PATOLOGI KIMIA

Head of Unit

Dr Nur Shafini Binti Che Rahim

Phone

+60326155555 ext 5630

1.

INTRODUCTION

The Chemical Pathology Unit provides diagnostic and consultative services to Hospital
Kuala Lumpur for patient management. It also serves as referral centre for all the
hospitals in Malaysia. Our services cover analysis and interpretation of biochemical
changes in body fluids for diagnostics, monitoring and screening of diseases.

2.

SERVICES

Chemical Pathology Unit offers specialized biochemical testing. The list of services
includes:

i.

Endocrine
Thyroid

Function

Catecholamines,

Test,
Extended

Fertility

Test,

Hormone

Serum

and

Urinary

Cortisol,

(Dehydroepiandrosterone

sulphate

(DHEAS), Insulin, C-peptide, Growth Hormone, Adrenocorticotrophic Hormone

(ACTH), Intact Parathyroid Hormone (IPTH))
ii.

Metabolic
HbA1c, Homocysteine

iii.

Protein and Proteomic

Serum and Urine Protein Electrophoresis, Special Protein (Alpha 1 anti-trypsin,
haptoglobin, transferrin, caeruloplasmin, IgG, IgA, Ig M

iv.

Hematological Biochemistry

v.

Toxicology.

Requests are made as either single test or multiple tests in a dynamic function tests.

3.

SERVICE HOURS

Operating hours : 7.30 am 5.30 pm (Monday Friday)

URGENT request: Appointment should be made by contacting Pathologist,Medical
Officer and Section in-charge. The request form should be signed or countersigned by
requesting Specialist.
4.

REQUEST FORMS

Request forms for all tests are PERPAT 301 form.

5.

SAMPLE COLLECTION

5.1

BLOOD

Most of tests in chemical Pathology require serum sample that need to be collected in
plain tube. Special requirement needed for certain tests:

For HbA1c test require whole blood sample that need to be collected in EDTA
tube. Request less than 2 months from previous result will be rejected.

For morning serum cortisol: between 8 to 10 am; for midnight serum cortisol:
between 10 to 12 pm.

For fertility test: Progesterone collected at day 21 menstrual cycle, estradiol, FSH
and LH is collected at day 2 to 5 of menstrual cycle.

Certain tests required to be sending in ice such as ACTH.

Serum and Urine Protein Electrophoresis should be send as paired sample for
better interpretation of tests results

5.2

URINE
24 hours Urine Collection

Most quantitative assays are performed on urine specimen collected over 24 hours. The
24 hours timing allows for circadian rhythmic changes in excretion at certain time of day.
Procedure of collection:

The 24 hours urine bottle which contains appropriate preservative for the
required test is available at the Stor Integrasi, Jabatan Patologi. Urine bottle will
be provided on request, with the accompanying request form or note.

On the day of collection, the first urine voided must be thrown away. Time of first
urine voided is the start of the timing for the 24 hour collection.

Collect the second and subsequent voided urine for 24 hour from the timed start
into the 24 hour urine bottle.

For male patient, it is advisable NOT to void the urine directly into the 24 hour
urine bottle. This is to avoid possible chemical burns.

At the end of 24-hours, the last urine voided is collected. For best result,
refrigerate if possible.

Label the bottle as directed and send immediately to the laboratory.

eg. of tests: 24-hours urine cortisol and 24-hours urine catecholamine

24-hours Urine Catecholamines

Please refer to procedure 24 hour urine collection to collect urine for 24hr urine
catecholamines.

For adult minimum 500 mls of urine should be collected. For paediatric samples
urine creatinine will be run for every request.

Please note that, preservative 10 mls of 25% HCl is added into the bottle to
preserve the analytes. It is important for the requesting physician to advise the
patient NOT to discard the preservative.

Instruction on patient preparation and specimen collection

Abstain from bananas, coffee, pineapple and walnuts one day prior to and
during the 24 hour urine collection.

