4.0 ml 4 hrs
76
25. Cannabinoids / THC Sterile Container Urine 30 ml Screening :
3 working days
Confirmation:
5 working days
26. Cardiac Enzyme (CE): Plain tube Blood 4.0 ml 4 hrs

i) AST, ii) CK
27. Carcinoembryonic Antigen (CEA) Plain tube Blood 4.0 ml 3 working days
28. Chloride Plain tube Blood 4.0 ml STAT: 45 minutes

Routine: 4 hrs
29. Cholesterol,Total Plain tube Blood 4.0 ml 4 hrs
30. Cortisol (Blood) Plain tube Blood 4.0 ml 3 working days 8.00 am / 12.00 pm samples
31. C-Reactive Protein (CRP) Plain tube Blood 4.0 ml 4 hrs
32. Creatine Kinase (CK) Plain tube Blood 4.0 ml 4 hrs
33. Creatinine Plain tube Blood 4.0 ml 4 hrs
34. Creatinine Clearance Plain tube Blood 4.0 ml 1 day Urine must be accompanied
with patient’s blood
(creatinine)
35. CSF Biochemistry: i) Chloride, ii) Sterile Container CSF 2.5 ml STAT: 45 minutes
Total Protein, iii) Glucose 4 hrs
77
36. eGFR Plain tube Urine & Plasma 4.0 ml STAT: 45 minutes Sample needed plasma
4 hrs creatinine to calculate eGFR
37. Fasting Serum Lipid (FSL): Plain tube Blood 4.0 ml 4 hrs
i) Cholesterol, Total, ii) HDL-
cholesterol, iii) LDL- cholesterol,
iv) Triglyceride
38. Folate Plain tube Blood 4.0 ml 7 working days
39. Ferritin Plain tube Blood 4.0 ml 3 working days
40. Follicle Stimulating Hormone Plain tube Blood 4.0 ml 7 working days
(FSH)
41. Glucose Sodium Fluoride / Blood 4.0 ml STAT: 45 minutes

Disodium EDTA or Potassium Routine: 4 hrs
Oxalate + Sodium Fluoride
42. HbA1c K2 EDTA Blood 2.5 ml 4 working days
43. HDL-Cholesterol Plain tube Blood 4.0 ml 4 hrs
44. Inorganic Phosphates Plain tube Blood 4.0 ml 4 hrs
45. Iron Plain tube Blood 4.0 ml 4 hrs
78
46. Lactate Sodium Fluoride / Disodium EDTA Blood 2.5 ml STAT: 45 minutes Specimen must be sent in
or Potassium Oxalate + Sodium Routine: 4 hrs ice.
Fluoride
47. Lactate Dehydrogenase (LDH) Plain tube Blood 4.0 ml 4 hrs
48. Lithium Plain tube Blood 4.0 ml 7 working days Form: Therapeutic Drug
*Toxicity *STAT: 45 min Monitoring (TDM) Request
Form- MS ISO HM/ FAR 14
49. LDL-Cholesterol Plain tube Blood 4.0 ml 4 hrs
50. Liver Function Test (LFT): i) Total Plain tube Blood 4.0 ml 4 hrs If Total Bilirubin > 50
Bilirubin, ii) Direct Bilirubin, iii) mmol/L (adult)
Total Protein, iv) Albumin, v)
Globulin, vi) ALP, vii) ALT
51. Luteinizing Hormone (LH) Plain tube Blood 4.0 ml 7 working days
52. Magnesium Plain tube Blood 4.0 ml 4 hrs
53. Microalbumin Sterile Container Urine 5 ml 7 working days Fresh morning urine
54. Morphine / Opiate Sterile Container Urine 30 ml Screening:

3 working days
Confirmatory:
5 working days
55. Osmolality (Blood) Plain tube Blood 4.0 ml 4 hrs
79
56. Osmolality (Urine) Sterile Container Urine 20 ml 4 hrs
57. Paraquat Sterile Container Urine 20 ml STAT: 45 minutes

Routine: 4 hrs
58. Potassium Plain tube Blood 4.0 ml STAT: 45 minutes

Routine: 4 hrs
59. Progesterone Plain tube Blood 4.0 ml 7 working days
60. Prolactin Plain tube Blood 4.0 ml 7 working days
61. Protein Creatinine Ratio/Index Plain tube Urine Min. 750 ml 1 day 1st morning urine
62. Prostate Specific Antigen Plain tube Blood 4.0 ml 3 working days
(PSA), total
63. Renal Profile (RP): i) Urea, Plain tube Blood 4.0 ml 4 hrs
ii) Sodium, iii) Potassium, iv)
Chloride, v) Creatinine
64. Sodium Plain tube Blood 4.0 ml STAT: 45 minutes

Routine: 4 hrs
65. Testosterone Plain tube Blood 4.0 ml 7 working days
66. Thyroid Stimulating Hormone Plain tube Blood 4.0 ml 3 working days
(TSH)
80
67. Thyroid Stimulating Hormone Cord Blood 4.0 ml 3 working days National Congenital
(TSH) (New Born) Hypothyroidism Screening
form
68. Thyroxine, Free (FT4) Plain tube Cord Blood 4.0 ml 3 working days National Congenital
(New Born) Hypothyroidism Screening
form
69. Thyroxine, Free (FT4) Plain tube Blood 4.0 ml 3 working days
70. TIBC Plain tube Blood 4.0 ml 4 hrs
71. Total Protein Plain tube Blood 4.0 ml 4 hrs
72. Triglycerides Plain tube Blood 4.0 ml 4 hrs
73. Urea Plain tube Blood 4.0 ml STAT: 45 minutes

Routine: 4 hrs
74. Uric Acid Plain tube Blood 4.0 ml 4 hrs
75. Urine Biochemistry (Qualitative): Sterile Container Urine 20 ml STAT: 45 minutes

i) pH, ii) Specific gravity (SG), Routine: 4 hrs
iii) Leucocyte (Pus cells),
iv) Nitrite, v) Protein, vi) Glucose,
vii) Ketone, viii) Urobilinogen, ix)
Bilirubin, x) Red blood cells (RBC)
76. Urine Pregnancy Test Sterile Container Urine 2.0 ml 4 hrs Fresh morning urine
(Preferred)
77. Vitamin B12 Plain tube Blood 4.0 ml 7 working days
81
CHEMICAL
PATHOLOGY
(REFERRAL)
82
NO TEST SPECIMEN CONTAINER VOLUME (mL) LTAT REMARKS / APPENDIX
1. 17-OH Progesterone Serum Plain Tube 2.0 20 working days
24-hr urine
2. 5-Hydroxyilndoles Acid (5-HIAA) 24-hr Urine 10 ml 25% HCL 10 working days
collection
ACE (Angiotensin Converting

3. PRIVATE LABORATORY
Enzyme)
Whatmann 903
Dried Blood Spot
filter paper / Dry up filter paper 4 hrs at RT or
Acid Alpha Glucosidase enzyme or 1 ml Whole
4. Whole Blood in - 15 working days transport in 4°C for blood in EDTA.
(POMPE) Blood in
Paediatric Form : IEM Request Form
Paediatric EDTA
EDTA
Acylcarnitine & Acid Amino Whatmann 903 Dry up 4 hrs at RT

5. Dried Blood Spot - 3 working days
(Screening IEM) filter paper Form : IEM Request Form
Adrenocorticotropic hormone Pre-chilled Collect sample at 8 am. Send in ice box.

6. Plasma 2.0 14 working days
(ACTH) EDTA Freeze plasma immediately.
83
Keep cooled / refrigerated if > 24 hrs

Alagille Syndrome (JAG1) -
7. Blood EDTA 1-2 x 2.5 30 working days Form : Request Form for Molecular
Genetic Syndrome
Diagnostic Services
8. Alcohol (Ethanol) Serum Plain Tube 2.5 18 hrs
Sodium
Blood 5.0
Flouride
Alcohol / Ethyl Alcohol / Ethanol Sodium

9. Random Urine 5.0 10 Days Form : Kimia 15-Pin.1/2004
(Quantitative by GCFID) Flouride
Sodium
Ocular Fluid 5.0
Flouride
Specialist signature & Stamp needed.

Sent to laboratory immediately after
10. Aldosterone Plasma EDTA 2.5 30 working days blood collection. Laboratory person has
to centrifuge & Freeze plasma
immediately
84
Serum must be sent within 7 days after

11. Alpha-1-acid-glycoprotein Serum Plain Tube 3.0 7 days
collection

Alpha-1-Antitrypsin
12. Serum Plain Tube 1.0 10 working days collection
(phenotyping)
Form : IMR-Specific Proteins
Alpha-1-Antitrypsin
13. Serum Plain Tube 2.5 7 days
(Quantitation)

14. Alpha-2-Macroglobulin Serum Plain Tube 3.0 7 days
collection
15. Alpha Galactosidase Blood EDTA 6.0 20 working days IEM Request Form
85
Send together with plasma. Freeze

Sterile
CSF 0.5 10 working days sample. Transport frozen in dry ice*
Container
Form : IEM Request Form
Morning (fasting) OR 4 hrs after last

Lithium
Amino Acids (Amino Acids meal. Centrifuge and freeze
16. Plasma Heparin / Plain 2.0 10 working days
Disorder) immediately.Transport frozen in dry ice*
tube
After consultation only. Please contact

Sterile
Random Urine 2.0 10 working days IMR for appointment
Container
Screening:
Borang Permintaan Ujian Pengesahan
Amphetamine (Screening & Sterile 7 working days
17. Urine 10.0 Dadah dalam Air Kencing-PER
Confirmation) Container Confirmation:
(LABORATORY)-SS-301A
14 working days
18. Androsterodione Serum Plain Tube 2.5 30 working days

Angelman Syndrome (Genetic
Syndrome)
Diagnostic Services
86
Antidiuretic Hormone (ADH) /

20. PRIVATE LABORATORY
Arginine Vasopressin (AVP)

21. Apolipoprotein C III Serum Plain Tube 3.0 10 working days
collection
Sterile
22. Arsenic Urine 10.0 4 Weeks Form : Kimia 15-Pin.1/2004
Container
Serum Plain Tube 3.0
Sterile Serum must be sent within 7 days after

Beta-2-microglobulin CSF 1.0 – 2.0 7 days
23. Container collection
Sterile
Urine 20.0
Container
87
Whatmann 903
Dried blood spot
filter paper OR
Biotinidase enzyme activity / 1 ml Whole Dry up filter paper 4 hrs at RT
24. Whole Blood in - 5 working days
(BIOTIN) - (Screening IEM) Blood in Form : IEM Request Form
Paediatric
Paediatric EDTA
EDTA
25. C- Peptide Serum Plain Tube 2.5 14 working days
26. C1 Esterase Inhibitor PRIVATE LABORATORY
27. CA 15-3 Serum Plain Tube 2.5 2 days
28. CA 19-9 Serum Plain Tube 2.5 2 days
29. Caeruloplasmin Serum Plain Tube 2.5 7 days
88
Send in ice & Fasting sample at least 8

30. Calcitonin Serum Plain tube 4.0 14 days hrs
Lithium Freeze plasma. Transport frozen in dry

31. Carnitine (Total & Free) Plasma Heparin / Plain 2.0 5 working days ice*
tube Form : IEM Request Form
Specialist signature & Stamp needed.

Catecholamine (Dopamine, 24-hr Urine
32. 24-hr Urine 10 ml 25% HCL 30 working days Volume > 750 ml. For pH 5 - 6, adjust
Epinephrine, Norepinephrine) collection
pH to 2 - 4
Catecholamine (Dopamine, Specialist signature & Stamp needed.

33. Epinephrine, Norepinephrine) - Random Urine 5 ml 25% HCL 25.0 30 working days Paeds sample ONLY. For pH 5 - 6, adjust
Paediatric ONLY pH to 2 - 4
34. Cholinesterase Serum Plain Tube 2.5 1 day
Sterile
35. Citrate Random Urine 5.0 14 working days
Container
89
36. Copper Serum Plain tube 0.5 3 - 4 weeks
24-hr Urine
container 24-hr Urine
37. Copper 24-hr Urine 14 working days
without collection
preservatives
24-hr Urine
container 24-hr Urine
38. Cortisol (Urine) 24-hr Urine 14 working days
without collection
preservatives
39. Cryoglobulin Patient has to refer to Hospital Ampang
Must be accompanied with serum

CSF Electrophoresis/ Oligoclonal Sterile
40. CSF 1.0 30 days sample. Serum & CSF must be sent
band Container
within 7 days after collection
41. C-telopeptide / N-telopeptide PRIVATE LABORATORY
90
Therapeutic Drug Monitoring (TDM

42. Cyclosporine (Peak / Trough) Blood EDTA 2.5 18 hrs
Request Form) - HKL/JP/CT/PK-01-06
Sterile 7 working days

43. Cystine Random Urine 5.0 Protect from light. Freeze urine
Container Urgent : 2-3 days
Dehydroepiandrosterone
44. Serum Plain Tube 2.5 14 working days
Sulphate (DHEA-S)
Delta Amino Levulinic Acid (ALA) 24-hr Urine / 10 ml glacial 24-hr Urine Protect from light. Freeze urine.
45. 15 working days
- (IEM) Random acetic acid collection Form : IEM Request Form
46. Estradiol Serum Plain Tube 2.5 7 working days
Based on request by MO.

