Laboratory Test Preparation

• TB Quantiferon
• TB Gold
• Interferon Gamma Production
• Elispot TB
• Quantiferon TB Gold (QFT)
• QuantiFERON®-TB Gold Plus (QFT-Plus)
• Latent Tuberculosis Infection Test
•Interferon-gamma Release Assays (IGRA)
•TB QuantiFERON®-TB Gold (QFT-G)
•QuantiFERON®-TB Gold In-Tube (QFT-GIT)

Not Applicable

• An indirect test for Mycobacterium tuberculosis that can cause TB infection
• It detects inteferon gamma used to identify in vitro responses to peptide antigens (ESAT-6, CFP-10 and TB7.7[p4]) that are associated with the disease

ELISA (Enzyme-Linked Immunosorbent Assay)

Serology

No patient preparation necessary.

HPD Branches/Send In Clients:

• Request sample collection container from Warehouse 1 day prior to blood extraction.

1 mL Whole Blood for each tube

(2) Two pieces 4 mL Heparinized Whole Blood (Lithium Heparin ONLY) OR

(4) Four pieces 2 mL Heparinized Whole Blood (Lithium Heparin ONLY)

16 Hours

Unacceptable

Unacceptable

•  Transport specimen at 15-25°C (room temperature) within 16 hours of collection within 16 hours of collection
• Do not refrigerate the blood

• Insufficient volume of blood to anticoagulant
• Over filling of Collection tubes
• Vigorous shaking of tubes that may cause gel disruption.
• Improperly labeled specimens
• Specimen stored/transported outside the temperature range

Batch running every Wednesdays and Saturdays

Tuesday, 6:00 PM

Friday, 6:00 PM

Thursday, 9AM

Monday, 9AM

None identified.

1. What is QFT?

QuantiFERON-TB Gold is an in-vitro laboratory test for detection of immune responses to tuberculosis (TB) infection in whole blood. It is used as a diagnostic aid for M. tuberculosis complex infection, whether active tuberculosis disease or latent tuberculosis infection (LTBI), and is intended for use in conjuction with risk assessment, radiography, and other medical and diagnostic evaluations

2. Can QFT distinguish between active TB and LTBI?

QFT cannot distinguish between active TB and LTBI. Anyone testing positive should be assessed for active TB using clinical examination and/or a chest radiograph.

3. What is the minimum time necessary to wait between exposure to M. tuberculosis and QFT testing?

The CDC guidelines on the use of QFT recommend that recent contacts who test QFT NEGATIVE soon after the end of exposure be retested 8-10 weeks later – similar to the recommendations for the Tuberculin Skin Test (TST). Many other national guidelines recommend a similar approach.

4. What is the specificity and sensitivity of QuantiFERON-TB Gold In-Tube?

The specificity of QuantiFERON-TB Gold In-Tube has consistently shown to be >99% in low risk individuals. On the other hand, the sensitivity is as high as 92% in individuals with active disease, but varies depending on the setting and extent of TB disease.

5. Can Interferon Gamma Release Assay (IGRA) tests be used for infants and children?

Evidence shows that QFT performs as well in children as it does in adults and there is no apparent loss of performance in children under 5 years.QFT has been shown to be effective in children less than 6 months of age and in children with bacteriologically confirmed TB.

6. How are QFT results interpreted?

A positive result suggests that current M. tuberculosis infection is likely. The result does not differentiate between recently acquired or old infection, or between LTBI and active TB. A negative QFT result suggests that M. tuberculosis infection is unlikely but cannot be excluded especially when illness is consistent with tuberculosis disease or the likelihood of progression to disease is increased (ex. Because of immune suppression). An indeterminate QFT result suggests that TB infection can neither be excluded nor confirmed and that test should be repeated. However, an indeterminate result is meaningful, suggesting patient’s immune suppression.

7.  Are the results affected by pregnancy?

No definitive information is currently available on whether the results of IGRA tests are affected by pregnancy. However, there is no reason to suspect that QFT would be affected any more than in the TST.