Certain drugs alter the metabolism of catecholamines. It is advisable to stop

such medication at least 5 days prior to urine sampling i.e Alpha2 agonists,
Calcium channel blockers, ACE inhibitors, Bromocriptine, Methyldopa,
Monoamine

oxidase

inhibitors,

Alpha

blockers

and

Beta

blockers,

Phenothiazines and Tricylic antidepressants.

Please advice patient to avoid stress, exercise, smoking and pain prior to and
during urine collection.
24-hours Urine Cortisol

Please refer to procedure 24 hour urine collection to collect urine for 24hr
urine cortisol.

6.

Minimum of 500 mls of urine should be collected.

RECEIPT OF SPECIMEN

Specimens will be received at the main counter (Pre-analytical Unit).

7.

REPORTING OF RESULTS

Results will be validated by Chemical Pathologist/Medical Officer/Scientific Officer

according to the test. Test results will be ready according to promised Laboratory
turnaround time (please refer to Section List of Tests).
Current reference intervals will be provided for all results. These may be subject to
variation differentiated by age and sex where important / available.
Reports are dispatched to the respective pigeon hole or posted via mail for referral
external samples.

8.

ENQUIRY OF RESULTS

Enquiry of results can be made to Unit Patologi Kimia by telephone (ext 5284). Enquiry
for result from external customer can be made via tracing letters.
9.

SERVICES AFTER OFFICE HOURS

If test needed after working hours, consultation and agreement from Chemical
Pathologist/ Medical Officer in charged are required.
10.

PROTOCOLS FOR INVESTIGATION OF ENDOCRINE DISORDERS

The protocols listed below are only as guide and are subjected to changes according to
clinician requirement. These protocols are mainly for adult.
10.1

PITUITARY DISORDERS

Assessment of Anterior pituitary Hormone

1. Pituitary Hormone Insufficiency
Anterior pituitary hormones include Growth Hormone (GH), Prolactin, Thyroid
Stimulating Hormone (TSH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone
(LH) and Adrenocorticotrophic Hormone (ACTH). Main abnormalities to look for are
Corticotroph deficiency, Thyrotroph deficiency, Gonadotroph deficiency or Somatotroph
deficiency.
Assessment of Anterior Pituitary Reserve
a)

Initial assessment

Morning serum Cortisol and ACTH or Short Synachten Test

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH

Testosterone for man


b)

Estradiol for woman

Combine Anterior Pituitary Stimulation Test (Insulin Stress Test +

Gonadotrophin Stimulation Test)
Procedures:

Fast the patient overnight.

Insert intravenous catheter or intravenous line.

Rest patient for 30 minutes. Take samples for glucose, growth hormone,
cortisol, LH, FSH and TSH (as baseline investigation).

Give insulin 0.1-0.15 unit/kg body weight, 200g TRH and GnRH 100ug
intravenously.

Collect samples into plain tubes and Glucose tubes and label as follows:

Time

Tests

Tube

0 min (basal)

Glucose

Glucose tube

Cortisol,

GH,

LH, 1 plain tube

FSH,TSH
15 min

Glucose

Glucose tube

20 min

FSH, LH, TSH

1 plain tube

30 min

Glucose

Glucose tube

Cortisol, GH, LH

1 plain tube

45 min

Glucose

if

patient Glucose tube

become
clinically/biochemically
(glucose < 2.2 mmol/L)
hypoglycaemic
60 min

Glucose
Cortisol,

Glucose tube
GH,

LH, 1 plain tube

FSH,TSH
90 min

120 min

Glucose,

Glucose tube

cortisol, GH

1 plain tube

Glucose,

Glucose tube

cortisol, GH

1 plain tube

* GH-Growth hormone, LH-Luteinizing hormone, FSH- Follicular stimulating

hormone, TSH Thyroid Stimulating Hormone
Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,
Mosby, 2008, pg 140.

Label specimens according to sampling time.

Send all samples after test is completed to main counter, Pathology

Department.

Notes:

Plasma glucose level must fall below 2.2 mmol/L and/or clinical signs and
symptoms of hypoglycaemia (sweating, tachycardia etc) must be observed.