Form : Therapeutic Drug Monitoring
47. Everolimus Blood EDTA 2.5 18 hrs
(TDM Request Form) - HKL/ JP/CT/PK-
01-06
91
Post = 2days after 1st injection;

48. Fluconazole Blood EDTA 3.0 7 days Steady state = 4/5 days after daily
injection

Fragile X - Analysis (FmR) -
(Genetic Syndrome)
Diagnostic Services
Free Light Chain Serum must be sent within 5 days after

50. 7 days
(Kappa : Lambda Ratio) collection
Urine (Random / Sterile
20.0
24-hr) Container
51. Free PSA Serum Plain Tube 2.5 2 days

52. Fructosamine Serum Plain Tube 2.5 7 days
collection
92
53. FT3 (Tri-Iodothyronine Free ) Serum Plain Tube 2.5 7 working days
Whatmann 903
Dried blood spot
Galactose-1-phosphate filter paper OR
/ 1 ml Whole Dry up filter paper 4 hrs at RT
54. Uridylyltransferase (GALT / Whole Blood in - 5 working days
Blood in Form : IEM Request Form
G1PUT) Paediatric
Paediatric EDTA
EDTA (1 ml)
Gamma-glutamyl transferase
(GGT)
56. Gastrin PRIVATE LABORATORY
Glycosaminoglycan (GAG) / Freeze urine. Transport frozen in dry

Early morning Sterile
57. Mucopolysaccharides (MPS) - 5.0 10 working says ice*
Urine Container
(Lysosomal Storage Diseases) Form : IEM Request Form
58. Growth Hormone Serum Plain Tube 2.5 14 working days
93
59. Haptoglobulin Serum Plain Tube 2.5 7 days
Centrifuge immediately. Freeze plasma.

60. Homocysteine, Total - (SHOMO) Plasma EDTA 2.0 10 working says Transport frozen in dry ice*
Plain Tube in
61. Homocysteine, Total (Adult) Serum 2.5 20 working days
ice
Sterile 7 working days

62. Homocysteine - IEM Random Urine 5.0 Protect from light. Freeze urine.
Container Urgent: 2-3 days
Paeds
Centrifuge plasma immediately. Freeze
EDTA,Lithium
Inborn Error of Metabolism (IEM) Plasma & plasma & urine. Transport frozen in dry
63. Heparin & Plain - 10 working days
for Paediatric > 1 year old Random Urine ice*
Urine
Container
64. Insulin Serum Plain tube 2.5 14 working days
94
Insulin-like Growth Factor-1

(IGF-1)
Intact Parathyroid Hormone 20 - 25 working Fasting sample. Send sample in ice box.
66. Plasma EDTA 0.5
(i-PTH) days Freeze plasma immediately
67. Ketone Serum Plain Tube 2.5 7 working days
68. Lipase PRIVATE LABORATORY
69. Lipoproteins (A) Serum Plain Tube 2.5 20 working days
Lysosomal Storage Disorders Whatmann 903 Dry up 4 hrs at RT

70. Dried Blood Spot - 3 working days
Screening (LSDS) filter paper Form : IEM Request Form
95
24-hr Urine
71. Mercury 24-hr Urine 3 - 4 weeks
collection
0.2g sodium Urine must be sent within 5 days after

72. Myoglobin (Quantitative) Urine 10.0 14 days
bicarbonate collection
Freeze urine. Transport frozen in dry

Myoglobin / Haemoglobin Sterile
73. Random Urine 5.0 15 working days ice*
(UMYOHG) Container

Noonan Syndrome (PTPN11) -
Genetic Syndrome
Diagnostic Services

Oligosaccharides / Early morning Sterile
75. 5.0 15 working days ice*
Tetrasaccharides (OLIGO) Urine Container
Freeze urine immediately. Transport

Random Sterile
76. Organic Acid 5.0 5 working days frozen in dry ice*
(morning) Urine Container
96
Blood
Stomach Wash-
Sodium
77. Organophosphate out 5.0 4 Weeks Form: Kimia 15-Pin.1/2004
Flouride
Liquid Bile
Orosomucoid (Alpha-1-acid Serum must be sent within 7 days after

78. Serum Plain Tube 2.5 7 days
glycoprotein) collection

Sterile
79. Orotic Acid Urine 5.0 5 working days ice*
Container
Form: IEM Request Form
Sterile
80. Oxalate Random Urine 5.0 14 working days
Container
Sodium
81. Paraquat Blood 5.0 4 Weeks Form: Kimia 15-Pin.1/2004
Flouride
97
82. Plumbum / Lead Blood EDTA 3.0 4 weeks
Porphyrins / Porphobilinogen Sterile Protect from light.

83. Random Urine 5.0 5 working days
(POR) Container Form : IEM Request Form

Prader Willi / Angelman
Syndrome - (Genetic Syndrome)
Diagnostic Services

85. Prealbumin (Quantitative) Serum Plain Tube 2.5 7 days
collection
1. Requested Dr has to call Chemical

Pathologist HUKM, Diagnostic
Laboratory to make request.
2. Patient has to buy RM50.00 money
86. Pro-Calcitonin Serum Plain Tube 2.5
order.
3. Laboratory has to call HUKM
Diagnostic Laboratory to make an
appointment.
98
Serum must reach the laboratory (IMR)

not more than 7 days @ 2-8°C after
Serum Plain Tube 2.5 30 working days collection date
Form: Request Form for Multiple
Myeloma & Specific Proteins
Protein Electrophoresis
87.
Urine must be refrigerated after
Random / 24-hr
collection & must reach the laboratory
Urine but must
Plain Urine (IMR) not more than 5 days @ 2-8°C
be accompanied 25.0 30 working days
Container after collection
by 2.5ml Serum
Form: Request Form for Multiple
(Plain Tube)
Protect from light. Freeze urine.

88. Pterins 2.0 10 working days Transport frozen in dry ice*
Urine Container
Early morning Sterile 14 working days

89. Purine & Pyrimidine 5.0 Freeze urine
Urine Container Urgent: 2-3 days
Send sample in ice box. Laboratory has

4 ml 8%
90. Pyruvate (for Paediatric / Adult) Blood 2.0 ml 7 working days to call HKL, Paeds. Inst. Biochem to get
perchloric acid
perchloric acid tube and make
appointment.
99
Specialist signature & stamp needed.

Send to laboratory immediately after
91. Renin Plasma EDTA 2.5 30 working days blood collection. Laboratory person has
to centrifuge & Freeze plasma
immediately

92. S- Sulfocysteine (SSC) 2.0 15 working days ice*
Urine Container

Schinzel Giedion Syndrome
93. Blood EDTA 1-2 x 2.5 30 working days Form: Request Form for Molecular
(SETBP1)- Genetic Syndrome
Diagnostic Services

SCN 1A gene - (Neurogenetic
94. Blood EDTA 1-2 x 2.5 30 working days Form: Request Form for Molecular
Disorder)
Diagnostic Services
Sex Hormone Binding Globulin

(SHBG)
100
Early morning Sterile Freeze urine.Transport frozen in dry ice*

96. Sialic Acid (Total & Free) - (USA) 5.0 15 working days
Urine Container Form : IEM Request Form
Form : Therapeutic Drug Monitoring

97. Sirolimus Blood EDTA 2.5 18 hrs (TDM Request Form) - HKL/JP/CT/PK-01-
06

Spinal Muscular Atrophy (SMA) -
(Neurogenetic Disorder)
Diagnostic Services
Protect from light. Freeze urine.

99. Succinylacetone (SAC) 5.0 15 working days Transport frozen in dry ice*
Urine Container

100. Sulphite (Dipstick) 25.0 2-3 hrs Freeze urine
Urine Container
Form: Therapeutic Drug Monitoring

101. Tacrolimus Blood EDTA tube 2.5 18 hrs (TDM Request Form) - HKL/JP/CT/PK-01-
06
101
102. Thyroglobulin Serum Plain Tube 0.5 20 working days
Blood 3.0
Toxicology (Non Police Case) -

Urine Sodium 7.0
103. Screening for Basic Drugs in 4 weeks Form: Kimia 15-Pin.1/2004
Flouride
Blood by GCMS
Stomach Wash-
6.0
out
104. Transferrin (Quantitative) Serum Plain Tube 2.5 7 days
Serum must be sent within 7 days @

Transferrin Isoform for CDG 2-8°C after collection
Type I & Type II (Phenotyping) Form: Request Form for Multiple
Urine Metabolic Screening Sterile Freeze urine.Transport frozen in dry ice*

106. Random Urine 2.0 10 working says
(UTMS) - IEM only Container Form: IEM Request Form
102
Freeze plasma. Transport frozen in dry

Very Long Chain Fatty Acid Lithium
107. Plasma 2.0 10 working days ice*
(VLCFA) & Phytanic acids (IEM) Heparin / EDTA
108. Vitamin B3 PRIVATE LABORATORY
109. Vitamin D Serum Plain Tube 2.5 30 working days
110. Vitamin E PRIVATE LABORATORY

111. Zinc 4 weeks Form : Kimia 15-Pin.1/2004
Sterile
Urine 25.0
Container
103
MICROBIOLOGY
(IN HOUSE)
104
NO TEST CONTAINER SPECIMEN VOLUME LTAT REMARKS / APPENDIX UNIT
1. Acid Fast Bacilli (AFB) Direct Smear for Sterile Sputum, Pus, Urine, 2-5ml 24 hrs Form TBIS 20C Microbiology
MTB container Aspirate, Gastric lavage,
Dialysate, ETT, Body
Fluid
2. Air sampling Not applicable Not applicable Not 7 days Form PER PAT 301 (On Microbiology
applicable request by appointment)
3. Aspirate culture & sensitivity Sterile Aspirate 3-5ml 7 days Microbiology

container
4. Bacterial Antigen Test (BAT) Sterile CSF 1ml 2 hrs Microbiology

container
5. Biopsy culture & sensitivity Sterile Biopsy specimen Not 7 days Microbiology
container applicable
6. Blood buffy coat for gram stain EDTA tube Blood 5ml Daily Microbiology
7. Blood culture & sensitivity (Aerobic) Aerobic blood Blood 8-10ml 7 days Microbiology
bottle
8. Blood culture & sensitivity (Anaerobic) Anaerobic Blood 8-10ml 7 days Microbiology
blood bottle
105
9. Blood culture & sensitivity (Fungal) Myco F Lytic Blood 1-5ml 14 days Microbiology
blood bottle
10. Blood culture & sensitivity (Pediatric) Paeds blood Blood 1-3ml 7 days Microbiology
bottle
11. Blood culture & sensitivity for (MTB) Myco F Lytic Blood 1-5ml 21 days Form TBIS 20C Microbiology
blood bottle
12. Blood Film Malaria Parasites (BFMP) Thick/ Thin Film Blood Smear 24 hrs To send thick and thin film Microbiology
smear slide separately. Make
sure smear slide is dried
before send to the lab.
13. Blood Film Filariasis Parasites Thick Film Blood Smear 24 hrs To send thick film slide (time Microbiology
of sample collection only
from 12am to 6am). Make
sure smear slide is dried
before send to the lab.
14. Body fluid culture & sensitivity Sterile Pleural fluid, Peritoneal 2-5 ml 7 days Microbiology
container fluid, Broncho alveolar
lavage, Gastric lavage,
Ascites fluid, Pericardial
fluid, Dialysate,
Synovial/ Joint fluid
15. Bone culture & sensitivity Sterile Bone Not 7 days Microbiology
106
16. Catheter tips culture & sensitivity (only Sterile 2 inch of distal segment Not 7 days Microbiology
from central venous line) container of tips applicable
17. Cerebrospinal fluid (CSF) culture & Sterile Cerebrospinal fluid 1ml 7 days Form PER PAT 301 & Form Microbiology
sensitivity container QAP/CSF-1
18. Clostridium difficile toxin Sterile Stool Peanut size Daily Microbiology
container
19. Diphteria culture & sensititvity Charcoal/ Throat swab Not 7 days Microbiology
Stuart transport applicable
medium
20. Ear swab culture & sensitivity Charcoal/ Pus Not 7 days Microbiology
medium
21. Efficiency testing on autoclaves (Attest) Attest Attest Biological Not 5 days Microbiology
Indicator strip applicable
22. Environmental screen Not applicable Not applicable Not 7 days Form PER PAT 301 (By Microbiology
applicable appointment)
23. Eye swab culture & sensitivity Charcoal/ Eye swab Not 7 days Microbiology
medium
24. Fungal culture Sterile Tissue/ Hair/ Nail/ Skin/ Not 21 days Microbiology
container Sputum/ Fluid/ Urine/ applicable
Corneal scrapping/
Dialysate
107
25. Genital female culture & sensitivity Charcoal High vaginal/ Vaginal Not 7 days Microbiology
transport swab/ Endocervical applicable
medium (for swab
C&S)
26. Genital male culture & sensitivity Plain sterile Urethral swab Not 7 days Microbiology
swab(for FEME) applicable
Charcoal
transport
medium
27. In use testing Sterile Presep, Surgical scrub, 5ml 7 days Form PER PAT 301 (By Microbiology
container Germiseps schedule)
28. Milk culture & sensitivity Sterile Milk 5-10 ml 7 days Microbiology
container
29. Mycobacterium (MTB) culture & Sterile Sputum, Pus, Urine, 2-5ml 2 months Form TBIS 20C Microbiology
sensitivity container Aspirate, Gastric lavage,
Dialysate, ETT, Body
Fluid, CSF
30. Nasal swab culture & sensitivity (for Charcoal/ Swab Not 7 days Microbiology
MRSA carrier only) Stuart transport applicable
medium
31. Pus culture & sensitivity (Anaerobic) Sterile Pus 3ml 7 days To send immediately to the Microbiology
container laboratory
108
32. Pus swab culture & sensitivity (Aerobic) Charcoal/ Pus Not 7 days Microbiology
medium
33. Rectal swab culture & sensitivity Sterile Rectal swab Not 7 days Microbiology
34. Respiratory culture & sensitivity Sterile Sputum 3ml 7 days Microbiology
container
35. Secretion for culture & sensitivity Sterile ETT/ Tracheal 3-5ml 7 days Microbiology
container
36. Sputum culture & sensitivity Sterile Sputum 3-5 ml 7 days Microbiology
container
37. Sterility testing culture & sensitivity Instrument in Not applicable Not 14 days Microbiology
wrapping/ applicable
actual pack
38. Stool culture & sensitivity (Salmonella, Sterile Stool 1/4 of 7 days Microbiology
Shigella, Vibrio cholerae) container container
volume
39. Stool for ova & cyst Sterile Stool 1/4 of Daily Microbiology
container container
volume
40. Stool for Rotavirus/ Adenovirus Antigen Sterile Stool 1/4 of Daily Microbiology
container container
volume
109
41. Stool for Salmonella (CONTACT) Selenite F broth Rectal swab 1/4 of 7 days Microbiology
container
volume
42. Stool for Shigella (CONTACT) Selenite F broth Rectal swab 1/4 of 7 days Microbiology
container
volume
43. Stool for Vibrio cholerae (CONTACT) Alkaline Rectal swab 1/4 of 7 days Microbiology
Peptone Water container
volume
44. Throat swab culture & sensitivity Charcoal/ Throat swab Not 7 days Microbiology
medium
45. Tissue culture & sensitivity Sterile Tissue Not 7 days To send immediately to the Microbiology
container applicable laboratory
Thioglycolate Tissue (anaerobic)
transport
medium
(request from
the laboratory)
Stuart Tissue (aerobic)
Transport
Medium
46. Urine culture & sensitivity (included Sterile Urine 3-5ml 7 days Microbiology
microscopy) container
47. Urine ME for dysmorphic RBC Sterile Urine 3-5ml Daily Microbiology
container
110
MICROBIOLOGY
(REFERRAL)
111
1. Anaerobe Identification & Anaerobic Blood NA 1 week Hosp. Sg. Buloh Microbiology
Sensitivity blood bottle
*Transport in ambient temperature
2. Aspergillus Antigen Detection Plain tube Serum 1-2 ml 1-2 days Hosp. Sg. Buloh Microbiology
(Galactomannan)
*Transport in ice (2-8°C)
3. Bacterial Meningitis PCR Sterile CSF Minimum 2-3 days Hosp. Sg. Buloh Microbiology
container/ 500µl = 20-
Falcon tube 30 drops *Transport in ice (2-8°C)
Plain tube Serum 3-5ml
EDTA tube Plasma 3-5ml
4. Bordetella pertussis PCR Dacron swab in Pernasal swab / NA 1 week IMR, KL. Microbiology
Stuart’s Nasopharyngeal swab
transport *Transport in ice (2-8°C)
media
Sterile Nasopharyngeal 1-2 ml

