ABDOMINAL PAIN
Baseline: ECU, LFT, CRP, cTn, Lipase, Amylase, HCG, FBE, urine MCS
Additional: Calcium, Phosphate, Lactate, Blood Gas, faeces
(MCS, OCP, PCR), Urine Porphobilinogen
Supplementary: Blood Culture, H. Pylori Faecal Antigen Test,
Urea Breath Test
ADRENOCORTICAL FUNCTION
Addison’s disease
Baseline: S-Cortisol, ACTH, ECU
Additional: Synacthen stimulation test.
Supplementary: Adrenal-Ab, thyroid-Ab, ovarian-Ab, Tuberculosis,
septicaemia, HIV, 17-OHP, VLCFA, Fine Needle Biopsy
Cushing syndrome
Baseline: 3 x 24 hour urinary free cortisol, or 1 mg overnight
Dexamethasone Suppression Test, am serum Cortisol.
Additional: Prolonged Dexamethasone Suppression test, ACTH,
Electrolytes, midnight salivary Cortisol.
Supplementary: Diagnostic imaging
Congenital Adrenal Hyperplasia
Baseline: 17-OHP, Electrolytes
Additional: Renin
Supplementary: Synacthen Stimulation with 17-OHP determination
to exclude partial 21-Hydroxylase deficiency
Phaeochromocytoma
Baseline: Plasma Metanephrines or 24 hour Urinary
Fractionated Metanephrines
Additional: 24 hour Urinary Catecholamines
ALLERGY
Baseline: RAST
Additional: IgE, FBE, ESR
AMENORRHOEA
Baseline: HCG, LH, FSH
Additional: E2, Prolactin, TFT
Supplementary: Cytogenetics, Ovarian-Ab, Urinary Anabolic Steroids,
Testosterone, DHEAs, Androstenedione, 17-OHP
ANAEMIA
Macrocytic
Baseline: FBE, blood film, ECU, LFT, LDH, B12, Folate, TSH
Additional: AIF, PCA, EPG, FLC, Haptoglobin
Supplementary: Bone marrow biopsy
Microcytic:
Baseline: FBE, IS, ECU, LFT
Additional: FOB, EPG, Hb-electrophoresis
Supplementary: Blood Lead
Normocytic:
Baseline: FBE, Reticulocyte count, ESR, ECU, CRP
Additional: IS, B12, folate, LFT
Supplementary: EPG, Bone marrow biopsy
ANTENATAL TESTING
Note: "Antenatal Screen" is no longer a valid test request.
Please specify which of the tests below are requested.
First visit and < 20 weeks: FBE, ECU, LFT, TFT, Blood group and antibodies,
Fasting glucose, Rubella Ab status, Hep B surface Antigen
and Hep C antibody, HIV serology, Syphilis serology, Urine
MCS, Cervical Cytology
Also consider: Maternal antenatal screening (triple test) First Trimester
Screen (FTS), or Non-Invasive Pre-Natal test
26 – 28 weeks: FBE, blood group and antibodies, glucose tolerance test.
30 – 36 weeks: FBE, Group B Streptococcal vaginal rectal swab for culture
Additional: Down syndrome and Neural Tube Defect risk assessment
High risk patients: TSH, Thyroid Ab, Vitamin D
ARTHRITIS
Baseline: Rh factor, anti-CCP Ab, ANA, ENA, anti-dsDNA
Additional: FBE, ESR, CRP, Synovial fluid examination and
biopsy if indicated
BLEEDING DISORDERS
Baseline: FBE and film, PTT/INR, APTT, Fibrinogen, TT
Additional: Blood: Lupus anticoagulant
Serum: Cardiolipin Ab, β2GP1
Supplementary: D-Dimer, Assays for Factor VIIIC, Von Willebrand Disease
Screen (VIIIC, VIIIAg, VIIIVWF), Factor IX, Factor XI, XIII and
Platelet Aggregation or other Factor Assays, Factor V
Leiden, Prothrombin 20210, Protein C and S
A
B
This quick reference guide may be useful in some clinical
situations. The suggested investigations are neither
comprehensive nor applicable in all circumstances. Tests
should be selected after consideration of the patient’s
clinical history, signs, symptoms and previous test results.