Additional intravenous insulin may be given if this does not occur by 30 min
and sampling should be prolonged by another 30 min.

Physician should be in attendance throughout the tests and 50% i.v. dextrose
should be kept by bed side if severe hypoglycemia is documented.

Giving glucose for severe hypoglycemia does not invalidate the test results.

Test is contraindicated for patient with seizure, IHD or cardiovascular

insufficiency and in young children.

c)

Normal ECG is mandatory.

Insulin Stress Test

Procedures:

Similar as Combine Anterior Pituitary Stimulation Test but without GnRH

injection.

Blood samples are taken at 0 minute (basal), 30 minutes and 60 minutes

after insulin injection for glucose, cortisol and growth hormone (GH) as
follows:

Time
0 min (basal)

Tests
Tube
Glucose
Glucose tube
Cortisol, GH
1 plain tube
30 min
Glucose
Glucose tube
Cortisol, GH
1 plain tube
60 min
Glucose
Glucose tube
Cortisol, GH
1 plain tube
Label specimens according to sampling time.

Send all samples after test is completed to main counter, Pathology

Department.

d)

Gonadotrophin- Releasing Hormones Stimulation Test

Procedures:

Collect samples into plain tubes for LH and FSH (basal sample).

Give 100 ug GnRH.

Collect samples into plain tubes at 15 minutes, 30 minutes, 60 minutes and

90 minutes after GnRH injection for Luteinizing Hormone (LH) and Follicular
Stimulating Hormone (FSH).

Time

Tests

Tube

0 min (basal)

FSH, LH

1 plain tube

15 min

FSH, LH

1 plain tube

30 min

FSH, LH

1 plain tube

60 min

FSH, LH

1 plain tube

90 min

FSH, LH

1 plain tube

Label specimens according to sampling time.

Send all samples to main counter Pathology Department

2. Pituitary surgery assessment

a)

b)

Pre-operative assessment

Morning serum cortisol

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH

Testosterone for man

Estradiol for woman

Post-operative assessment (2-4 days after surgery)

Steroid coverage with hydrocortisone is administered immediately before,

during and after surgery.

If adrenal function was normal before surgery, hydrocortisone is stopped on

second or third post-operative day.

c)

24 hours after stopping take morning blood for cortisol

Follow up assessment ( one month after surgery)

FT4

Testosterone for man

Estradiol for woman

Cortisol and ACTH at 9.00 am and Short Synacthen test, even if function is
subnormal after surgery. ACTH deficiency after surgery is often transient.

After pituitary irradiation, patient should be evaluated at least once per year with
measurement of FT4, estradiol (if female), testosterone (if male), FSH, LH, prolactin,
cortisol, ACTH and Short Synacthen Test.

3. Acromegaly
a)

Screening and biochemical diagnosis

2 tests must be done to attain biochemical diagnosis of active acromegaly.

Measure IGF 1 level according to age-adjusted reference.

Perform oral glucose tolerance test with 75g oral glucose after at least 8
hours of overnight fasting.

Active acromegaly is indicated by elevated IGF 1 and failure of GH to be

suppressed below 1 ng/ml.

GH may not be suppressed in poorly controlled diabetes mellitus, severe

illness, chronic liver disease and chronic kidney disease.

b) Other biochemical tests

Serum prolactin

ACTH and cortisol (morning sample)

TFT

LH, FSH, testosterone (male), estradiol (female) morning sample

Fasting serum lipids

RP, uric acid

LFT, calcium, phosphate

Urine FEME

Assessment of Posterior Pituitary Hormone

Posterior pituitary secretes vasopressin (ADH) and oxytocin. These hormones are
synthesized in hypothalamus and pass down nerve axons into the posterior pituitary
and released into the circulation.
1.

