US Army: WB%20PAM%2040-4%202

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*WBAMC Pam 40-4

*This pamphlet supersedes WBAMC Pamphlet , dated 18 September 2000.

DEPARTMENT OF THE ARMYWILLIAM BEAUMONT ARMY MEDICAL CENTER

Fort Bliss, Texas 79920-5001

WBAMC PAMPHLET 2 AUG 2006No. 40-4

Medical ServicesGUIDE FOR OBTAINING LABORATORY SUPPORT

Contents Paragraph Page

Purpose 1 1Applicability 2 1

References 3 1Explanation of Abbreviations and Terms 4 2Background 5 2Responsibilities 6 2General Information 7 2Anatomic Pathology Service 8 12Clinical Pathology Service 9 26Appendix A Explanation of Abbreviations and Terms 31

B Telephone Numbers 35C Emergency (STAT) Test Menu 37D Tube Requirements for Laboratory Specimen Submission 38E Clinical Pathology Service Test Manual 39F Laboratory Request Forms 125G Names and Synonyms of Laboratory Tests 126

Laboratory Guide for Soldier Family Medical Clinic 176Laboratory Guide for McAfee Clinic, White Sands Missile Range 209

1. PURPOSE. This pamphlet is designed to assist the medical staff of WilliamBeaumont Army Medical Center (WBAMC) and outside submitting stations inutilizing laboratory resources.

2. APPLICABILITY. This pamphlet applies to all direct Health Care Providers (HCP)assigned or attached to WBAMC and to all submitting stations requesting services or support from the Department of Pathology and Area Laboratory Services (DPALS) atWBAMC.

3. REFERENCES.

a. Comprehensive Accreditation Manual for Hospitals, Joint Commission onAccreditation of Healthcare Organization, current edition.

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b. College of American Pathologists Laboratory Accreditation Program Guidelinesand Checklists, College of American Pathologists, current edition.

4. EXPLANATION OF ABBREVIATION AND TERMS. Appendix A.

5. BACKGROUND.

a. The Department of Pathology and Area Laboratory Services is responsible for providing responsive, high quality laboratory testing in support of patient care.Use of this pamphlet will reduce ordering errors and conserve resources.

b. Access to this pamphlet is also provided on the WBAMC intranet and on theWBAMC internet web page, http://www.wbamc.amedd.army.mil. From theWBAMC home page, click on Departments and then Pathology. A link to the

pamphlet is included on the Department of Pathology and Area LaboratoryServices page.

6. RESPONSIBILITIES.

a. Chief, DPALS will develop, maintain, and implement guidance for HCP to obtainlaboratory support, WBAMC Pamphlet.

b. Department/Division/Service Chiefs and Clinic/Hospital staff will familiarizethemselves with the WBAMC Pamphlet, and obtain laboratory support andservice using guidelines found within the pamphlet.

c. DPALS staff will monitor current laboratory practices and when technical and/or procedural guidance change, they will develop and broadcast LaboratoryBulletins updating HCP to the new laboratory guidance.

7. GENERAL INFORMATION.

a. Location. DPALS is located on the third floor, Building 7777, WBAMC, Fort Bliss,Texas.

b. Telephone Numbers. Appendix B.

c. Information. HCP may request information on the current test methods utilizedby DPALS, to include method performance specifications, by calling theappropriate section chief or the laboratory manager.

d. Laboratory Hours.

(1) The laboratory maintains 0600-1700, Monday-Friday, as normal duty hours.Routine services are offered during these times. Routine services are NOT

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offered on weekends, Federal holidays, and designated training holidays.

(2) Core Laboratory services are offered 24 hours a day, 7 days a week. When

laboratory testing is required during a time other than normal duty hours, thespecimen is to be collected by the requesting service and brought to the thirdfloor laboratory for processing and testing.

(3) Emergency (STAT) testing is performed 24 hours a day, 7 days a week. HCPare given the opportunity to order a laboratory test using the STAT priority if the test is found on the DPALS Emergency (STAT) Test Menu (Appendix C)or any other assay after seeking Pathologist’s approval. The collection anddelivery of STAT laboratory specimens are the responsibility of thephysician/clinic/ward. Because of their emergency or critical nature, thelaboratory will not collect these specimens on morning ward rounds. STAT

and ASAP priority requests must be collected and transported to thelaboratory by clinic/ward personnel.

e. Phlebotomy Hours.

(1) Ward Round Collection. Ward rounds are conducted at 0600 and 1400everyday with the exception of weekends, Federal and training holidays,when ward rounds are performed at 0600 only. Appropriately markedlaboratory requests must be entered into CHCS by 0545 or received by thethird floor laboratory no later than 0400 (in the event of CHCS downtime).Collection of specimens other than blood or collection of blood at timesother than 0600 or 1400 will be performed by the physician or wardpersonnel. Certain laboratory requests requiring special handling are notcollected on ward rounds. TESTS NOT COLLECTED ON WARDROUNDS: Urines, Sputum, and Timed Drug Levels. Tests ordered for times other than scheduled ward round times as well as STAT and ASAPwill not be collected on ward rounds.

(2) Outpatient Collection. Third floor ambulatory patient specimen collectionand processing service is staffed by phlebotomists and processingpersonnel 0600-1700, Monday through Friday to support outpatientclinic/service operations. This service is NOT offered on weekends, Federalholidays, and training holidays. When the third floor specimen collectionservice is closed, the requesting clinic/service is responsible for thecollection and transportation of the sample to the third floor processing area.

(3) Inpatient Processing. Third floor inpatient specimen and processing serviceis staffed 24 hours a day, 7 days a week. This service supports theprocessing of inpatient/ outpatient (ER) samples that have been collected byward personnel and transported to the laboratory.

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(4) Clinical/Commercial Laboratory Service. The laboratory has a variety of military and commercial laboratory services for those tests not performed in-house. All specimens submitted to the laboratory processing section for a

civilian referral laboratory other than the Clinical contracted laboratory willrequire a properly completed submission form (SF 557 Miscellaneous Formif the test is not in CHCS). Failure to correctly fill out the submission formmay result in shipping delays. In order to ship out a specimen on the sameday received the specimen must be submitted prior to 1400.

f. Request Procedures.

(1) CHCS is the primary means by which HCP submit laboratory orders. HCPsubmitting laboratory orders for outpatients, PreOp patients, and patientsbeing seen in the clinic or service will use CHCS order entry.

(2) Whenever the Hospital Information System (CHCS) is inoperative, whenplacing an order on an inpatient, or for locations without Order Entrycapability, it is necessary for the HCP to submit the appropriate laboratoryrequest slip. See Appendix F, Laboratory Request Forms. All specimensand accompanying request slips must be clearly and appropriately labeled.All request slips MUST be printed legibly and MUST include the following:

(a) Patient's name (last, first, MI).

(b) Social security number (SSN) with Family Member Prefix (FMP).

(c) Ward, clinic, or requesting location, to include the MEPR locationcode.

(d) Date/time collected.

(e) Test(s) requested.

(f) Priority (ROUTINE, ASAP, PREOP, STAT).

(g) Physician's full name (name stamp if available) and physician’sclinic/ward/pager telephone number. Outside provider testrequests must include the address of the office/facility of theprovider.

(h) Pertinent clinical information for assays requiring laboratoryinterpretation.

(i) Cultures must show specimen source and site.

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(j) All Blood Bank specimens and SF 518s MUST have a legibleembossed or computer generated label. Trauma patients arethe ONLY exception and may have a legible handwritten label on

SF 518. Specimen label MUST match information contained on theSF 518. If there is a discrepancy or any doubt of specimenintegrity, specimen MUST be recollected. Identifying information onthe label or SF 518 is Patient Name, FMP/ SS #, Date, Time of collection and Phlebotomist Initials or signature. SF 518 also musthave patient diagnosis.

(3) During extended CHCS downtimes (1+ hours), laboratory personnel willonly accept written requests using the appropriate laboratory requisitionslips. These orders are manually completed on the wards or units.Laboratory personnel will place test orders into CHCS once it is back on-

line.

(4) Decentralized Order Entry using CHCS allows HCP to enter orders for ALLclinical laboratory tests, cytology tests, surgical specimens, and Blood Bankprocedures. Orders for blood and blood products will continue to be placedin CHCS and an SF 518 will follow with specimen when needed.Additionally, autopsy requests will be completed in writing and not byusing CHCS.

(a) At the present time, Order Entry is available for all locations.

(b) The appropriate laboratory requisition slips must be used for ordering all procedures whenever the computer system isinoperative and patient care would be compromised by waiting untilthe system is again available for use. If the computer downtime isknown to be one hour or less, please refrain from placing manualorders unless absolutely necessary for patient care.

g. Laboratory Priorities. The following four processing priorities are used byDPALS:

(1) STAT. The priority STAT will be used ONLY when a patient's life is indanger or in a situation wherein immediate life-saving treatment is pendingthe laboratory result. This priority should rarely be used. Rule of thumb:The patient's status should be that or equal to being on the SI or VSI(seriously ill or very seriously ill, respectively) list or in an unstable state inthe ED (Emergency Department). Test results submitted with STAT prioritywill be rigidly managed with a goal to keep turnaround-time (TAT) to onehour or less. ONLY the tests listed in Appendix C may be ordered in CHCSwith a STAT priority.

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(2) ASAP. The priority ASAP is used only in a situation wherein treatment of apatient is urgent and the results are required as soon as possible to alleviatepatient suffering and to ensure the patient's well being. This category will

normally be used for the typical ED/ICU request or for requests fromOutpatient Clinics when the patient must wait for a laboratory result beforetreatment is initiated or modified by the appropriate HCP.

(3) ROUTINE. This is the usual category for most laboratory orders.Specimens with this priority will be managed in the most efficient waypossible. Expected TAT for this priority is provided in the laboratory test list.

(4) PREOP. This category is for patients who are pre-scheduled for surgery.Specimens will be managed in the most efficient way possible.

h. CHCS Order Entry. See Online User's Manual (OLUM) provided within theComposite Health Care System.

i. Mail In Specimens.

(1) Medical Treatment Facilities (MTFs) on-line with CHCS will processlaboratory requests in CHCS. CHCS transmittal lists will be used andaccompany all shipments.

(2) Individual request slips must be completed for EACH test/panel requestedfor those MTF's not on-line with WBAMC’s CHCS (see Appendix F,Laboratory Request Forms). Each slip must be clearly stamped with thename and address of the submitting activity. Alternatively, a shipping list(e.g., a work document or transmittal list that lists the patient name, SSN,date of birth, and requested tests) containing all necessary information maybe used to place the orders within WBAMC’s CHCS. A copy of the shippinglist will be returned immediately to the shipping activity to acknowledgereceipt and advise the shipper of any irregularity (ies) found.

(3) Each specimen container must have an appropriate label that includes thepatient's full name and FMP/SSN. Specimens will be placed in two zip lockbags to prevent spillage/leakage. Paperwork accompanying the samplesshould be in the OUTER zip lock bag and samples should be in the INNERbag to protect the paperwork in case of leakage.

(4) Facilities utilizing Laboratory Interoperability will include a copy of theShipping List Batch with each shipment. Prior to shipment, it isrecommended that a DEERS check be performed on all patients whosespecimens are included in the shipment.

j. Specimen Collection, Handling, and Transport.

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(1) Laboratory tests reveal and contribute vital information about a patient'shealth. Correct diagnostic and therapeutic decisions rely, in part, on the

accuracy of test results.

(2) Unlabeled samples will not be tested. No relabeling of specimens will beallowed, except in extreme circumstances (i.e. tissue, CSF). The accuracyof test results is dependent on the integrity of the specimen (patientpreparation, specimen collection, and handling). In all settings in whichspecimens are collected and prepared for testing, laboratory and healthcare workers must follow OSHA and local infectious disease regulations andpolicies. The specimen collection container should be labeled with thefollowing information:

(a) Patient's complete name.

(b) Patient's complete SSN with FMP.

(c) Date and time of specimen collection.

(d) Initials of individual who collected the specimen.

(e) Specimens for compatibility testing require special labeling. Refer toWBAMC REG 40-5-7.

(3) Because the potential for infectivity of any patient's blood and body fluids isunknown, Blood and Body Fluid Precautions required by OSHA will beadhered to for all patients. These precautions, called Standard Precautions,will be followed regardless of any lack of evidence of the patient's infectivestatus.

(4) The practice of Standard Precautions eliminates the need for using specificwarning labels on specimens obtained from patients infected with ClinicalChemistry virus or Human Immuno-deficiency Virus (HIV). All specimensmust be treated as if infectious and capable of transmitting a seriousinfectious disease.

(5) Upon being collected from the patient, all specimens should be placed into aleak-proof primary container with a secure closure. Care must be taken bythe person collecting the specimen not to contaminate the outside of theprimary container.

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(6) Before being transported to the laboratory, the primary container must beplaced into a secondary container that will contain the specimen if theprimary container breaks or leaks in transit to the laboratory. Plastic bags

with zip-lock or twist-tie closures may be used as secondary containers.

(7) Laboratory requisition slips (or computer-generated orders) should beprotected from contamination and separated from the primary container.Contaminated requisition slips will not be accepted. The submitting locationwill be notified and requested to replace any contaminated slip.

(8) Preparation. Prior to each collection, review the laboratory's specimenrequirement(s). (See Clinical Pathology Service Test Manual, Appendix E.)Note the proper specimen to be collected, the amount, the procedure to beused, the collection material, and the storage and handling requirements.

(a) Preparing the Patient. Provide the patient in advance with appropriatecollection instructions and information on fasting, diet, and medicationrestrictions when necessary.

(b) Preparing the Specimen. To avoid incorrect identification, label thespecimen container using an adhesive specimen label immediatelyfollowing the collection. Confirm the accuracy of identification of thespecimen in the presence of the patient. Process the specimen asrequired and store properly. During specimen collection, preparation,and submission, there is a much greater possibility of clerical error thanduring the actual testing or examination of the specimen. Errors instorage and handling compromise the integrity of the specimen and,thus, the test results.