container aspirate
(falcon tube)
112
5. Brucella PCR Blood in EDTA Blood 5ml 1 week IMR, KL Microbiology
* Form:
(IMR/IDRC/BACT/BRUCE/01-
IMR)
6. Candida Antigen Detection Plain tube Serum 1-2 ml 1-2 days Hosp. Sg. Buloh Microbiology
(Mannan)
7. Cryptosporidium/Isospora/ Sterile Stool 1/4 of 1-2 days IMR, KL Microbiology

Microsporidium container container
volume *Transport in ice (2-8°C)
8. Fungal DNA PCR EDTA tubes Blood/ CSF / Bone 2-3 ml 1 week Microbiology
marrow (bloody)
IMR, KL
Sterile Sterile body fluid: Not specific 1 week
container CSF, bronchial lavage, *Transport in ambient temp. For
tissue, Bone marrow delayed spec, keep at 2-8°C.
(trephine), sinus
aspirate.
9. Fungal (Yeast) Identification & NA Slant/ Isolate from culture NA 1-2 weeks Hosp. Sg. Buloh Microbiology
Sensitivity Culture plate plate
*Transport in ambient temp.
113
10. Fungal (Candida) Antibiotic NA Slant/ Only from sterile NA 1-2 weeks Hosp. Sg. Buloh Microbiology
Sensitivity Test Culture plate culture specimen
*Transport in ambient temp.
11. Legionella Antigen Detection Sterile Urine 3-5ml 1-2 days Hosp. Sg. Buloh Microbiology
container
12. Malaria PCR EDTA tube Blood 2-5 ml 1 week IMR, KL Microbiology
13. Mycobacterium culture & sensitivity Sterile Sputum/ Aspirate/ NA 2-3 months MKAK Sg. Buloh Microbiology
container Urine/ Body fluid/ Pus/
Dialysate/ ETT/ Gastric *(Form TBIS 20C)
lavage *Transport in ice (2-8°C)
Sterile Bone NA 2-3 month MKAK Sg. Buloh
container
*(Form TBIS 20C)
Sterile Tissue/ Slough/ Skin NA 2-3 month MKAK Sg. Buloh
container
*(Form TBIS 20°C)
Sterile Bone marrow NA 2-3 month MKAK Sg. Buloh
container (trephine)
*(Form TBIS 20C)
114
14. Mycobacterium culture & sensitivity Myco F Lytic Blood/ Dialysate/ Bone 1-5 ml 1-2 months MKAK Sg. Buloh Microbiology
(BACTEC) (BACTEC marrow
Bottle) *(Form TBIS 20C)
15. Mycobacterium culture & sensitivity Sterile Sputum/ Aspirate/ 2-5 ml 1-2 months MKAK Sg. Buloh Microbiology
(MGIT) container Body fluid/
*(Form TBIS 20C)
16. Tibi LPA (Line Probe Assay) for MDR Sterile Sputum, Pleural 3-5 ml 1 week MKAK Sg. Buloh Microbiology
Detection container effusion, Bronchial
aspirate *(Form TBIS 20C)
*Test criteria:
- At least result AFB Direct
smear 1+ from previous
pulmonary sample.
- Need to call lab before send
sample
17. Tibi PCR Universal Sputum/ CSF/Pus 1-2ml 1 week MKAK Sg. Buloh Microbiology
sterile Tissue/ Other Body
container fluids *(Form TBIS 20C)
115
18. Tibi Gene Xpert Universal Sputum/ Body Fluid 3-5 ml 1 week IPR, KL Microbiology
Sterile
container *Transport in ice (2-8°C)
* Test criteria:
- Test requested only by
Respiratory Physician.
- Need to call laboratory before
send sample.
19. Streptococcus pneumococcal Sterile Urine 3-5ml 1 week Hosp. Kuala Lumpur Microbiology
Antigen Detection container
116
SEROLOGY
(IN HOUSE)
117
1. Anti –ds DNA Plain tube Blood 5 ml 5 working days PER-PAT 301
2. Anti- HCV Plain tube / EDTA / Blood 5 ml 3 working days PER-PAT 301
lithium heparin
3. Anti-Nuclear Antibody IF Plain tube Blood 5 ml 5 working days PER-PAT 301

(ANA)
4. Anti Streptolysin O Titre Plain tube Blood 5 ml 1 working day PER-PAT 301
(ASOT)
5. Chlamydia trachomatis IF Do smear on slide Swab from cervix, urethra, N/A 3 working days PER-PAT 301
eye
6. CMV IgG/ IgM Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
Lithium heparin
7. Cryptococcus neoformans Plain tube Blood 5 ml 1 day PER-PAT 301

antigen
Sterile container CSF 2 ml
8. Dengue COMBO Rapid Test Plain tube Blood 5 ml 1 hour Laboratory Request Form for
(preliminary Dengue and Flavivirus
report) (Appendix 11)
9. Dengue EIA (IgG / IgM) Plain tube Blood 5 ml 3 working days Laboratory Request Form for
Dengue and Flavivirus
(Appendix 11)
118
10 Extractable Nuclear Antibody Plain tube Blood 3 ml 7 working days PER-PAT 301
(ENA):
i. Anti – Jo 1
ii. Anti – U1RNP antibodies
iii. Anti – Scl – 70
iv. Anti – Sm
v. Anti – SSA/ R0
vi. Anti – SSB/ La
vii. Anti-Centromere
11. Hepatitis B Surface Antigen Plain tube / EDTA / Blood 5 ml 3 working days PER-PAT 301
(HBsAg) Lithium heparin
12. Hepatitis B Surface Antibody Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
(HBsAb) Lithium heparin
13. Hepatitis B e Antigen (HBeAg) Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
Lithium heparin
14. Hepatitis B e Antibody Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
(HBeAb) Lithium heparin
15. Hepatitis B core Total Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
Antibody (HBc Total Ab) Lithium heparin
16. Hepatitis C RNA PCR Plain tube / EDTA Blood 5 ml / 2.5 ml 10 working PER-PAT 301
days
17. HIV Antibody (Rapid Test) Plain tube Blood 4 - 5 ml 1 hour PER-PAT 301
(preliminary
report)
119
18. HIV Antigen / Antibody Plain tube / EDTA / Blood 4 - 5 ml 4 working days PER-PAT 301
Lithium heparin
19. Leptospira Rapid Test Plain tube Blood 4 - 5 ml 1 working day MKAK Laboratory Request
Form
(Form Appendix 21)
20. MERS-CoV (Real Time RT-PCR) Sterile container Sputum, Nasopharyngeal N/A 1 working day Laboratory Request Form for
aspirate, ETT secretion, BAL Novel Coronavirus
Investigation
VTM Nasopharyngeal swab N/A (Form Appendix 12)
21. Mycoplasma pneumoniae Plain tube Blood 4 - 5 ml 2 working days PER-PAT 301
22. Pneumocystis carinii (PCP) Sterile container Induced sputum N/A 3 working days PER-PAT 301
Falcon tube BAL
23. Respiratory Virus Screening Sterile container Sputum, Nasopharyngeal N/A 3 working days PER-PAT 301
(RVS) aspirate, ETT secretion
24. Rheumatoid Factor (RF) Plain tube Blood 5 ml 1 working day PER-PAT 301
25. Rapid Plasma Reagin (RPR) Plain tube Blood 5 ml 1 working day PER-PAT 301
120
26. Rubella IgG / IgM Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
Lithium heparin
27. Seminal Analysis Sterile container Seminal fluid 5 ml 10 working PER-PAT 301
days
28. Toxoplasma IgG / IgM Plain tube / EDTA / Blood 5 ml 5 working days PER-PAT 301
Lithium heparin
29. Treponema Pallidum Particle Plain tube Blood 5 ml 2 working days PER-PAT 301
Agglutination Test (TPPA)
30. Zika Virus PCR Plain tube Blood / Umbilical cord 5 ml 2 working days Laboratory Request Form for
Dengue and Flavivirus
(Form Appendix 11)
Sterile container Urine 15 ml
Falcon Tube CSF 2 ml
121
SEROLOGY
(REFERRAL)
122
1. Acute Flaccid Paralysis (AFP) / Sterile container Stool 10 gm 14 working * Procedure of taking & packaging, refer
Polio virus days Guideline for Sample Collection
*IMR
(Form Appendix 13)
2. Adenovirus PCR VTM Throat Swab, NA 7 working days MKAK Sg. Buloh
Nasopharyngeal
Swab
Falcon tube Nasopharyngeal

Aspirate, ETT
Secretion, Lower
respiratory Fluid
3. Amoeba Serology Plain tube Blood 2.5 ml 5 working days IMR
4 Amoeba PCR EDTA Blood 2.5 ml 7 working days IMR
Sterile Container Pus / Aspirate / N/A 7 working days IMR

Biopsy / Scrapings
5. Anti-Acetycholine Receptor Plain tube Blood 5 ml 21 working IMR
days
6. Anti-Aquaporin 4 Plain tube Blood 5 ml 7 working days IMR
7. Anti-Beta-2-Glycoprotein-1 Plain tube Blood 5 ml 10 working IMR

days
123
8. Anti Cardiolipin IgM / IgG Plain tube Blood 5 ml 10 working IMR

days
9. Anti Cyclic Citrulinated Peptides Plain tube Blood 5 ml 14 working IMR
(Anti CCP) days
10. Anti-Glomerular Basement Plain tube Blood 5 ml 10 working IMR
Membrane (GBM) days
11. Anti-HCV Confirmation Plain tube Blood 5 ml 14 working HKL
days
12. Anti-HIV Confirmation Plain tube Blood 5 ml 14 working HKL
days
13. Anti-Thyroid Microsomal Plain tube Blood 5 ml 7 working days HKL
Antibody (AMC)
14. Anti-Thyroglobulin Antibody Plain tube Blood 5 ml 7 working days HKL
(ATG)
15. Anti-N-Methyl-D-Aspartate Plain tube Blood 5 ml 7 working days IMR
Receptor (NMDAR)
16. Anti – Neutrophil Cytoplasmic Plain tube Blood 5 ml 14 working IMR
Antibodies: days
i. C-ANCA
ii. P-ANCA
iii. Myeloperoxidase (MPO)
iv. Proteinase 3 (PR3)
17. Anti-Parietal Cells Antibody Plain tube Blood 5 ml 14 working IMR

days
124
18. Anti – RNP Antibody Plain tube Blood 5 ml 14 working IMR

days
19. Anti-TSH Receptor Antibody Plain tube Blood 5 ml 14 working *Request by Endocrine Specialist
days *HKL
20. Avian Influenza VTM Nasal swab / N/A 14 working IMR