Diabetes Insipidus (DI)

Lack of ADH caused by pituitary/hypothalamic disease (cranial DI) or failure

of kidney to respond to ADH (nephrogenic DI)

Presented with polyuria urine volume >3 L/day

common causes of polyuria such as diabetes mellitus , hypokalemia ,

hypercalcemia and diuretic therapy have been excluded

Measure serum and urine osmolality and sodium

If serum osmolality 295 mOsm/kg, urine osmolality is < 300 mOsm/kg and
sodium 145 mmol/l - Diagnosis of Diabetes Insipidus is unlikely and not for
Fluid Deprivation test

a)

If diagnosis is in doubt; perform Fluid Deprivation test

Protocol for Fluid Deprivation Test

Procedure

Allow fluids overnight before test and give light breakfast with no fluid; no
smoking permitted

Weigh patient

Allow no fluid for 8hours; patient must be under constant supervision

Every 2 hours

Weigh patient (stop test is weight falls by > 5% initial body weight)

Measure urine volume and osmolality

Measure plasma osmolality ( stop test if osmolality >300 )

After 8 hours
-

Allow patient to drink ( no more than twice urine volume of period of fluid
deprivation, to avoid acute hyponatraemia) and give 2 g desmopressin i.m

Measure urine osmolality every 4 hours for further 16 hours

Interpretation:
Algorithm for the investigation of polyuria.
polyuria

measure:
blood glucose
plasma
creatinine
potassium
calcium

abnormal

diagnosis

normal

fluid deprivation
test

Urine osmolality (mmol/kg) after:

8 h fluid

desmopressin

deprivation
<300

>750

Cranial diabetes
insipidus

<300

<300

Nephrogenic

>750

>750

300-750

<750

diabetes insipidus
Primary polydipsia
Non-diagnostic

Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,
Mosby, 2008, pg 152

10.2 ADRENAL DISORDERS

Disorders of Adrenal Cortex
Adrenal hypofunction (Addisons Disease)

1.

a.Short Synacthen Test/Cosyntropin Test

High index of suspicion is required to diagnose adrenal insufficiency.
Indications for screening:
Unexplained hyponatremia.
Prolonged corticosteroid or traditional medication ingestion.
Bilateral adrenal mass.
Screening is by doing short synacthen test.

Procedure:

Take blood sample for baseline cortisol level (0 minutes).

Give 250ug cosyntropin (synthetic ACTH) intramuscularly or intravenously.

Take samples at 30 minutes and 60 minutes after injection for cortisol level.
Time

Tests

Tube

0 min (basal)

Cortisol

1 plain tube

30 min

Cortisol

1 plain tube

60 min

Cortisol

1 plain tube

Interpretation:

Normal response is cortisol peak is greater than 550 nmol/l.

Patient with atrophy of adrenal cortex (exogenous steroid / pituitary or

hypothalamic disease) shows slight rise in serum cortisol.

2.

Adrenal Hyperfunction (Cushings syndrome)

Screening tests should be done in patients:
With multiple and progressive features of Cushing syndrome

With adrenal incidentaloma.

After excluding exogenous steroid intake.

Screening tests are:

i.

24-hours urine free cortisol: if less than 380 nmol/day, Cushing

syndrome is excluded and if level is 3-4 times greater than upper limit
normal, suggestive of Cushing syndrome.

ii.

Overnight Low Dose Dexamethasone Suppression Test (OLDDST)

Procedure:
Give 1 mg dexamethasone orally at 2300 or 2400 hours.

Fill up the request form complete with clinical summary and

request test mentioned above.

Collect blood at 8.00 am the next morning for determination

of serum cortisol and send to main counter, Pathology
Department.

Interpretation: In normal subjects, serum cortisol is suppressed

to less than 50 nmol/l. Serum cortisol level of more than 50
nmol/l can also be seen in cases of stress, obesity, infection,
acute or chronic illness, alcohol abuse, severe depression, oral
contraceptive, pregnancy, estrogen therapy, failure to take
dexamethasone,

or

treatment

with

diphenylhydantoin

phenobarbital (enhancement of dexamethasone metabolism).

iii.

Low Dose Dexamethasone Suppression Test

Procedure:

or

At 9.00am on 1st day of test, collect blood for serum cortisol

(basal) and request test mentioned above.

Immediately after sampling, give 0.5mg dexamethasone orally

every 6 hrs for 2 days (8 times).

Collect blood for serum cortisol 6 hours after last dose of 0.5mg
dexamethasone

and send to main counter Pathology

Department.
Note:

Ensure the times are followed strictly and with full compliance.
Day 1

Sample taken for

serum cortisol.

Day 2

0900 am (basal)

Day 3
0900 am

Drug given: 0.5mg 0900 am

dexamethasone
every 6 hours (8
1500 pm
times)

0300 am

0300
dose)

0900 am

2100 pm

1500 pm

2100 pm

am

(last

Interpretation:
In normal subjects, serum cortisol will be suppressed to <50nmol/l.

After 2 concordantly positive screening tests, localization tests are

recommended, which include:
iv.

Plasma ACTH

Procedure:
Blood should be taken together with serum cortisol at 9am.
Keep the tube in ice water bath and send to lab for
centrifuged and frozen as soon as possible to avoid falsely
low result.

Interpretation:
ACTH < 5 ng/L (<1 pmol/L): ACTH independent Cushing
proceed with CT scan of adrenals.
ACTH >15 ng/L (>3 pmol/L): ACTH dependent Cushing
proceed with MRI pituitary/ CXR.

v.

Bilateral inferior petrosal sinus sampling:

11.

12.

For localization of pituitary tumour (Cushing disease).

REFERENCES

Special Endocrinology Test Protocols for Adults ,Endocrinology Unit, Department

of MedicineHospital Putrajaya, 2010

Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert, Mosby,
2008

CONTACT NUMBERS

Location

Ext.

Direct Line

Bilik Ketua Unit

5630

03-26155630

Scientific Officer Room

5611

03-26155611

Medical Officer Room

7530

03-26157530

Laboratory

5284

03-26155284

TESTS AVAILABLE AT CHEMICAL PATHOLOGY UNIT

(ACCORDING TO ALPHABETICAL ORDER)
NO

TEST

SPECIMEN
TYPE

CONTAINER

VOLUME

TAT

Blood
Blood

EDTA tube in
ice
Plain tube

3 ml

Adenocorticotrophic Hormone
(ACTH)
Alpha-1-antitrypsin

Caeruloplasmin

Blood

Plain tube

3 ml

5 working
days
5 working
days
5 working
days

Catecholamines :

Urine

24 hrs urine
container with
10mL of 25%
HCL

24 hrs urine
collection

3 ml

20 working
days

REFERENCE RANGE

10.2 pmol/L

REMARK

Packed with ice

0.9 2.0 g/L

Male : 0.15 0.30 g/L
Female : 0.16 0.45 g/L
Reference range for 24 hour urine
catecholamines 750mL :
Epinephrine : 0.5 - 20ug/24 hrs
Norepinephrine : 15.0 80.0ug/24 hrs
Dopamine : 64- 400ug/24 hrs
Reference range for random urine
catecholamines < 750mL
Epinephrine :
< 2 yr : < 75.0 ug/g creatinine
2 4 yr : < 57.0 ug/g creatinine
5 9 yr : < 35.0 ug/g creatinine
10 19 yr :< 34.0 ug/g creatinine
Norepinephrine :
< 2 yr : < 420.0 ug/g creatinine
2 4 yr : < 120.0 ug/g creatinine
5 9 yr: < 89.0 ug/g creatinine
10 19 yr :< 82.0 ug/g creatinine

Rejection criteria :
i) Inadequate urine
collection (Adult <
500 ml
ii) Urine pH > 5.

Dopamine :
< 2 yr : < 3000.0 ug/g creatinine
2 4 yr : < 1533.0 ug/g creatinine
5 9 yr: < 1048.0 ug/g creatinine
10 19 yr :< 545.0 ug/g creatinine
5

Cholinesterase

Blood

Plain tube

3 ml

1 working
day

Male and Children;

Female ( 40 years old) :
5320 12,920 U/L
Female (16 39 years old), not
pregnant, not taking contraceptives :
4260 11,250 U/L

Cortisol

Blood

Plain tube

3 ml

3 working
days

Morning Cortisol
: 171 536 nmol/L
Midnight Cortisol
: 64 327 nmol/L

Urine

24 hrs urine
container
without
preservative

24 hrs urine
collection

5 working
days

24 hrs Urine Cortisol

: 100 379 nmol/24 hrs

5 working
days
10 working
days

298 2350 pmol/L

5 working
days

Female (Adult) :
Follicular phase : 45.4 - 854 pmol/L
Ovulation phase : 151 - 1461 pmol/L
Luteal Phase : 81.9 1251 pmol/L
Post-menopausal : < 18.4 505
pmol/L

C-Peptide

Blood

Plain tube

3 ml

Dehydroepiondosterone
Sulphate (DHEAS)

Blood

Plain tube

3 ml

Estradiol

Blood

Plain tube

3 ml

24 hours urine
collection with
volume 500 ml

Male : 2.20 15.20 umol/L

Female : 0.95 11.70 umol/L
Blood taking at Day
2 to Day 5 menses

Male (Adult) :
94.8 223 pmol/L
10

Ferritin

Blood

Plain tube

3.5 ml

10 working
days

Children :
< 1yr : 12 327 ug/L
1 6 yr : 4 67 ug/L
Male :
7 17 yr : 14 152 ug/L
> 17 yr : 30 400 ug/L
Female :
7 17 yr : 7 84 ug/L
> 17 yr : 13 150 ug/L

11

Folate

Blood

Plain tube

3.5 ml

12.0 43.9 nmol/L

12

Follicle Stimulating Hormone

(FSH)

Blood

Plain tube

3 ml

10 working
days
5 working
days

Female :
Follicular phase : 3.5 12.5 IU/L
Ovulatory phase : 4.7 21.5 IU/L
Luteal Phase : 1.7 7.7 IU/L
Post-menopausal : 25.8 134.8 IU/L
Male (Adult) :1.5 12.4 IU/L
Children :
Boys :
< 5 yr : 0.2 2.8 IU/L
6 10 yr : 0.4 3.8 IU/L
11 13 yr : 0.4 4.6 IU/L
14 17 yr : 1.5 12.9 IU/L
Girls :
< 5 yr : 0.2 11.1 IU/L
6 10 yr : 0.3 11.1 IU/L
11 13 yr : 2.1 11.1 IU/L
14 17 yr : 1.6 17.0 IU/L

13

Free Thyroxine (FT4)

Blood

Plain tube

3 ml

3 working
days

Children :
Newborns : 11.0 32.0 pmol/L
6 d 3 mth : 11.5 28.3 pmol/L

Blood taking at Day

2 to Day 5 menses

4 12 mth : 11.9 25.6 pmol/L

1 6 yr : 12.3 22.8 pmol/L
7 11 yr : 12.5 21.5 pmol/L
12 20 yr : 12.6 21.0 pmol/L
Adults : 12.0 22.0 pmol/L
14

Free Triiodothyronine (FT3)

Blood

Plain tube

3 ml

5 working
days

Children :
Newborns : 2.7 9.7 pmol/L
6 d 3 mth : 3.0 9.3 pmol/L
4 12 mth : 3.3 9.0 pmol/L
1 6 yr : 3.7 8.5 pmol/L
7 11 yr : 3.9 8.0 pmol/L
12 20 yr : 3.9 7.7 pmol/L
Adults, euthyroid : 3.1 6.8 pmol/L

15

Gamma Glutamyl Transferase

(GGT)

Blood

Plain tube

3 ml

5 working
days

Male : < 60 U/L

Female : < 40 U/L

16

Growth Hormone

Blood

Plain tube

3 ml

10 working
days

Male : 3 ug/L
Female : 8 ug/L

17

Haptoglobin

Blood

Plain tube

3 ml

0.30 2.00 g/L

18

Haemoglobin A1c (HbA1c)

Blood

EDTA tube

3 ml

5 working
days
3 working
days

19

Homocysteine

Blood

3 ml

Immunoglobulin G (IgG)

Blood

21

Immunoglobulin A (IgA)