For further information, please contact our pathologists,
senior scientists or refer to The Royal College of Pathologists
of Australia manual at www.rcpamanual.edu.au
GUIDE TO
PATHOLOGY TESTS
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BONE DISEASE & CALCIUM DISORDERS
Baseline: Ca, Mg, PO4, ALP, Vitamin D, PTH
Additional: ALP isoenzymes (if ALP elevated), P1NP, CTx
BULLOUS SKIN LESIONS
Baseline: Swab for MCS
CHEST PAIN
Baseline: cTn, DDimer
Supplementary: CK, CKMB
CHRONIC FATIGUE
Baseline: FBE, TFT, CRP, ECU, LFT, Cortisol, Glucose
(There are no diagnostic tests for chronic fatigue syndrome)
COELIAC DISEASE
Baseline: Transglutaminase Ab, FBE
Additional: IgG Antigliadin antibody (in cases of IgA deficiency)
Supplementary: Small bowel biopsy
DELIRIUM
Baseline: FBE, ESR, ECU, LFT, TSH, Glucose, Blood Culture,
Urine MCS, CRP
Additional: Blood Gas, COHB, Calcium, Salicylate, Lithium, Cortisol
CSF: MCS, blood, protein, glucose, immunoglobulins,
Urine Drug Screen
DIABETES MELLITUS
Baseline: Glucose or HbA1c (high risk, asymptomatic)
Monitoring HbA1c, Urine Albumin
Additional: GTT
Acutely ill: Glucose, ECU, Blood Gas, FBE, Hydroxybutyrate, Lactate,
exclude underlying infection, ketones
DIABETES (PREGNANT)
GTT (Traditional): 0 min = 5.4 mmol/L, 2 hour =7.9 mmol/L
GTT (ADIPS): 0 min = 5.0 mmol/L, 1 hour > 9.9 mmol/L, 2 hour
> 8.4 mmol/L
DIARRHOEA
Laboratory requires clinical information.
Suggested testing:
Acute:
Baseline: Faeces MCS (1 per 7 days), PCR, OCP
Additional: Determined by history
Blood Cultures for typhoid, C. difficile toxin testing,
viral outbreaks
Chronic:
Baseline: Faeces MCS, OCP, PCR
Additional: Cryptosporidia/Cyclospora stains, Microsporida stain
(HIV patients), Sudan black stain for fat globules
Supplementary: Disaccharidases and/or Reducing Substances, Lactose
Tolerance Test, H Breath Test, Coeliac Screen, Laxative
Screen Faecal Na, K, Osmolality
ELECTROLYTE DISORDERS
Hyperkalaemia
Consider spurious result, renal failure, acidosis, adrenocortical insufficiency, drug
induced, cellular injury.
Baseline: ECU, Glucose, FBE plus platelets
Additional: Aldosterone:Renin ratio, random Urine K and Na
Hypernatraemia
Baseline: ECU
Additional: Serum: Osmolality
Aldosterone:Renin ratio, ADH
Urine: Osmolality, Na, K, Creatinine
Hypokalaemia
Baseline: ECU, Mg, Glucose. Urine Na, K, Mg
Additional: Aldosterone:Renin ratio.
24 hour Urinary Free Cortisol
Urine: Na, K, Cl
Hyponatraemia
Baseline: ECU, glucose, LFT, TSH
Additional: TP, Cholesterol plus Triglycerides, Osmolality, Cortisol, ADH.
Urine Osmolality, Na, K, Creatinine
ERECTILE DYSFUNCTION
Take the following into consideration when assessing the patient:
Assess cardiac risk, diabetes mellitus, testicular failure, drug therapy,
post-surgical, prostate radiation, neurological disease, renal failure,
psychogenic causes.
Baseline: ECU, LH, FSH, Testosterone, Prolactin, Glucose
GENITAL ULCER
Baseline: Swabs for PCR (Herpes) and MCS
Serum: Syphilis serology
HAEMATURIA
Baseline: Urinalysis, MCS and red cell morphology
Additional: Cytology
HAEMOLYSIS
Baseline: FBE, RETC, DAT, ECU, LFT (inc. bilirubin), LDH, Haptoglobin
Additional: Cold Haemagglutinines
CRP, ANA, DNA, NUC
HEPATITIS
Baseline: LFT, Urinalysis, FBE, PT
Acute: Infectious: Hep A, B, C
Alcoholic hepatitis
Drugs (Paracetamol, anticonvulsants, NSAIDS, etc.)