(preferred Nasal Swab / NPA / Throat swab / days
Respiratory Secretion) Nasopharyngeal
swab
Falcon tube ETT aspirate / NPA
Plain tube Blood 5 ml
21. Bartonella Antibody Plain tube Blood 5 ml 5 working days IMR
22. BK Virus PCR EDTA tube Blood 2.5 ml 2 working days Hosp. Sg. Buloh
(PER-PAT 301; 3 copies)
Falcon tube Urine N/A
23. Borrelia burgdorferi IgG / IgM Plain tube Blood 5 ml 2 working days Hosp. Sg. Buloh
(LYME disease) (PER-PAT 301; 3 copies)
24. Brucella Antibody Plain tube Blood 5 ml 5 working days IMR
(Form Appendix 14)
125
25. Brucella PCR EDTA tube Blood 3 ml 5 working days IMR

(Form Appendix 14)
26. Chlamydia pnemoniae Antibody Plain tube Blood 5 ml 3 working days HKL
IgM
27. Coeliac Antibodies: Plain tube Blood 5 ml 21 working IMR

i) Anti - Gliadin days
ii) Anti-Tissue Transglutaminase
iii) Anti - Endomysium
28. Chikungunya Plain tube Blood 5 ml 5 working days IMR
29. CMV PCR EDTA tube Plasma 5 ml/ min 2 working days Hospital Sg. Buloh
0.3 ml (PER-PAT 301; 3 copies)
Falcon tube CSF
Sterile container Tissue/BAL N/A
30. CMV Culture Sterile container Urine N/A 28 working IMR

days
31. Complement C3, C4 Plain tube Blood 3 ml 2 working days HKL
32. Coxiella burnetti Antibody Plain tube Blood 5 ml 2 working days Hospital Sg. Buloh
33. Cysticercosis / Taeniasis Plain tube Blood 2.5 ml 5 working days IMR
126
34. Dengue PCR Plain tube Blood 5 ml 5 working days IMR
35. Dengue Serotyping Plain tube Blood 5 ml 7 working days MKAK Sg Buloh
(Form Appendix 11)
Sterile container Organ biopsies 1.5 cm cube
in a few
drops VTM
36. Diabetes Antibodies: Plain tube Blood 5 ml 14 working IMR
i. Anti-Glutamic Acid days
Decarboxylase (GAD)
ii. Anti-Insulinoma-
Associated Antigen 2
(IA2)
iii. Anti-Islet Cells (ICA)
iv. Anti-Insulin G
37. Echinococcosis Serology Plain tube Blood 2.5 ml 5 working days IMR
38. Enterovirus Culture Sterile container Stool 5g / pea size 7 working days MKAK Sg. Buloh
(Eg. Coxsackie A16, Coxsackie (Form Appendix 25)
A24, Coxsackie B, Enterovirus VTM Rectal Swab / N/A
70, Enterovirus 71, Echovirus Vesicle Swab /
and Poliovirus) Throat Swab /
Ulcer swab
Falcon tube CSF / Pleural fluid 3 ml

in few drops
VTM
127
39. Enterovirus RT-PCR Sterile container Stool 5g / pea size 7 working days MKAK Sg. Buloh
(Eg. Pan Entero & EV 71) (Form Appendix 25)
VTM Rectal Swab / N/A
Vesicle Swab /
Throat Swab /
Ulcer swab
Falcon tube CSF / Pleural fluid 3 ml

in few drops
VTM
40. EBOLA Virus PCR Plain tube Blood 5 ml 3 working days *Procedure of taking & packaging refer
Guideline For Sample Collection
*MKAK
41. EBV PCR EDTA tube Blood 2.5 ml 2 working days Hospital Sg. Buloh
Falcon tube CSF 3 ml
42. Epstein Barr Virus IgG Plain tube Blood 5 ml 7 working days HKL
43. Epstein Barr Virus IgM Plain tube Blood 5 ml 3 working days HKL
128
44. Gangliosides antibodies: Plain tube Blood 5 ml 14 working IMR

i. Anti-GM1 days
ii. Anti-GM2
iii. Anti-GM3
iv. Anti-GM4
v. Anti-GD1a
vi. Anti-GD1b
vii. Anti-GD2
viii. Anti-GD3
ix. Anti-GT1a
x. Anti-GT1b
xi. Sulfatide
xii. Anti-GQ1b
45. Hanta Virus IgM Plain tube Blood 5 ml 2 working days Hospital Sg. Buloh
46. Hepatitis A IgM / IgG Plain tube Blood 5 ml 2 working days HKL
47. Hepatitis B Core IgM Ab Plain tube Blood 5 ml 2 working days HKL
48. HBV – DNA PCR Viral Load Plain tube Blood 5 ml 7 working days *Request by Gastrohepatologist
(Quantitative) *HKL
49. HCV – RNA PCR Genotyping Plain tube Blood 5 ml 7 working days *Request by Gastrohepatologist
(Quantitative) *HKL
129
50. HFMD VTM Throat swab, N/A 7 working days MKAK Sg Buloh
Vesicle swab, (Form Appendix 25)
Rectal swab
Sterile container Stool 10 mg
51. HIV Drug Resistant EDTA tube Blood 5 ml 40 working IMR

days (Form Appendix 15)
52. HIV PCR (DNA) EDTA tube Blood 2.5 ml 5 working days IMR
(Form Appendix 16)
53. HIV RNA Viral Load EDTA tube Blood 5 ml 14 working HSAJB
days (PER-PAT 301; 2 copies)
54. HLA typing (Molecular Class I EDTA tube Blood 6 ml / 15 ml 10 working *Procedure of taking & packaging refer
and II) for bone marrow and days Guideline for Sample Collection
solid organ transplantation *IMR (Appendix 17a & 17b)
HLA Cross Matching Plain tube Blood Patient: * Procedure of taking & packaging refer
5 ml Guideline for Sample Collection
*IMR (Appendix 18a & 18b)
Sodium Heparin Blood Donor:
18 ml
HLA Antibody Plain tube Blood 10 ml 20 working *IMR

days (Form Appendix 18c)
130
55. H1N1 (death case) Sterile container Liver N/A 5 working days IMR
Sterile container Liver, Lung
56. H7N9 PCR Falcon tube Nasopharyngeal N/A 2 working days *Should inform to Clinical
aspirate (NPA) / Microbiologist before sending a sample
Nasopharyngeal * IMR
wash (NPW) / BAL / (Form Appendix 19)
Endotracheal tube
aspirate (ETT)
VTM Nasopharyngeal /
Nasal / Throat
swab
57. HHV6 DNA PCR EDTA Blood 5 ml 2 working days Hosp. Sg Buloh
(Quantitative) (PER-PAT 301;3 copies)
58. HHV6 DNA PCR Falcon tube CSF 5 ml 2 working days Hosp. Sg Buloh
(Quantitative) (PER-PAT 301; 3 copies)
59. HSV I & II – IgG Plain tube Blood 3-5 ml 7 working days HKL
60. HSV I & II – IgM Plain tube Blood 4-5 ml 3 working days HKL
61. HSV I & II PCR EDTA tube Blood 2.5 ml 2 working days Hospital Sg. Buloh
131
62. HSV I & II PCR Falcon tube CSF 2 ml 2 working days Hospital Sg. Buloh
63. HSV I & II PCR Sterile container Tissue / BAL N/A 2 working days Hospital Sg. Buloh
64. HTLV I & II – Antibody Screening Plain tube Blood 3 – 5 ml 1 – 2 working Hospital Sg. Buloh
ELISA (Total Antibody) days (PER-PAT 301; 3 copies)
65. Indirect Immunoperoxidase for Plain tube Blood 4 – 5 ml 5 working days PER-PAT 301
Rickettsial (IIP)
66. IIF (Pemphigus vulgaris) Plain tube Blood 5 ml 7 working days HKL
67. Influenza-Like Illnes (ILI) VTM Nasopharyngeal / N/A 7 working days MKAK Sg Buloh
Nasal / Throat (Form Appendix 20)
swab
Falcon tube Nasopharyngeal N/A

aspirate (NPA) /
BAL / Endotracheal
tube aspirate (ETT)
68. Immunoglobulin G / M / A / E Plain tube Blood 5 ml 10 working IMR

(Paediatric) days
69. Immunoglobulin G / M / A Plain tube Blood 5 ml 10 working IMR
(Adult) days
70. Total Immunoglobulin E (IgE) Plain tube Blood 5 ml (Adult) 5 working days IMR
test 3 ml (Infant)
71. Specific Immunoglobulin E (IgE) Plain tube Blood 5 ml 5 working days IMR
132
72. Japanese Encephalitis IgM Plain tube / Falcon Blood / CSF 5 ml 7 working days MKAK Sg Buloh
tube
73. Legionella IgM / IgG Plain tube Blood 5 ml 5 working days MKAK Sg Buloh
74. Leishmaniasis Serology Plain tube Blood 2.5 ml 5 working days IMR
75. Leishmaniasis Microscopic EDTA tube Blood 2.5 ml 3 working days *Send within 24 hours
*IMR
76. Leishmaniasis PCR EDTA tube Blood 2.5 ml 7 working days *Need appointment
*Send within 24 hours
*IMR
Sterile container Tissue / Skin N/A 7 working days *Send within 24 hours
scraping *IMR
77. Leptospira Antibody IgM (MAT) Plain tube Blood 5 ml 10 working MKAK Sg Buloh
78. Leptospirosis Culture Plain tube Blood 5 ml 21 working IMR

EMJH Urine 5 ml
(Obtained from IMR)
133
79. Leptospirosis PCR EDTA tube Blood 2.5 ml 5 working days IMR
(Form Appendix 22)
Sterile container Sterile body fluid N/A
(CSF, BAL, tissue
biopsies / post
mortem samples)
80. Measles IgM & IgG Plain tube Blood 5 ml 7 working days MKAK Sg. Buloh
(Form Appendix 23)
81. Measles Virus Isolation Falcon tube Nasopharyngeal N/A 7 working days MKAK Sg. Buloh
secretion (Form Appendix 23)
Sterile container Urine N/A
VTM Throat swab N/A
82. Measles RT-PCR Falcon tube Nasopharyngeal N/A 7 working days MKAK Sg. Buloh
secretion (Form Appendix 23)
Sterile container Urine N/A
VTM Throat swab N/A
83. Melioidosis (Antibody) Plain tube Blood 2 ml 5 working days IMR
84. Microfilaria Microscopic EDTA tube Blood 2.5 ml 3 working days *Blood taken between 6pm - 12am &
send within 24hours
*IMR
Slide box / folder 60 µl thick blood 1 slide
film
134
85. Microfilaria PCR EDTA tube Blood 2.5 ml 7 working days *Blood taken between 6pm - 12am &
send within 24 hours
*IMR
86. Microfilaria Serology Plain tube Blood 2 ml 1 working day IMR
87. Mumps IgM Plain tube Blood 5 ml 7 working days HKL
88. Mumps IgG Plain tube Blood 5 ml 3 working days HKL
89. Nipah Virus IgM/IgG Plain tube Blood 5 ml 14 working IMR

days
90. Nipah Virus IgM/IgG Falcon tube CSF 1-3 ml 14 working IMR
days
91. Panel Reactive Antibody Test Plain tube Blood 5 ml 10 working IMR
(PRA) days (Form Appendix 18c)
92. Paraneoplastic Neurological Plain tube Blood 5 ml 14 working IMR
Syndrome (PNS) Test: days
i. Anti –Hu
ii. Anti – Ri
iii. Anti – Yo
iv. Anti – Ma
v. Anti –Amphiphysin
vi. Anti – CV2
93. Parvovirus-B19 IgG Plain Tube Blood 5 ml 7 working days HKL
94. Parvovirus-B19 IgM Plain Tube Blood 5 ml 3 working days HKL
135
95. Parvovirus PCR Plain tube Blood 5 ml 7 working days MKAK Sg. Buloh
96. Primary Immunodeficiency EDTA tube Blood 2.5 ml 5 working days * Procedure of taking & packaging refer
Disease (PID): Guideline for Sample Collection
*IMR
i) T & B cell Subset (Form Appendix 24)
Enumeration
ii) Immunoglobulin & Plain tube Blood 5 ml 10 working
Complement Quantitation days
iii) Dihydrorhodamine test EDTA tube Blood 2.5 ml

(DHR) for Chronic
granulomatous disease.
97. Rabies Virus Antigen IF Sterile Container Brain biopsy, 5 - 6 mm 5 working days *Consult by Clinicians / Doctors before
Neck biopsy; sending in the samples
(10 hair follicle *IMR
from nape of the
neck).
** Place samples
on saline-soaked
gauze.
98. Rabies Virus Isolation Sterile Container Brain biopsy, 5 to 6 mm 14 - 28 working *Consult by Clinicians / Doctors before
Neck biopsy; days sending in the samples
from nape of the
neck).
** Place samples
on saline-soaked
gauze.
136
99. Rabies Virus Isolation Sterile Container Saliva 3 ml 14 - 28 working *Consult by Clinicians / Doctors before
days sending in the samples
*IMR
100. Rabies Virus Isolation Falcon Tube CSF 3 ml 14 - 28 working *Consult by Clinicians / Doctors before
days sending in the samples
*IMR
101. Rabies Virus Nucleic Acid Sterile Container Brain biopsy, 5 to 6 mm 5 working days *Consult by Clinicians / Doctors before
RT-PCR Neck biopsy; sending in the samples
from nape of the
neck).
** Place samples
on saline-soaked
gauze.
102. Rabies Virus Nucleic Acid Sterile Container Saliva 3 ml 5 working days *Consult by Clinicians / Doctors before
RT-PCR sending in the samples
*IMR
103. Rabies Virus Nucleic Acid Falcon Tube CSF 3 ml 5 working days *Consult by Clinicians / Doctors before
RT-PCR sending in the samples
*IMR
104. SARS VTM Nasopharyngeal N/A 28 working IMR
swab days
Falcon tube Nasopharyngeal
aspirate (NPA) /
BAL/ Endotracheal
tube aspirate (ETT)
137
105. SARS Sterile container Urine N/A 28 working IMR

days
106. Skin Antibodies: Plain tube Blood 5 ml 14 working IMR

i. Anti-BP 180 days
ii. Anti-BP 230
ii. Anti-Desmoglein 1, 3
107. Specific Immunoglobulin E Plain tube Blood 5 ml 5 working days IMR