(c) One specimen should be submitted for each test requested. However,a single tube for a multiple test request may be drawn when a largenumber of tests are being ordered on a particular patient and the testsare performed on the same test specimen (e.g., serum or plasma).Drawing a tube for multiple test requests helps to ensure that blooddraws are limited to the least amount of blood possible, which benefitsthe patient. When a single tube is collected for a multiple test request,laboratory Specimen Processing personnel will split the specimen andensure patient demographics are accurately transcribed to each aliquottube. The individual overseeing the specimen collection must ensuresufficient specimen is provided for performing the requested tests.(NOTE: Serum or plasma normally makes up approximately 40% -45% of a blood collection. Of this amount, about 75% can be removedfrom the clot/sedimented cells, i.e., only about 2.5 mL of serum/plasmacan be obtained from a full 6-mL tube.)

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(9) Specimen Rejection (General Guidelines). The rejection of unacceptablespecimens and the special handling of sub-optimal specimens will be

considered very carefully and on a case-by-case basis by laboratorymanagement or the section supervisor. If a specimen must be rejected, therequester will be notified and advised of the reason(s) and a comment will beentered in the laboratory report. Specimens may be rejected in the followingsituations:

(a) Mismatched specimen and slip - submitting service will be notifiedand a new specimen will be requested when possible. Exceptionswill require DPALS approval.

(b) Unlabeled specimens - submitting service will be notified and given

the opportunity to resubmit for irreplaceable samples (ex. CSF,tissue, etc) only. Blood samples and swabs are not consideredirreplaceable samples. A disclaimer form must be completed for improperly labeled irreplaceable specimens.

(c) Contaminated specimen or slip - submitting service will becontacted and given the opportunity to provide a new specimen or slip.

(d) Improper specimen container used for requested assay.

(10) Common Errors to Avoid. Careful attention to routine procedures caneliminate most of the errors outlined in this section. The complete bloodcollection system and other collection materials provided by the laboratorycan maintain the integrity of the specimen only when they are used in strictaccordance with instructional materials. The following are GeneralSpecimen Collection Errors:

(a) Some of the common errors affecting all types of specimens include:

• Insufficient quantity (ensure collection container is filled to the appropriatelevel).

• Failure to use correct container for appropriate specimen preservation.

•Inaccurate/incomplete patient instructions prior to collection.

• Failure to label specimen correctly and to provide all pertinentinformation.

• Failure to tighten specimen container lids, resulting in leakage and/or contamination of specimens.

• Failure to provide legible physician's full name (name stamp if available),physician’s last four of SSN or unique provider number, and physician’sclinic/ward/pager telephone number so that results can be sent to theproper provider.

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(b) Serum Preparation Errors (Most Common):

• Failure to separate serum from red cells within 30 to 45 minutes after

venipuncture.• Hemolysis – RBC’s damaged and intracellular components spilled into

serum.

• Turbidity - cloudy or milky serum sometimes due to patient's diet.

(c) Plasma Preparation Error (Most Common):

• Failure to mix with proper additive immediately after collection.

• Hemolysis - damage to RBC’s.

• Incomplete filling of the collection tube, thereby creating an error in theanticoagulant to blood ratio, which can affect the accuracy of the testresult(s).

• Failure to separate plasma from cells within 30 to 45 minutes after venipuncture.

(d) Urine Collection Errors (Most Common):

• Failure to obtain a clean-catch, midstream specimen.

• Failure to refrigerate specimen.

• Failure to provide a complete 24-hour collection or other timed specimen.

• Failure to add proper preservative to the urine collection container after receipt of the specimen, prior to aliquotting.

• Failure to provide a sterile collection container and to refrigeratespecimen when bacteriological examination of the specimen is required.

• Failure to tighten specimen collection lids, resulting in leakage of specimen.

• Failure to provide patients with adequate instructions for 24-hour urinecollection.

(e) Hemolysis. In general, grossly or even moderately hemolyzed bloodspecimens are not acceptable for testing. Hemolysis occurs when thered blood cells rupture and hemoglobin and other intracellular components spill into the serum/plasma. Hemolyzed serum/plasma ispink or red, rather than the normal, clear, straw color.

(f) Vacuum Tubes Containing Anticoagulants. When using vacuum tubescontaining anticoagulants and preservatives:

• Tap the tube gently at a point just below the stopper to release anyadditive adhering to the tube or stopper.

• Permit the tube to fill completely to ensure the proper ratio of blood toadditive.

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• To ensure adequate mixing of blood with anticoagulant or preservative,use a slow, rolling wrist motion to invert the tube gently five or six times.Rapid wrist motion or vigorous shaking contributes either to small clot

formation or hemolysis and fails to initiate proper mixing action.• Check to see that all the preservative or anticoagulant is dissolved. If any

preservative powder is visible, continue inverting the tube slowly until thepowder is dissolved.

• If multiple samples are drawn, invert each as soon as it is drawn. DONOT DELAY.

(g) Vacuum Tubes Without Anticoagulants. Permit the tube to completelyfill when using vacuum tubes not containing anticoagulants or preservatives.

(h) Turbidity (Lipemic Serum). Lipid-containing serum/plasma may not be atrue indicator of the patient's physiological state. It is important toobtain a representative specimen that will help the physiciandifferentiate between transient dietary lipemia and chronic lipemiacaused by other factors. To avoid dietary induced high lipid levels prior to testing, many physicians require patients to exclude the high fatfoods from their diets or to fast 10 to 14 hours prior to specimencollection. For morning specimen collection, the laboratoryrecommends that the patient be required to fast from 8 P.M. on theprevious evening.

k. Laboratory Critical Values.

(1) A critical laboratory value is defined as, "a value at such variation withnormal as to present a pathophysiologic state that is life-threatening unlesssome action is taken in a very short time and for which an appropriate actionis possible." It is a laboratory's responsibility to communicate these valuesimmediately and flawlessly to the responsible clinician(s).

(2) Whenever possible, CHCS will be programmed to identify and report criticalvalues. Tests whose results are critical will cause a PRIORITY RESULTBULLETIN to be automatically generated. The bulletin is sent to the HCP

entered in CHCS as the ordering physician.

(3) Telephonic notification of critical values will also be made in accordancewith WBAMC Regulation 40-407. CHCS does not relieve the laboratory of its responsibility to ensure that all critical values are reported. Whenever possible, the requesting physician will be contacted. If that person isunavailable, another clinician or nurse from the requesting location or floor will be notified.

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l. Retrieval of Laboratory Results.

(1) All results for tests ordered STAT, ASAP, all tests whose certified results

exceed laboratory "CRITICAL VALUES", and all results that are amendedcause a PRIORITY RESULT BULLETIN to be automatically generated inCHCS. The bulletin is sent to the HCP entered in the system as theordering physician. The bulletin informs the user that Priority LaboratoryResults are waiting and instructs the user to use the RNR option to retrievethe results.

(2) Results for tests ordered with ASAP or ROUTINE priorities are NOTautomatically printed at the ordering location.

(3) The electronic patient file is considered the official file. HCP should review

patient results in CHCS. There are no laboratory cumulative reports printed.

m. Misrouted Laboratory Results.

(1) HCP who receive laboratory results that they have not ordered should notdiscard/toss the results until contact is made to the DPALS LaboratoryInformation System (LIS) manager.

(2) HCP who receive critical laboratory results that they have not orderedshould bring the issue to the immediate attention of the pathologist on call.The pathologist will take appropriate steps to notify the correct provider of the critical laboratory results. The pathologist will pass the information tothe DPALS LIS manager on the next normal duty day.

(3) HCP who receive routine non-critical laboratory results that they have notordered should bring the issue to the attention of the DPALS LIS manager.

(4) The DPALS LIS manager will take appropriate steps to determine thecorrect ordering HCP/department/service from which the order originated.The LIS manager will then contact the HCP originally receiving the resultsand request that he/she forward the results to the correct HCP. If that HCPcannot forward the results for whatever reason, the LIS manager willforward a hard copy of the results to the HCP who originated the orders or to his/her department/service chief. The HCP originally receiving the resultsmay then discard/toss the results.

8. ANATOMIC PATHOLOGY SERVICE. The Anatomic Pathology Serviceencompasses the sections of Cytology, Surgical, and Autopsy Pathology. Theservice is in back of the laboratory on the third floor, and is open routinely 0730-l630Monday through Friday. A staff pathologist is on call for problems arising duringnon-duty hours. Pathology on call roster is distributed monthly.

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a. Autopsies.

(1) Autopsies are performed in the Anatomic Pathology Service. Indicationsinclude clarification of cause of death, manner of death, delineation of extentof disease, evaluation of the effects of therapy, and medico legal reasons.The attending physician generally requests the autopsy. After thepermission form (SF 523) has been signed by the legal next of kin, it mustbe sent to the Decedent Affairs officer in the Patient Administration Officefor authentication and the hospital commander’s approval.

(2) For those deaths in which there is a question whether or not the El PasoCounty Medical Examiner has jurisdiction, the attending physician shouldcontact the Decedent Affairs officer in the Patient Administration Office

(569-2503) during duty hours. During non-duty hours and onweekends/holidays, the AOD should be contacted (569-2121). The MedicalExaminer's Office will be contacted by either the AOD or the DecedentAffairs officer. If the Medical Examiner has jurisdiction, he may either assume responsibility for the case or relinquish responsibility to WBAMC.

(3) Before Anatomic Pathology can schedule an autopsy, both the patient'scomplete chart and authenticated autopsy permission must be received.Scheduling of autopsies is at the discretion of the Anatomic PathologyService. It is our policy to perform autopsies during normal duty hours,Monday through Friday. If there is a need for an autopsy during times other than those listed above, the Pathologist on call should be notified.Autopsies cannot be performed until autopsy permission is authenticated.This stipulation also applies to postmortem needle biopsies.

(4) Physicians requesting postmortem examinations are encouraged to contactthe pathologist performing the autopsy to provide information as to thequestions expected to be answered by the autopsy (569-3724/1440, NCOICpager 4469). Attendance at the autopsy by the requesting physician,though not required, is encouraged.

(5) The Preliminary Autopsy Report of Death and the final autopsy report aresubmitted directly to the Patient Administration Division and the chief of theservice attending the patient. The Preliminary Report is submitted within 3working days and the final report of uncomplicated cases within 30 days.Physicians needing copies of these reports should contact the PatientAdministration Division or the chief of their service.

(6) Any other questions relating to the Autopsy Service may be addressed tothe office of the Chief, Anatomic Pathology Service (569-3724).

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b. Cytology Section.

(1) General. The following guidelines for the handling and collecting of

cytologic specimens have been developed by the Cytology Section toensure the quality of care, patient safety, and to help the nursing staff andphysicians obtain meaningful diagnostic information. Many of theprocedures are required in accordance with our certifying agencies,including CAP and JCAHO.

(2) Location. The Cytology Section is located on the 3rd floor of the AnatomicPathology Service, Cytology room 3172. The section telephone # is 569-1486/3769. The NCOIC phone number is 569-1440.

(3) General Information.

(a) Specimen Labeling. All cytology specimens should be submitted inproperly labeled containers whether they are in a specimen cup,

Preservcyt® vial, Cytolyt® vial, specimen trap, Plasma-Lyte® bag,thoracentesis bag, paracentesis bag or bottle, etc. Labels must havethe following minimum information:

• Patient’s Name

• SSN

• FMP

• HCP Name

• Hospital Area, Clinic or Ward

(b) Submitted Slides. Must have the following information on the frostedend written with a #2 lead pencil or solvent resistant pen.

• Patient’s last name and first initial

• Last four digits of SSN

• FMP

(c) Laboratory Requests. All cytology specimens (Gyn, Non-Gyn, andFNA's) must have a CHCS order entry placed by the submitting HCP

before the specimen is accepted by the Cytology Section.

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(d) All Cytology laboratory requests and/or computer-generated copiesmust be in compliance with CAP and JCAHO requirements and havethe following legible data on the submission slip:

• Patient’s full name

• SSN

• FMP

• Age and/or Date of Birth

• Sex

• Date of Specimen Collection

• Submitting HCP Name (with phone or beeper #)

• Hospital Area, Clinic or Ward

• Anatomic Site/Source

• Pertinent Clinical Information

• Reason for the Exam

(e) Other pertinent clinical information includes:

•Date of Last Menstrual Period (LMP)

•Menopausal Status

•Current Pregnancy status

•Oral Contraceptive/IUD use

•Hormone Therapy

•History of Hysterectomy

•Previous Abnormal Gyn Cytology Results

(f) CHCS order entry procedures for Gyn Cytology Specimens:

• At the CHCS Order Entry (ORE) prompt type PATIENT NAME.Select requesting location and at the action prompt enter “N” for new order. Select Order Type LAB.

• At the select LABORATORY TEST prompt, enter CYTO to displaya pick-list of:

1. Cytologic Gyn (PAP Smears)2. Cytologic Non-Gyn

Select option 1.

• For all PAP Smear orders, please include LMP, menopausalstatus, current pregnancy status, oral contraceptive/IUD use,hormone replacement therapy, history of hysterectomy, and anyprevious abnormal GYN results when ordering in CHCS.

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(g) CHCS order entry procedures for Non-Gyn Cytology Specimens:

• Orders for Non-Gyn specimens (e.g., FNA’s, urines, respiratory

specimens, fluids, etc.) will be entered at the ORE prompt byrequesting LABORATORY for order type.

• At the Select LABORATORY TEST prompt, enter CYTO todisplay a pick-list of:

1. Cytologic Gyn2. Cytologic Non-Gyn

Select option 2.

• Then follow the same steps for Order Entry of routine surgicalspecimens. Pertinent clinical information should include history,

preoperative, operative, and postoperative findings are required.• If there are multiple Non-Gyn specimens obtained from differentsites on the same patient, each specimen site should have aseparate order entry.

(h) Delivery of Specimens.

• Normal Duty Hours: Cytology Specimens are to be delivered tothe Cytology Section, Room 3-172 between the hours of 0730 to1500. Specimens will not be accepted without acknowledgementby a Cytology Prep Tech or a Cytotechnologist. It is strongly

recommended that specimens be delivered to the laboratory asearly in the normal duty day as possible to enable processing of specimens on the same day. Check the table at paragraph8.b.(3)(l) for Procedures and Submission Requirements.