Mycobacterium tuberculosis infection, Purified Protein Derivative, PPD, Mantoux, Latent Tuberculosis Infection Test, Interferon-gamma Release Assays, IGRA, T-Spot, Tuberculin Skin Test

None

Not Applicable

Determines the length of a patient’s telomerase in relation to the patient’s age.  Knowing the rate of telomere loss allows a patient and clinician to work together to make adjustments in nutrition and other lifestyle modifications known to influence telomere length.

Quantitative Real Time PCR

Special Test

No patient preparation necessary.  Fasting not required.

• Test collection container (blue top) will be provided by HPD. Branch to coordinate with Special Test (HPD Main) 2-3 days before specimen collection.
• Collect samples using one blue top (sodium citrate) tube.
• Mix by inverting 5 – 6 times.
• Do not centrifuge or freeze the specimen.
• Label with the patient’s name, date of birth, date of collection.
• Send sample immediately to HPD Del Monte for ship out within the day.

NOTE: Check for completeness of information in the required documents prior to sending to HPD Main Laboratory to avoid delay in processing of sample.

Sodium citrate (blue top) tube, 2.7 ml

3 ml whole blood

None

None

5 days

5 days

Not Applicable

• Transport samples from HPD branch to HPD Main laboratory at room temp (15°C to 25°C). 
• To ship these samples to the Processing Laboratory, use the shipping kits providedand ship in refrigerated temp.

• Blood collection tubes used other than sodium citrate (blue top) tubes
• Frozen blood specimens
• Centrifuged specimens
• Incomplete documentation requirement
• Specimen stored/transported outside the temperature range
• Quantity not sufficient
• Improperly labeled specimen

Batch Running

Monday, Tuesday, Wednesday at  3:00 PM

1 month (excluding saturday, sunday and holidays)

Available upon request

Not Applicable

Q:  What are telomeres?

A: Telomeres are sections of repetitive DNA sequences at the end of each chromosome that serve as a cap to your genetic material.  Every time a cell replicates, the cell ages and its telomere will become shorter.  Eventually the telomeres become too short to allow cell replication and the cell ultimately dies.  This is all part of a normal biological process. 

Q:  What is Telomere Testing?

A: Telomere Testing is a quantitative real-time PCR test that can determine the length of a patient’s telomere in relation to the patient’s age, using the patient’s whole blood as specimen. 

Q:  What do the results in Telomere Testing tell me?

A:  The Patient Telomere Score is calculated based on the patient’s average telomere length in whole blood and compared to a population sample in the same age range as the patient’s to determine the patient’s percentile score.  The higher the Telomere Score, the “younger” the cells. 

Q:  If I have a low telomere score, what can I do to reduce the rate of telomere loss?

A: Minimizing associated risk factors that are linked to shortened telomere activity is recommended.  These include:

• Smoking cessation
• Change sedentary lifestyle and increase physical activity
• Maintain a healthy weight
• Stress reduction
• Sleep for at least 8 hours each night

Q:  What effect does diet and nutrition have on telomere length and repair?

A: An inflammatory diet – one that increases oxidative stress – will shorten telomeres faster.

      These include:

• Refined carbohydrates
• Fast food
• Processed food
• Sodas
• Artificial sweeteners
• Trans fats and saturated fats

     Diets that promote oxidative defense will help preserve telomere length.

     These include:

• Fruits and vegetables
• Mixed fiber
• Monounsaturated fats
• Omega-3-fatty acids
• Vegetable proteins

 Antioxidant supplements can reduce oxidative stress effectively.  Micronutrient status also has direct implications on telomere length.  Correcting micronutrient deficiencies can affect the rate of telomere shortening.  These include:

• Copper
• Folate
• Glutathione
• Magnesium
• Selenium
• Zinc
• B Vitamins
• Vitamin C
• Vitamin D
• Vitamin E

Total Testosterone

Not applicable

• The determination of testosterone in women is helpful in the diagnosis of androgenic syndrome (AGS), polycystic ovaries (Stein?Leventhal syndrome) and when an ovarian tumor, adrenal tumor, adrenal hyperplasia or ovarian insufficiency is suspected.
• Testosterone is determined in men when reduced testosterone production is suspected, e.g. in hypogonadism, estrogen therapy, chromosome aberrations (as in the Klinefelter's syndrome) and liver cirrhosis.