(RAST)
108. Specific Liver Antibodies: Plain tube Blood 5 ml 14 working IMR
i. Anti-AMA-M2 days
ii. Anti-M2-3E/BPO
iii. Anti-Sp100
iv. Anti-PML
v. Anti-gp120
vi. Anti-LKM1
vii. Anti-LC-1
viii. Anti-SLA/LP
ix. Anti-Ro-52
x. Anti-M2
138
109. Tissue Antibody Test: Plain tube Blood 5 ml 14 working IMR

i. Anti-Gastric Parietal days
ii. Anti-Smooth Muscle
iii. Anti-Mitochondrial
iv. Anti-Liver-Kidney
v. Microsome antibodies
110. Toxocariasis Serology Plain tube Blood 2.5 ml 5 working days IMR
111. Trichinellosis Serology Plain tube Blood 2.5 ml 5 working days IMR
112. Trypanosomiasis Microscopic EDTA tube Blood 2.5 ml 3 working days *Send within 24 hours
*IMR
Slide box / folder Biopsy lymph node, 1 slide
bone marrow film
113. Trypanosomiasis PCR EDTA tube Blood 2.5 ml 7 working days *Need appointment
*Send within 24 hours
*IMR
139
114. VDRL CSF Sterile container CSF 3 ml 7 working days HKL
115. Varicella Zoster (VZV) IgG Plain tube Blood 5 ml 7 working days HKL
116. Varicella Zoster (VZV) IgM Plain tube Blood 5 ml 3 working days HKL
117. Varicella Zoster (VZV) PCR EDTA tube Blood 5 ml 2 working days Hospital Sg. Buloh
Sterile container BAL N/A
118. Viral Respiratory Infections VTM Nasal swab / N/A 14 working MKAK Sg. Buloh
(Culture) Throat Swab / days
e.g. Adenovirus, Influenza, Nasopharyngeal
Parainfluenza, RSV swab
Falcon tube Nasopharyngeal N/A
aspirate (NPA) /
BAL / Endotracheal
tube aspirate (ETT)
119. Viral Study Sterile container Autopsy specimen N/A 28 working IMR
(e.g liver, heart, days
lung)
120. Viral Study Falcon tube CSF 2 ml 28 working IMR

days
140
HAEMATOLOGY
(IN HOUSE)
141
1. Apt Test Sterile container Gastric Lavage 3.0mL 6 hours
2. *Bone Marrow Direct smear Marrow 10 slides 7 days By appointment

Aspiration
3. *CD4 / CD8 K2 EDTA Blood 2.0mL 3 days Must be sent on Monday or

Wednesday
4. D-Dimer 3.2% trisodium citrate Blood 2.0mL Urgent: 1 hour Need approval from Pathology
Non-urgent: 4 hours Medical Officer (Ext 2859)
5. ESR 3.8% trisodium citrate Blood 1.2mL 6 hours Daily (office hours)
6. *Factor VIII 3.2% trisodium citrate Blood 2.0mL 3 days By appointment
7. *Factor IX 3.2% trisodium citrate Blood 2.0mL 3 days By appointment
8. *Factor Inhibitors Assay 3.2% trisodium citrate Blood 2 x 2.0mL 2 weeks By appointment
9. Fibrinogen 3.2% trisodium citrate Blood 2.0mL Urgent: 1 hour

Non-urgent: 4 hours
10. Full Blood Count (FBC) K2 EDTA Blood 2.0mL Urgent: 45mins
Non-urgent: 4 hours
11. *Full Blood Picture K2 EDTA Blood 2.0mL Urgent: 3 days Preferable office hours. Urgent
(FBP) Non-urgent: 7 days FBP (after office hour) need
approval from Pathology MO
142
12. G6PD screening Filter paper Blood size of 20 cent 1 day

or coin
K2 EDTA 2.0mL
13. *Haemoglobin Analysis K2 EDTA Blood 2 x 2.0mL 6 weeks
14. *Kleihaeur Test K2 EDTA Blood 2.0mL 2 days By appointment
15. *Lupus Anticoagulant 3.2% trisodium citrate Blood 2 x 2.0mL 3 weeks Need approval from Pathologist /
(LA) Medical Officer (Ext 2857 / 2868)
16. *Mixing study 3.2% trisodium citrate Blood 2 x 2.0mL 2 days Need approval from pathologist.
Sample must be sent to the
laboratory before 2 pm.
17. *NAP Score Fresh finger prick Blood 5 slides 2 days By appointment
18. *Osmotic Fragility Test Lithium heparin & Blood 5.0mL 2 days By appointment
(OFT) EDTA Blood 2.0mL For paediatric cases, send
together with parents’ samples
19. PT / APTT 3.2% trisodium citrate Blood 2.0mL Urgent: 60 mins

Non-urgent: 4 hours
20. *Urine Haemosiderin Sterile screw cap Urine 10mL 2 days By appointment
container
*Specialized tests 143

HAEMATOLOGY
(REFERRAL)
144
1. Acute Myeloid EDTA Blood / BMA 2 x 2.0ml 30 days IMR

Leukaemia Mutation Form:
Studies MOLECULAR ANALYSIS FOR LEUKAEMIA
(FLT3, NPMI, CEBPA, C- (Date of issue -31/7/2013)
KIT, CBFB/MYHII, - Must be accompanied with unstained bone
RUNXI/RUNXITI) marrow slide, FBC, BMA and immunophenotyping
reports.
2. ADAMTS-13 3.2% trisodium citrate Blood 1 x 2.0ml 4-8 weeks Hospital Ampang
(Plasma) (batch test) Form:
HOSPITAL AMPANG SPECIAL HAEMATOLOGY
LABORATORY REQUISITION
(HA:HEMA2015-2 8/3/15)
- Must be requested / authorized by a
Haematologist.
- To contact Haematology laboratory Hospital
Ampang prior to sample collection.
3. Anti-Xa 3.2% trisodium citrate Blood 1 x 2.0ml 1 day Hospital Ampang

(Plasma) Form:
HOSPITAL AMPANG SPECIAL HAEMATOLOGY
(HA:HEMA2015-2 8/3/15)
- To contact Haematology laboratory Hospital
Ampang prior to sample collection.
145
4. BCR-ABL1 EDTA Blood / BMA 2 x 2.0ml 4 weeks IMR

QUALITATIVE Form:
(CML case only) MOLECULAR ANALYSIS FOR LEUKAEMIA
At Diagnosis (Date of issue -31/7/2013)
- Must be accompanied with 1 unstained smear of
sample.
5. BCR-ABL1 EDTA BMA 2 x 2.0ml 8 weeks Hospital Ampang

(Chronic / acute Form:
leukaemia) HOSPITAL AMPANG SPECIAL HAEMATOLOGY
Follow up cases Blood 5 x 2.0ml LABORATORY REQUISITION
(HA:HEMA2015-2 8/3/15)
- Please state BCR-ABL1 fusion transcript subtype
(eg: b2a2, b3a2 or e1a2)
6. Blood cytogenetic
(Down, Patau, Edwards,
Turner, Klinefelter,
William, Cri Du Chat,
Prader Willi, DiGeorge,
Smith-Magenis,
Angelman, Miller-dieker
and Wolf-Hirschhom
Syndrome)
i. Conventional Lithium heparin Blood 1 x 5.0ml 30 working HKL

Cytogenetic (5.0 mL) days Form: HKL/HA/TPM/N-1-(1)
-to get appointment from Genetic Laboratory HKL
ii. Molecular EDTA Blood 1 x 2.0ml 14 working prior to sample collection.
Cytogenetic days
146
(If negative
molecular
result, LTAT
will be as
conventional
cytogenetic)
7. Bone marrow Sodium heparin BMA 1 x 4.0ml 18 days IMR

chromosome analysis Form:
for Haemato-Malignant Blood 2 x 4.0ml BONE MARROW CYTOGENETIC FORM
Disease (WBC >10,000 VERSION 4.1 (23/5/2014)
WBC/mL & at
least 20% 14 days Hospital Ampang
blasts) Form:
CYTOGENETIC REQUISITION FORM (HEMA-
CYTOGEN 08-01 V05)
8. Chromosome Breakage Lithium heparin 1. Blood 2 x 5.0ml 18 days IMR

Study for Fanconi’s Form:
anaemia 2. Control 2 x 5.0ml BONE MARROW CYTOGENETIC FORM
blood VERSION 4.1 (23/5/2014)
(matched for - To get appointment from Genetic laboratory
age and sex) IMR.
- Patient must not be on any antibiotic in 2 weeks
preceding blood collection.
147
9. CML Mutation Study EDTA BMA / Blood 2 x 2.0ml 30 days IMR

(BCR-ABL T315I) Form:
MOLECULAR ANALYSIS FOR LEUKAEMIA
(Date of issue -31/7/2013)
- Must be accompanied with 1 unstained smear of
sample
10. DNA analysis for EDTA Blood Adult: 30 days IMR

Thalassaemia 1 x 2.0ml Form:
Syndromes i) DNA Ana for Thal Synd & Hbpathy(s) REQform,
Paeds: Haematology Unit, CaRC IMR (VERSION 3.0)
1 x 0.5ml ii) IMR/CaRC/HAEM/22/2203/03(1)/REQForm
- DNA analysis for Beta Thalassemia, variant
haemoglobin and alpha thalassemia for further
testing.
- All paeds sample must be accompanied with
parents’ samples.
11. Factor assays 3.2% trisodium citrate Blood 3 x 2.0ml 2 days PDN
(FII, FV, FVII, FVIII, FIX, (Plasma) Form: PDN/HA/QP-01/01
FX, FXI, FXII, FXIII)
1 day (urgent Hospital Ampang
request) Form:
HOSPITAL AMPANG SPECIAL HEMATOLOGY
2 days (normal LABORATORY REQUISITION
request) (HA:HEMA2015-2 8/3/15)
12. Factor Inhibitors assay. 3.2% Blood 3 x 2.0ml 2 days PDN

(Bethesda assay) trisodium citrate (Plasma) Form: PDN/HA/QP-01/01
148
13. FISH for BCR-ABL1 Sodium heparin Blood / BMA 1 x 4.0ml 7 days IMR
Form:
BONE MARROW CYTOGENETIC FORM
VERSION 4.1 (23/5/2014)
14. FISH for Haemato- Sodium heparin Blood / BMA 1 x 4.0ml 14 days Hospital Ampang
Oncology Form:
CYTOGENETIC REQUISITION FORM (HEMA-
CYTOGEN 08-01 V05)
15. FISH for PML-RARA Sodium heparin Blood / BMA 1 x 4.0ml 7 days IMR
Form:
BONE MARROW CYTOGENETIC FORM
VERSION 4.1 (23/5/2014)
16. G6PD assay EDTA Blood Adult: 7 days HKL

(Quantitative) 1 x 2.0ml Form: PER PAT301
Paeds: -Recent reticulocyte count is required.