• Non-Duty Hours: If an unfixed specimen is obtained when theCytology Section is closed, deliver the specimen to SpecimenHandling and Receiving window, 3144, and give to laboratorypersonnel. Specimens can be refrigerated up to 24 hours unfixed.

•If a question arises as to how a specimen should be handled,

please contact the Cytology On-Call tech at beeper #4469/4464.

(i) Handling of Improperly Submitted Specimens. All improperly submittedspecimens (those in a manner other than that required on the SF 541,SF 515, or CHCS Order Entry request) will be held unprocessed until theHCP is contacted. When the proper requests are made/corrected or completed by the submitting HCP the specimen will be processed. Theabove same will be true for unlabeled specimens which will not beaccepted for processing or examination until the submitting clinic and/or

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HCP is notified. (Unlabeled specimens are automatically rejected by theCytology Section and returned to the submitting HCP/Clinic.

(j) Fixation of non-GYN/FNA Specimens Prior to Submission to theCytology Section. As a general rule, optimal cytologic diagnosis is madeon fresh specimens, without addition of Cytolyt or Preservcyt fixative.However, certain specimens and situations require fixation at thebedside or prior to submission to the Cytology Section. Please note thetype specimen being sent below for proper handling. Cytolyt or Preservcyt fixative solutions are available from the Cytology Section,Room 3172. Ordering information will also be made available for anydepartment needing larger amounts. Please contact the CytologySection at 569-1486 or the Cytology Supervisor at 569-1440

(k) Any specimen amenable to cytological study will be accepted by theCytology Section for processing. If questions arise as to how aspecimen should be handled, please telephone Cytology at 569-1486/3769. Unusual cases should be coordinated with the Chief of theCytology Section (569-1419) or the Cytology Supervisor (569-1440).

(l) Procedures and Submission Requirements:

PROCEDURE SUBMISSION REQUIREMENTSAbdominal Cavity

Washings

Vigorously wash appropriate areas (diaphragm colic gutters, cul-

de-sac, etc.) with adequate volumes of physiologic balanced saltsolution (Plasmalyte). Normal saline is not recommended.Aspirate washing and submit immediately (within one hour) to thelaboratory. If more than a 1 hour delay is expected in delivery to

the laboratory, mix washing an equal volume of Cytolyt® fixativesolution.

Bladder or UreteralWashing/Lavage

Washing/barbotage should be performed with an adequatevolume of Plasmalyte. Normal saline is not recommended. After

obtaining the specimen, mix with an equal volume of Cytolyt® fixative solution. Optimal diagnostic evaluation requiressimultaneous submission of voided urine on a well-hydrated

freely-voiding patient immediately prior to any instrumentationprocedure.

Breast CystAspiration

Specimens of breast cyst fluid should be submitted unfixed to theCytology Section. Refer to the “Fine Needle Aspirations” table.

Breast NippleDischargeSpecimens

For obtaining a specimen from a nipple discharge, gently grip thesubareolar area and nipple with thumbs and forefinger. Whensecretion occurs, allow only a pea-sized drop to accumulate.Touch a clean, labeled glass slide (Note: identify the slide bywriting on the frosted end with a #2 pencil the patient’s name, last

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four digits of SSN and FMP) to the nipple and withdraw slidequickly. Repeat procedure until all secretions from nipple arecollected on two or more slides. Smears of nipple discharge

should be air-dried and submitted unfixed without delay to theCytology Section, Room 3172. Do not spray fix or wet fix theslides.

Bronchial BrushSpecimens

Prepare patients for bronchoscopy in the usual manner. Anyvisible lesions can be brushed. Cut brush off catheter andimmediately place the brush along with any cell clumps into a pre-

filled vial of Preservcyt® fixative. Note: Preservcyt® fixativesolution is a poison that contains methanol and it must never

come in direct contact with the patient. Preservcyt® isavailable from the Cytology Section.

Bronchial

Washings/Lavages(BAL)

Prepare patients for bronchoscopy in the usual manner. Fill the

bronchus with 0.9% Normal Saline. Aspirate and re-instill thesolution several times. Aspirate all the fluid from the bronchus,label, and send immediately, without fixative, to the CytologySection. If there will be more than a one-hour delay anticipated inforwarding the specimen to Cytology, place the fluid in a pre-filledvial of Cytolyt fixative immediately after collecting the specimen.Cytolyt is available from the Cytology Section.BAL's should be sent to cytology unfixed especially if specialstains are required. BAL’s performed during non-duty hoursrequire coordination with the on-call Pathologist who can bereached through the WBAMC AOD at 569-2121.

Note: Cytolyt fixative solution is a poison that containsmethanol and it must never come in direct contact with thepatient.

Buccal Smears Call Cytology Section, 569-1486/569-3769.

Cerebrospinal FluidCytology (CSF)

Perform spinal tap in the usual manner. Collect a CSF sample ina separate container for cytologic examination. As much volumeas possible should be obtained. Send the sample immediately(within one hour) to the Cytology Laboratory Room 3172 withoutfixative. If a delay is anticipated, mix with an equal volume of Cytolyt fixative solution and send to the Specimen Control (frontdesk), Room 3143 for immediate Cytology processing the next

duty day. Samples for cell count, chemical, microbiologicalstudies, and/or flow cytometry should be delivered to the mainSpecimen Control Area, Room 3143, and follow the respectivedepartment’s protocol.

Cytogenic Studies Call AP NCOIC or AP Chief,569-1440/1419

Effusions andFluids

Fluids yield the best cytologic diagnosis if the specimen isimmediately processed without fixation. The fluid does not needfixative even when a few days delay is expected but should be

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sent to the Cytology Section as soon as possible.

Fine NeedleAspirations (FNA)

Aspiration biopsies should be coordinated andscheduled with the Cytology Section at phone 569-1486/3769

and/or Medical Director, Cytology 569-1419 preferably with a oneday notice for optimal processing and correlation with clinical andradiographic findings. A cytotechnologist and/or pathologistassistant will be provided upon request. Due to processingrequirements, assistance for FNA’s cannot be provided after 1600(regular duty hours). Any FNA assistance needed during non-duty hours requires coordination with the on-call Pathologist whocan be located through the WBAMC AOD at 4-2121.

FNA Equipment: A FNA cart with all the necessaryequipment and materials is available which allows performance of the procedure in any location of the hospital (clinic, inpatient

ward, radiology suite, operating room, etc.). A cytotechnologist isavailable during normal duty hours to assist in preparing smearsand/or render a determination of specimen adequacy. If necessary, a preliminary diagnosis can be rendered by apathologist only, during or immediately after the procedure.

Informed Consent. The patients must be counseledabout the procedure and any associated risks (infection, bleeding,bruise, pain, swelling, and damage to vital structures). Inaddition, limitations of representative sampling, to include non-diagnostic or inadequate samples, and the alternative of opentissue biopsy should be discussed. A written informed consent

must be completed (SF 522) – refer to WBAMC Regulation 40-38.Procedure for FNA of Superficial Palpable Masses.

The area to be aspirated is examined and cleansed with alcoholpads. A local anesthetic may or may not be used. In general,superficial palpable masses are aspirated using small gaugeneedles (25 or 23 gauge, 5/8, 1 or 1 ½ inch long), attached to a10 or 20 cc syringe in a plastic Inrad syringe holder or metalCameco holder. After proper mobilization of the mass, the needleis inserted, suction is applied and maintained, and the needle ismoved in and out of the mass in short, rapid strokes.

When aspirate material (including blood) is visible inthe hub of the needle, release suction and remove the needlefrom the mass and skin. If no obvious material is seen in the hubof the needle, continue the aspiration attempt for at least 15seconds, then release the suction and remove the needle.Gentle pressure should be applied to the aspiration site. Three tofive separate aspiration passes should be performed for eachpalpable mass being evaluated by FNA. This will improvesampling adequacy.

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Slide Staining/Needle Rinsing. One air-dried slidepreparation is stained with Diff-Quik solution (Romanowsky-typestain) for immediate review. The other slide is submitted to the

Cytology Laboratory for rehydration and subsequent fixation in95% alcohol and Pap staining. The aspiration needle is rinsed inCytolyt solution which is sent for preparation of ThinPrepmonolayer smear (Pap-stained) and, if enough cellular material isavailable in the rinse fluid, a paraffin-embedded cell block will bemade (hematoxylin and eosin stain). When the differentialdiagnosis includes lymphoproliferative disorders, flow cytometryfor lymphoid surface marker analysis can be performed on anymaterial rinsed into a vial of pink-colored RPMI sterile solution(provided by the Cytology Laboratory). In addition, aspirationmaterial can be submitted in sterile saline for culture (prior

coordination with Cytology Laboratory is required in the request of a culture).Smear Preparation. Place bevel of needle directly on one of theglass slides, in approximately the center of the slide. A smalldrop of fine needle aspirate material is expressed onto the glassslide. Lay another slide parallel or cross-way to and on top of thefirst so that the aspirate spreads to create a thin smear. Air-dryboth slides completely.

GastrointestinalTract Brushings or Washings

Prepare patients for endoscopy as usual. Any visible lesions(esophageal, gastric, small intestinal, colonic) can be brushed or lavaged. The disposable brush tip (“brush cut”) can be placed

into a pre-filled vial of Cytolyt solution. Note: Cytolyt®

fixativesolution is a poison that contains methanol and it must nevercome in direct contact with the patient. Gastrointestinal tractwashings or lavages can be sent in the trap bottles and/or placed

into sterile specimen cup(s) with approximately 30 mL of Cytolyt® labeled with the patient’s name, SSN, specimen source, and typeof specimen (e.g., washing).

Pap Smear: Thin

Prep® Collectionwith Medscand

Cytobrush® Plus

GT, gentle touch tipand Pap-Perfect® plastic spatula

To collect specimen from the ectocervix, select contoured end of the plastic spatula and rotate it 360° around the entire ectocervixwhile maintaining tight contact with the ectocervical surface.Remove spatula. Rinse contoured end of plastic spatula in a vial

of Preservcyt solution by swirling vigorously 10 times. Discard thespatula. Place the cap on the vial.Insert Cytobrush Plus GT device into the endocervix until thebottom-most fibers are exposed. Slowly rotate one-quarter toone-half turn in one direction. Remove device. Do not over rotate. Additional rotation may cause bleeding and contaminatethe specimen.Remove the cap from the original Preservcyt vial and rinse theCytobrush Plus GT in the Preservcyt solution by rotating the

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device in the solution 10 times while pushing it against the wall of the vial. Swirl the device vigorously to further release material.Discard the device.

Tighten the Preservcyt vial cap so that the torque line on the cappasses the torque line on the vial.Warning: Do Not use the Cytobrush Plus GT cell collectorgentle touch tip for endometrial sampling.

Pap Smear: Thin

Prep® Collectionwith Broom-likeDevice

Prepare the patient for Pap procedure in the usual manner. For collection with the Broom-like device:

•Obtain: Insert the central bristles of the broom into theendocervical canal deep enough to allow the shorter bristles tofully contact the ectocervix. Push gently, and rotate the broom ina clockwise direction five times.

•Rinse: Rinse the broom as quickly as possible into the

Preservcyt® solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirlthe broom vigorously to further release material. Discard thecollection device.

•Tighten: Tighten the cap so that the torque line on the cappasses the torque line on the vial.

•Record: Record the patient’s name and SSN/FMP on the vial.

•Place: Place the vial and appropriate requisition form in aspecimen bag for transport to the Cytology Section.

Pap Smear:Conventional Pap

Smear (Cervical-Vaginal Cytology)

Prior to obtaining the smear, identify the slide by writing on thefrosted end with a #2 pencil the patient’s name, last four digits of

SSN, and FMP. Utilize the spatula for the ectocervical samplefirst and spread the material onto the glass slide, then use thecytobrush for the endocervical sample and spread the brushmaterial directly over the previously spread spatula sample bygently twirling the handle. Spray fix the slide IMMEDIATELY witha spray Pap fixative (Cyto-fix, Pro-fix, etc.). Make sure the nozzleof the spraying apparatus is held approximately8 – 10 inches from the slide. An alternative to the spatula andbrush is the Broom-like device which takes a sample from boththe ectocervix and endocervix simultaneously and this is thenspread onto a glass slide with a single smooth stroke again as

above spray fix the slide IMMEDIATELY with Pap fixative (Cyto-fix, Pro-fix, etc.) and the nozzle apparatus about 8 – 10 inchesfrom the slide. For cytohormonal evaluation, a lateral vaginal wallscraping smear from the middle third of the vagina is required (for evaluation of possible vaginal adenosis, the vagina should be freeof mucus before smears are made.)

Post-BronchialSputum

Give the patient a specimen cup before the bronchoscope iswithdrawn. All sputum expectorated after bronchoscopy and for

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the next one hour should be collected in the patient’s specimencup.

Skin Scrapings or

Mucosal Vesicular Fluid (Tzanck CellPreparation)

Submit two smears, one spray fixed with a Pap fixative and one

air dried un-fixed for Diff-Quik staining.

Sputum Upon awakening in the morning, the patient should be instructedto cough deeply and expectorate into a specimen cup. Addapproximately 30 mL of Cytolyt fixative and refrigerate. Note:Cytolyt fixative solution is a poison that contains methanoland it must never come in direct contact with the patient .Any additional sputum from deep coughing after the initialspecimen may be included in the same sample. For maximumdiagnostic accuracy, repeat for three consecutive days. The

specimen should be brought to the Cytology Section, third floor Room 3172 during normal duty hours.

Voided Urine Patient should be well hydrated prior to obtaining the specimen.Collect a clean catch specimen after the first morning sample hasbeen voided (50-100mL of midstream urine) and immediately mixwith an equal volume of cytolyt fixative. Alternatively, thespecimen can be submitted fresh (unfixed) to the CytologySection within one hour after collection. Note: 24 hour urinespecimens or those obtained from a Foley catheter bag cannot beevaluated cytologically.

c. Surgical Pathology Section.

