IU (Chemical Pathology)

IU (Hematology)

IU (Immunology)

IU (Outsource)

Genetics

Histo & Cyto

Microbiology

Transfusion Med

Molecular Diagnostics

WELCOME TO INTEGRATED UNIT (CHEMICAL PATHOLOGY)

Introduction
Available Test (Biochemistry)
Available Test (Immunoassay)
Urgent Test
Sampel Collection and Transportations
Outsource Tests
Request of Repeat/Additional Test
Reference Ranges
Critical Value
Turn Around Time (TAT)
Special Procedures

Introduction

Chemical Pathology Unit offers diagnostic investigations in chemical pathology.
Dr Salbiah Binti Isa

Muhammad Amali Bin Kamarudin

Salwa Binti Jamil

Aizat Hafifi Hafriz Ahmad Sabri

Nur Atifah Rosidi

Siti Hazirah Hassan

Vithiya Rasasooria

Available Test (Biochemistry)

PROFILE	TEST	CONTAINER	VOLUME	SPECIMEN	REMARKS
*Blood Gas	Arterial / Venous Blood gas	Heparinized syringe	1 mL**	Blood	Refer to Special Procedures
Renal Function Test (RFT)	Sodium, Blood, Potassium, Chloride ,Urea, Creatinine, Uric Acid, Calcium, Inorganic Phosphate	Plain tube /Lithium Heparin	3 - 5 mL**	Blood	-
Liver Function Test (LFT)	Total Protein, Albumin, Globulin, Albumin / Globulin ratio, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP) Total Bilirubin, Direct Bilirubin	Plain tube /Lithium Heparin	3 - 5 mL**	Blood
Lipid Profile (LP)	Total Cholesterol Triglyceride High Density Lipoprotein (HDL) Low Density Lipoprotein (LDL)	Plain tube /Lithium Heparin	3 - 5 mL**	Blood	8 - 10 hours fasting
Cardiac Profile	Creatinine Kinase (CK) Lactate Dehydrogenase (LDH) Aspartate Aminotransferase (AST)	Plain tube /Lithium Heparin	3 - 5 mL**	Blood	-
Diabetic Profile	Glucose	Sodium Fluoride tube	2 mL**	Blood	Refer to Special Procedures (MGTT)
Diabetic Profile	*HbA1c	EDTA tube	2.5 ml**	Blood
-	Troponin T (TnT)	Lithium Heparin	3 ml**	Blood	-
-	Magnesium	Plain tube / Lithium Heparin	3 ml**	Blood	-
-	*Iron	Plain tube / Lithium Heparin	3 ml**	Blood	-
-	*Total iron-binding capacity (TIBC)	Plain tube / Lithium Heparin	3 ml**	Blood	-
-	*Serum osmolality	Plain tube	3 ml**	Blood	-
-	*Urine osmolality	Urine Container	10 ml	Urine	-
*Urine Analysis	Urine microscopy pH Specific Gravity Blood Leucocyte Nitrite Glucose Protein Bilirubin Urobilinogen Ketone	Urine Container	10 ml	Urine	Magnification x 40 - - - - - - - - -
*Urine Drug (Screening)	Amphetamine Benzodiazepines Marijuana Methamphetamine Morphine	Urine Container	10 ml	Urine	-
*Urine Pregnancy Test (UPT)	Pregnancy Test	Urine Container	10 ml	Urine	-
-	Urine Microalbumin	Urine Container	10 ml	Urine	-
-	Urine Protein Creatinine index (PCI)	Urine Container	10 ml	Urine	-
-	Creatinine Clearance (CCR)	24 hour urine container	10 ml	Urine	Refer to Special Procedures
Urine Biochemistry (quantitative)	Urine glucose Urine sodium Urine potassium Urine chloride Urine calcium Urine magnesium Urine urea Urine phosphate Urine uric acid Urine protein Urine creatinine	Urine Container	10 ml	Urine	-

**Note: Please make sure the volume of blood collected is correct, fill the tube to the indicator line.
Note: All specimen collection with EDTA, Sodium Fluoride and Lithium Heparin tube should be mixed gently and thoroughly for 1 minute by a rotary wrist movement.
*Note: Marked tests are not MS ISO 15189 accredited.