1 x 0.5ml
149
17. Immunophenotyping EDTA BMA / Blood 2 x 2.0ml Verbal: 2 days HKL

for Leukaemia / Formal: 10 Form: PER PAT301 (2 copies)
Lymphoma days - Accompanied with 1 unstained smear.
(Haemato-oncology)
2 days Hospital Ampang
Form:
(HA:HEMA2015-2 8/3/15)
- Accompanied with 1 unstained smear.
18. Immunophenotyping EDTA Blood 2 x 2.0ml 10 days HKL

for PNH (CD55 & CD59) Form: PER PAT301 (2 copies)
2 days Hospital Ampang

Form:
(HA:HEMA2015-2 8/3/15)
19. JAK2 EDTA Blood / BMA 2 x 2.0ml 8 weeks Hospital Ampang

Form:
(HA:HEMA2015-2 8/3/15)
- Accompanied with 1 unstained smear of sample.
150
20. Leukaemia EDTA BMA / Blood 2 x 2.0ml 10 days IMR

Translocation Studies Form:
MOLECULAR ANALYSIS FOR LEUKAEMIA
(Date of issue -31/7/2013)
- Accompanied with 1 unstained smear of sample.
21. Molecular / DNA EDTA Blood 1 x 2.0ml 60 days HKL

Analysis for Alpha Form:
Globin Gene i) DNA Ana for Thal Synd & Hbpathy(s) REQform,
Haematology Unit, CaRC IMR (VERSION 3.0)
ii) IMR/CaRC/HAEM/22/2203/03(1)/REQForm
22. Molecular Genetic for EDTA Blood 2 x 2.0ml 3 – 6 months Paediatric Institute HKL
congenital anomaly Form: HKL/HA/TPM/N-1-(1)
i) Duchene Muscular
Dystrophy - To get appointment from Genetic Molecular
(Dystrophine Gene) laboratory HKL prior to sample collection.
ii) Muenke Syndrome
(FGFR3 gene)
iii) Rett Syndrome
(MECP2 gene)
23. Molecular Analysis for 3.2% trisodium citrate Blood Index case: 4 weeks PDN
Haemophilia - New case: Form:
4 x 2.0ml 1) PDN/HA/QP-01/01
- Known case: 2) Molecular Analysis for Haemophilia, Date of
3 x 2.0ml issue: 31-07-2013
Cascade: 3) PDN Consent form
3 x 2.0ml
151
24. Platelet serology / Blood 14 days PDN

Antibody (MAIPA) a) Mother:
1. EDTA 5 x 2.0ml Form: PDN/HA/QP-01/01
2. Plain tube 2 x 4.0ml
b) Father: EDTA 5 x 2.0ml
c) Baby: EDTA 1 x 2.0ml

25. PML-RARA EDTA BMA 2 x 2.0ml 10 weeks Hospital Ampang
Follow-up cases (at follow-up) Form:
(HA:HEMA2015-2 8/3/15)
- Please state PML-RARA fusion transcript subtype
(eg: L-form-BCR1, S-form-BCR3 or Variant BCR2)
26. RUNXI / RUNXITI EDTA BMA 2 x 2.0ml 6 weeks Hospital Ampang

Follow-up cases (at follow-up) Form:
(HA:HEMA2015-2 8/3/15)
27. Serum Erythropoietin Plain tube Blood 1 x 4.0ml 90 days Hospital Ampang
(serum) Form:
(HA:HEMA2015-2 8/3/15)
- Haemolysed/lipemic specimens are not suitable.
- By appointment at least 2 days before sample
delivery.
152
28. Thrombophilia 3.2% trisodium citrate Blood (Plasma) 6 x 2.0ml 14 days Hospital Ampang
screening: (including for Form:
i. Anti cardiolipin lupus HOSPITAL AMPANG SPECIAL HEMATOLOGY
ii. Anti Beta2 anticoagulant) LABORATORY REQUISITION
Glycoprotein 1 (HA:HEMA2015-2 8/3/15)
iii. Protein S
iv. Protein C 14 days PDN
v. Anti-thrombin Form: PDN/HA/QP-01/01
vi. APCR
(lupus anticoagulant
testing done in Hosp.
Melaka)
29. Von Willebrand Study: 3.2% trisodium citrate Blood (Plasma) 3 x 2.0ml 1 day Hospital Ampang
i. vWF Antigen (urgent Form:
ii. vWF Activity request) HOSPITAL AMPANG SPECIAL HEMATOLOGY
iii. vWF:Ricof LABORATORY REQUISITION
iv. Collagen Binding 2 days (normal (HA:HEMA2015-2 8/3/15)
Assay request)
14 days PDN Form: PDN/HA/QP-01/01
153
ANATOMICAL
PATHOLOGY
(IN HOUSE)
154
1. Autopsy specimen Tissue Cassette Grossed specimen 2-4 weeks (upon request)
2. HPE (Frozen section) Capped container Fresh specimen on Within 30 minutes from By appointment via phone at least 1 day
filter paper in empty the time specimen before test. Result by phone.
container and pack in received till result of first
ice sample informed.
3. HPE (Renal biopsy / Capped container Fresh specimen on 1 week By appointment via phone at least 1 day
Skin filter paper in empty before test.
Immunofluorescence container and pack in
Specimen) ice
4. HPE (Surgical Capped container Resected tissue Formalin to Urgent (small biopsy):
specimen) specimen specimen ratio- 3 days
10:1 Urgent (big biopsy):
2 week
Routine: 6 weeks
5. Pap Smear Fixed, thin smear Pap Smear - Urgent: 3 days Form: PS1/98 pindaan 2007 in duplicate
prepared on glass slide Routine: 28 working days
6. Fine Needle Aspirate Smear Aspirate Urgent: 3 days By appointment

Cytology (FNAC) Routine: 2 weeks
7. Body Fluid for Sterile, screw capped Pericardial, Urgent: 3 days

Cytology bottle Peritoneal, Ascetic, Routine: 2 weeks
Pleural, etc.
8. Body / Nipple Fixed, thin smear Body discharge Urgent: 3 days
Discharge prepared on glass slide Routine: 2 weeks
for Cytology or sterile, screwed
capped bottle
155
9. Bronchial Brushing Fixed, thin smear Bronchial Brushing Urgent: 3 days
for Cytology prepared on glass slide Routine: 2 weeks
10. Bronchial Washing Sterile, screw capped Bronchial Washing 10 ml Urgent: 3 days
for Cytology bottle Routine: 2 weeks
11. Buccal smear Fixed, thin smear Buccal Urgent: 3 days

for Cytology prepared on glass slide Scrape Routine: 2 weeks
12. Cerebrospinal fluid Sterile, screw capped CSF Urgent: 3 days

(CSF) for Cytology bottle
13. Gastric Lavage Sterile, screw capped Stomach 10 ml Urgent: 3 days

for Cytology) bottle Washout Routine: 2 weeks
14. Sputum for Cytology Wide mouth, sterile, Sputum Urgent: 3 days
screwed capped bottle Routine: 2 weeks
15. Urine for Cytology Urine FEME Container Urine 10 ml Urgent: 3 days
Routine: 2 weeks
156
ANATOMICAL
PATHOLOGY
(REFERRAL)
157
1. HPE (Muscle specimen) Dry clean Resected fresh - 3-4 weeks By appointment.
bottle muscle tissue Refer to UMMC.
2. EGFR Mutation Study - 10 unstained - 2-4 weeks Unit Genetic, Hospital Kuala
tissue slides Lumpur
3. HER2 In-Situ Hybridization - Paraffin - 6-8 weeks Hospital Kuala Lumpur

embedded tissue
block
4. KRAS - 10 unstained - 2-4 weeks Unit Genetic, Hospital Kuala
tissue slides Lumpur
158
BLOOD
TRANSFUSION
SERVICES
(IN HOUSE)
159
REMARKS /
NO TEST CONTAINER SPECIMEN VOLUME LTAT UNIT
APPENDIX
1. ABO & Rhesus K2 EDTA Blood 2.0ml Within 1 working day Transfusion
(D) grouping Medicine
2. Group Screen & Hold (GSH) K2 EDTA Blood 2.0ml Within 4 hours Transfusion
Medicine
3. Antibody K2 EDTA Blood 8ml-10ml Within 3 working days (2nd Opinion to Transfusion
identification (4 tube K2 PDN KL, TAT 2 – 4 Medicine
EDTA- 2.0 ml weeks)
each)
4. Anti-D titre K2 EDTA Blood 2.0ml Within 1 working day Transfusion

Medicine
5. Cross matching K2 EDTA Blood 2.0ml 2 hours Transfusion

Medicine
6. Coomb’s test K2 EDTA Blood 2.0ml Within 3 working days Transfusion

Medicine
7. Red cell phenotyping K2 EDTA Blood 2.0ml Within 1 working day Transfusion
Medicine
160
REFERENCE
RANGES
161
CHEMICAL
PATHOLOGY
162
NO BLOOD TESTS CATEGORY LOWER UPPER UNIT REFERENCE TEST METHOD
1. Alanine Amino 10 49 U/L ALT Modified IFCC
Transferase Instruction for
(ALT/SGPT) Use
2. Albumin (ALB) 32 48 g/L ALB BCG Dye Binding

Instruction for
Use
3. Alkaline 45 129 U/L ALP Modified IFCC

Phosphatase (ALP) Instruction for
Use
4. Alpha-feto Protein Male 0 6.6 IU/mL AFP CMIA
(AFP) Instruction for
Female 0 6.6 Use
5. Ammonia (AMM) 11.2 35.4 µmol/L AMM Enzymatic

Instruction for
Use
6. Amylase (AMY) 30 118 U/L AMY Ethylidene Blocked-
Instruction for pNPG7
Use
7. Aspartate Amino <34 U/L AST Modified IFCC

Transferase Instruction for
(AST/SGOT) Use
8. Bilirubin – Direct ≤5.1 µmol/L DBIL Vanadate Oxidation

(DBIL) Instruction for
Use
9. Bilirubin – Total <21.0 µmol/L TBIL Vanadate Oxidation

(TBIL) Instruction for
Use
10. CA 125 Male 0 35 U/mL CA125 CMIA

Female Instruction for
Use
11. Calcium (CA) 2.18 2.60 mmol/L CA Arsenazo III

Instruction for
Use
12. Carcinoembryonic Non smoker 0 2.5 µg/L CEA CMIA

Antigen (CEA) Instruction for
Smoker 0 5 Use
163
13. Chloride (CL) 99 109 mmol/L CL Ion Selective
Instruction for Electrode (ISE),
Use Diluted
14. Cholesterol (CHOL) Low <5.2 mmol/L CHOL Enzymatic

(desirable) Instruction for
Moderate 5.2 6.2 Use
(borderline)
High ≥6.2
15. Cortisol COR CMIA

Serum nmol/L Instruction for
(7 - 9 am) 118.6 618.0 Use
Serum
(3 - 5 pm) 85.3 459.6
16. Creatinine (CREA) Male 62 115 µmol/L CREA Jaffe, Alkaline

Instruction for Picrate, Kinetic with
Female 44 97 Use Blank Rate
Correction
17. Creatine Kinase Male 32 294 U/L CK NAC Activated, IFCC
(CK) Female 33 211 Instruction for
Use
18. C-Reactive Protein Adults 0 5.0 mg/L CRP Latex Enhanced
(CRP) Instruction for Immuno
Newborns, <0.6 Use turbidimetric
Cord Blood
Infants, <1.6
4days-
1month
19. Ferritin Male 48 708 pmol/L FER CMIA

Female 22 640 Instruction for
Use
20. Follicle Stimulating Male IU/L CMIA
Hormone (FSH) 2-3 yo 0.3 1.3
4-9 yo 0.4 2.0
10-12 yo 0.4 4.6
12-21 yo 1.4 7.5
>21 yo 1.4 18.1
Female
Follicular
Phase 2.5 10.2
Midcycle Peak 3.4 33.4
Luteal Phase 1.5 9.1
Post- 23 116.3
menopausal
Female Not
164
(pregnant) detected 0.3
2-3 yo 1.3 5
4-9 yo 0.5 5
10-12 yo 1.4 9.3
12-21 yo 2.2 10.1
21. Folate (FOL) Normal >12.9 nmol/L FOL CMIA

Indeterminate 7.64 12.9 Instruction for
Deficient 0.79 7.63 Use
22. Glucose Adults, <11.1 mmol/L Tietz Hexokinase

Random
Adults,
Fasting 4.1 5.9
Newborns,
Fasting
1 day 2.2 3.3
>1 day 2.8 4.4
Children,
Fasting 3.3 5.6
23. HbA1c <6.5 % NGSP Immunoassay

Turbidimetric
24. HDL-Cholesterol Low <1.0 mmol/L HDL Elimination/Catalase

(HDL) (Undesirable, Instruction for
High Risk) Use
High ≥1.6
(Desirable,
Low Risk)
25. Inorganic 0.78 1.65 mmol/L PHOS Phosphomolybdate/

Phosphate (PHOS) Instruction for UV
Use
26. Iron (FE) Male 10.6 28.3 µmol/L Roche Fe Ferrozine

(Hitachi/ Modular
Female 6.6 26.0 P) Product Insert
27. Lactate (LAC) 0.5 2.20 mmol/L LAC Lactate Oxidase,

Instruction for Colorimetic
Use
165
28. Lactate 120 246 U/L LDH Lactate/NAD
Dehydrogenase Instruction for
(LDH) Use
29. Lithium 0.3 1.2 mmol/L Tietz Ion Selective

Electrode (ISE),
Direct Measurement
30. Luteinising Male IU/L CMIA

Hormone (LH) 2-3 yo 0.07
4-9 yo 0.07 0.4
10-12 yo 0.07 2.9
13-20yo 1.0 7.1
21-70 yo 1.5 9.3

>70 yo 3.1 34.6
Female
Follicular
Phase 1.9 12.5
Midcycle Peak 8.7 76.3
Post-
menopausal 15.9 54
2-3 yo 0.07
4-9 yo 0.07 0.2
10-12 yo 0.07 11.8
12-21 yo 1 52.2
31. Magnesium (MG) 0.53 1.11 mmol/L MG Xylidyl Blue
Instruction for
Use
32. Osmolality (Serum) 275 300 Mmol Advanced Freezing point

Micro depression
/kg Osmometer
33. Potassium Adults 3.5 5.1 mmol/L Roche Ion Selective

Diagnostics Electrode (ISE),
GmbH 2008 Diluted
34. Progesterone Male 0.9 3.9 nmol/L CMIA

Female
Follicular
Phase 4.45
Post- Not 2.3
menopausal Detected
<12 yo 0.7 5.5
13-21 yo 0.7 39.4
166
35. Prolactin (PRL) Male 45 375 uIU/mL PRL CMIA
Female Instruction for
Non pregnant 59 619 Use
Pregnant 206 4420
Post-
menopausal 38 430
36. Protein, Total (TP) 57 82 g/L TP Biuret

Instruction for
Use
37. Prostate Specific Male 0 4 ug/L PSA CMIA

Antigen (PSA) Instruction for
Use
38. Sodium Adults 136 145 mmol/L Roche Ion Selective

Diagnostics Electrode (ISE),
GmbH 2008 Diluted
39. Total Beta-Human Male 0 10 U/L ThCG CMIA

