Preparing for a Test

Indication

This assay is used for evaluation of patients with suspected Sarcoidosis & confirm Gaucher disease and Leprosy.

What "high" or "increased" may indicate

  • Sarcoidosis
  • Leprosy
  • Gaucher disease
  • Diabetic retinopathy
  • Liver disease
  • Hyperthyroidism

Sample

Plain clotted blood/CSF Immediately freeze separated serum.

Patient Preparation

Overnight fasting is preferred (11 - 12 hrs). Fasting is defined as no consumption of food or beverages other than water before blood collection.

Indication

This assay is useful for biochemical diagnosis and monitoring of intestinal carcinoid syndrome. It is an indicator of serotonin producing tumor.

Sample

24 hrs urine

Patient's Preparation

The patient should strictly avoid Banana, Kiwis, Walnut, Avocado, Eggplant, Pineapple, Plum, Tomato and Promethazine, Alcoholic beverages, Tea/Coffee, Tobacco and strenuous exercise at least 72 hrs before and during specimen collection. Drugs including

  • Fluorouracil
  • Melphalan
  • Phenothiazines
  • Acetaminophen
  • Guaifenesin
  • Isoniazid
  • MAO inhibitors
  • Mephenesin
  • Methenamine compounds
  • Methocarbamol
  • Methyldopa
  • Phenothiazine
  • Reserpine salicylates
  • Tricyclic antidepressants

Indication

Helps differentiate between primary and secondary adrenal insufficiency & helps diagnose Cushing 's disease.

What "high" or "increased" may indicate

  • Addison' s disease
  • Cushing' s disease

What "low" or "decreased" may indicate

  • Adrenal - cortex tumor

Sample

EDTA blood (Chilled tube) Obtain ice before draw for specimen transport.

Patient's Preparation

Draw blood between 6 -10 am Limit your physical activities for 10-12 hrs before the test. You may be put on a low carbohydrate diet for 2 days before. Alcohol (ethanol, whiskey, wine or beer) can also affect test results.

Indication

This assay is useful in the management of diabetes. It is also used for diagnosis of insulin resistant status. Helps confirm diagnosis of hypoglycemia resulting from tumor, abnormal increase of pancreatic islet cells, glucocorticoid deficiency or severe liver disease.

What "high" or "increased" may indicate

  • High insulin levels with a Corresponding low blood sugar level , suggest insulinoma.
  • Insulin resistant diabetes mellitus

What "low" or "decreased" may indicate

  • Non-insulin resistant diabetes mellitus.

Sample

Plain clotted blood

Patients Preparation

Preferred fasting. Fasting is defined as no consumption of food or beverages other than water for at least 8-12 hrs before blood collection.

Indication

Investigation of primary Aldosteronism (Adrenal Adenoma / Carcinoma and Adrenal Cortical hypoplasia) and secondary Aldosteronism (Renovascular disease, salt depletion, potassium loading , cardiac failure with ascites and pregnancy)

What "high" or "increased" may indicate

  • Hypertension Primary Aldosteronism
  • Cancer of the adrenal cortex Overactive adrenal cortex
  • Congestive heart failure Cirrhosis
  • Third trimester of pregnancy

What "low" or "decreased" may indicate

  • Hypo Aldosteronism 2 Addison' s disease
  • Toxemia of pregnancy
  • Loss of too much salt

Sample

Plain clotted blood (Chilled tube)

Patient's Preparation

Complete 30 min rest before blood collection. Eat a law carbohydrate, normal salt diet (3g/day for at least 2 weeks before the test. If possible eat this diet for 30 days before the test. Don't eat licorice for at least 2 weeks before the test.

Indication

This assay provides additional information or Coronary Heart Disease (CHD).

What "high" or "increased” may indicate

  • High HDL generally indicates a healthy state.
  • High LDL generally indicates a higher than average risk for developing coronary artery disease.

Sample

Plain clotted blood

Patient's Preparation

10 -12 hrs fasting before blood collection. Fasting is defined as no consumption of food or beverages other than water. Eat a normal diet for 2 weeks before the test.

Indication

Lipid disorders. Helps determines the risk of heart disease, especially the risk of coronary- artery disease. Evaluates fat metabolism Helps confirm diagnosis of nephrotic syndrome Pancreatitis, liver disease, hypothyroidism (CHD)

What "high" or "increased" may indicate

  • Bile-duct blockage
  • Hyperthyroidism
  • Early hepatitis
  • Liver disease
  • Consumption of a high -fat diet
  • Hypothyroidism Increase risk of coronary- artery disease
  • Pancreafitis

What "low" or "decreased" may indicate

  • Liver disease
  • Hypothyroidism
  • Malnutrition

Sample

Plain clotted blood

Patient's Preparation

Overnight fasting is required. Minimum 12 hours. (Fasting is mandatory)

Adults: 12 -14 hrs

Pediatric less than 6 yrs: Just before the feed/meal

Pediatric older than 6 yrs: Overnight fast specially the fasting period

For optimal results, the patient should be on a stable diet for 2- 3 weeks prior to testing. Fasting is defined as no consumption of food or beverages other than water before blood collection.

Indication

This assay useful for diagnosis and differential diagnosis of hypercalcemia. It also help in the diagnosis of Primary/Secondary/Tertiary Hyperparathyroidism and Hypoparathyroidism.

What "high" or "increased" may indicate

  • Hyperparathyroidism

What "low" or "decreased" may indicate

  • Hyperparathyroidism
  • Lung cancer
  • Kidney, pancreas or Ovarian cancer

Sample

Plain clotted blood (Chilled tube) Obtain ice before drow for specimen transport.

Patient's Preparation

12 hrs fasting before the sample collection. Fasting is defined as no consumption of food or beverages other than water.

Indication

Adrenocortical function Helps confirm diagnosis of Cushing' s disease &Addison' s disease Helps diagnose secondary adrenal insufficiency.

What "high" or "increased" may indicate

  • Cushing' s disease

What "low" or "decreased" may indicate

  • Addison' s disease
  • ACTH secretion Hypophysectomy
  • Post - Partum pituitary necrosis
  • Craniopharingioma
  • Chromophobe adenoma

Sample

Plain clotted blood

Patient's Preparation

Cortisol blood test may be drawn at about morning 9 am or mid night or any special request .Limit your physical activity for 10 -12 hrs before the test. Eat normal salt diet (3g/day) for 3 days before the test.

CORTISOL, STIMULATION BY ACTH J CORTISOL SUSPRESSION TEST BY ZONE.

Indication

Measurement of free testosterone may be useful when disturbances in SHBG are suspected as in obesity and estrogen excess.

Sample

Plain clotted blood

Patient's Preparation

12 hrs fasting before the sample collection. Fasting is defined as no consumption of food or beverages other than water.

Indication

C-peptide is useful in distinguishing insulinomas from exogenous insulin administration. Its concentration is severely decreased or absent in Type I Diabetes mellitus. C- peptide is also useful in monitoring patients who have received Islet cell or pancreatic transplants.

Sample

Plain clotted blood

Patient's Preparation

Fasting is defined as no consumption of food or beverages other than water for 12-14 hrs before blood collection.

Indication

Suspected colorectal cancers. Polyps, gastrointestinal bleeding.

What “abnormal" may indicate

  • A positive test indicates gastrointestinal bleeding.
  • Varices.
  • Peptic Ulcer.
  • Carcinoma.
  • Ulcerative Colitis.
  • Dysentery.
  • Haemorrhagic disease.

Sample

Approximately 5 -10 g

Patients Preparation

Random sample In case of menstrual period, delay the sample collection by 3 days. Refrain from taking alcohol, aspirin or other gastro-irritant medicine which could provoke bleeding, at least 48 hrs before the sample collection. For the three day before and during stool collection eat a well-balanced diet including fiber such as bran cereals, fruit and vegetable. Avoid red meats Including beef, lamb, and liver.

Indication

Helps distinguish between folic-acid deficiency and vitamin B 12 deficiency.

What "high" or "increased" may indicate

  • Leukemia
  • Liver disease

What "low" or "decreased" may indicate

  • Inadequate ingestion of folic acid from natural sources. (common in vegetarian)
  • Malabsorption syndrome
  • Hyperthyroidism
  • Pernicious anemia

Sample

Plain clotted blood

Patient's Preparation

Fasting is preferred, defined as no consumption of food or beverages for 12-14 hrs other than water before blood collection. However, your doctor may request that you have blood drawn when you are not fasting. Don't drink any alcohol for 24 hours before the test

Indication

This assay helps for determining male fertility status.

What "abnormal" may indicate

  • Men who can't deliver any viable spermatozoa in their ejaculation during sexual inter cause are sterile
  • Subnormal sperm count, decreased sperm motility and abnormal morphology are associated with decreased fertility

Sample

  • Sterile screw capped container
  • Specimen must be kept at body temperature after collection
  • Specimen must reach the lab within 30 mint of collection.

Patients Preparation

Patient should refrain from ejaculation for 2 - 7 days (ideally 3 days ) prior to collection. If you are taking any drugs or medication, discuss with your doctor

OUTSTATION SAMPLES ARE NOT ACCEPTABLE

Indication

Folate & iron deficiency

Sample

EDTA blood

Patient's Preparation

Fasting is preferred. No consumption of food or beverages for 12-14 hrs other than water before blood collection. However, your doctor may request that you have blood drawn when you are not fasting. Do not drink any alcohol for 24 hours before the test.

Indication

This test along with Homo vanillic acid is useful for screening children for catecholamine Secreting tumor Helps detect pheochromocytoma tumor and some disorders of the autonomic nervous system. Evaluates the function of adrenal medulla

What "high" or "increased" may indicate

  • Catecholamine secreting tumor such as pheochromocytoma.
  • Endocrine disorders

Sample

24 hour urine collection

Patient's Preparation

This patient should strictly avoid Theophylline, Chocolate, Vanilla, Banana, Alcoholic beverages, Tea/Coffee, Tobacco, and strenuous exercise at least 72 hrs before and during collection.

The following drugs may affect test results, you may be asked not to take this medications before the test.

  • Amino salicylic acid (PAS)
  • Penicillin
  • MAO Inhibitors Reserpine
  • Methocarbamol
  • Clofibrate
  • Aspirin
  • Oxytetracycline
  • Bromsulphalein (BSP)
  • PSP
  • Imipramine
  • Guanethidine analogs
  • Phenazopyridine
  • Mephenesin
  • Nalidixic acid
  • Chlorpromazine
  • Glyceryl guaiacolate
  • Bromsuphalein (BSP)
  • Sulfa drugs

Indication

This assay is extremely useful in the diagnosis of Gastrinoma. Helps determines cause of severe ulcer disease of the stomach or small intestine. Helps detect pernicious anemia.

What “high" or “increased" may indicate

  • Low stomach acid
  • Pernicious anemia
  • Stomach cancer
  • Over 1000pg/m1 establishes diagnosis of Zollinger Ellison syndrome

Sample

Plain clotted blood

Patient's Preparation

Overnight fasting is preferred (12 hrs) Fasting is defined as no consumption of food or beverages other than water before blood collection. Don't drink any alcohol for 24 hours before the test.

Indication

Determines if blood clots properly Detects congenital and acquired platelet bleeding disorders

What “low" or “decreased" may indicate

  • Bernard-Soulier syndrome
  • Glanzmann's thrombasthenia
  • Polycythemia
  • Storage - pool disease
  • Von-will-brand’s disease

Sample

Sodium Citrate blood & EDTA blood

Patients Preparation

Avoid following drugs for 10 days prior to the test.

  • Aspirin & Aspirin compounds Clopidrogel ,
  • Non steroid and inflammatory drugs Corticosteroids
  • Ticlopidin Garlic Concentrates Anti biotic like Penicillin & Cepholoporin and fasting 8-10 hours.

Fasting is defined as no consumption of food or beverages other than water.

Indication

Anterior pituitary function. This assay is useful for the diagnosis of Acromegaly/ Gigantism and assessment of treatment efficacy. It is used to diagnose Growth Hormone deficiency specially in children with short stature, helps confirm diagnosis of Dwarfism and suspected Tumor of the Pituitary.

What "high" or “increased" may indicate

  • Pituitary or hypothalamic tumor Dwarfism that cause Gigantism in children acromegaly in adults

What “low" or “decreased" may indicate

  • Loss of normal blood supply to the pituitary
  • Metastatic cancer
  • Tumors
  • Dwarfism

Sample

Plain clotted blood

Patients Preparation

Fasting 12 hrs & complete rest 30 min before blood collection. Fasting is defined as no consumption of food or beverages other than water before blood collection.

Indication

This assay is a screening test for the diagnosis of catecholamine secreting Pheochromocytoma & Paragangliomas.

Sample

24 hour urine collection.

Patient's Preparation

Patient should strictly avoid alpha-methyldopa, buspirone, codeine, isoproterenol metabolite, mandelamine, L dopa, paracetamol, metoclopramide, pepper, alcoholic beverages, tea/coffee tobacco and strenuous exercise at least 72 hours before and during specimen collection.

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Indication

Screening for Diabetes mellitus

What “high" or “increased" may indicate

  • Levels of 110mg/100ml or more two or more occasions suggests diabetes mellitus

What “low" or “decreased" may indicate

  • Too much insulin
  • Tumor of pancreas islet cells
  • Hypothyroidism
  • Adrenal insufficiency
  • Hypopituitarism
  • Malabsorption syndrome
  • Liver disease

Sample

Na F and potassium oxalate in 1:3 ratio

Patient's Preparation

Overnight Fasting

Adults: 9-12 hours

Pediatric less than 6 years: Just before the feed/meal

Pediatric more than 6 years: Overnight fast

Fasting is defined as no consumption of food or beverages other than water before blood collection. Avoid the strenuous exercise before the test

  • All relevant data should be given on the request form with correct labeling of the container.
  • All specimens should be collected into a sterile container prior to commencing treatment with antimicrobial agents.
  • Specimens of body fluids including, Blood, CSF, Pleural, Peritoneal
  • Synovial fluids should be collected under strict aseptic conditions. For collection of blood refer instructions given previously.
  • Pus should be collected from the depth of wound or wall of an abscess after wiping surface exudate with sterile saline.
  • Sputum an early morning sample preferable.
  • Urine should be a clean mid-stream specimen and proper instructions should be given to patient. Clean catch specimen for babies -thoroughly clean urethral area and perineum with soap and water-wipe with sterile gauze and collect urine into sterile urine collection bag.
  • Stool the bloody mucoid part of stool should be collected.
  • Collection of urine from patient with indwelling catheter- contact Asiri Hospital lab for instructions.

All specimens should be transported to the laboratory without delay as specimens kept for long periods would not give accurate results on culture.

Indication

The OGTT is used for the diagnosis of diabetes mellitus, where the random or fasting plasma glucose concentration is inconclusive in reaching a diagnosis. The test is also used in pregnancy to diagnose gestational diabetes (GD1v1) in women who are in a high risk group.

What "high" or "decreased" may indicate

  • Acromegaly
  • Acute stress (response to trauma, heart attack, and stroke for instance)
  • Chronic kidney failure
  • Cushing syndrome
  • Excessive food intake
  • Hyperthyroidism
  • Pancreatic cancer
  • Pancreatitis

Sample

  • Na F and potassium oxalate in 1:3 ratio
  • Urine samples

Patient preparation

OGTT

  • Three days unrestricted, carbohydrate rich diet and activity.
  • No medication on the day of the test.
  • Do not eat during the test Fasting overnight for 10-12 hours is required. Fasting is defined as no consumption of food or beverages other than water before blood collection.
  • After taking the 1st blood sample 75g or 100 g of glucose is given (according to the doctor’s order) (glucose is dissolved in 200 ml water).
  • Take the 2nd blood sample 30 minutes after glucose.
  • Take sample as follows: 1 hour, 1 % hour 2 hour.
  • Take urine sample too, when taking each blood sample.
  • Patient should wait in the hospital premises till the test is over.

Indication

This assay is used to evaluate diabetic patients to assess the potential of early onset of nephropathy before overt proteinuria develops.

Sample

Second morning urine collection

Patient's Preparation

Patient should be rest before the sample collection.