(1) All tissue removed from patients at this institution must be submitted to theAnatomic Pathology Service for examination. The specimens can bedelivered to the Laboratory Grossing Room 3176 between 0630 – 1530,Monday through Friday. Tissue should be placed in a 10% formalin solutionunless special procedures like a frozen section are required. For specialprocedures, contact the grossing room at 569-4436 during normal dutyhours. After hours, take the specimen to room 3144, ring the buzzer andleave the specimen at the drop-off window. For any questions, contact theNCOIC at 569-1440.

(2) Specimen containers must be labeled properly with the patient's hospitalmedical card and contain the following items:

• Patient's name, SSN, DOB, and registration number.

• Patient's location (ward or clinic).

• Physician's name.

(3) The LAB ORDERS must be placed into CHCS under “TISSUEEXAM~WARD/ CLINIC COLLECT”. The printed orders should accompany

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the specimen. Each container should be identified as “A”, “B”, etc. andshould match identically to the COPATH orders.

(4) For Inpatient, Operating Room specimens (to include frozen sections orother special procedures), a Patient transmittal list from the CHCS order must contain the same information as listed above in paragraph 8. c. (2).

(5) Surgical Pathology reports (routine, non-complicated cases) are completedwithin two working days (48 hours), with cases complicated by specialprocedures such as special stains, Immunohistochemical stains,decalcification, or extensive consultation taking longer. Inquiries concerningstatus of cases will be facilitated by knowledge of the date the specimenwas accessioned, the accession number, and the Pathologist involved in thecase. Inquiries should be directed to the Pathology Transcription Section

569-1434/1435. It is emphasized that definitive therapy or invasivediagnostic procedures predicated by the results of the surgical biopsyshould be taken only after a final written Surgical Pathology report is inhand.

(6) All slides and tissue submitted to the Anatomic Pathology Service are themedical and legal responsibility of the Anatomic Pathology Service and,therefore, require stringent control to maintain the integrity of our files.Specimens picked up from the clinics and the operating room are verified,appropriately labeled and signed by the DPALS technician on their log. Thetechnician will verify that each sample is appropriately labeled and that aproper surgical order accompanies each specimen. No sample will beaccepted by DPALS without logbook/ledger verification. The DPALScontrol over these materials must also comply with requirements of the l974Privacy Act. Physicians are required to sign for all slides borrowed from theService's files and must return them promptly.

(7) All patients admitted to WBAMC for therapy (particularly for cancer therapy)based on a tissue diagnosis rendered at another institution must have atissue diagnosis from WBAMC Anatomic Pathology based on a review of the outside slides and tissue examination report.

(8) To request review of outside slides by WBAMC, submit a completed SF 5l5,to include the patient's name, age, SSN, type of specimen, date tissue wasobtained, and referring hospital. Completed DD Form 2005 (Privacy Actstatement) signed by the patient must accompany the SF 5l5. WBAMCAnatomic Pathology will then request the material and upon its arrival willrender a tissue examination report and will return the material to the originalcontributor. If the patient arrives at WBAMC with outside slides, they shouldbe submitted to the Anatomic Pathology Service with a copy of the outside

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report, if available (for gross information to document the accuracy of theslides), and a completed SF 5l5 requesting review of this material.

(9) Electron Microscopy (EM) and Tissue Immuno-fluorescence Microscopy(IFM). The EM Section of the Anatomic Pathology Service is inactive;however, specimens for EM/IFM are still submitted to Histology, WBAMCand will be shipped for testing. All renal biopsies are examined routinely; inaddition, any other tissue specimen of unusual interest can be processed for EM and IFM. These special microscopy procedures require specialhandling and fixation of the tissues submitted. Submit tissue in fresh state.

(a) EM specimens must be cut into one mm3 pieces and immediatelyplaced into special EM fixative (1% Glutaraldehyde).

(b) IFM specimens must be placed directly into a special fixative (Zeustissue fixative) which preserves the reactivity of immunoglobulins.Although fixative for EM is available in Anatomic Pathology Serviceat WBAMC, persons who are to perform biopsies on which EMand/or IFM may be useful should contact Histology Sectionpersonnel (569-2251/4436) or the Medical Director of SurgicalPathology (569-3724) prior to the biopsy in order to coordinateactivities and ensure proper handling of the specimens. Routineformalin fixation is UNACCEPTABLE for EM and IFM. It isrequested that all tissues submitted for EM and/or IMF studies belabeled properly with the following information:

•

Patient's name, SSN, FMP and DOB• Description (what the specimen represents, e.g. Liver biopsy).

• Requesting physician's name.

(c) Specimens must be accompanied with the computer printed order.In any case where there is doubt as to the value of EM or IFM, thephysician should feel free to consult with Medical Director of Surgical Pathology Service (569-3724)

(10) Special Procedures.

SPECIAL PROCEDURE SUBMITTING REQUIREMENTSEstrogen/ProgesteroneAssays (ER/PR)

Estrogen and progesterone receptor studies will beperformed by the immunohistochemical method at theProPath Laboratory. Request for quantitative assay of ER/PR should be prearranged with the Histology Laboratory.

IntraoperativeConsultations

Tissue specimens should be taken to the Laboratory in afresh state. The purpose of the frozen section is to assistthe surgeon in making intraoperative or immediate

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postoperative decisions on patient management. Frozensections for reasons other than immediate therapeuticdecisions are strongly discouraged, particularly when only

small pieces of tissue are available for examination.Diagnosis demanding evaluation of subtle microscopicchanges cannot be made with certainty on frozen sections.Furthermore, the process of freezing induces severe cellular artifacts that usually impair the evaluation of permanentsections. Under normal circumstances, frozen sections willnot be performed on lymph nodes suspected of harboring alymphoproliferative disorder. The CHCS computer print outsent with tissue for frozen section must transmit to COPATHto be able to accession the specimen. The neededinformation if available will provide the Pathologist for proper

orientation of the tissue. This will aid the Pathologist inarriving quickly at the correct diagnosis and shorten patient'sanesthesia time. If multiple specimens from the samesurgical event are to be sent at different times, it will bewritten on DA Form 4700. This will ensure that all specimensare properly identified and will aid in preventing errors inspecimen control.

Lymph Nodes Lymph nodes removed for diagnostic evaluation should bebrought immediately to Anatomic Pathology Service in thefresh state wrapped (not suspended) in saline-wet gauzes(without fixative). This is essential. Whenever bacteriologic

or fungal cultures are desired, a portion of the lymph nodeshould be removed in a sterile manner by the surgeon andplaced in an appropriate container for microbiologic studiesbefore the remainder of the node is delivered to thepathologist. Studies that can be performed on lymph nodesreceived in the above manner include EM, histochemistry,flow cytometry, IFM, and light microscopy, and touchpreparations. Delay in handling lymph nodes can result in adegree of autolysis that renders the material diagnosticallyinadequate.

Muscle and Nerve

Biopsies

Muscle specimens are handled in a unique manner. To

obtain maximum benefit (histochemistry, light microscopy,and EM) tissue must be submitted fresh. To ensure anadequate specimen for proper handling, it is necessary tonotify the Pathologist on call 24 hours prior to the biopsyprocedure. Nerve biopsies require special handling,including light microscopy and EM, teasing, and flash-freezing (in certain cases). Submit fresh. The pathologystaff will take care of the specimen right after it has beenobtained; and coordination with the pathologist, preferably

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24 hours in advance, is necessary to assure proper preservation and processing of the biopsies.

Renal Biopsies EM, IFM, and light microscopy are routinely performed on all

renal biopsies. It is imperative that the special fixatives for EM and IFM be available at the time tissue is removed fromits blood supply and that the biopsy be placed into thefixative IMMEDIATELY. Personnel from the HistologySection are available for assisting in the collection andfixation of specimens, and should be contacted at least 4hours (preferably 24 hours) in advance of the biopsy. For scheduling of Renal Biopsies, call the Histology Section,569-4436/2551. A completed Renal Biopsy Clinical HistoryForm should be submitted with every renal biopsy in additionto the other required documents.

Spleens On all spleens that are to be removed for other than traumaor incidental reasons, the Anatomic Pathology Serviceshould be notified in advance of the procedure. The spleenshould be handled in a manner similar to diagnostic lymphnode biopsies and delivered immediately to AnatomicPathology Service in the fresh state. Spleens removed asincidental specimens in other operations or removed for splenic trauma should be handled as routine surgicalspecimens and placed in formalin fixative.

9. CLINICAL PATHOLOGY SERVICE. DPALS offers clinical pathology services toWBAMC and other medical treatment facilities using qualified professionals andstate of the art methods and instrumentation. Clinical Pathology Service consists of the following services: Core Laboratory (Hematology and Chemistry), Microbiology,and Blood Bank. Our service captures in excess of one million CPT test codesper year. Quality is the top priority and will not be compromised in any situation.Test results from all sections are continuously monitored for reliability, precision, andaccuracy by both internal and external quality control programs. All laboratories aredirected by board-certified pathologists. The laboratory’s accreditation, licensure,and other inspections include: Joint Commission for the Accreditation of HealthcareOrganizations (JCAHO); College of American Pathologists (CAP); Inspector

General; DoD Center for Clinical Laboratory Management (CCLM); U.S. ArmyEnvironmental Hygiene Agency; American Association of Blood Banks (AABB);Food and Drug Administration (FDA); Occupational, Safety and HealthAdministration (OSHA); and the Nuclear Regulatory Commission (NRC).

a. Microbiology. The Microbiology Laboratory offers services in bacteriology,mycology, parasitology, immunology, and virology.

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(1) Specimen Collection. Proper specimen selection, collection, and transportare critical to ensure that the specimen is representative of the diseaseprocess with minimal contamination from the microorganisms present in

adjacent tissues. When possible, indicate disease process or etiologicagent suspected. For questions regarding specimens containing agents of emerging disease or bioterrorism, please contact Microbiology OIC at 569-1475. Specimen containers should be transported within a sealable, leak-proof, plastic bag. Do not transport syringes with needles to the laboratory.Instead, contents should be transferred to a sterile container or the needleshould be removed with a protective device and the capped syringe placedin a sealable, leak-proof, plastic bag.

(2) Specimen Suitability. Specimens which have not been properly collected or transported will be subject to rejection. Irretrievable specimens will be

judged on an individual basis and the specimen will be salvaged whenever possible. The HCP will be contacted to help resolve the deficiency or toexplain the rejection.

(3) General Rejection (Microbiology Guidelines).

(a) Delays in transport which affect test results.

(b) Duplicate specimens (except for blood culture) in a 24-hour period.

(c) Improper collection container, handling, or collection, includingunsuitable preservation and incorrect use of transport media.

(d) Inadequate volume.

(e) Inappropriate specimen for a given test.

(f) Leaking specimen or gross external contamination of collectioncontainer.

(g) Sample contaminated with barium.

(h) Specimen received in fixative.

(i) Specimen received without a label or improper label.

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b. Blood Bank (Transfusion Medicine and William Beaumont Blood Donor Center).

(1) General Information.

(a) Blood Bank is located in Room # 3163 at the hospital and theWilliam Beaumont Army Medical Center Donor Center is located atLazar St and Fred Wilson Gate. The role of blood bank is to providesafe, quality, compatible blood products to support WBAMC patienttransfusion needs. The role of the Donor Center is to collect andmanufacture those blood products.

(b) Blood Bank is located on the third floor of the hospital Rm # 3163(phone: 569-2219 / 2388) and is operational 24 hours a day, 7 daysa week.

(c) The William Beaumont Army Medical Center Donor Center operations usually occur Monday through Friday during normal dutyhours. Special requests/procedures or blood products requiredirect consultation with the Medical Director, Chief of the BloodBank and Blood Bank Supervisor. These products and/or servicesmay be available in limited quantities, have relatively short shelf life,or require mobilization of donors and/or specialized technicalpersonnel; therefore they require consultation prior to approval or release

(d) Any issues regarding Blood Bank or Donor Center operationsshould be addressed to the Medical Director at 569-1452 or theChief of the Blood Bank at 569-1504.

(e) Policies governing Blood Bank and Donor Center operations areavailable in WBAMC Regulation 40-5-7 (Administration of Bloodand Blood Components) and DOD Policy 40-3 (Blood Donor Program). It is critical that WBAMC staff become familiar withthese WBAMC regulations in order to ensure effective and efficientuse of available Blood Bank and Donor Center resources.

(2) Test and Blood Ordering Categories.

(a) Routine Type and Crossmatch (T&C). Pretransfusion testing isperformed on the patient's blood including ABO group, Rh type, antibodyscreen, and a crossmatch. An immediate-spin crossmatch is performedwhen the patient's antibody screen is negative and no history of antibodyformation is documented. Routine T&C procedures are usuallyperformed for elective surgical procedures associated with blood loss.See Maximum Surgical Blood Ordering Schedule (MSBOS), WBAMC

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REG 40-5-7, pages 26 thru 33. Procedures for the Use of Blood andBlood Products. Blood products are usually available within four hours.

(b) Type and Screen (T&S). The ABO group, Rh type and antibody screenis performed on the patient's blood. A crossmatch is performed if unexpected antibodies are present in the antibody screen. T&Sprocedures are used primarily for elective surgical procedures notusually associated with blood loss (see MSBOS, WBAMC REG 40-5-7,pages 26 thru 33. The SF 518 and corresponding specimen are valid for 3 days from the date requested. T&S requests are usually processedwithin two hours. In the unlikely event that blood is required for thepatient; an immediate-spin crossmatch will be performed on anexpedited basis (10 to 20 minutes).

(c) ASAP. Blood Bank doesn't utilize this category due to the nature of apatient's need for blood; all requests are performed as soon as possible.

(d) STAT. This refers to the performance of expedited pretransfusion T&Cprocedures requested for emergency or semi-emergency surgicalprocedures and is usually completed within the hour. Previouslysubmitted T&S blood requests are converted to STAT after asubsequent need for blood develops. A Type & Screen Converted toCrossmatch needs to be ordered in CHCS.

(e) Emergency Medical Release (EMR). See Appendix A of WBAMC Reg40-5-7, Emergency Transfusion Guidelines.

(3) Maximum Surgical Blood Ordering Schedule (MSBOS).