Available Test (Immunoassay)

PROFILE	TEST	CONTAINER	VOLUME	SPECIMEN	REMARKS
Tumor Markers	CA 125, CA 15-3, Carcino Embryonic Antigen (CEA), Total Prostate Specific Antigen (TPSA), Beta Human Chorionic Gonadotropin (BHCG)	Plain tube	3 - 5 mL**	Blood	-
Thyroid Function Test	Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Free Triiodothyronine (FT3)	Plain tube	3 - 5 mL**	Blood	-
-	Ferritin	Plain tube	3 - 5 mL**	Blood	-

Urgent Test
List of Urgent Test:
1. Blood Urea Serum Electrolyte (BUSE)
2. Calcium
3. Creatinine
4. Total Bilirubin (Paediatric case)
5. Beta hCG
6. Thyroid Function Test
7. Blood Gases
Procedure on Urgent Test:
1. Paste a green sticker at the sample
2. Remark "urgent" on the request form or equivalent
3. In the case of Hospital Information System (HIS) problem, inform all urgent test to the Integrated Unit (Chemical Pathology) staff and send sample to the laboratory with request form.
4. The request which failed to adhere to the above instruction are not classified as urgent.
Sample Management
Sample Submission Requirements
1. Request forms from either the requesting party or Chemical Pathology Unit, ADL, IPPT, USM are acceptable.
2. The request form should be completely and correctly filled manually or equivalent. Details of the patient must include the following information:
  - Name
  - Identification Cad No.
  - Age/Date of Birth
  - Gender
  - Location/contact details of the patient
  - Clinical summary
  - Date and time of sample collection
  - Type of sample and test requested
  - Name and signature of the doctor requesting the test and stamp
3. Each specimen shall have a label firmly attached to the specimen container and bearing the following information:
  - Patient's name
  - Pateint's registration number (PID)
  - Name of ward or clinic
  - Type of specimen
  - Date and time of specimen collection
4. For multiple specimen collection, please follow “order of draw” rules.
5. For internal request (within PPUSMB), all request shall be made using Hospital Information System, Care2X.
6. In the case of Hospital Information System (HIS) problem, send sample to the laboratory with request form.
7. All samples should be treated as biohazards and sent directly to the CDL receiving counter within 2 hours, except for blood gases within 30 minutes.
Note: All specimen collection with EDTA, Sodium Fluoride and Lithium Heparin tube should be mixed gently and thoroughly for 1 minute by a rotary wrist movement.

*Note: Marked tests are not MS ISO 15189 accredited.