Hepatic ischemia
Chronic: Severity and degree determined on liver biopsy
Monitoring: LFTs
EPG (helpful in certain cases)
Consider Hep B, C, autoimmune hepatitis, alcoholic hepatitis,
drugs, Wilson’s disease, AAT deficiency, PBC, PSC
Granulomatous: Diagnosis requires liver biopsy
Causes: Idiopathic, sarcoidosis, drugs (Allopurinol), infective,
Hodgkin lymphoma, Berylliosis
HEPARIN THERAPY
Baseline: APTT
HEREDITARY HAEMOCHROMATOSIS
Baseline: Iron studies, HFE gene mutations (C282Y, H63D)
Additional: HFE mutation S65C, liver biopsy
HIRSUTISM
Baseline: LH, FSH, E2, Testosterone, SHBG, FAI
Additional: 17-OHP, DHEAS, Androstenedione
HYPERLIPIDAEMIA
Baseline: Cholesterol and triglyceride, HDL
Additional: HDL, LDL, ECU, TSH, Glucose
Supplementary: ApoB, Lp(a), Apo-A, Lipoprotein Electrophoresis
HYPERTENSION
Baseline: ECU, urine MCS
Additional: TFT, 24 hour Urinary Free Cortisol, Plasma/Urine
Metanephrines, Aldosterone:Renin ratio
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HYPOGLYCAEMIA
Baseline: Glucose, Insulin, C-peptide
Additional: Cortisol, Growth Hormone, Proinsulin, Oral Hypoglycaemia
Screen, Lactate, Hydroxybutyrate
IMMUNODEFICIENCY
Baseline: FBC, WCC diff, blood film, Ig’s (G, A, M), Blood Group,
lymphocyte immunophenotyping
Additional: IgG subtypes, Neutrophil Function tests
INFERTILITY - MALE
Baseline: Semen analysis (must reach lab in 2 hours with completed
patient information sheet)
Additional: LH, FSH, Testosterone, Prolactin, Iron Studies
Supplementary: Chromosome studies, Sperm antibodies, Testicular biopsy
INFERTILITY - FEMALE
Baseline: LH, FSH, day 21 Progesterone, E2
Additional: Prolactin, Testosterone, TFT
Supplementary: Chromosome studies, Endometrial biopsy
Exclude PID, STI
INFLAMMATORY BOWEL DISEASE
Baseline: Faecal Calprotectin, M&C, CRP and ESR
JAUNDICE
See liver disease and haemolysis
LIVER DISEASE
Baseline: ECU, Glucose, LFT, FBE, Coags, serology relevant to history
Additional: Ca, PO4
Supplementary: AAT, Ceruloplasmin, Iron studies, EPG, Urine Copper
ANA, anti-dsDNA, SMA, LKM, IgM, AMA
LUMPS
Biopsy for histological investigation
LYMPHADENOPATHY
Depends on site, age and clinical history/presentation
Baseline: FBE plus diff, EBV, CMV, Throat Swab MCS
Additional: HIV, Syphilis, Toxoplasma, ACE, EPG
Supplementary: Lymph node FNA, TB culture
MALABSORPTION
Baseline: FBE, ECU, LFT, CMP
Stool: MCS, Reducing Substances, Elastase, and Sudan
black for fat globules
Additional: IS, B12, folate, Ig’s, tTG Ab (coeliac screen),
H-breath Test, Lactose Tolerance Test
Supplementary: Small bowel biopsy for histology and disaccharidases
MENOPAUSE
Baseline: E2, LH, FSH
NEPHROCALCINOSIS
Baseline: Stone analysis, ECU, Calcium, Phosphate
Urine Calcium, Oxalate, Uric Acid, pH, Citrate, Cystine,
Magnesium
Additional: ACE (to exclude Sarcoid)
OSTEOPOROSIS
Calculate absolute fracture risk:
http://garvan.org.au/promotions/bone-fracture-risk/calculator/
Baseline: Blood: Calcium, Phosphate, Albumin, Vitamin D, ALP, PTH
Urine: Calcium, Creatinine, BTM (CTx, P1NP)
PHARYNGITIS
Baseline: Throat swab MCS, EBV, CMV serology, respiratory PCR
POLYURIA
Baseline: ECU, Glucose, Urine MCS
Additional: Urine and serum Osmolality