(a) The transfusion guidelines listed in Appendix F are recommendedaverage transfusion levels derived by tabulating blood usage over several years for each elective surgical procedure performed in thishospital. Those procedures that have a historically low probability of requiring blood transfusion are listed as Type and Screen (T&S). T&Sincludes an ABO/Rh typing and antibody screen performedpreoperatively for discussion of T&S procedures in WBAMC Reg 40-5-7(Administration of Blood and Blood Components). Elective surgicalprocedures that have a greater risk and a historically higher probability of requiring transfusion are crossmatched). The maximum number of blood units that should be crossmatched is listed in the MSBOS.

(b) T&S procedures listed in the schedule may be converted to crossmatch(T&C) procedures if the physician determines that the probability for transfusion is likely based on the patient’s clinical condition. In suchcases, the SF 518 must be clearly annotated “T&C”; otherwise, a T&S

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procedure will be performed. A Type & Screen Converted to Crossmatchneeds to be ordered in CHCS.

(c) The Hospital Transfusion Practices Committee annually reviews thetransfusion data on elective surgical procedures to ensure compliancewith the MSBOS. The committee will also change the schedule asneeded when transfusion levels dictate modifications.

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APPENDIX A

Explanation of Abbreviations and Terms

AABB American Association of Blood Banks

Ab Antibody

ACTH Adrenocorticotropic Hormone

AF Air Force

AFB Acid Fast Bacillus

AG Antigen

ALK Alkaline

ALT Alanine Aminotransferase

ANA Anti Nuclear Antibody

AOD Administrative Officer of the Day

AP Anatomic PathologyAPTT Activated Partial Thromboplastin Time

ASAP As Soon As Possible

ASO Antistreptolysin O

AST Aspartate Aminotransferase

WBAMC William Beaumont Army Medical Center

BASO Basophile

BATT Battery

BBF Blood Body Fluid

BC Blood Culture

BUN Blood Urea NitrogenBNP B-Type Natriuretic Peptide

C Clostridium

CA Calcium

CAP College of American Pathologists

CBC Complete Blood Count

cc cubic centimeter

CCMS Clean Catch Midstream

CDC Center for Disease Control

CHCS Composite Health Care System

CK Creatine Kinase

CK-MB Creatine Kinase Muscle/BrainCCLM Center for Clinical Laboratory Management

CMV Cytomegalovirus

CO2 Carbon Dioxide

COAG Coagulation

COMP Complete

CP Clinical Pathology

CSF Cerebrospinal Fluid

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CT Cell Titer

CULT Culture

Cytotech Cytology Technologist

DFA Direct Fluorescent AntibodydL Deciliter

DNA Deoxyribonucleic Acid

DoD Department of Defense

DPALS Department of Pathology and Area Laboratory Services

DSN Defense Switched Network

EDTA Ethylenediaminetetraacetate

EIA Enzyme Immunoassay

EM Electron Microscopy

EMR Emergency Medical Release

ENA Extractable Nuclear Antigen

EOS Eosinophil

ER Emergency Department

ER/PR Estrogen/Progesterone

FBS Fasting Blood Sugar (Glucose)

FDA Food and Drug Administration

FFP Fresh Frozen Plasma

FIB Fibrinogen

FMP Family Member Prefix

FNA Fine Needle Aspiration

FTA Fluorescent Treponemal Antibody

GGT Gamma Glutamyltransferasegm Gram

GYN Gynecological

HC2 HPV Hybrid Capture 2 Human Papillomavirus

HCG Human Chorionic Gonadotropin

HCP Healthcare Providers

HCT Hematocrit

HDL High Density Lipoprotein

Hem/Onc Hematology/Oncology Service

HGB Hemoglobin

HIAA Hydroxyindoleacetic Acid

HIV Human Immunodeficiency Virus

HLA Human Leukocyte Antigen

HR Hour

HSC Health Services Command

IAW In Accordance With

ICU Intensive Care Unit

IFA Immunofluorescent Antibody

IFM Immunofluorescence Microscopy

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IgA Immunoglobulin A

IgG Immunoglobulin G

IgM Immunoglobulin

INR International Normalized RatioIRR Immediate Result Reporting

IV Intravenous

JCAHO Joint Commission on Accreditation of Healthcare Organizations

LCX Ligase Chain Reaction

LD Lactate Dehydrogenase

MCH Mean Corpuscular Hemoglobin

MCHC Mean Corpuscular Hemoglobin Concentration

MCV Mean Corpuscular Value

MEPR Medical Expense and Performance Reporting

mg Milligrams

MI Middle Initial

mL Milliliter

MLT Medical Laboratory Technician

mm Millimeter

MOD Medical Officer of the Day

MONO Monocyte

MPV Mean Platelet Volume

MRSA Methicillin Resistant Staphylococcus Aureus

MSBOS Maximum Surgical Blood Ordering Schedule

MTF Medical Treatment Facility

NCOIC Non Commissioned Officer in ChargeNCR Nuclear Regulatory Commission

NLT Not Later Than

NRC Nuclear Regulatory Commission

O&P Ova and Parasite

OIC Officer in Charge

OSHA Occupational, Safety, and Health Administration

PAN Panel

Ped Pediatric

PERI Peripheral

PLT Platelet

POC Pathologist On Call

POD Pediatrician of the Day

PREOP Preoperative

PT Prothrombin Time

PTT Partial Thrombin Time

PVA Polyvinylalcohol

QUAL Qualitative

QUANT Quantitative

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R/O Rule Out

RBC Red Blood Cells

RDW Red Cell Distribution Width

RIA RadioimmunoassayRIBA Recombinant Immunoblot Assay

RNP Ribonucleoprotein

RPMI Roswell Park Medical Institute

RPR Rapid Plasma Reagin

RSV Respiratory Syncytial Virus

SCR Screen

SI Seriously Ill

SPEP Serum Protein Electrophoresis

SSA Sjögrens Syndrome, A Marker

SSB Sjögrens Syndrome, B Marker

SSN Social Security Number

SST Silicone (Serum) Separator Tube

STAT Emergency, Request Priority

SUM Summation

T&C Type and Crossmatch

T&S Type and Screen

TAT Turn Around Times

TB Tuberculosis

TdT Terminal Deoxyribonucleic Transferase

TM Transfusion Medicine

TOT TotalTSH Thyroid Stimulating Hormone

UA Urinalysis

UCA Uniform Charge Account

URN Urine

UUN Urine Urea Nitrogen

vCJD variant Creutzfeldt-Jakob Disease

VDRL Venereal Disease Research Laboratory

VRE Vancomycin Resistant Enterococcus

VSI Very Seriously Ill

WBC White Blood Count

WHMC Wilford Hall Medical Center

β-HCG Beta Human Chorionic Gonadotropin

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APPENDIX B

DPALS Telephone Numbers

Commercial (915) 569-xxxx, DSN is 979-xxxx.

Chief, DPALS 569-1455Secretary 569-1427NCOIC 569-1426Laboratory Manager 569-1112

DPALS LIS Manager/QI Coordinator 569-1436Co-Path Manager 569-1436 Point-of-Care Testing Coordinator 569-3347

Chief, Anatomic Pathology Service 569-3724

Secretary 569-1427NCOIC 569-1440 Cytology Processing 569-1486Cytology Screening 569-3769Histology 569-2551/1493Gross Room 569-2310Morgue 569-2230Surgical Reports 569-1435/1434

Chief, Clinical Pathology Service 569-1419Secretary 569-1427NCOIC 569-1460

OIC, Blood Bank 569-1504Blood Bank Medical Director 569-1453Blood Bank Supervisor 569-1441Blood Bank 569-2388/2219Blood Donor Center 568-3366/3365

OIC, Core Laboratory Services 569-1551 Chemistry Supervisor 569-3511Chemistry 569-2533/1465Urinalysis 569-1511Hematology Supervisor 569-1422Hematology 569-1511

OIC, Microbiology Section 569-1475Microbiology Supervisor 569-2500Immunology Supervisor 569-1471Microbiology Section 569-2210/1476Immunology 569-2351/4431

OIC, Pathology Support Service 569-144291K (MLT) Phase II Coordinator 569-3008Accounting and Supply Section 569-1491Specimen Processing NCOIC 569-1492

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Specimen Processing Supervisor 569-1423Commercial Laboratory Representative 569-1461 Receptionist (third floor processing) 569-2231/2505

Receptionist (third floor processing) 569-2105/2187Shipping/Receiving 569-1461/1463

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APPENDIX C

Emergency (STAT) Test Menu

Procedures authorized to be ordered and performed as Emergency (STAT)

The tests listed in this appendix may be ordered STAT, individually. If other tests areordered on the same laboratory specimen, the request will automatically be reprioritizedto an ASAP request. ASAP turnaround time is within 4 hours.

BLOOD BANK(see WBAMC Reg 40-5-7 for specific policies)

Crossmatch and emergency release of components

Transfusion reaction evaluation

CHEMISTRY SECTION, CORE LABORATORYRenal Panel: BUN, Chloride, CO2, Creatinine, Glucose, Potassium, Sodium

Acetaminophen Lactate

Albumin Magnesium

Alcohol Myoglobin

Ammonia Phenobarbital

Amylase Phosphorus

β-HCG, quantitative Phenobarbital

B-Type Natriuretic Peptide (BNP) Salicylate

Calcium BHCG

CK Theophylline

CK-MB Troponin IDigoxin Urinalysis, macroscopic

HEMATOLOGY SECTION, CORE LABORATORYBody fluid cell count CBC with automated differential D-Dimer

Monospot PT/PTT/FIB/Thrombin Time

MICROBIOLOGYFLU A/B Antigen RSV Antigen

Gram Stain on sterile body site (CSF, etc) Rapid Strep Antigen

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APPENDIX D

Tube Requirements for Laboratory Specimen Submission

The following table lists the collection tubes that should be used when drawing and/or submitting specimens. Point of contact for questions or additional guidance is Ms.Cecilia Mendez at (915) 569-1423.

Test Tube(s) Other Instructions

Coagulation Na Cit BD Blue, 1.8 mL or 2.7 mLFill to middle of blue area

Hematology CBCHemoglobinElectrophoresis

Hgb A1C

EDTA BD Lavender, 4 mL

ChemistryPST BD Mint Green, SST BD withgel, or BD Plain Red without gel

Lipid ProfilesPST BD Mint Green or SST BD with

gel Hormone and Cancer Markers

BD Plain Red without gel

Blood Bank BD Pink 6 mL

Cardiac ProfilesPST BD Mint Green or SST BD

with gel

Immunology/SerologySST/Red BD with or without gel/BD

Lavender 4 mLThyroid Panel

PST BD Mint Green or SST BDwith gel

Renin Lavender BD Vacutainer

Sed Rates 4 mL BD Lavender top

Urine Cultures Sterile Cup

UrinalysisUrine Cup

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APPENDIX E

Clinical Pathology Service Test Manual

TEST NAME SUBMITTING REQUIREMENTS

1:1 COAG MIX STUDY 1. Patient Preparation: None.2. Collection Container: Two 1.8 mL or one 2.7 mL blue top

tubes (sodium citrate).3. Specimen and Volume Required: Fill to line on tube that

indicates "sodium citrate".4. Specimen Processing Instructions: Gently mix.

Performed only on patients not on Comedian or Heparinwith abnormal PT and/or APTT.

5. Cause for Rejection: Clotted, hemolysis, or quantity notsufficient.6. Expected TAT: 4 hours.7. Test Performed in Core Laboratory Section.

17-ALPHAHYDROXYPROGES-TERONE (17-OHP)

1. Patient Preparation: Early morning specimen preferred2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: Freeze serum.

Record patient age and collect time on request form.Ship on dry ice.

5. Cause for Rejection: Hemolyzed sample. Non-frozenspecimen from outside source.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

17-HYDROXYCORTICOSTEROID PANEL

1. Patient Preparation: Instruct patient to keep 24-hour urine collection refrigerated during collection period.

2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 25 mL of 24-hour urine

collection.4. Specimen Processing Instructions: Laboratory will add

1-2 gm of Boric Acid to the 24-hour urine collection. After

mixing well, aliquot 25 mL of the 24-hour urine collectedinto a labeled separate container. Record 24-hour collection total volume and date and time of collection onrequest. Ship on dry ice.

5. Cause for Rejection: pH of urine must be between 4-7.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.8. Tests in Panel:

17-HYDROXYCORTICOSTEROIDS;URINE TOTAL

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TEST NAME SUBMITTING REQUIREMENTSVOLUME;17-HYDROXYCORTICOSTEROIDS 24-HR

1HR GLUCOSE

CHALLENGE,PREGNANT

1. Patient Preparation: None.

2. Collection Container: Sodium Fluoride tube (gray top).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Give patient 50

grams Glucola. Draw 1 hour after ingestion. If utilizingany tube other than a gray top, centrifuge and removefrom clot within 30 minutes of collection.

5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

24 HR URINECALCIUM (PANEL)


2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 10 mL aliquot of

random or 24-hour urine collection.4. Specimen Processing Instructions: No preservative

required. Mix well before pouring off aliquot. Record 24-hour collection total volume and date and time of collection on request. Ship on dry ice.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: URINE TOTAL VOLUME; CALCIUM,

URINE (24HR); URN CALCIUM CONCENTRATION24 HR URINECATECHOLAMINES


2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 50 mL aliquot of 24-

hour urine collection.4. Specimen Processing Instructions: Record 24-hour

collection total volume and date and time of collection onrequest. Ship on dry ice.

5. Cause for Rejection: Must be frozen. Do not addpreservative.

6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.8. Tests in Panel: URINE TOTAL VOLUME; DOPAMINE,

URINE; DOPAMINE, URINE (24HR); EPINEPHRINE,URINE (24HR); EPINEPHRINE, URINE (24HR);NOREPINEPHRINE, URINE; NOREPINEPHRINE,URINE (24HR)

24 HR URINECHLORIDE (PANEL)

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. All future urine voids should be

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TEST NAME SUBMITTING REQUIREMENTScollected in a clean 24-hour urine collection container.Final collection is made when patient empties their

bladder the next morning at the same time. Keep 24-hour urine collection refrigerated during collection period.2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 10 mL aliquot of 24-

hour urine collection.4. Specimen Processing Instructions: No preservative

required. Laboratory staff will mix the 24-hour urine wellbefore pouring off a 10 mL aliquot. Record total volumeof 24-hour urine on accession labels. Store refrigerated.Ship on wet ice.