Outsource Tests

Test	Container	Referral Laboratory	TAT
24 hour Urine Cortisol	24 hour urine bottle	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	4-6 weeks
Urine Electrophoresis	24 hour urine bottle	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	NA
C-Peptide	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Insulin	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	1-2 month
Dehydroepiandrosterone-Sulfate	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	1-2 month
Intact Parathyroid Hormone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Thyroglobulin	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Anti-Thyroglobulin	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Follicle-Stimulating Hormone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Luteinizing Hormone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Progesterone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Prolactin	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Estradiol	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Testoterone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Estrogen	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Cortisol	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
Epilin	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3 - 4 month
Growth Hormone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	4-6 weeks
Anti-Thyroid Peroxidase	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
17-OH Progesterone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	2 weeks
17-OH Progesterone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Insulin-like Growth Factor	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Anti-Glutamic Acid Decarboxylase Antibody	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
TSH Receptor Autoantibodies	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Islet Cell Antibody	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Adrenocorticotropic Hormone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Plasma Renin Activity	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Aldosterone	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	3-4 month
Vitamin B12	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	NA
Folate	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	NA
Serum Electrophoresis	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	NA
Ca 19.9*	Gel / plain tube	Innoquest Pathology Sdn. Bhd. Lablink Medical Laboratory Sdn. Bhd.	NA
Ca 19.9*	Heparinized tube	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	2 working days
Carbamazepine	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Valproic Acid	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Phenobarbitone	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Phenytoin	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Gentamicin	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Amikacin	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Digoxin	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Theophylline	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Acetaminophen	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Salicylis acid	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Vancomycin	Plain tube without gel	Makmal Biokimia, Hospital Seberang Jaya, Jalan Tun Hussein Onn, 13700 Seberang Jaya, Pulau Pinang. 04-3827158	24 hours
Methotrexate	Plain tube without gel	Jabatan Patologi, Hospital Tunku Azizah Kuala Lumpur, Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300 Kuala Lumpur 03-26003000 (ext: 2133 / 2134) 03-26003455 (Fax)	4 working days
Sirolimus	EDTA	Jabatan Patologi, Hospital Tunku Azizah Kuala Lumpur, Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300 Kuala Lumpur 03-26003000 (ext: 2133 / 2134) 03-26003455 (Fax)	4 working days
Tacrolimus	EDTA	Jabatan Patologi, Hospital Pulau Pinang, Jalan Residensi, 10990 Georgetown, Pulau Pinang 04-2225156	24 hours
Cyclosporin	EDTA	Jabatan Patologi, Hospital Pulau Pinang, Jalan Residensi, 10990 Georgetown, Pulau Pinang 04-2225156	24 hours
Lactate	Urine container – random urine	Unit Patologi dan Transfusi Darah, Hospital Kepala Batas, Jalan Bertam 2, 13200 Kepala Batas, Pulau Pinang.	24 hours

Request of Repeat/Additional Test
Procedure on Repeat / Additional Test
1. Clients need to call lab for request repeat / additional test.
2. Request can only be accepted if sample is sufficient and within the stability period for the requested analyte.
3. Requested test is suitable to sample collected.
4. Request the additional test in HIS.
5. Inform Lab the new order no.
Please contact Integrated Unit (Chemical Pathology) - 2686 for more information.

Reference Ranges

Biochemistry (Serum)

PROFILE	TEST	CRITERIA	RANGES	SI UNIT	REFERENCE
Blood Gas (Please Refer to Special Procedures)	Arterial Blood gas (ABG)	pH PCO2 PO2 HCO3 TCO2 BE O2SAT	7.35 - 7.45 35 - 48 83 - 108 18 - 23 22.0 - 29.0 +3/-3 95 - 98%	- mmHG mmHG mmol/L mmol/L mmol/L -	REAGENT IFU
Liver Function Test (LFT)	Total Protein	Adults Children (1 - 18 years) Newborns (1 - 30 days)	66 – 83 57 – 80 41 – 63	g/L g/L g/L	REAGENT IFU
Liver Function Test (LFT)	Albumin	Adults Newborns (0 - 4 days)	35 - 52 28 - 44	g/L g/L	REAGENT IFU
Liver Function Test (LFT)	Globulin A/G Ratio	- -	23 - 35 1.10 - 2.10	g/L -	REAGENT IFU
Liver Function Test (LFT)	Alkaline phosphatase (ALP)	Male (≥ 20 years old) Female (18 - 49 years old)	43 - 115 33 - 98	U/L U/L	REAGENT IFU
Liver Function Test (LFT)	Alanine Transaminase (ALT)	Male Female Newborn/Infant	< 50 <35 13 − 45	U/L U/L U/L	REAGENT IFU
Liver Function Test (LFT)	Aspartate Transaminase (AST)	Male Female Newborn Infant	< 50 < 35 25 − 75 15 − 60	U/L U/L U/L U/L	REAGENT IFU
Liver Function Test (LFT)	Total Bilirubin	Adults Children (0 − 1 day) Children (1 − 2 days) Children (3 − 5 days)	5 – 21 24 – 149 58 – 197 26 – 205	μmol/L μmol/L μmol/L μmol/L	REAGENT IFU
Liver Function Test (LFT)	Direct Bilirubin	Adults	< 3.4	μmol/L	REAGENT IFU
Renal Function Test (RFT)	Sodium Potassium Chloride	Adults Adults Adults	136 - 146 3.5 - 5.1 101 - 109	mmol/L mmol/L mmol/L	REAGENT IFU
Renal Function Test (RFT)	Urea (Adults) Urea (Newborn) Urea (Infant/child)	Adults Newborn Infant/child	2.8 - 7.2 1.4 – 4.3 1.8 – 6.4	mmol/L mmol/L mmol/L	REAGENT IFU
Renal Function Test (RFT)	Creatinine	Male Neonate Infant (2 months - < 3 years) Child (3 months- < 15 years) Female Neonate Infant (2 months - < 3 years) Child (3 months- < 15 years)	59 - 104 27 - 87 11 - 34 23 - 68 45 - 84 27 - 87 11 - 34 23 - 68	μmol/L μmol/L μmol/L μmol/L μmol/L μmol/L μmol/L μmol/L	REAGENT IFU
-	Iron	Adult Newborn Infant Child	12.5 – 32.2 17.90 – 44.8 7.2 – 17.9 9.0 – 21.5	μmol/L μmol/L μmol/L μmol/L	REAGENT IFU
Renal Function Test (RFT)	Uric Acid	Male Female	208.3 - 428.4 154.7 - 357.0	μmol/L μmol/L	REAGENT IFU
Renal Function Test (RFT)	Calcium	Adult Child (0 - 10 days) Child (10 day - 24 months) Child (2 - 12 years)	2.20 - 2.65 1.9 - 2.6 2.25 - 2.75 2.2 - 2.7	mmol/L mmol/L mmol/L mmol/L	REAGENT IFU
Renal Function Test (RFT)	Inorganic Phosphate	Adult Child	0.81 - 1.45 1.29 - 2.26	mmol/L mmol/L	REAGENT IFU
Lipid Profile (LP)	Total Cholesterol	Desirable Borderline High High	< 5.2 5.2 - 6.2 ≥ 6.2	mmol/L mmol/L mmol/L	REAGENT IFU
Lipid Profile (LP)	Triglyceride	Normal Borderline High High Very high	< 1.70 1.70 - 2.25 2.26 - 5.64 ≥ 5.65	mmol/L mmol/L mmol/L mmol/L	REAGENT IFU
Unsaturated Iron Binding Capacity	UIBC	Adults	27.8 - 63.6	μmol/L	REAGENT IFU
Lipid Profile (LP)	High Density Lipoprotein (HDL)	Adults	High HDL: ≥ 1.55 Low HDL: < 1.03	mmol/L mmol/L	REAGENT IFU
Lipid Profile (LP)	Low Density Lipoprotein (LDL)	Optimal Near optimal Borderline High High Very high	< 2.59 2.59 - 3.34 3.36 - 4.11 4.14 - 4.89 ≥ 4.91	mmol/L mmol/L mmol/L mmol/L mmol/L	REAGENT IFU
Cardiac Profile (CE)	Creatinine Kinase (CK)	Male Female	≤ 171 ≤ 145	U/L U/L	REAGENT IFU
Cardiac Profile (CE)	Lactate Dehydrogenase (LDH)	Male Female Child (0 - 4 days) Child (4 - 10 days) Child (10 d - 24 months) Child (24 m - 12 years)	< 248 < 247 290 - 775 545 - 2000 180 - 430 110 - 295	U/L U/L U/L U/L U/L U/L	REAGENT IFU
Cardiac Profile (CE)	Aspartate Aminotransferase (AST)	Male Female	< 35 < 31	U/L U/L	REAGENT IFU
Diabetic Profile	Glucose	Adult Children	4.1 - 5.9 3.3 - 5.6	mmol/L mmol/L	REAGENT IFU
Diabetic Profile (Please Refer to Special Procedures)	MGTT	Fasting (Normal) Fasting (DM) Fasting (IGT) 2 Hours (Normal) 2 Hours (DM) 2 Hours (IGT)	< 6.1 > 7.0 6.1 - 7.0 < 7.8 > 11.1 7.8 - 11.1	mmol/L mmol/L mmol/L mmol/L mmol/L mmol/L	REAGENT IFU
Diabetic Profile	*HbA1c	Normal Pre-diabetes Diabetes	<5.6% (38) 5.6 - 6.2% (38 - 44) ≥6.3% (45)	mmol/mol mmol/mol mmol/mol	Management of Type 2 Diabetes Mellitus: Quick reference guide (6th ed.)
Others	Troponin T (TnT)	-	≥ 50	ng/L	REAGENT IFU
Others	Magnesium	Male Female	0.73 - 1.06 0.77 - 1.03	mmol/L mmol/L	REAGENT IFU
Others	*Osmolality (Serum)	Male/Female	276 - 297	mOsm/kgH2O	REAGENT IFU
Others	C Reactive Protein (CRP)	Male/Female	< 5	mg/L	REAGENT IFU

Biochemistry (Urine, Plasma & Cerebrospinal fluid (CSF))

PROFILE	TEST	CRITERIA	RANGES	SI UNIT	REFERENCE
Cerebrospinal fluid (CSF)	CSF Glucose	Male Female	2.2 – 3.9 2.2 – 3.9	mmol/L mmol/L	REAGENT IFU
Renal Function Test (RFT)	Urine Calcium	24hours (Adult) 24hours (Male) 24hours (Small Children) 2hours (Male) 24hours (Adult) 24hours (Female) 24hours (Small Children) 2hours (Female)	< 7.5 mmol ≤ 0.1 mmol (4 mg)/kg of body weight ≤ 0.8 g/g creatinine ≤ 0.57 mmol mmol/mmol of creatinine < 6.2 mmol ≤ 0.1 mmol (4 mg)/kg of body weight ≤ 0.8 g/g creatinine ≤ 0.57 mmol mmol/mmol of creatinine	mmol mmol mmol mmol mmol mmol mmol mmol	REAGENT IFU
Renal Function Test (RFT)	Urine Creatinine	24 Hours (Male) 24 Hours (Female)	124 – 230 97 – 177	μmol/kg/day μmol/kg/day	REAGENT IFU
-	Urine Glucose	Male Female	0.1 – 0.8 0.1 – 0.8	mmol/L mmol/L	REAGENT IFU
-	Urine Urea	Male Female	250 – 570 250 – 570	mmol/day mmol/day	REAGENT IFU
-	Urine Magnesium	Male Female	3 – 5 3 – 5	mmol/24 h mmol/24 h	REAGENT IFU
-	Urine Phosphate	Male (On non-restricted diet) Female (On non-restricted diet)	12.9 – 42.0 12.9 – 42.0	mmol/d mmol/d	REAGENT IFU
-	Urine Uric Acid	Urine, 24 Hours (Male) Urine, 24 Hours (Female)	1488 – 4463 1488 – 4463	μmol/day μmol/day	REAGENT IFU
-	Urine Potassium	Urine, 24 Hours (Male) Urine, 24 Hours (Female)	25 – 125 25 – 125	mmol/day mmol/day	REAGENT IFU
-	Plasma Potassium	Male Female	3.4 – 4.5 3.4 – 4.5	mmol/L mmol/L	REAGENT IFU
-	Urine Chloride	Urine, 24 Hours (Male) Urine, 24 Hours (Female)	110 – 250 110 – 250	mmol/day mmol/day	REAGENT IFU
-	Urine Sodium	Urine, 24 Hours (Male) Urine, 24 Hours (Female)	40 – 220 40 – 220	mmol/day mmol/day	REAGENT IFU
-	Urinary/CSF Protein	Male (Urine) Male Adults (CSF) Male Newborn (CSF) < 1 Month Female (Urine) Female Adults (CSF) Female Newborn (CSF) < 1 Month	0.05 – 0.08 g/day 0.15 – 0.45 g/L 0.15 – 1.30 0.05 – 0.08 g/day 0.15 – 0.45 g/L 0.15 – 1.30	g/L g/L g/L g/L g/L g/L	REAGENT IFU
Others	*Osmolality (Serum)	Male/Female	300 – 900	mOsm/kgH2O	REAGENT IFU
*Urine FEME	*Urine microscopy	Casts / Hyaline	Occasional	Per high power field (/hpf)	REAGENT IFU
*Urine FEME	*Urine microscopy	Casts / Epithelial Casts / Erythrocyte Casts / Granulated Casts / Leucocyte	Not Detectable	Per high power field (/hpf)	REAGENT IFU
*Urine Analysis	pH Specific Gravity Erythrocytes Leukocytes Nitrite Glucose Protei Bilirubin Urobilinogen Ketone	Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal	4.6 - 8.0 1.001 - 1.035 <3 NEG NEG < 30 < 15 < 0.02 < 1.0 NEG	- - Ery/μL Leu/μL - mg/dL mg/dL mg/dL EU/dL -	REAGENT IFU
*Urine Drug (Screening)	Amphetamine Benzodiazepines Marijuana Methamphetamine Morphine	Normal Normal Normal Normal Normal	NEG NEG NEG NEG NEG	- - - - -	REAGENT IFU
*Urine Pregnancy Test (UPT)	Pregnancy Test	Not pregnant Pregnant	NEG POS	- -	REAGENT IFU

Immunoassay (Serum)

PROFILE	TEST	CRITERIA	RANGES	SI UNIT	REFERENCE
Tumor Markers	CA 125 in serum	Male Female	NA 0 - 35	- U/mL	REAGENT IFU PAEDS: JOURNAL STUDY
Tumor Markers	CA 15-3 in serum	Male Female	0 - 23.5 0 - 23.5	U/mL U/mL	REAGENT IFU PAEDS: JOURNAL STUDY
Tumor Markers	CEA in serum	Male Female	0.0 - 3.0 0.0 - 3.0	ng/mL ng/mL	REAGENT IFU PAEDS: JOURNAL STUDY
Tumor Markers	PSA in serum	Male Female	0.0 - 4.0 N/A	ng/mL -	REAGENT IFU PAEDS: JOURNAL STUDY
Tumor Markers	Beta hCG in serum	Male Female: Adult 18 - 40y Female: Adult > 40y Female: Adult Post-menopausal female	NA 0 - 0.6 0 - 3.1 0.1 - 11.6	mIU/mL mIU/mL mIU/mL mIU/mL	REAGENT IFU
Thyroid Function Test	Free T3 in serum	Male: Adult Male: Paed 0 to < 1 year Male: Paed 1 to < 15 years Male: Paed 15 to < 19 years Female: Adult Female: Paed 0 to < 1 year Female: Paed 1 to < 15 years Female: Paed 15 to < 19 years	3.8 - 6.0 4.32 - 6.85 3.98 - 6.19 3.81 - 5.67 3.8 - 6.0 4.32 - 6.85 3.98 - 6.19 3.47 - 5.31	pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L	REAGENT IFU PAEDS: JOURNAL STUDY
Thyroid Function Test	Free T4 in serum	Male: Adult Male: Paed 0 to < 20 days Male: Paed 20 days to < 3 years Male: Paed 3 to < 19 years Female: Adult Female: Adult 1st Trimester Female: Adult 2nd Trimester Female: Adult 3rd Trimester Female: Paed 0 to < 20 days Female: Paed 20 days to < 3 years Female: Paed 3 to < 19 years	7.86 - 14.41 17.37 - 57.66 9.52 - 17.76 7.85 - 13.64 7.86 - 14.41 6.67 - 14.12 5.79 - 12.70 6.11 - 12.20 17.37 - 57.66 9.52 - 17.76 7.85 - 13.64	pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L pmol/L	REAGENT IFU PAEDS: JOURNAL STUDY
Thyroid Function Test	TSH in serum	Male: Adult Male: Paed 0 to < 12 years Male: Paed 12 to < 19 years Female: Adult Female: Adult 1st Trimester Female: Adult 2nd Trimester Female: Adult 3rd Trimester Female: Paed 0 to < 12 years Female: Paed 12 to < 19 years	0.38 - 5.33 0.79 - 5.85 0.68 - 3.35 0.38 - 5.33 0.05 - 3.70 0.31 - 4.35 0.41 - 5.18 0.79 - 5.85 0.68 - 3.35	μIU/mL μIU/mL μIU/mL μIU/mL μIU/mL μIU/mL μIU/mL μIU/mL μIU/mL	REAGENT IFU PAEDS: JOURNAL STUDY
-	Ferritin in serum	Male: Adult Male: Paed 0 to < 15 days Male: Paed 15 days to < 6 months Male: 6 months to < 1 year 1 year to < 16 years 16 years to < 19 years Male: Adult Male: Paed 0 to < 15 days Male: Paed 15 days to < 6 months Male: 6 months to < 1 year 1 year to < 16 years 16 years to < 19 years	23.9 - 336.2 39.84 - 539.8 15.25 - 374.58 13.32 - 191.89 10.29 - 55.84 18.67 - 102.06 11.0 - 306.8 39.84 - 539.8 15.25 - 374.58 13.32 - 191.89 10.29 - 55.84 3.20 - 75.11	ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL ng/mL	ADULT: REAGENT IFU PAEDS: JOURNAL STUDY

Note: All specimen collection with EDTA, Sodium Fluoride and Lithium Heparin tube should be mixed gently and thoroughly for 1 minute by a rotary wrist movement.
*Note: Marked tests are not MS ISO 15189 accredited.

*Note: Tests that are not MS ISO 15189 accredited.

References:

Biochemistry: Beckman Coulter Reagent Guide Manual
HbA1c: HbA1c test pamphlet
Immunoassay: Beckman Coulter Reagent Guide Manual
Urine:
1. Siemens Clinitek Advantus test pamphlet
2. Roche Diagnostics Reference Ranges for Adults and Children (Pre-Analytical Consideration) 2002/03
Men B-Hcg: http://en.wikipedia.org/wiki/Human_chorionic_gonadotropin
Malaysian CPG – Management of Type II DM
Mediven ProDetect Drug of Abuse Test (5in1) test pamphlet.
Mayo Clinic Laboratories, Endocrinology Catalog Additional Information: mml-diabetes-metabolic-nutrition.
Total Protein and A/G Ratio: University of Rochester Medical Center.
Clinical Chemistry, Volume 59, Issue 9, 1 September 2013, Pages 1393–1405, https://doi.org/10.1373/clinchem.2013.204222
Karbasy, K., Lin, D. C. C., Stoianov, A., Chan, M. K., Bevilacqua, V., Chen, Y., & Adeli, K. (2016). Pediatric reference value distributions and covariate-stratified reference intervals for 29 endocrine and special chemistry biomarkers on the Beckman Coulter Immunoassay Systems: A CALIPER study of healthy community children. Clinical Chemistry and Laboratory Medicine, 54(4), 643–657. https://doi.org/10.1515/cclm-2015-0558
Ministry of Health Malaysia, Academy of Medicine Malaysia, Malaysia Endocrine & Metabolic Society, Family Medicine Specialists Association of Malaysia, & Diabetes Malaysia. (2022). Management of Type 2 Diabetes Mellitus: Quick Reference Guide for Healthcare Professionals (6th ed.). Ministry of Health Malaysia.