Supplementary: Water Deprivation test
RENAL DISORDERS/DISEASE
Baseline: FBE, ECU, Calcium, Phosphate, Albumin, Uric Acid, Glucose,
Urine Protein and MCS
Additional: Urine Creatinine Clearance
RESPIRATORY INFECTIONS
Baseline: Sputum MCS, respiratory PCR
SEXUALLY TRANSMITTED DISEASES
Baseline: Serum: HIV, Syphilis
Urine: Chlamydia PCR, Gonorrhoea MC&S and PCR
Urethral/vaginal Swab: Chlamydia PCR, Gonorrhoea
MC&S and PCR
Additional: Urine: Mycoplasma genitalium PCR
Rectal/throat Swabs: Chlamydia PCR, Gonorrhoea
MC&S and PCR
Lesion: Herpes PCR if indicated
Trichomonas: PCR if indicated
Pap smear or dry swab: HPV PCR
If indicated: HBV sAg + Ab, HCV Ab
STEATORRHOEA
Baseline: Faeces: Sudan black stain for fat globules, Elastase
URETHRITIS
See sexually transmitted diseases
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AAT Alpha-1-Antitrypsin
ACE Angiotensin Converting
Enzyme
ACTH Adrenocorticotrophic
Hormone
ADH Antidiuretic Hormone
(Vasopressin)
AIF Intrinsic Factor Antibody
ALP Alkaline phosphatase
AMA Anti-Mitochondrial Antibody
ANA Antinuclear Antibody
ANCA Anti-Neutrophil Cytoplasmic
Antibody
ANNA Anti-Neuronal Nuclei
Antibody
APTT Activated Partial
Thromboplastin Time
ASOT Antistreptolysin O / Anti
DNAse
B Titre
β2GP1 Beta-2-Glycoprotein 1
Antibody
B12 Vitamin B12
BTM Bone Turnover Markers
Ca Calcium
CCP Cyclic Citrinulated Peptide
Antibody
Cl Chloride
CK Creatine Kinase
CKMB Creatine Kinase MB
CMP Calcium, Magnesium,
Phosphate
CMV Cytomegalovirus
COHB Carboxyhaemoglobin
CRP C-Reactive Protein
CSF Cerebrospinal Fluid
cTn Cardiac Troponin
DAT Direct Antiglobulin Test
DHEAS Dehydroepiandrosterone
Sulphate
DNA Anti-Double-stranded DNA
Antibody
E2 Oestradiol
EBV Epstein-Barr Virus
ECU Electrolytes, Creatinine
& Urea
ENA Extractable Nuclear Antibody
EPG Serum Protein
Electrophoresis
ESR Erythrocyte Sedimentation
Rate
FAI Free Androgen Index
FBE Full Blood Examination
FLC Serum Free light Chains
FNA Fine Needle Aspiration
FOB Faecal Occult Blood
FSH Follicle Stimulation Hormone
GTT Glucose Tolerance Test
HCG Human Chorionic
Gonadotrophin
HDL HDL-Cholesterol
Hep Hepatitis (Specify A, B or C
Serology)
17-OHP 17-Hydroxyprogesterone
HIV Human Immunodeficiency
Virus
Ig Immunoglobulin
IgE Immunoglobulin E
INR International Normalised
Ratio
IS Iron Studies
K Potassium
LDH Lactate Dehydrogenase
LDL Low Density Lipoprotein
LFT Liver Function Test
LH Luteinizing Hormone
LKM Liver Kidney Microsomal
Antibody
Mg Magnesium
MCS Microscopy, Culture &
Sensitivity
M&C Microscopy & Culture
MTHFR Methylenetetrahydrofolate
Reductase
Na Sodium
NUC Nucleosome Antibody
OCP Ova, Cysts and Parasites
PCA Gastric Parietal Cell Antibody
PCR Polymerase Chain Reaction
PID Pelvic Inflammatory Disease
PO4 Phosphate
PTT Partial Thrombin time
PTH Parathyroid Hormone
RAST Radioallergosorbent Test
RETC Reticulocyte Count
Rh Rhesus
SMA Smooth Muscle Antibody
STI Sexually Transmitted
Infection
TFT Thyroid Function Test
TP Total Protein
tTG Tissue Transglutaminase
Antibody
TSH Thyroid Stimulating Hormone
TT Thrombin Time
Vit D 25-Hydroxy Vitamin D
VLCFA Very Long Chain Fatty Acids
WCC White Cell Count
GLOSSARY OF
ABBREVIATIONS
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