Electrochemiluminescence Immunoassay (ECLIA)

Immunology

• Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.

NOTE: This test is not suitable for patients under Nandrolone (an anabolic steroid) treatment.

Red or Gold tube

1-3 mL Serum

1-3 mL Plasma (Li-Heparin, K2- and K3- EDTA)

Not specified

1 Week

6 Months

Transport specimen at 2°C – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic
• Exceeded sample stability requirement
• Quantity not sufficient
• Improperly labeled specimen
• Improper collection tube used
• Samples from patients under Nandrolone treatment.

Monday, Wednesday, Friday

Monday to Saturday: 10:00 PM

Sunday: 6:00PM

ROUTINE (on running days)
• 4 hours after receipt of specimen/ arrival of messenger
STAT (on running days only)
• 2½ hours from extraction/messenger arrival

Male: 2.80-8.00 ng/mL
Female: 0.06-0.82 ng/mL
Boys:
<1 y/o: 0.12-0.21 ng/mL
1-6 y/o: 0.03-0.32 ng/mL
7-12 y/o: 0.03-0.68 ng/mL
13-17 y/o: 0.28-11.10 ng/mL

• Samples should not be taken from patients receiving therapy with high biotin doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin administration.
• In rare cases, interference due to extremely high titers of antibodies to analyte-specific antibodies, streptavidin or ruthenium can occur.
• Two special drugs were additionally tested. A strong interaction with Nandrolone (INN international nonproprietary name, WHO) was found. Do not use samples from patients under Nandrolone treatment.
• In isolated cases, elevated testosterone levels can be seen in samples from female patients with end stage renal disease (ESRD).

Not applicable

FSH, LH, SHBG, DHEAS, Estradiol, Dihydrotestosterone (DHT), Gonadotropin-releasing Hormone, Semen Analysis, Anti-Mullerian Hormone, Androstenedione

• Total Testosterone
• Bioavailable Testosterone

Not applicable

Testosterone is the main sex hormone (androgen) in men. It is responsible for male physical characteristics. Although it is considered to be a "male" sex hormone, it is present in the blood of both men and women. This test measures the level of testosterone in the blood.

Radioimmunoassay (RIA)

Special Test

No patient preparation necessary.

Red or Gold Tube

3 mL Serum

Not Applicable

24 Hours

3 Days

7 Days

Transport specimen at 2 – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Exceeded sample stability requirement
• Quantity not sufficient
• Improperly labeled specimen
• Improper collection tube used

Tuesday

Monday,  7:00 AM

3 days after running (excluding Saturdays, Sundays and Holidays)

Available upon request

None specified.

Q: Why get tested?

A:To detect an abnormal testosterone level in males and females; in males, to help diagnose the cause of erectile dysfunction or the inability of your partner to get pregnant (infertility); in females, to help diagnose the cause of masculine physical features (virilization), infertility, or polycystic ovary syndrome (PCOS); in children, to help determine the cause of genitals that are not clearly male or female (ambiguous genitalia) or delayed or early puberty

Q: Why to get tested?

A:For males, when you may be infertile or are unable to get or maintain an erection; when you are a boy with either early or delayed sexual maturity (puberty)

For females, when you have male traits, such as a low voice or excessive body hair (hirsutuism),, when you have abnormal uterine bleeding, do not menstruate (amenorrhea), or are infertile

Q: If I have low testosterone level, will taking supplemental testosterone help?