5. Cause for Rejection: None.

6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: CHLORIDE, URINE (24HR); URINE

TOTAL VOLUME; URN CHLORIDE CONCENTRATION

24 HR URINE CITRATE(PANEL)




collection total volume and date and time of collection on

request. Ship on dry ice.5. Cause for Rejection: Must be frozen. Do not addpreservative.

6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.8. Tests in Panel: CITRATE, URINE; URN CITRATE

CONCENTRATION; URINE TOTAL VOLUME

24 HR URINE COPPER(PANEL)


2. Collection Container: Acid-washed 24-hour urinecontainer.

3. Specimen and Volume Required: 25 mL aliquot of 24-hour urine collection.4. Specimen Processing Instructions: No preservative

required. Mix urine in 24-hour urine container well.Aliquot 25 mL of 24-hour collection into a separatelabeled container. Record 24-hour collection totalvolume and date and time of collection on request. Shipon dry ice.

5. Cause for Rejection: Must be collected in acid-washed

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TEST NAME SUBMITTING REQUIREMENTScontainer.

6. Expected TAT: 7 days.

7. Test performed by Reference Laboratory.8. Tests in Panel: COPPER, URINE (24HR); URN

COPPER CONCENTRATION; URINE TOTAL VOLUME

24 HR URINECREATININE (PANEL)




required. Mix well before pouring off aliquot. Record 24-hour collection total volume and date and time of

collection on request. Ship on dry ice.5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: CREATININE,URINE (24HR); URINE

TOTAL VOLUME; URN CREATININECONCENTRATION

24 HR URINEMAGNESIUM (PANEL)



hour urine collection.4. Specimen Processing Instructions: No preservativerequired. Mix well before pouring off aliquot. Record 24-hour collection total volume and date and time of collection on request. Ship on dry ice.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: MAGNESIUM, URINE (24HR); URINE

TOTAL VOLUME; URN MAGNESIUMCONCENTRATION

24 HR URINEMETANEPHRINEPANEL

1. Patient Preparation: Instruct patient to keep 24-hour urine collection refrigerated during collection period.2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 50 mL aliquot of 24-

hour urine collection.4. Specimen Processing Instructions: Record 24-hour collection total volume and date and time of collection onrequest. Ship on dry ice.

5. Cause for Rejection: Must be frozen. Do not add

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TEST NAME SUBMITTING REQUIREMENTSpreservative.


7. Test performed by Reference Laboratory.8. Tests in Panel: URINE TOTAL VOLUME;METANEPHRINE,URINE (24HR); URNMETANEPHRINE CONCENTRATION;NORMETANEPHRINE,URINE (24HR); URNNORMETANEPHRINE CONC; URN 3-METHOXYTYRAMNE CONC; 3-METHOXYTYRAMNE,URINE (24HR); TOTAL METANEPHRINE,URINE(24HR)

24 HR URINEOXALATE PANEL


2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 20 mL aliquot of 24-hour urine collection.

4. Specimen Processing Instructions: Record 24-hour collection total volume and date and time of collection onrequest. Ship on dry ice.


6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.8. Tests in Panel: URN OXALATE CONCENTRATION;

OXALATE,URINE (24HR); URINE TOTAL VOLUME24 HR URINEPHOSPHORUS(PANEL)





5. Cause for Rejection: None.

6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: PHOSPHORUS, URINE (24HR); URINE

TOTAL VOLUME; URN PO4 CONCENTRATION

24 HR URINEPOTASSIUM (PANEL)

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. All future urine voids should becollected in a clean 24-hour urine collection container.Final collection is made when patient empties their bladder the next morning at the same time. Keep 24-

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TEST NAME SUBMITTING REQUIREMENTShour urine collection refrigerated during collection period.

2. Collection Container: 24-hour urine container.

3. Specimen and Volume Required: 10 mL aliquot of 24-hour urine collection.

4. Specimen Processing Instructions: No preservativerequired. Mix the 24-hour urine collection well beforepouring off a 10 mL aliquot. Record total volume onaccession labels.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: POTASSIUM, URINE (24HR); URINE

TOTAL VOLUME; URN POTASSIUM

CONCENTRATION24 HR URINEPROTEIN (PANEL)





5. Cause for Rejection: Do NOT add acid. Acidified

specimen cannot be run.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: PROTEIN,URINE (24HR); URINE

TOTAL VOLUME; PROTEIN, URINE

24 HR URINE SODIUM(PANEL)

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. All future urine voids should becollected in a clean 24-hour urine collection container.Final collection is made when patient empties their bladder the next morning at the same time. Keep 24-hour urine collection refrigerated during collection period.

2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 10 mL aliquot of 24-hour urine collection.

4. Specimen Processing Instructions: No preservativerequired. Mix the 24-hour urine well before pouring off a10 mL aliquot. Record total volume on accession labels.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.

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TEST NAME SUBMITTING REQUIREMENTS8. Tests in Panel: URINE TOTAL VOLUME; SODIUM,

URINE (24HR); URN SODIUM CONCENTRATION

24 HR URINE URICACID (PANEL)




required, mix urine in 24-hour urine container well beforepouring off aliquot. Note date, time of collection and totalvolume on request slip.

5. Cause for Rejection: Do NOT add acid. Acidifiedspecimen cannot be run.

6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory, 569-2533.8. Tests in Panel: URIC ACID,URINE (24HR); URINE

TOTAL VOLUME; URN URIC ACID CONCENTRATION

24 HR URINE UREANITROGEN (PANEL)

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. From then on collect in a cleanbottle all urine during the day and night. Final collectionis made when patient empties their bladder the nextmorning at the same time. Keep 24-hour urine collectionrefrigerated during collection period.


3. Specimen and Volume Required: 10 mL aliquot of 24-hour urine collection.4. Specimen Processing Instructions: No preservative

required. Mix the 24-hour urine well before pouring off a10 mL aliquot. Record total volume on accession labels.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: UUN, URINE (24HR); URINE TOTAL

VOLUME; URN UUN CONCENTRATION

2HR POSTPRANDIAL

GLUCOSE

1. Patient Preparation: Patient is to eat 2 hours prior to

having their blood drawn.2. Collection Container: Sodium Fluoride tube (gray top).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Draw 2 hours after

meal. If utilizing any tube other than a gray top,centrifuge and remove from clot within 30 minutes of collection.

5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

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TEST NAME SUBMITTING REQUIREMENTS7. Test Performed in Core Laboratory.

2HR URINE AMYLASE

(PANEL)

1. Patient Preparation: Instruct patient to empty bladder

first thing in the morning. From then on collect in a cleanbottle all urine during the 2-hour time period. Keep 2-hour urine collection refrigerated during collection period.



required. Mix the 2-hour urine well before pouring off a10 mL aliquot. Record total volume on accession labels.

5. Cause for Rejection: None.6. Expected TAT: 24 hours.

7. Test Performed in Core Laboratory.8. Tests in Panel: URINE TOTAL VOLUME; AMYLASE,URINE (TIMED)

5 HIAA URINE PANEL(PANEL)





5. Cause for Rejection: Must be frozen. Do not addpreservative.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.8. Tests in Panel: URINE TOTAL VOLUME; 5 HIAA; 5

HIAA (24 HR)

ABO GROUP & RHTYPE

1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 mL Pink Top3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled;

hemolysis.6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

ACETAMINOPHEN 1. Patient Preparation: Serum levels most accuratelypredict toxicity when samples are drawn between four and 12 hours after ingestion.

2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).

3. Specimen and Volume Required: 1 mL Serum or

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TEST NAME SUBMITTING REQUIREMENTSPlasma.

4. Specimen Processing Instructions: None.

5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ACETEST (URINE) 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ACETONE (SERUM) 1. Patient Preparation: None.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ACETYLCHOLINERECEPTORANTIBODY

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze within 1 hour.

Ship on dry ice.5. Cause for Rejection: Hemolysis or lipemia.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ACID FAST CULTUREAND STAIN(MYCOBACTERIALCULTURE)

1. Patient Preparation: NA.2. Collection Container: See number 3 below.3. Specimen and Volume Required:

a. 3-10 mL body fluid, sterile tubeb. 1-3 mL CSF, sterile tubec. Greater than 1 gram feces, specimen cup. Clean,

dry, wax-free cup without preservatives.

d. Gastric fluid, representative portion, sterile cup.e. Pericardial, representative portion, sterile cup.f. 3-5 mL pleural fluid, sterile tube.g. Tissue/bone, sterile cup. Do not allow specimen to

dry out, small amount of saline may be added.h Bronchial wash, representative portion, sterile cup.i. 5-10 mL sputum, sterile cup.

j. Minimum 40 mL urine, sterile cup. Early morningCCMS, 3 consecutive days. Do not submit 24-hour

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TEST NAME SUBMITTING REQUIREMENTSurines.

4. Specimen Processing Instructions: If submitted from off-

post, ship on ice.5. Cause for Rejection: See Microbiology Section, general

rejection criteria. Transport delay more than 24 hours for local specimens, and more than 72 hours for off-postspecimens.

6. Expected TAT: 6 weeks (Acid-Fast Bacilli stain resultsare normally available within 24 hours).

7. Test performed by Reference Laboratory. ACID FAST STAINFORCRYPTOSPORIDIUM

(INCLUDED INROUTINE O&PREQUESTS)

1. Patient Preparation: Collect 1 stool each day for 3consecutive days. Select the bloody or slimy portion of sample for submission.

2. Collection Container: O&P Collection Kit.3. Specimen and Volume Required: Preserved or freshstool. Add stool to the sample vial until formalin liquidreaches the Clinical line on the bottle.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.

Specimens submitted in PVA. Specimen taken fromtoilet bowl or contaminated with urine or water.Specimen containing barium or bismuth compounds.

6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ACTH 1. Patient Preparation: None.2. Collection Container: Pre-chilled siliconized EDTA.3. Specimen and Volume Required: 2 mL plasma.4. Specimen Processing Instructions: Separate cells from

plasma and freeze plasma immediately. Ship on dry ice.5. Cause for Rejection: Hemolyzed sample. Non-frozen

specimen from outside source.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ALBUMIN 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ALDOLASE 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.

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TEST NAME SUBMITTING REQUIREMENTS4. Specimen Processing Instructions: Store frozen. Ship

on dry ice.

5. Cause for Rejection: Specimen must be frozen if notanalyzed within 24 hours.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ALDOSTERONE,SERUM

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship

on dry ice.5. Cause for Rejection: Gross hemolysis or lipemia. Non-

frozen specimen from outside source.

6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ALK PHOSPHATASE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ALKALINE

PHOSPHATASEISOENZYMES


2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 4 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

ALPHA-1ANTITRYPSIN

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Store frozen.5. Cause for Rejection: Gross hemolysis

6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory. ALT 1. Patient Preparation: None.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

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AMIKACIN PEAK 1. Patient Preparation: For intravenous therapy, peak

concentrations occur 15 to 30 minutes followingcompletion of infusion. For intramuscular therapy, peakconcentration occurs 45 to 75 minutes followingadministration.

2. Collection Container: Red top.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

AMIKACIN RANDOM 1. Patient Preparation: None.

2. Collection Container: Red top.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

AMIKACIN TROUGH 1. Patient Preparation: For intravenous therapy andintramuscular therapy, trough concentration occurs notmore than 30 minutes before next dose.

2. Collection Container: Red top.3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

AMMONIA 1. Patient Preparation: None.2. Collection Container: Lithium Heparin tube NO GEL

(Dark green top).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Submit on ice.

Centrifuge and separate within 15 minutes from cells.5. Cause for Rejection: Submitted at room temperature.

6. Expected TAT: 1 hour.7. Test Performed in Core Laboratory.

AMYLASE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

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AMYLASE, URINE

(RANDOM)


2. Collection Container: Urine collection container.3. Specimen and Volume Required: 1 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

AMYLASE, URINE(TIMED)

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. All future urine voids should becollected in a clear 24-hour urine collection container.Final collection is made when patient empties their bladder the next morning at the same time. Keep 24-

hour urine collection refrigerated during collection period.2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 10 mL aliquot of 24-


required. Mix this 24-hour urine well before pouring off a10 mL aliquot. Record time and total volume onaccession labels.


ANCA (NEUTROPHILCYTOPLASMICANTIBODY)C-ANCA – PR3 andP-ANCA - MPO

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Refrigerate.5. Cause for Rejection: Hemolysis, icteric, lipemic6. Expected TAT: 4 days.7. Test performed in Immunology.

ANGIOTENSINCONVERTINGENZYME

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.

5. Cause for Rejection: Gross hemolysis.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

ANTI-DNASE B 1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Frozen.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.

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TEST NAME SUBMITTING REQUIREMENTS7. Test performed by Reference Laboratory.

ANTI NUCLEAR

ANTIBODIES (ANA)PANEL

1. Patient Preparation: Aseptic technique.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Refrigerate5. Cause for Rejection: Hemolysis, icteric, lipemic.6. Expected TAT: 4 days.7. Test Performed in Immunology.8. Tests in panel: ANA, SSA, SSB, Sm, RNP, Scl 70, Jo-1,

DS DNA, Centormere B, and Histone

ANTIBODY SCREEN/IDENTIFICATION

1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 mL Pink Top3. Specimen and Volume Required: 6 mL whole blood.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled;

hemolysis.6. Expected TAT: 4-24 hours.7. Test Performed in Blood Bank.

ANTIBODY TITER 1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 mL Pink Top3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.

Hemolysis.

6. Expected TAT: 4-24 hours.7. Test Performed in Blood Bank.

ANTI-CARDIOLIPINPANEL

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and

improperly labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

ANTIGLOBULIN TEST,

DIRECT (DAT)


2. Collection Container: EDTA 6 ml Pink Top.3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

ANTIGLOBULIN TEST,INDIRECT

1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 ml Pink Top.3. Specimen and Volume Required: 6 mL whole blood.

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TEST NAME SUBMITTING REQUIREMENTS4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.