Chorionic Instruction for
Gonadotropin Female 0 10 Use
(ThCG)
40. Testosterone Male 8.4 28.7 nmol/L TESTO CMIA
Instruction for
Female 0.5 2.6 Use
41. Thyroxine, Free Cord blood <15 pmol/L National CMIA

(FT4) Congenital
Hypothyroidism
Program
Guideline
1-23 mth 12.1 18.6 FT4

2-12 yr 11.1 18.1 Instruction for
13-18 yr 10.7 18.4 Use
>18 yr 11.5 22.7
42. Thyroxine Cord blood mIU/L National CMIA
Stimulating (Normal) <21 Congenital
Hormone (TSH) Borderline 21 60 Hypothyroidism
High >60 Program
Guideline
2-<12 yr 0.64 6.27 TSH

12-<18 yr 0.51 4.94 Instruction for
>18 yr 0.55 4.78 Use
167
43. Total Iron Binding 44.8 76.1 µmol/l TIBC Sequential Release
Capacity (TIBC) Instruction for and Uptake of Iron
Use
44. Triglycerides Normal <1.70 mmol/L TG GPO-Trinder without

Borderline Instruction for Serum Blank
High 1.70 2.25 Use
High 2.26 5.64
Very High ≥5.65
45. Urea (UN) 3.2 8.2 mmol/L UN Urease with GLDH

Instruction for
Use
46. Uric Acid Male 220 547 µmol/L UA Uricase / Peroxidase

Instruction for
Female 184 464 Use
47. Vitamin B12 156 672 pmol/L VITB12 CMIA

Instruction for
Use
48. Arterial Blood
Gases (ABG)
i) pH 7.35 7.45 - Radiometer Potentiometric
ii) pCO2 Male 35 48 mmHg Radiometer Potentiometric

Female 32 45
iii) pO2 83 108 mmHg Radiometer Amperometric
iv) ctHb Male 13.5 17.5 g/dL Radiometer Optical

Female 12.0 16.0
v) SO2 95 99 % Radiometer Optical
cHCO3 21 28 mmol/L Radiometer Optical
49. URINE
Drug of Abuse
(DOA)
i) Cannabinoids cut off 50 ng/ml guideline on Immunoassay

Screening DOA 2002
ii) Cannabinoids cut off 25 ng/mL guideline on TLC
TLC DOA 2002
iii) Morphine cut off 300 ng/ml guideline on Immunoassay
Screening DOA 2002
168
iv) Morphine cut off 200 ng/ml guideline on TLC
TLC DOA 2002
50. Urine ≤650 U/L AMY Ethylidene Blocked-
Amylase/Diastase Instruction for pNPG7
Use
51. Urine <30 mg/L µALB PEG-enhanced

Microalbumin Instruction for Immuno-
(µALB) Use turbidimetric
52. 24hrs Urine Adults 2.50 8.00 mmol/ Ca Product o-Cresolphthlaein

Calcium 24H Insert complexone
Paeds mmol/kg
/24H
53. 24hrs Urine 110 250 mmol/ CL Instruction Ion Selective

Chloride 24H for Use Electrode (ISE),
Diluted
54. 24hrs Urine Male 7.1 17.7 mmol/ CREA Jaffe, Alkaline
Creatinine 24H Instruction for Picrate, Kinetic with
Female 5.3 15.9 Use Blank Rate
Correction
55. 24hrs Urine Adults 12.9 42.0 mmol/ PHOS Phosphomolybdate/

Phosphate 24H Instruction for UV
Use
56. 24hrs Urine Adults 25 125 mmol/ Roche Ion Selective

Potassium 24H Diagnostics Electrode (ISE),
GmbH 2008 Diluted
57. 24hrs Urine Normal <0.15 g/day Standardisation Dye Binding

Protein of Creatinine
Trace Assay, eGFR
Proteinuria 0.15 0.44 Reporting and
Laboratory
Overt Investigation of
Proteinuria >0.44 Chronic Kidney
Disease
58. 24hrs Urine Adults Roche Ion Selective

Sodium (Male) 40 220 mmol/ Diagnostics Electrode (ISE),
(Female) 27 287 24H GmbH 2008 Diluted
59. 24hrs Urine Adults 430 710 mmol/ PHOS Urease with GLDH
Urea 24H Instruction for
Use
169
60. 24hrs Urine Adults 1.48 4.43 mmol/ UA Uricase / Peroxidase
Uric Acid 24H Instruction for
Use
61. Urine Albumin Normal mg/ Standardisation

Creatinine Ratio (Male) <2.5 mmol of Crea. Assay,
(Female) <3.5 eGFR Reporting
Microalbumin and Laboratory.
-uria (Male) 2.5 30 Investigation of
(Female) 3.5 30 CKD
Macroalbumi- >30
nuria
62. Urine Protein Normal <15 mg/ Standardisation

Creatinine Ratio mmol of Crea. Assay,
Trace eGFR Reporting
Proteinuria 15 44 and Laboratory.
Investigation of
Overt >44 CKD
Proteinuria
63. Creatinine Adults mL/min Standardisation Jaffe, Alkaline

Clearance of Crea. Assay, Picrate, Kinetic with
eGFR Reporting Blank Rate
and Lab. Correction
Investigation of
CKD
64. eGFR Adults >90 ml/ min/ Standardisation Jaffe, Alkaline
1.73 m2 of Crea. Assay, Picrate, Kinetic with
eGFR Reporting Blank Rate
and Laboratory. Correction
Investigation of
CKD
65. Urine Osmolality 50 1400 mmol/kg Advanced Freezing point

Micro depression
Osmometer
66. Urine Paraquat Adults Negative Positive Qualita- Colour Formation

tive
67. Urine pH 4.80 7.40 - Roche Photometry

Diagnostics
GmbH 2008
68. Urine Specific 1.016 1.022 - Roche

Gravity (SG) Diagnostics
GmbH 2008
170
69. Body Fluid
Biochemistry
i) Total Protein g/L

ii) LDH U/L
70. Pleural Fluid

Biochemistry
i) Total Protein g/L

ii) LDH U/L
71. CSF Biochemistry

i) CSF Protein 0.08 0.32 g/L Standardisation Dye Binding
of Creatinine
Assay, eGFR
Reporting and
Laboratory
Investigation of
Chronic Kidney
Disease
ii) CSF Glucose Adults 2.2 3.9 mmol/L Tietz Hexokinase
Infants/ 3.3 4.4

Children
iii) CSF Chloride mmol/L Ion Selective

Electrode (ISE),
Diluted
171
HAEMATOLOGY
172
NO TEST AGE GROUP REF RANGE TEST METHOD REFERENCES
1 FULL BLOOD COUNT
Adult:
(male) 130 – 170
(female) 120 – 150
Infant:
(birth) 140 – 220
(day 3) 150 – 110 Dacie and
(day 7) 171 – 179 SIS Hb Lewis
i. Haemoglobin
detection Practical
(g/L) (day 14) 161 – 169
Method Hematology,
(1 month) 115 – 165
12th Edition
(2 months) 94 – 130
(3 months – 1 year) 111 – 141
Children:
(2 - 6 years) 110  140
(6 - 12 years) 115 155
Adult:
(male) 4.5  5.5
(female) 3.8  4.8
Infant:
(birth) 5.0  7.0
Dacie and
(day 3) 4.0 – 6.6
Lewis
ii. Red Cell Count (day 7) 3.9 – 6.3 Hydrodynamic
Practical
(x1012/L) (day 14) 3.6 – 6.2 Focusing
Hematology,
(1 month) 3.0 – 5.4
12th Edition
(2 months) 3.1 – 4.3
(3 - 6 months) 4.1 – 5.3
Children:
(1 year) 3.9  5.1
(2 - 12 years) 4.0 5.2
Adult:
(male) 40  50
(female) 36  46
Infant:
(birth) 45  75
Dacie and
(day 3) 45 – 67 RBC cumulative
Lewis
iii. Hematocrit (day 7) 42 – 66 pulse height
Practical
(%) (day 14) 49 – 53 detection
Hematology,
(1 month) 33 – 53 method
12th Edition
(2 months) 28 – 42
(3 - 6 months) 30 – 40
Children:
(1 year) 30  38
173
(2 - 6 years) 34 – 40
(6 - 12 years) 35  45
Adult: 83  101
Infant:
(birth) 100 – 120
(day 3) 92 – 118
(day 7) 88 – 126 Dacie and
iv. Mean Cell (day 14) 86 – 124 Lewis
Volume (MCV) (1 month) 92 – 116 Calculation Practical
(fl) (2 months) 87 – 103 Hematology,
(3 - 6 months) 68 – 84 12th Edition
Children:
(1 year) 72  84
(2 - 6 years) 75  87
(6 - 12 years) 77  95
Adult: 27  32
Infant:
(birth to day 14) 31 – 37
v. Mean Cell (1 month) 30 – 36 Dacie and
Hemoglobin (2 months) 27 – 33 Lewis Practical
Calculation
(MCH) (3 – 6 months) 24 – 30 Hematology,
(pg) Children: 12th Edition
(1 year) 25  29
(2 - 6 years) 24  30
(6 - 12 years) 25  33
Adult: 31.5 34.5
Infant:
(birth) 30 – 36
vi. Mean Cell (day 3) 29 – 37
Dacie and
Hemoglobin (day 7 to day 14) 28 – 38
Lewis Practical
Concentration (1 month) 29 – 37 Calculation
Hematology,
(MCHC) (2 months) 28.5 – 35.5 12th Edition
(g/dL) (3 – 6 months) 30 – 36
Children:
(1 year) 32 – 36
(2 – 12 years) 31 – 37
Adult: 4.0  10.0
Infant:
Dacie and
vii. White Cell (birth) 10.0 26.0
Flowcytometry Lewis Practical
Count (WBC) (day 3) 7.0 – 23.0
method Hematology,
(x109/L) (day 7 - 14) 6.0 – 22.0
12th Edition
(1 month) 5.0 – 19.0
(2 months) 5.0 – 15.0
174
(3 - 6 months) 6.0 – 18.0
Children:
(1 year) 6.0 16.0
(2 - 6 years) 5.0 15.0
(6 - 12 years) 5.0 13.0
Adult:
Neutrophil 40  80 Dacie and
viii. Differential Lymphocyte 20  40 Flowcytometry Lewis Practical
counts
Monocyte 2  10 method Hematology,
(%)
Eosinophil 16 12th Edition
Basophil <1  2
 Neutrophil
Infant:
(birth) 4.0 – 14.0
(day 3) 3.0 – 5.0
(day 7) 3.0 – 6.0
(day 14) 3.0 – 7.0
(1 month) 3.0 – 9.0
(2 months) 1.0 – 5.0
(3 – 6 months) 1.0 – 6.0
Children:
(1 year) 1.0 – 7.0
(2 - 6 years) 1.5 – 8.0
(6 - 12 years) 2.0 – 8.0
Adult: 2.0 – 7.0
 Lymphocyte
ix. Differential Dacie and
Infant:
counts Flowcytometry Lewis Practical
(birth) 3.0 – 8.0
(Absolute count method Hematology,
(day 3) 2.0 – 8.0
– x103/µL) 12th Edition
(day 7) 3.0 – 9.0
(day 14) 3.0 – 9.0
(1 month) 3.0 – 16.0
(2 months) 4.0 – 10.0
(3 – 6 months) 4.0 – 12.0
Children:
(1 year) 3.5 – 11.0
(2 - 6 years) 6.0 – 9.0
(6 - 12 years) 1.0 – 5.0
Adult: 1.0 – 3.0
 Monocyte
Infant:
(birth) 0.5 – 2.0
(day 3) 0.5 – 1.0
(day 7 – 14) 0.1 – 1.7
175
(1 month) 0.3 – 1.0
(2 months) 0.4 – 1.2
(3 – 6 months) 0.2 – 1.2
Children:
(1 – 12 years) 0.2 – 1.0
Adult: 0.2 – 1.0
 Eosinophil
Infant:
(birth) 0.1 – 1.0
(day 3) 0.1 – 2.0
(day 7) 0.1 – 0.8
(day 14) 0.1 – 0.9
(1 month) 0.2 – 1.0
(2 – 6 months) 0.1 – 1.0
Children:
(1 – 12 years) 0.1 – 1.0
Adult: 0.02 – 0.5
 Basophil
Adult: 0.02 – 0.1
Haematology
Reference
Intervals for
x. Immature Established
Granulocyte and Novel
Flowcytometry
0.0 – 0.06 Parameters in
method
a) Absolute IG - Adult: Healthy Adults
x103/µL Diagnostic
Perspectives,
Volume I. PS
01-11,2010
b) IG% Adult: 0.0 – 0.6
Adult: 150 - 410
Infant:
(birth) 100 – 450
(day 3) 210 – 500
(day 7) 160 – 500
Dacie and
(day 14) 170 – 500
xi. Platelet count Hydrodynamic Lewis Practical
(1 month) 200 – 500
(109/L) Focusing Hematology,
(2 months) 210 – 650
12th Edition
(3 - 6 months) 200 – 550
Children:
(1 year) 200 – 550
(2 - 6 years) 200 – 490
(6 - 12 years) 170 – 450
176
Adult: Haematology
Reference
Male 10.1 – 16.1
Intervals for
Established
xii. Platelet
and Novel
Distribution Hydrodynamic
Parameters in
Width (PDW) Focusing
Female 9.9 – 15.4 Healthy Adults
(fl)
Diagnostic
Perspectives,
Volume I. PS
01-11,2010
Adult: Haematology
Reference
Male 9.3 – 12.1
Intervals for
Established
xiii. Mean Platelet
and Novel
Volume (MPV) Hydrodynamic
Parameters in
(fl) Focusing
Female 9.1 – 11.9 Healthy Adults
Diagnostic
Perspectives,
Volume I. PS
01-11,2010
Adult: 0.5  2.5
xiv. Reticulocyte
Infant:
count
(birth) 2.0  6.0
(%)
(1 day) 3.0 – 7.0
(2 day) 1.0 – 3.0 Dacie and
Adult: 0.050 – 0.100 Flowcytometry Lewis Practical
xii. Reticulocyte Infant: method Hematology,
count (birth) 0.120 – 0.400 12th Edition
(Absolute count (day 3) 0.050 – 0.350
 x106/µL) (day 7 – 14) 0.050 – 0.100
(1 month) 0.020 – 0.060
(2 months) 0.030 – 0.050
(3 - 6 months) 0.040 – 0.100
Children:
(1 – 12 years) 0.030 – 0.100
Haematology
Reference
xiii. Reticulocytes Intervals for
Hemoglobin Flowcytometry Established
Adult: 32.1 – 38.8
Equivalent (Ret-He) method and Novel
(pg) Parameters in
Healthy Adults
Diagnostic
177
Perspectives,
Volume I. PS
01-11,2010
xvi. CV (%) 11.6  14.0 Dacie and
Red cell Lewis Practical
Calculation
distribution Hematology,
width (RDW) SD (fl) 39.0 – 46.0 12th Edition
2 HAEMOGLOBIN ANALYSIS
i. Hb A (%) Normal 96.7 – 97.8
Capillary
ii. Hb A2 (%) Normal 2.2 – 3.2 Sebia CEFP
Electrophoresis
User Manual
iii. Hb F (%) (CE)
Normal ≤0.5
High
iv. Hb A2 (%) Normal 2.3 - 3.3 Performance
BioRad Variant
Liquid
II User Manual
v. Hb F (%) Normal <1.0 Chromatography
(HPLC)
3 HAEMOSTASIS
i. Prothrombin
Coagulometric
Time (PT) - 9.3 – 11.5
(turbidimetric)
seconds Based on
ii. Activated Partial current
Thromboplastin Coagulometric product insert
26.5 – 35.9
Time (APTT) - (turbidimetric)
seconds
Congenital heart
2.0 – 3.0
surgery
Mechanical heart
valve recipients: Clinical
-All mechanical Practice
4.5 – 3.5
mitral valves Guidelines
iii. International -Caged-ball or Prevention &
Normalised Ratio tilting-disk aortic Treatment of
2.5 – 3.5
(INR) valves Venous
-Bileaflet or Thrombo-
Medtronic-Hall Embolism
2.0 – 3.0
aortic valve (August 2013)
Dilated
Cardiomyopathy, 2.0 – 3.0
with complications
178
Recurrent vascular
2.0 – 3.0
thromboembolism
Based on
iv. Plasma
2.38 – 4.98 Clauss current
Fibrinogen (g/L)
product insert
v. Factor VIII (%) 50  150
Dacie and
Coagulometric Lewis Practical
vi. Factor IX (%) 50  150 Hematology,
(turbidimetric)
12th Edition
vii. D-Dimer (mg/L) < 0.50
4 CD4 / CD8 T cell Enumeration

Total T cells 690 – 2540 (u/L)
T-helper cells
31 – 60 (%)
(CD4+) BD
410 – 1590 (u/L) Flowcytometry
FACSCalibur
Supressor T cells method
190 – 1140 (u/L) User Manual
(CD8+)
CD4 / CD8 ratio 0.83 – 6.10
10 – 19 years 0–8
Men
20 – 29 years ≤ 10.8
30 – 39 years ≤ 10.4
40 – 49 years ≤ 13.6
Erythrocyte 50 – 59 years ≤ 14.2 Dacie and
Westergren,
Sedimentation Women Lewis Practical
5 sodium
Rate (ESR) 60 – 69 years ≤ 16 Hematology,
citrate diluted
(mm in 1h) 70 – 79 years ≤ 16.5 12th Edition
80 – 70 years ≤ 15.8
Pregnancy
Early gestation 48 (62 if anaemic)
Later gestation 70 (95 if anaemic)
Cytochemical
Neutrophil Alkaline Demonstration
Phosphatase (NAP) 14 - 100 score / &
6
Score 100 neutrophils Measurement
of LAP, BJH,
1958.
179
REQUEST
FORMS
180
REQUEST FORM APPENDIX
GENERAL
PER- PAT 301 1
CHEMICAL PATHOLOGY
Borang Permintaan Ujian Pengesahan Dadah dalam Air Kencing-PER (LABORATORY)- 2

SS-301A /UPD 1 (Pindaan)
National Congenital Hypothyroidism Screening form 3
IEM Request Form, Ver. 5.1- IMR/ SDC/ FORM-RO 4
Request Form for Molecular Diagnostic Services, Ver. 5.0- IMR/ UMDP/ 02 5
Request Form for Multiple Myeloma & Specific Proteins, Ver. 4.0- IMR/ UMDP/01 6
Borang Permohonan Bagi Pemeriksaan Forensik / Toksikologi -Kimia 15-Pin.2/2016 7
Therapeutic Drug Monitoring (TDM) Request Form- HKL/ JP/ CT/ PK-01-6 8
Therapeutic Drug Monitoring (TDM) Request Form- MS ISO HM/ FAR 14 9
MICROBIOLOGY
Brucellosis Laboratory Request Form - IMR/IDRC/BACT/BRUCE/01 14
TBIS 20C (Only for Direct Smear AFB, Tibi Culture & Sensitivity) 10
SEROLOGY
Laboratory Request Form for Dengue and Flavivirus- MKAK-BPU-D02(rev_Nov 2015) 11
Laboratory Request Form for Novel Coronavirus Investigations 12
AFP Case Laboratory Request Form- Annex 2 13
Brucellosis Laboratory Request Form- IMR/IDRC/BACT/BRUCE/01 14
HIV Genotyping Resistant Testing- IMR/Viro/HIV/24 15
Ujian Polymerase Chain Reaction (PCR) untuk Human Immunodeficiency Virus (HIV) 16
dikalangan bayi- IMR/Viro/HIV/2 - IMR/VIRUS/NARL2
Request for HLA Typing Test- IMR/AIRC/TI/RF-2 17a
181
Request for HLA Typing Test (Disease Association)- IMR/AIRC/TI/RF-3 17b
Request for HLA Crossmatch Test- IMR/AIRC/TI/RF-1 18a
Request for HLA Crossmatch Test (Deceased Donor) - IMR/AIRC/TI/RF-5 18b
Request for HLA Antibody Screening Test - IMR/AIRC/TI/RF-4 18c
Laboratory Request Form for Influenza A(H7N9) Investigations - ANNEX 7 19
National-Influenza Surveillance Diagnostic Request Form - (Appendix 8) NIPP 2006 20
MKAK Laboratory Request Form - MKAK-BPU-U01 21
IMR Laboratory Request Form (Leptospirosis Culture & PCR) -IMR/IDRC/BACT/LEPTO/01 22
MEASLES – Borang Permohonan dan Keputusan Ujian Makmal - MSLF:01/2004 23
Primary Immunodeficiency Screening Request Form- IMR/AIRC/PID/RF Version 3.0 24
MKAK Borang Permohonan Ujian Makmal HFMD – MKAK/ENT/20__/__) 25
HAEMATOLOGY
National Blood Center, Hematology/Serology Request Form, PDN/HA/QP-01/01 26
Cytogenetic Request Form for Blood Samples, HKL/HA/TPM/N-1(1). 27
Bone Marrow Cytogenetics Request Form – Institute for Medical Research, Date of Issue: 23 May 28
2014, Version 4.1.
Molecular Analysis for Leukaemia - Institute for Medical Research, Date of Issue: 31-07-2013. 29
Hospital Ampang Special Hematology Laboratory Requisition, HA:HEMA2015-2 8/3/15. 30
Hospital Ampang, Cytogenetics Requisition Form, HEMA-CYTOGEN 08-01 V05 31
DNA Analysis for Thalassemia Syndromes, DNA Ana for Thal Synd & Hbpathy(s) REQform, 32
Hematology Unit, CaRC IMR, Version 3.0 (06/04/2017)
Borang Kebenaran Untuk Ujian DNA, IMR/CaRC/HAEM/22/2203/03(1)/REQForm 32
Molecular Analysis for Haemophilia- Institute for Medical Research, Date of Issue: 31-07-2013. 33
Borang Keizinan Untuk Pengambilan Sampel Darah, Pusat Darah Negara 34
182
PER- PAT 301 (In duplicate) 1
Cytology PAP SMEAR- PS 1/98-Pindaan 2007 35
BLOOD TRANSFUSION SERVICES
Borang Permohonan Transfusi Darah- PER-SS-BT 105 (Pind. 2/2016) 36
183
Appendix 1
184
Appendix 2
185
Appendix 3
186
Appendix 4 (page 1)
187
Appendix 4 (page 2)
188
Appendix 5 (page 1)
189
Appendix 5 (page 2)
190
Appendix 5 (page 3)
191
Appendix 6
192
Appendix 7 (page 1)
193
Appendix 7 (page 2)
194
Appendix 7 (page 3)
195
Appendix 8
Appendix 8
196
Appendix 9
197
Appendix 10
198
Appendix 11
199
Appendix 12
200
Appendix 13
201
Appendix 14
202
Appendix 15
203
Appendix 16
204
Appendix 17a
205
Appendix 17b
206
Appendix 18a
207
Appendix 18b
208
Appendix 18c
209
Appendix 19
210
Appendix 20
211
Appendix 21
212
Appendix 22
213
Appendix 23
214
Appendix 24 (page 1)
215
216
Appendix 25
217
Appendix 26
218
219
220
Appendix 28
221
Appendix 29
222
223
224
Appendix 31
225
226
227
Appendix 33
228
229
230
Appendix 35
231
Appendix 36
232

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FOREWORD

DR. CHIA KAM PIK

Coordinator : Dr. Hasmah Binti Hashim

Secretary : Pn. Noor Hafizah Yacob

Administration : Dr. Mazny Binti Abu Bakar

Administrative Office Anatomic Pathology

En Othman Suboh 2864 Dr. Najah Momin 2854

Main Specimen Reception Counter Dr. Diyana Abdullah 2853

Akmal Rais B Ridzuan 2865 Nasrudin Muslim 2855

Blood Donation Officer (PRO) 2873 Norzamawati Sarzaman 2860

Blood Bank Laboratory 2874 Senior MLT 2867

Blood Donation Room 2870 Microbiology Laboratory 2879

Blood Bank Registration Counter 2871 / 2872 TB Laboratory 2880

Haematology Serology Laboratory 2881

Dr. Raudhawati Osman (Head of Unit) 2857 Chemical Pathology Unit

Medical Officer 2859 Noor Aishah Mohd Dawi 2885

1. Result for Urgent (STAT) tests will be provided as follows:

* 45 minutes for FBC, BUSE and Creatinine

2. No blood transfusion incident due to laboratory error.

4. Ensure clean, safe and condusive laboratory facilities and environment.

If encounter any problem, please do not hesitate to contact

Print Report Correct

Administrative : Monday – Friday 8:00 am – 5:00 pm

Blood Donation : Monday – Friday 8.00 am – 5.00 pm

Anatomic Pathology : Monday – Friday 8.00 am – 5.00 pm

Serology : Monday – Friday 8:00 am – 5:00 pm

Lunch services : Monday – Thursday 1.00 pm – 2.00 pm

Histopathology / Cytology laboratory operate only during normal working hours.

Afternoon shift : Monday - Thursday 2.00 pm – 9.00 pm

UNIT TEST LTAT

NOTIFICATION OF CRITICAL RESULTS

vi) Requester Detail:

B. SAMPLES / SPECIMENS / TYPE OF CONTAINERS

E. GUIDE FOR SPECIMENS COLLECTION

TEST RESULTS / REPORTS

DISPATCH OF LABORATORY RESULTS

The diagnostic services are divided into:

i. Urgent Test (STAT).

D. SPECIMEN COLLECTION AND HANDLING

ii. A minimal tourniquet pressure should be applied in performing venesection to avoid

i) Blood Gas Analysis

ii) 24-hour Urine Collection

e) Send the urine container to the laboratory.

c) Collect a Fasting Blood Sugar sample and label as ‘FBS’.

 Samples from other hospitals

 Samples from other hospitals

vi) Drug of Abuse (DOA)

Time Tests Tube

ix) Low Dose Dexamethasone Suppression Test

Day 1 Day 2 Day 3

Sample taken for serum 9.00 am (basal) - 9.00 am

9.00 am 3.00 am 3.00 am (last dose)

Drug given: 3.00 pm 9.00 am -

x) High Dose Dexamethasone Suppression Test

Sample taken for 9.00 am and - - - 9.00 am and

Drug given: 2.0mg 9.00 am 3.00 am 3.00 am

xi) Renin and Aldosterone

xii) 24 Hours Urine Collection for Urine Catecholamine

2. Sodium Fluoride / Disodium Glucose; Lactate Blood Potassium 2.5ml (Adult);

3. K2 EDTA tube HbA1c; Ammonia Blood K2 EDTA 2.0ml (Adult);

4. Sterile Container Urine Biochemistry Urine; Nil Urine: 20 –

Stool Occult Blood

5. 24-hour Urine Container 24-hour Urine for 24-hour Nil Minimal

6. Plain tube Referred test Blood None Clot 4ml

4 a. Enterovirus Test Borang Permohonan Ujian Makmal (MKAK/ENT/20/)