A:Maybe. Testosterone supplements, either with gels, patches or injections, can raise testosterone levels. They may help to relieve some symptoms and/or prevent muscle and bone loss that occurs with aging in men; however, this has not been definitively proven. There is concern that testosterone replacement therapy may exacerbate preexisting prostate cancer, but no evidence of causing cancer. There are label warnings that testosterone administration may result in possible increased risk of heart attack and stroke. Although men with erectile dysfunction may have low testosterone, in many cases testosterone administration does not improve the symptoms because there are other underlying conditions. Therefore, consult a healthcare practitioner for a medical evaluation and consultation to determine if this is the right therapy for you.

Steroid hormone, Development of Male Secondary Sexual Characteristics, Total Testosterone, Free Testosterone, Bioavailable Testosterone, Testosterone, FSH, LH, SHBG, DHEAS, Estradial (estrogens)), Semen Analysis, Anti-

• Tetanic
• vaccination
• Anti-tetanus antibodies - vaccination control
• Clostridium tetani - immunity test - IgG antibodies
• Anti tetanus antibodies
• Tetanus

Not applicable

Tetanus is caused by a neurotoxin produced by an anaerobic soil bacterium, clostridium tetani. The toxin stimulates sustained muscle contraction. Diagnosis depends on clinical evaluation but serological analysis can be useful to estimate the degree of protection conferred by immunization.

Enzyme Immunoassay (EIA)

Special Test

No patient preparation necessary.

Red or Gold Tube

3 mL Serum

Not Applicable

24 Hours

7 Days

28 Days

Transport specimen at 2 – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Exceeded sample stability requirement
• Quantity not sufficient
• Improperly labeled specimen
• Improper collection tube used

Batch Running

Friday, 4:00 PM

2 weeks after cut-off (excluding Saturdays, Sundays and Holidays)

Available upon request

None specified.

Not applicable

Toxin from Clostridium tetani bacteria

Monohydroxybenzene

Not applicable

Exposure to thallium is primarily through food and may occur in highly selected industrial environments. Urinary thallium may be used in assessing toxicity.

Mass spectometry

Special Test

Collection Procedures:
1. Instruct the patient to void at the beginning of collection period and discard the specimen
2. Collect all urine including the final voided at the end of collection period.
3. Mix 24 hour urine collected.
4. Label the bottle with patient name, date & time collection started, date and time collection ended and total volume measured.
5. Note total volume.
6. Submit the specimen to HPD.

Plastic leak proof clean container

100 mL of random urine

Not Applicable

48 Hours

5 Days

14 Days

Transport specimen at 2 – 8 °C (with cold packs)

• Quantity not sufficient
• Received room temperature
• Improperly labeled specimen
• Improper urine collection

Batch Running

Friday 4:00 PM

3 months after cut-off (excluding Saturdays, Sundays and Holidays)

Available upon request

None specified.

Not applicable

Toxic Metals, Heavy Metals Panel

• Aminophylline
• Marax
• Quandrinal
• Quibron

Not applicable

Used in assessment & adjustment of drug dosage and determine toxicity

Immunoassay Technique

Special Test

No patient preparation necessary.

Please note the following:

• Last dose 
• Dosage per day
• Time of extraction

Red or Gold Tube

3 mL Serum

Not Applicable

48 Hours

7 Days

Not applicable

Transport specimen at 2 – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Exceeded sample stability requirement
• Quantity not sufficient
• Improperly labeled specimen
• Improper collection tube used

Monday to Friday

Monday to Friday, 7:00 AM

After 3 Days (excluding Saturdays, Sundays and Holidays)

Available upon request

None specified.

Not applicable

Aminophylline, Theophylline, Caffeine

•TG

Not applicable

• Used as an aid in monitoring after thyroid ablation.
• The main application of TG testing is the post-operative follow-up of patients with differentiated thyroid carcinoma (DTC).

Electrochemiluminescence Immunoassay (ECLIA)

Immunology

No patient preparation necessary.