Hemolysis.6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

ASO 1. Patient Preparation: Aseptic technique.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Refrigerate5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

AST 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

TRANSFUSION,PREOPERATIVEDEPOSIT

(AUTOLOGOUS)

1. Patient Preparation: The request for autologousdonation is made using WBAMC Form 1122,Authorization for Autologous Transfusion. After

completion of the authorization form, the patient'sphysician must refer the patient to the Blood BankMedical Director 569-1453

2. Collection Container: NA.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: NA.6. Expected TAT: NA.7. Request processed at the WBAMC Blood Donor Center,

Lazear St & Fred Wilson Gate 568-3365.

BETA 2

MICROGLOBULIN


2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Store frozen. Ship

on dry ice.5. Cause for Rejection: Specimen must be frozen if not

analyzed within 24 hours.6. Expected TAT: 7days.7. Test Performed by Reference Laboratory.

BILIRUBIN, DIRECT 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTS2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Protect from light.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

BILIRUBIN, INDIRECT 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Protect from light.5. Cause for Rejection: None.

6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

BILIRUBIN, TOTAL 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Protect from light.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

BLEEDING TIME 1. Patient Preparation: Patient will be subjected to a small

cut on the surface of the skin (usually on the inside of theforearm). The time it takes for a clot to form andbleeding to stop will be monitored. Patient must remainin the collection room during the procedure. Procedurewill last approximately 15 minutes.

2. Collection Container: NA3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: NA.6. Expected TAT: Test performed 0700-0930 M-F. 1-4

hours.

7. Test Performed in Specimen Processing.BLOOD CULTURE 1. Patient Preparation:

a. Site preparation. Decontaminate venipuncture sitewith 1-step ChloraPrep. If kits are unavailable or patient is allergic to this type of preparation, use 70%isopropyl. Vigorously cleanse the site with 70%isopropyl or ethyl alcohol, repeat two times. Allow thesite to dry. Do not palpate vein.

b. Specimen collection. Disinfect top of bottle with 70%

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TEST NAME SUBMITTING REQUIREMENTSalcohol or iodine. Allow to sit on bottle tops for 1minute. Wipe off excess with sterile gauze. Collect

the blood aseptically. If vein is missed, redraw usinga new needle and syringe. For difficult to drawpatients, direct draw with a butterfly adapter can beperformed.

2. Collection Container:a. Adults: BacT Alert SA (aerobic)/BacT Alert SN

(anaerobic) set. (FA or FN for patients on antibiotics)b. Pediatric patients: Use pediatric bottle. (Note: can

also be used for adults with difficult access and lowvolume draws).

3. Specimen and Volume Required:

a. Adults: 5 to 10 mL blood/bottle. (Do not overfill)b. Pediatrics: up to 3 mL blood./bottle. (Do not overfill)4. Specimen Processing Instructions: Label bottle with

patient information. Do not cover bottle bar code. Do notcover bottle sensor on bottom. Submit to specimenprocessing immediately.

5. Cause for Rejection: Improperly collected or labeledblood cultures, and items listed under Microbiologygeneral rejection criteria. Transport delays more than 24hours. Bottles which have been refrigerated.

6. Expected TAT: 5-7 days. Positive blood culture bottles

are Gram stained and reported immediately after detection of growth.7. Test Performed in Microbiology Section.

BLOOD PARASITES(MALARIA SMEARS)

1. Patient Preparation: Aseptic technique.2. Collection Container: Aseptically obtain capillary blood

from finger sticks for slide preparation, 3 thick and 3 thinsmears. For thick smears, place 2 drops of blood on aslide and spread each drop out to the size of a dime. For thin smears, place a drop of blood on a slide and usinganother slide, streak out the blood as you would for adifferential slide. Allow both thick and thin smears to dry.

Whole blood may also be submitted in an EDTA lavender top tube.3. Specimen and Volume Required: Capillary blood or 4

mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly labeled or collected.6. Expected TAT: Preliminary report available within 48

hours during normal duty hours. Final report availablewithin 3 days.

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TEST NAME SUBMITTING REQUIREMENTS7. Test Performed in Core Laboratory Section.

BODY FLUID CELL

COUNT ANDDIFFERENTIAL(PLEURAL,PERICARDIAL,PERITONEAL,SYNOVIAL)


2. Collection Container: EDTA lavender top tube, gentlymix tube immediately after collection.

3. Specimen and Volume Required: ½ volume of tube.4. Specimen Processing Instructions: Gently mix tube

immediately to assure anti-coagulant is effective.5. Cause for Rejection: Clotted specimens.6. Expected TAT: 2 hours.7. Test Performed in Core Laboratory Section.

BODY FLUID CELLCOUNT ANDDIFFERENTIAL

(CEREBROSPINALFLUID, CSF)

1. Patient Preparation: None.2. Collection Container: Sterile screw capped (CSF) tubes.3. Specimen and Volume Required: 3-5 mL CSF.

4. Specimen Processing Instructions: All CSF's must becollected in a sterile screw capped tube, labeled #1, #2,#3, #4, in the order they are filled. Tube #1 is for Chemistry and Immunology testing. Do not perform acell count as this tube contains cells introduced by thespinal tap procedure. Tube #2 is for Microbiology (keepat room temperature). Tube #3 is for Hematology for acell count and differential. Tube #4 may be used for asecond cell count if requested and for Microbiology. If acell count and microbiology request is ordered on Tube#4, deliver to Hematology with Microbiology labels. The

Hematology technologist will pour off fluid for the cellcount to avoid contamination and deliver Tube #4 toMicrobiology with the correct labels. Chemistry andHematology tubes are to be refrigerated following test.

5. Cause for Rejection: Quantity not sufficient; clotted.6. Expected TAT: 2 hours.7. Test Performed in Core Laboratory Section.

BODY FLUIDCRYSTAL EXAM(SYNOVIAL FLUID)

1. Patient Preparation: None.2. Collection Container: Green top, Sodium Heparin, tube,

gently mix tube after collection to ensure anti-coagulantis effective.

3. Specimen and Volume Required: ½ volume of tube.4. Specimen Processing Instructions: None.5. Cause for Rejection: Quantity not sufficient.6. Expected TAT: 2 hours.7. Test Performed in Core Laboratory Section.

BODY FLUIDCULTURE

1. Patient Preparation: Disinfect overlying skin with iodine.Obtain specimen via percutaneous needle aspiration or surgery. Transport to the laboratory immediately.

2. Collection Container: Sterile Container.

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TEST NAME SUBMITTING REQUIREMENTS3. Specimen and Volume Required: Peritoneal, ascites,

dialysates, synovial, and pleural fluid. (5-10 mL). (For

other body fluids see Wound Culture, Deep).4. Specimen Processing Instructions: Transport tolaboratory immediately.

5. Cause for Rejection: Items listed under Microbiologygeneral rejection criteria.

6. Expected TAT: 5 days. Gram Stain: 1 hr.7. Test Performed in Microbiology Section.

B-TYPE NATRIURETICPEPTIDE (BNP)

1. Patient Preparation: None.2. Collection Container: EDTA lavender top.3. Specimen and Volume Required: 1 mL whole blood or

plasma.

4. Specimen Processing Instructions: If testing will not beperformed within 4 hours, centrifuge and freeze plasma.5. Cause for Rejection: Whole blood specimens older than

4 hours or samples received unfrozen from off-postfacilities.

6. Expected TAT: 1-4 hours.7. Test performed in Core Laboratory.

C DIFFICILE A/BTOXIN

1. Patient Preparation: NA.2. Collection Container: Sterile, leak-proof container.3. Specimen and Volume Required: 5 mL fresh stool.4. Specimen Processing Instructions: Deliver to laboratory

immediately. Specimens from off-post should be keptfrozen and shipped on ice.5. Cause for Rejection: Specimens submitted on swabs.

Preserved or formed stool specimens.6. Expected TAT: Test performed Monday and Thursday.

Results available within 24 hours of test date.7. Test Performed in Microbiology Section.

CARBOHYDRATEANTIGEN 15-3(CA 15-3)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.

5. Cause for Rejection: Hemolysis.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

CANCER ANTIGEN 27-29(CA 27-29)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis.6. Expected TAT: 7 days.

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TEST NAME SUBMITTING REQUIREMENTS7. Test Performed by Reference Laboratory.

CALCITONIN 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Hemolysis or lipemia.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

CALCIUM 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.


CANCER ANTIGEN125(CA 125)

1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship

on dry ice.5. Cause for Rejection: Non-frozen specimen from outside

source. Heterophilic antibodies in human serum can

react with the immunoglobulins included in the assaycomponents causing interference with in vitroimmunoassays. Patients receiving therapy with highbiotin doses (>5mg/day) no sample should be taken untilat least 8 hours after the last biotin administration.Samples taken from patients who have been treated withmonoclonal mouse antibodies or have received them for diagnostic purpose.

6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

CARBAMAZEPINE 1. Patient Preparation: For periodic testing and in

situations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

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TEST NAME SUBMITTING REQUIREMENTSCARBOHYDRATEANTIGEN 19-9

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

CARBON DIOXIDE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge within 4

hours of collection. Maintain integrity of sample by

keeping sample container closed until testing.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

CARCINOEMBRYONICANTIGEN (CEA)


Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: Turbid or lipemic serum.

Heterophilic antibodies in human serum can react with

the immunoglobulins included in the assay componentscausing interference with in vitro immunoassays.Patients receiving therapy with high biotin doses(>5mg/day) no sample should be taken until at least 8hours after the last biotin administration. Samples takenfrom patients who have been treated with monoclonalmouse antibodies or have received them for diagnosticpurpose.


CARDIAC PANEL (ER

ONLY)

1. Patient Preparation: Avoid exercise and/or intramuscular

injections prior to venipuncture.2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1 hour.7. Test Performed in Core Laboratory.8. Tests in Panel: CREATINE KINASE; CK-MB;

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TEST NAME SUBMITTING REQUIREMENTSTROPONIN I; MYOGLOBIN

CAROTENE 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Separate serum from

cells within 1 hour, place serum tube in light protectivebarrier (aluminum foil) to protect from light and freezeuntil analysis. Ship on dry ice.

5. Cause for Rejection: Hemolyzed specimens cannot beanalyzed, nor can specimens that are unfrozen or unprotected from light.


CBC ONLY 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube or

Pediatric bullet tube.3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Allow Vacutainer to

draw to the level of its vacuum, mix gently. Transportsample to the laboratory at room temperature. Must bereceived by the laboratory within 8 hours of collection.

5. Cause for Rejection: Hemolysis, clots, or quantity notsufficient.

6. Expected TAT: 1-4 hours.

7. Test Performed in Core Laboratory Section.8. Tests in Panel: HGB; HCT; WBC; RBC; MCV; MCH;MCHC; RDW; PLT; MPV

CBC/DIFF PROFILE 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube or



5. Cause for Rejection: Hemolysis, clots, or quantity notsufficient.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.8. Tests in Panel: HGB; HCT; WBC; RBC; MCV; MCH;

MCHC; RDW; PLT; MPV; %:NEUTRO; %:LYMPH;%:MONO; %:EOS; %:BASO; EOS; BASO; NEUTRO;LYMPH; MONO; RBC MORPH

CERULOPLASMIN 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTS2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Non-frozen specimen receivedfrom outside source.


CHLAMYDIATRACHOMATIS IgGANTIBODY

1. Patient Preparation: Aseptic technique. Collect acutesample upon onset of illness and convalescent sample 2-4 weeks from onset.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on wet ice.

5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

CHLAMYDIA/GONORRHEADNA SCREEN

1. Patient Preparation: Aseptic technique. Sample to becollected in clinic or ward. Female: Pink label swab. Usefirst swab to clean cervix, use second swab for samplecollection. Male: Blue label swab. Insert swab 2-3 cminto urethra and rotate.

2. Collection Container: PACE-2 Collection Kit.3. Specimen and Volume Required: Male urethra, female

endocervical canal using the Gen-Probe Pace specimen

collection kit.4. Specimen Processing Instructions: Transport ASAP atroom temperature.

5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 3 days.7. Test Performed in Immunology.

CHLORIDE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge within 4

hours of collection.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

CHLORIDE, URINE(RANDOM)

1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 1 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.

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TEST NAME SUBMITTING REQUIREMENTS6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

CHOLESTEROL 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone


CHOLINESTERASE,PLASMA

1. Patient Preparation: None.2. Collection Container: EDTA tube.3. Specimen and Volume Required: 2 mL EDTA plasma.

4. Specimen Processing Instructions: Freeze plasma if notanalyzed within 24 hours. Ship on dry ice.

5. Cause for Rejection: Hemolyzed specimens cannot beanalyzed. Non-frozen specimens from outside source.


CHROMOSOMEANALYSIS, BLOOD

1. Patient Preparation: Aseptic specimen2. Collection Container: Sodium Heparin tube (green top).3. Specimen and Volume Required: 3 mL whole blood.4. Specimen Processing Instructions: Ship at room

temperature.

5. Cause for Rejection: Hemolyzed specimen. Frozenspecimen.

6. Expected TAT: 3-4 weeks.7. Test Performed by Reference Laboratory.

CK 1. Patient Preparation: Avoid exercise and/or intramuscular injections prior to venipuncture.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.


CK-MB 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

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CLINITEST 1. Patient Preparation: None.

2. Collection Container: Urine collection container.3. Specimen and Volume Required: 2 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

COCCIDIOIDESANTIBODIES

1. Patient Preparation: Aseptic technique.2. Collection Container: Red top tube.3. Specimen and Volume Required: 2.5 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: Less than 2 mL, leaking

specimens, or specimens over 24 hours old.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.8. Tests in Panel: COCCIDIOIDES IMMITIS IGG,

COCCIDIOIDES IMMITIS IGM

COLD AGGLUTININS 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 4 mL serum.4. Specimen Processing Instructions: Blood must be

placed at 37◦ C for 30 minutes before centrifugation.Immediately separate serum from cells. If samples can

not be incubated immediately, leave at room temperatureuntil it can.

5. Cause for Rejection: Accurate testing CANNOT beperformed if blood is not incubated prior to centrifugation.

6. Expected TAT: 24 hours.7. Test Performed in Immunology.

COMPLEMENT C3 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.


COMPLEMENT C4 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.