Blood

Plain tube

3 ml

22

Immunoglobulin M (IgM)

Blood

Plain tube

3 ml

23

Insulin

Blood

Plain tube

3 ml

24

Intact Parathyroid Hormone

(IPTH)

Blood

20 working
days
5 working
days
5 working
days
5 working
days
10 working
days
5 working
days

< 15 umol/L

20

Plain tube in
ice
Plain tube

Plain tube

3 ml

3 ml

NGSP (< 6.5 %) /

IFCC (< 48 mmol/mol) - Optimal
Glycaemic Control

7.0 16.0 g/L

0.7 4.00 g/L
0.4 2.3 g/L
29.1 uIU/mL
1.3 6.8 pmol/L

Packed with ice

25

Iron (Fe)

Blood

Plain tube

3 ml

26

Luteinising Hormone (LH)

Blood

Plain tube

3 ml

10 working
days
5 working
days

5.8 34.5 umol/L

Female :
Follicular phase : 2.4 12.6 IU/L
Ovulatory phase : 14.0 95.6 IU/L
Luteal Phase : 1.0 11.4 IU/L
Post-menopausal : 7.7 58.5 IU/L

Blood taking at Day

2 to Day 5 menses

Male :
1.7 8.6 IU/L
Children :
Boys :
< 1 yr : < 0.4 IU/L
1 5 yr : < 1.3 IU/L
6 10 yr : < 1.4 IU/L
11 13 yr : 0.1 7.8 IU/L
14 17 yr : 1.3 9.8 IU/L
Girls :
< 1 yr : < 0.4 IU/L
1 5 yr : < 0.5 IU/L
6 10 yr : < 3.1 IU/L
11 13 yr : < 11.9 IU/L
14 17 yr : 0.5 41.7 IU/L
27

Paraproteins / Protein
electrophoresis

Blood

Plain tube

3 ml

Urine

24 hrs urine
container
or
50 ml sterile
container

5 ml

Albumin
: 53.8 65.2 % or 32.3 39.1 g/L
Alpha-1- globulins
: 1.1 3.7 % or 0.7 2.2 g/L
Alpha-2-globulins
: 8.5 14.5 % or 5.1 8.7 g/L
10 working
days

Beta globulins
: 8.6 14.8 % or 5.2 8.9 g/L
Gamma globulins
: 9.2 18.2 % or 5.5 10.9 g/L

Blood and urine

sample must be
sent together.

28

Progesterone

Blood

Plain tube

3 ml

5 working
days

Female :
Follicular phase : 0.6 4.7 nmol/L
Ovulatory phase : 2.4 9.4 nmol/L
Luteal Phase : 5.3 86 nmol/L
Post-menopausal : 0.3 2.5 nmol/L
Male (Adult) :
0.7 4.3 nmol/L

29

Prolactin

Blood

Plain tube

3 ml

5 working
days

Male : 98 456 mIU/L

Female : 127 637 mIU/L

30

Testosterone

Blood

Plain tube

3 ml

5 working
days

Female : 0.22 2.9 nmol/L

Male : 9.9 27.8 nmol/L

31

Thyroid Stimulating Hormone

(TSH)

Blood

Plain tube

3 ml

3 working
days

Children :
Newborns : 0.70 15.2 mIU/L
6 d 3 mth : 0.72 -11 mIU/L
4 12 mth : 0.73 8.35 mIU/L
1 6 yr : 0.70 5.97 mIU/L
7 11 yr : 0.60 4.84 mIU/L
12 20 yr : 0.51 4.30 mIU/L
Adult : 0.27 4.20 mIU/L

32

Transferrin

Blood

Plain tube

3 ml

33

Unsaturated Iron Binding

Capacity (UIBC)

Blood

Plain tube

3 ml

34

Vitamin B12

Blood

Plain tube

3 ml

5 working
days
10 working
days
10 working
days

2.0- 3.6 g/L

Male : 22.3 61.7 umol/L
Female : 24.2 70.1 umol/L
156 698 pmol/L

Blood taking at Day

21 of menses