Red or Gold tube

1- 3 mL of serum

1-3 mL Plasma (Li-heparin, K2- and K3-EDTA)

48 Hours

72 Hours

1 Month (Freeze only once)

Transport specimen at 2°C – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Exceeded sample stability requirement
• Quantity not sufficient
• Improperly labeled specimen
• Improper collection tube used

Monday, Thursday

Monday to Saturday: 10:00 PM

Sunday: 6:00PM

ROUTINE (on running days)
• 4 hours after receipt of specimen/ arrival of messenger
STAT (on running days only)
• 2½ hours from extraction/messenger arrival

3.50-77.00 ng/mL

• TG determinations can be affected by the presence of anti-thyroglobulin antibodies (anti-TG) or by non-specific effects in patient sera.

Not applicable

Thyroid Antibodies, Tumor Markers, TSH, Total T3, Free T4, Thyroid Panel, Calcitonin

125-I hTg IRMA

Not Applicable

Aids in the diagnosis of thyroid disorders such as Graves multinodular goiter, benign thyroid adenoma, thyroiditis acute phase and differentiated carcinoma.

Useful tool in screening population at risk for thyroid carcinoma after previous irradiation.

Immunoradiometric Assay (IRMA)

Special Test

No patient preparation necessary.

Gold or Red Top Tube

5 mL Serum

Not Applicable

Not Applicable.

24 Hours

30 Days

• Insufficient volume
• Improperly labeled specimens
• Markedly lipemic sample
• Hemolyzed sample
• Repeated freezing and thawing
• Exceeded sample stability requirement

Tuesday and Thursday

• Monday, 7:00 AM (for Tuesday running day)
• Wednesday, 7:00 AM (for Thursday running day)

7 days after running (excluding saturday, sunday and holidays)

Not Applicable.

Results should be interpreted in the light of the total clinical presentation of the patient, including clinical history, data from additional diagnostic procedures

Not Applicable.

Nuclear Medicine,Thyroid Antibodies, Tumor Markers, TSH, Total T3, Free T4, Thyroid Panel, Calcitonin

• Anti-Thyroglobulin
• Anti-Tg

Not applicable

• Helps diagnose an autoimmune thyroid disease and to distinguish it from other forms of thyroid dysfunction
• Thyroid antibodies are autoantibodies targeted against one or more components on the thyroid. Graves' disease and Hashimoto's thyroiditis are commonly associated with the presence of anti-thyroid autoantibodies.

Chemiluminescent Microparticle Immunoassay (CMIA)

Immunology

No patient preparation necessary.

Red or Gold tube

1-3 mL Serum
 

1-3 mL Plasma (Li-heparin, Na-Heparin, EDTA)

8 Hours

72 Hours

30 Days

Transport specimen at 2°C – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Specimen stored/transported outside the temperature range
• Quantity not sufficient
• Improperly labeled specimens

Monday, Thursday

Monday to Saturday: 10:00 PM

Sunday: 6:00PM

ROUTINE (on running days)
• 4 hours after receipt of specimen/ arrival of messenger
STAT (on running days only)
• 2½ hours from extraction/messenger arrival

<4.11 IU/mL

• Some specimens may not dilute linearly because of the heterogeneity of the autoantibodies with respect to physiochemical properties.
• Specimens from patients who have received preparations of mouse monoclonal antibodies for diagnosis or therapy may contain human antimouse antibodies (HAMA). Such specimens may show either falsely elevated or depressed values when tested with assay kits that employ mouse monoclonal antibodies.
• Heterophilic antibodies in human serum can react with reagent immunoglobulins, interfering with in vitro immunoassay. The presence of heterophilic antibodies in a patient specimen may cause anomalous values to be observed.

Not applicable

Thyroid Antibodies, Thyroid Autoantibodies; Antithyroid Antibodies; Antimicrosomal Antibody; Thyroid Microsomal Antibody; Thyroid Peroxidase Antibody; Thyroperoxidase Antibody; TPO; Anti-TPO; TBII; Antithyroglobulin Antibody; TgAb; TSH Receptor Antibody; TRAb; Thyrotropin Receptor Antibodies; Thyroid Stimulating Immunoglobulin; TSI, Thyroid Peroxidase Antibody; Thyroglobulin Antibody; Thyroid Stimulating Hormone Receptor Antibody

• Anti-Thyroglobulin

• Thyroglobulin Antibody

• Anti - Tg

• Anti-Thyroidean

• Measurement of thyroglobulin antibodies is useful in the diagnosis and management of a variety of thyroid disorders including Hashimoto's thyroiditis, Graves' disease and certain types of goiter.

Immunoradiometric Assay (IRMA)

Special Test

No patient preparation necessary.

Gold or Red Top Tube

2 mL Serum

Not applicable

Not applicable

24 Hours

1 Month

Transport specimen at 2 – 8 °C (with cold packs)

• Insufficient volume
• Improperly labeled specimens
• Markedly lipemic sample
• Hemolyzed sample
• Repeated freezing and thawing
• Exceeded sample stability equirement

Tuesday and Thursday

Friday for Tuesday running

Tuesday for Thursday running

After 3 days (excluding Saturdays, Sundays and Holidays)

Heterophil antibodies may produce falsely-elevated results.

Not applicable

Nuclear Medicine,Thyroid Antibodies, Tumor Markers, TSH, Total T3, Free T4, Thyroid Panel, Calcitonin

• Thyroid Autoantibodies
• Antithyroid Antibodies

• Thyroglobulin Ab (CMIA)
• Anti Thyroxine Peroxidase

• Helps diagnose an autoimmune thyroid disease and to distinguish it from other forms of thyroid dysfunction
• Thyroid antibodies are autoantibodies targeted against one or more components on the thyroid. Graves' disease and Hashimoto's thyroiditis are commonly associated with the presence of anti-thyroid autoantibodies.

Chemiluminescent Microparticle Immunoassay (CMIA)

Immunology

No patient preparation necessary.

1-3 mL Serum
 

1-3 mL Plasma (Li-heparin, Na-Heparin, EDTA)

8 Hours

72 Hours

30 Days

Transport specimen at 2°C – 8 °C (with cold packs)

• Hemolyzed specimen
• Markedly lipemic specimen
• Specimen stored/transported outside the temperature range
• Quantity not sufficient
• Improperly labeled specimens

Monday, Thursday

12:00 MIDNIGHT

ROUTINE (on running days)
• 4 hours after receipt of specimen/ arrival of messenger
STAT (on running days only)
• 2½ hours from extraction/messenger arrival

Anti Thyroxine Peroxidase: 0.00-5.61 IU/mL
Thyroglobulin Ab (CMIA): <4.11 IU/mL

• Some specimens may not dilute linearly because of the heterogeneity of the autoantibodies with respect to physiochemical properties.
• Specimens from patients who have received preparations of mouse monoclonal antibodies for diagnosis or therapy may contain human antimouse antibodies (HAMA). Such specimens may show either falsely elevated or depressed values when tested with assay kits that employ mouse monoclonal antibodies.
• Heterophilic antibodies in human serum can react with reagent immunoglobulins, interfering with in vitro immunoassay. The presence of heterophilic antibodies in a patient specimen may cause anomalous values to be observed.

Not applicable

Thyroid Antibodies, Thyroid Autoantibodies; Antithyroid Antibodies; Antimicrosomal Antibody; Thyroid Microsomal Antibody; Thyroid Peroxidase Antibody; Thyroperoxidase Antibody; TPO; Anti-TPO; TBII; Antithyroglobulin Antibody; TgAb; TSH Receptor Antibody; TRAb; Thyrotropin Receptor Antibodies; Thyroid Stimulating Immunoglobulin; TSI, Thyroid Peroxidase Antibody; Thyroglobulin Antibody; Thyroid Stimulating Hormone Receptor Antibody

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Ultrasound imaging or sonography is considered to be a non-invasive procedure and does not involve ionizing radiation which is usual in X-rays. An ultrasound scan is not only useful in assessing the structure of organs and different internal structures but can also show the movement of organs in real time.

It may be used to assess the size and location of abnormalities in the thyroid such as:

• cysts
• nodules
• tumors

PREPARATION

• No special preparation.
• Bring previous ultrasound result for comparison.

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