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COPPER, SERUM 1. Patient Preparation: None.2. Collection Container: Royal blue acid-washed trace

metal Vacutainer (no preservative).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Laboratory should

draw royal blue acid-washed trace metal tube and allowto clot. Centrifuge and transfer serum into another royalblue acid-washed trace metal tube. Refrigerate. Ship onwet ice.

5. Cause for Rejection: Specimens not drawn in tracemetal royal blue tubes.


CORTISOL 1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Record time of day

specimen was collected on laboratory request.5. Cause for Rejection: Grossly hemolyzed specimens.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

CORTISOL UA PANEL 1. Patient Preparation: Patient must be given instructionsto keep urine collection refrigerated during the collectionperiod.



required. Mix well before pouring off 50 mL aliquot.Record 24-hour collection total volume and date and timeof collection on request. Ship on dry ice.

5. Cause for Rejection: Unfrozen specimens cannot be

analyzed.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory. 8. Tests in Panel: CORTISOL,FREE, (24HR URINE); URN

CORTISOL CONCENTRATION; URINE TOTALVOLUME

C-PEPTIDE 1. Patient Preparation: Fasting (12 hours).2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).

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TEST NAME SUBMITTING REQUIREMENTS3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship

on dry ice.5. Cause for Rejection: Hemolyzed sample. Non-frozenspecimen from outside source.


C-REACTIVEPROTEIN-HIGHSENSITIVITY (CRP-H)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Store frozen. Ship

on dry ice.5. Cause for Rejection: Specimen must be frozen if not

analyzed within 24 hours.6. Expected TAT: 48 hours.7. Test Performed in Soldier Family Medical Clinic

Laboratory.

CREATININE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge and

remove from clot within 4 hours of collection.5. Cause for Rejection: None.


CREATININECLEARANCE PANEL

1. Patient Preparation: Patient must be given instructionsto keep urine collection refrigerated during the collectionperiod.

2. Collection Container:a. Mint Green PST or Silicone Stopper Tube (SST) for

serum/plasma.b. 24-hour urine container.

3. Specimen and Volume Required:a. 1 mL serum/plasma.

b. 5 mL aliquot urine.4. Specimen Processing Instructions:a. Refrigerate serum/plasma. Ship on wet ice.b. No preservative required for urine collection. Mix well

before pouring off aliquot. Record 24-hour collectiontotal volume and date and time of collection onrequest. Urine is stored refrigerated. Ship on wet ice.

5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: Test CANNOT be performed on

lipemic specimens. Accurate testing CANNOT be

performed if blood is not maintained at 37o

C prior totesting.6. Expected TAT: The next duty day following a 48-hour

incubation. Test is performed 0730-1530, Monday-Friday.

7. Test Performed in, Immunology.

CRYOPRECIPITATE 1. Patient Preparation: Requests for Cryoprecipitate aremade using a completed SF 518 and CHCS order.Patient must have a current T&S. Patient must meetWBAMC Reg 40-5-7 criteria for blood usage. Otherwise,a Pathologist must be contacted by transfusing

physician. Current fibrinogen result (within past 8 hrs).2. Collection Container: NA.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: Incomplete requests (SF 518s).6. Expected TAT: 1 hour.7. Test Performed in. Blood Bank.

CRYPTOCOCCALANTIGEN

1. Patient Preparation: Aseptic technique.2. Collection Container: Red top tube or CSF container.3. Specimen and Volume Required: 2 mL serum or CSF.4. Specimen Processing Instructions: None.

5. Cause for Rejection: Less than 2 mL, leakingspecimens, or specimens over 24 hours old.6. Expected TAT: 3 days.7. Test Performed in Microbiology Section.

CRYPTOSPORIDIUMSTAIN (MODIFIEDAFB)

1. Patient Preparation: None.2. Collection Container: Sterile screw-top cup. May be

submitted in a formalin O&P collection.3. Specimen and Volume Required: Stool,

1 gm.4. Specimen Processing Instructions: Transport directly to

the laboratory. If delay is anticipated, submit in a

formalin O&P, SAF, or C&S collection kit.5. Cause for Rejection: Items listed under the Microbiologygeneral rejection criteria.

6. Expected TAT: 48 hours during Monday – Friday.Requests received on weekends and holidays will beperformed on the next working day.

7. Test Performed in Microbiology.

CSF CULTURE 1. Patient Preparation: Disinfect site with iodine. Useaseptic technique to aspirate spinal fluid. Submit

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TEST NAME SUBMITTING REQUIREMENTSsamples to the laboratory in labeled tubes as follows:

Tube 1 – Chemistry (Tube 1 can never be used for

culture).Tube 2 – Microbiology (Gram stain included inculture).Tube 3 – Hematology.Tube 4 – Additional requests.

2. Collection Container: Sterile leak-proof CSF collectionset.

3. Specimen and Volume Required: Approximately 5 mLinto Tube #2 for complete Microbiology work-up (1 mL for bacterial culture only). In traumatic taps, the CSF willoften clear as the later tubes are collected. Always use

the most turbid tube for Microbiology4. Specimen Processing Instructions: For volumes lessthan 3 mL, prioritize order of requests (bacterial, fungal,viral, etc.). Transport immediately to the laboratory. Donot refrigerate.

5. Cause for Rejection: Quantity not sufficient when smallvolumes are submitted.

6. Expected TAT: 72 hours for bacterial culture. 6 weeksfor AFB culture. Gram stains available within 1 hour.AFB smears available within 24 hours of receipt.

7. Test Performed in Microbiology Section.

CYCLOSPORINMONOCLONAL 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 2 mL plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Clotted.6. Expected TAT: 12 hours.7. Test Performed by Reference Laboratory.

CYSTINE URN QUAL 1. Patient Preparation: Patient must be given instructionsto keep urine collection refrigerated during the collectionperiod.


3. Specimen and Volume Required: 5 mL aliquot of 24-hour urine collection or random urine.4. Specimen Processing Instructions: No preservative

required. Mix well before pouring off 5 mL aliquot.Record 24-hour collection total volume and date and timeof collection on request. Ship on dry ice.

5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

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TEST NAME SUBMITTING REQUIREMENTSCYTOMEGALOVIRUSIgG/IgM

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hours.7. Test Performed in Immunology.

D-DIMER 1. Patient Preparation: None.2. Collection Container: Blue top tube (sodium citrate).3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fill

to line on tube that indicates "sodium citrate". CAUTION:A discard tube (without additives) must be used before acitrate tube is drawn with a winged blood collection set.

If blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.Do not force blood into tube.

4. Specimen Processing Instructions: Allow Vacutainer tube to draw to level of its vacuum. Gently mix tube after collection to ensure effectiveness of anti-coagulant.Transport to laboratory immediately.

5. Cause for Rejection: Clotted, hemolysis, or quantity notsufficient.


DEHYDROEPIANDRO-STERONE SULFATE(DHEA-S)

1. Patient Preparation: None.2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship

on dry ice.5. Cause for Rejection: Hemolyzed or lipemic sample.

Non-frozen sample from outside source. Patientsreceiving therapy with high biotin doses (>5mg/day) nosample should be taken until at least 8 hours after thelast biotin administration. Samples taken from patientswho have been treated with monoclonal mouse

antibodies or have received them for diagnostic purpose.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

DIALYSATE FLUID 1. Patient Preparation: None.2. Collection Container: Sterile container.3. Specimen and Volume Required: 1 mL dialysate fluid.4. Specimen Processing Instructions: Label with source

(port).5. Cause for Rejection: See Microbiology Section, general

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TEST NAME SUBMITTING REQUIREMENTSrejection criteria.

6. Expected TAT: 72 hours.

7. Test Performed in Microbiology Section.DIGOXIN LEVEL 1. Patient Preparation: Collect 8 to 12 hours after last oral

dose, 12 to 14 hours after last intramuscular dose, and 4to 6 hours after last intravenous dose.


DILANTIN LEVEL

(PHENYTOIN)

1. Patient Preparation: For periodic testing and in

situations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.


DISOPYRAMIDE 1. Patient Preparation: For periodic testing and insituations of suspected inadequate dosage, sampling

should be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: Collection in a SST tube.6. Expected TAT: 1-4 hours.7. Test Performed by Reference Laboratory.

DONATION, BLOOD 1. Patient Preparation: Donors should be at least 18 yearsof age. Donors of age 17 must have parental consent.Donor should weigh at least 110 pounds, be in generally

good health, and afebrile.2. Collection Container: NA.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: History of Clinical Chemistry,

intravenous drug addiction, high risk sexual behavior,coronary heart disease permanently disqualify potentialdonors. Temporary disqualifications includehypotension, hypertension, anemia, positive syphilis

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TEST NAME SUBMITTING REQUIREMENTSImmunology (STS), travel to malaria endemic areas,travel to UK or European countries with vCJD risk,

exposure to Clinical Chemistry, pregnancy, recentsurgery, transfusion/transplantation within 12 months,tattoo within 12 months, and certain other medicalconditions. Donors who have taken penicillin should beexcluded from donation for 7 days. Use of vitamins,thyroid preparations, or oral contraceptives does notdisqualify donors. 6. Expected Procedure Time: 1.5hours.

7. Appointments can be made at the WBAMC Blood Donor Center, Building Lazar St & Fred Wilson Gate 568-3365

DIPHTHERIA

ANTIOXOID(DIPHTHERIA)


2. Collection Container: Red top tube.3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: Specimen must be

refrigerated.5. Cause for Rejection: Room temperature specimen, SST

serum.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

ELECTROLYTESPANEL

1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: SODIUM; POTASSIUM; CHLORIDE;

CARBON DIOXIDE

ELECTROPHORESIS,SERUM PROTEIN(SPEP)Immunofixation

available if necessary.


Tube (SST).3. Specimen and Volume Required: 3 mL serum.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Gross hemolysis or lipemia.6. Expected TAT: 14 days (TAT may vary depending on

results obtained).7. Test Performed in Immunology.8. Tests in Panel: ALBUMIN FRACTION; ALPHA-1

FRACTION; ALPHA-2 FRACTION; BETA FRACTION;GAMMA FRACTION; ALBUMIN/GLOBULIN (SPEP);PROTEIN, (SPEP) (TOTAL); IG G (SPEP); IG A (SPEP);

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TEST NAME SUBMITTING REQUIREMENTSIG M (SPEP); PATH REVIEW ELECTROPHORESIS

EMERGENCY

RELEASE OF BLOOD/COMPONENTS

1. Patient Preparation: NA.

2. Collection Container: EDTA 6 mL Pink Top3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: Follow Emergency

Department Level 1 trauma protocol.a. Completed WBAMC SF 518 , WBAMC OP 02-040 and

WBAMC Form 14-45b. Collect one appropriately labeled EDTA 6 ml Pink Top.5. Cause for Rejection: No patient ID (as a minimum,

require name and unique number).6. Expected TAT: 5-10 minutes.7. Test Performed in Blood Bank.

ENDOMYSIALANTIBODY (IgA)



EPSTEIN BARR VIRAL(EBV) PANEL

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.

4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed at Reference Laboratory. 8. Tests in Panel: EBV NAg; EBV IgG; EBV IgM; EBV EAb

ERYTHROCYTESEDIMENTATIONRATE (ESR)

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 4 mL EDTA whole

blood.4. Specimen Processing Instructions: Gently mix tube after

collection to ensure anti-coagulant is effective.

5. Cause for Rejection: Gross hemolysis.6. Expected TAT: 4 hours.7. Test Performed in Core Laboratory Section.

ERYTHROPOIETIN 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis or lipemia.6. Expected TAT: 7 days.

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ESTRADIOL, SERUM

(E2)


2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship


frozen specimen from outside source. Patients receivingtherapy with high biotin doses (>5mg/day) no sampleshould be taken until at least 8 hours after the last biotinadministration. Samples taken from patients who havebeen treated with monoclonal mouse antibodies or havereceived them for diagnostic purpose.


ESTRIOL, TOTAL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Separate serum from

cells, transfer serum to another transport tube andfreeze. Ship on dry ice.

5. Cause for Rejection: Must be stored frozen untilanalysis.


7. Test Performed by Reference Laboratory. ETHANOL (MEDICAL) 1. Patient Preparation: Do not use alcohol wipe to clean

arm before drawing blood. Disinfect arm using Betadinewipe.

2. Collection Container: Gray top tube (sodium fluoride) or red top tube.

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

ETHOSUXIMIDE 1. Patient Preparation: For periodic testing and insituations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.

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ETHYLENE GLYCOL 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and


FACTOR V LEIDEN 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 3 mL whole blood.4. Specimen Processing Instructions: Ship on wet ice.

5. Cause for Rejection: Improperly collected andimproperly labeled.


FECAL FAT, SCREEN(QUALITATIVE)

1. Patient Preparation: None.2. Collection Container: Sterile container.3. Specimen and Volume Required: Fresh, unpreserved

stool. Do not submit 24, 48, or 72-hour samples.4. Specimen Processing Instructions: Do NOT preserve.

Refrigerate if transport is delayed. Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.

Presence of preservative.6. Expected TAT: 24 hrs.7. Test Performed in Microbiology Section.

FECAL LEUKOCYTE 1. Patient Preparation: None.2. Collection Container: Sterile jar-type container.3. Specimen and Volume Required: Fresh, unpreserved

stool.4. Specimen Processing Instructions: Do NOT preserve.


Presence of preservative. Contaminated with urine.

6. Expected TAT: 1-4 hours.7. Test performed in Core Laboratory Section.

FETOMATERNALHEMORRHAGE (FMH)

1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 ml Pink Top.3. Specimen and Volume Required: 6 mL whole blood4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 30 minutes.7. Test Performed in Blood Bank.

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TEST NAME SUBMITTING REQUIREMENTSFIBRINOGEN 1. Patient Preparation: None.

2. Collection Container: Blue top tube (sodium citrate).

3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fillto line on tube that indicates "sodium citrate". CAUTION:A discard tube (without additives) must be used before acitrate tube is drawn with a winged blood collection set.If blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.Do not force blood into tube.

4. Specimen Processing Instructions: Tube must be filledto the fill line. The tube(s) must be mixed gently after collection. Avoid specimen hemolysis and clotting.Transport to the laboratory at room temperature.

5. