Immunology

Introduction

Immunology Unit offers diagnostic investigations in immunology.

You Start Treating Your Body Right and Your Immune System is Better

- Aaron Bruno

Muhammad Amali Bin Kamarudin
Wan Aslizan Binti Wan Azian
Dr Salbiah Binti Isa
Siti Hazirah Hassan
Vithiya Rasasooria
Aizat Hafifi Hafriz Ahmad Sabri
Nur Atifah Rosidi

Available Test and Sample Collection

All samples to be sent to Immunology Unit should use the specific containers according to the tests requested. Required volume, type of blood container and requirement of healthy control sample for stated test are listed in the table below:

Total and Specific IgE

PROFILE	TEST	CONTAINER	VOLUME	SPECIMEN	REMARKS
Total Immunoglobulin E	Total Immunoglobulin E	Plain tube	3.5 ml whole blood	Serum	-
Allergy Test	Allergen d1 - (Dermatophagoides pteronyssinus) Allergen d2 - (Dermatophagoides farinae) Allergen d201 - (Blomia tropicalis) Allergen e1 - (Cat Dander) - Felis catus Allergen e215 - (Pigeon Feathers) - Streptopelia spp Allergen f1 - (Egg White) - Gallus domesticus Allergen f2 - (Milk) - Bos spp. Allergen f3 - (COD Fish) - Gadus morhua Allergen f4 - (Wheat) - Triticum aestivum Allergen f9 - (Rice) - Oryza sativa Allergen f13 - (Peanut) - Arachis hypogaea Allergen f14 - (Soya Bean) - Glycine max Allergen f23 - (Crab) - Chionoecetes spp. Allergen f24 - (Shrimp) - Pandalus borealis, Penaeus monodon, Metapenaeopsis barbata, Metapenaus joyneri Allergen f27 - (Beef) - Bos spp. Allergen f41 - (Salmon) - Salmo salar Allergen f58 - (Pasific Squid) - Todarodes pacificus Allergen f75 - (Egg Yolk) - Gallus spp. Allergen f76 (Milk) NBOS D4, Alpha-Lactalbumin in serum Allergen f77 (Milk) NBOS D5, Beta-Lactalbumin in serum Allergen f78 (Milk) NBOS D8, Casein Milk in serum Allergen f83 - (Chicken Meat) - Gallus domesticus Allergen f93 - (Cacao) - Theobroma cacao Allergen f207 - (Clam) - Ruditapes spp. Allergen f300 - (Goat’s Milk) Allergen f313 - (Anchory) Allergen GX2 - (Mix Grass Pollen) - Bermuda grass, GX2 Rye grass, Timothy grass, Meadow grass, Johnson grass, Bahia grass Allergen I6 - (Cockroach) - Blatella germanica Allergen K82 - (Latex) - Hevea braziliensis Allergen MX2 - (Mix Fungi) – Penicillium chrysogenum, Cladosporium herbarum, Aspergillus fumigatus, Candida albicans, Alternaria alternata, Setomelanomma rostrata	Plain tube (Kindly be advised that pediatric collection tubes are not acceptable for allergy testing. Samples submitted in pediatric tubes will be rejected)	3.5 ml whole blood	Serum	Note: 3.5 ml of sample plain tube only for 14 allergens, if more than 14 allergens requested, please sent two tubes of 3.5 ml sample to ensure adequate sample volume

Specific Antibody Response

PROFILE	TEST	CONTAINER	VOLUME	SPECIMEN	REMARKS
*Specific Antibody Response	Tetanus toxoid vaccination (Pre) Tetanus toxoid vaccination (Pre)	Plain tube	3.5 ml whole blood	Serum	-Take the pre-vaccination sample before vaccinate the patient
*Specific Antibody Response	Pneumovax vaccination (Post) Pneumovax vaccination (Post)	Plain tube	3.5 ml whole blood	Serum	-Take the post vaccination sample 4 to 6 weeks after vaccination

Standard Operating Procedure for blood sampling, storage and transportation for Specific Antibody Response (SAR) Pneumococcal & Tetanus toxoid Test:

1. Withdraw 3ml of whole blood into Plain Gel Tube.
2. Then, vaccinate the patient.
3. Centrifuge & separate the serum to secondary tube labelled as “pre sample”.
4. Label the secondary tube with proper patient details such as name, IC number and date sample taken.
5. Store serum at -200C.
6. Between 4- 6 weeks after vaccination, withdraw 3ml of whole blood into Plain Gel Tube.
7. Centrifuge & separate the serum to secondary tube labelled as “post sample”.
8. Label the secondary tube with proper patient details such as name, IC number and date sample taken.
9. Store serum at -20 C.
10.Pack with ice pack / dry ice in polystyrene box.
11.Send both sample with completed request form and copy of proof of payment to:

Unit Integrasi (Imunologi),
Makmal Diagnostik Klinikal,
Pusat Perubatan USM Bertam (PPUSMB),
Universiti Sains Malaysia, Bertam,
13200 Kepala Batas, Pulau Pinang
Attn : Puan Wan Aslizan Binti Wan Azian
For any enquiries, please contact Immunology Unit: 04 - 5622331

Other Tests

PROFILE	TEST	CONTAINER	VOLUME	SPECIMEN	REMARKS
Diabetic Profile	*HbA1c	EDTA tube	2.5 ml*	Blood	-
-	*Serum osmolality	Plain tube	3 ml**	Blood	-
-	*Urine osmolality	Urine Container	10 ml	Urine	-

* For Specific Antibody Response, the tests should be requested via appointment. Appointment can be done by contacting 04-562 2331.

Verbal Request

Immunology Unit does not accept any verbal request due to optimum blood usage as requested per each test.

Outsource Tests

List of referral laboratories are as below:

Makmal Imunologi,
Hospital Pakar USM,
Kampus Kesihatan,
Universiti Sains Malaysia,
16150 Kubang Kerian, Kelantan.
09-7673000
09-7671060 (Fax)
Jabatan Patologi,
Hospital Pengajar Universiti Putra Malaysia,
Persiaran MARDI – UPM,
43400 Serdang,
Selangor.
03-97695500
Institute for Medical Research (IMR),
National Institues of Health (NIH),
Block C, No. 1, Jalan Setia Murni U13/52,
Seksyen U13, Setia Alam,
40170 Shah Alam,
Selangor.
03-33627900
03-33627901 (Fax)

Please refer to Immunology Unit for more details on the outsource samples.

Reference Range

PROFILE	TEST	CRITERIA	RANGES	SI UNIT
Total Immunoglobulin (Ig) E	Total Immunoglobulin (Ig) E	6 weeks 3 months 6 months 9 months 12 months 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years > 10 years	0.6 - 2.3 1.0 - 4.1 1.8 - 7.3 2.6 - 10 3.2 - 13 5.7 - 23 8.0 - 32 10 - 40 12 - 48 14 - 56 16 - 63 18 - 71 20 - 78 22 - 85	kU/L
Specific Immunoglobulin (Ig) E	ImmunoCAP Allergens	0 - 0.09 0.10 - 0.50 0.51 - 2.00 2.01 - 15.00 15.01 - 50.00 > 50.01	Undetectable Very Low Low Moderate High Very High	Unlikely Uncommon Low Common High Very High
Specific Immunoglobulin (Ig) E	Allergens Mixes	Below 0.35 ≥ 0.35	Undetectable levels or very low levels, of allergen specific IgE antibodies Specific IgE antibodies to one or more of the allergens coupled to immunoCAP Allergen mixes
Specific Antibody Response (SAR)	Tetanus toxoid vaccination	>0.15 IU/mL	Post vaccine response is more > 4X more than pre- vaccine, thus at protective level and normal response to tetanus vaccine >0.15 IU/mL
Specific Antibody Response (SAR)	Pneumovax vaccination	>110.00 mg/L	Post vaccine response is more > 4X more than pre- vaccine, thus at protective level and normal response to tetanus vaccine >110.00 mg/L

PROFILE	TEST	CRITERIA	RANGES	SI UNIT	REFERENCE
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	*Osmolality (Serum)	Male/Female	276 - 297	mOsm/kgH2O	REAGENT IFU

PROFILE	TEST	CRITERIA	RANGES	SI UNIT	REMARKS
Others	*Osmolality (Urine)	Male/Female	300 – 900	mOsm/kgH2O	REAGENT IFU

References:

Bhala RB, Rappaport I, De Filippi I, Schwartz MK. Serum IgE levels in a northest United States causian population. In: Heusghem C, Albert A, Benson E S, eds. Advanced interpretation of clinical laboratory data. New York: Marcel Dekker Inc, 1982:295-305.
Kjellman NI, Johansson SGO, Roth A. Clin Allergy 1976;6:51-9.
Bjorksten B, Weeke B.Allergy 1985;40 (Suppl 4).
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.

Turn Around Time (TAT)

Profile	Turn Around Time
Profile: Total Immunoglobulin E (IgE)	Turn Around Time: Within 15 working days from the date sample is received
Profile: Allergy Test	Turn Around Time: Within 15 working days from the date sample is received
Profile: Specific Antibody Response (Pneumovax vaccination, Pre & Post)	Turn Around Time: -
Profile: Specific Antibody Response (Tetanus vaccination, Pre & Post)	Turn Around Time: -

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)

WELCOME TO INTEGRATED UNIT (IMMUNOLOGY)