Critical Value

Panic value is defined as any result outside the normal ranges to a degree that may pose immediate health risk to the individuals or require immediate action on the part of the treating doctors.

All panic values below will be notified to requester or the authorized proxy within 30 minutes

Panic Value (Values for Adults)

Adults (>19 years)

ANALYTES	UNITS	LOWER CRITICAL LIMIT	UPPER CRITICAL LIMIT
Sodium	mmol/L	125	155
Potassium	mmol/L	2.8	6.0 (no haemolyse sample)
Magnesium	mmol/L	0.41	2.00
Glucose	mmol/L	2.8	20.0
Calcium	mmol/L	1.50	3.00
Inorganic Phosphate	mmol/L	0.32	2.87
Arterial Blood Gas	pH pCO2 mmHg pO2 mmHg	7.20 - 58.5	7.55 69.8 -

Panic Value (Values for Pediatric)

Neonates (<28 days), Children/Pediatrics (>29 days - 18 years)

ANALYTES	UNITS	LOWER CRITICAL LIMIT	UPPER CRITICAL LIMIT
Sodium	mmol/L	125	155
Potassium	mmol/L	2.8	6.0 (no haemolyse sample)
Magnesium	mmol/L	0.50	1.80
Total Bilirubin	μmol/L	-	Neonates (< 28 days) 513 μmol/L Children 428 μmol/L
Calcium	mmol/L	1.70	3.10
Inorganic Phosphate	mmol/L	0.32	2.87
Urea	mmol/L	-	19.0
Arterial Blood Gas	pH pCO2 mmHg pO2 mmHg	- 19.5 43.88	7.60 68.2 121.51

*Note: Marked tests are not MS ISO 15189 accredited.

Reference:

The cut off values above are adapted from: Quick Guide for Improving Notification of Critical Laboratory Results in MOH Hospitals. A project for Improving Patient Safety.

Turn Around Time (TAT)

Profile	Case	Turn Around Time
Profile: Biochemistry	Case: Urgent : Non-urgent:	Turn Around Time: Within 1 hour from the time sample is received Within 4 hours from the time sample is received
Profile: Immunoassay	Case: Urgent: Non-urgent:	Turn Around Time: Within 3 hours from the time sample is received Within 6 working days from the time sample is received

Profile	Turn Around Time	Time the sample will be tested
Profile: Hemoglobin A1C (HbA1c)	Turn Around Time: Within 3 working days from the date sample is received	Time the sample will be tested: 9.00 a.m. – 2.00 p.m. (Samples sent outside this time will be kept and tested the next day)

*Note:

The TAT for urgent & non-urgent biochemistry tests is applicable only during office hours (from 9.00 am- 5.00 pm)
Non-urgent immunoassay tests will be performed once a week.

Special Procedures

Test	Collection Procedure	Remarks
Test: *Blood Gas	Collection Procedure: Use disposable heparinised syringe. Draw 1 mL of blood. Invert the syringe and remove air bubbles inside the syringe. Use a lock stopper instead of needle to avoid exposure to air and to avoid blood sample leakage. Mix well by rotating the syringe to prevent clotting. Put the sample in ice bath	Remarks: The specimen must be kept embedded in crushed ice and sent immediately to the laboratory for analysis (at least within ½ hour).
Test: Modified Glucose Tolerance Test (MGTT)	Collection Procedure: Patients must fast for at least 8 hours. Collect blood sample. Give patient 75 g glucose in 300 ml water and drink within 5 minutes. For children, the glucose dose is 1.75 g/kg body weight to a maximum of 75 g. (Exception: Pregnant women receive 50 g glucose to screen for gestational diabetes) Collect blood sample after 2 hours.	Remarks: Each blood specimen collected must be labelled correctly.

*Note: Marked tests are not MS ISO 15189 accredited.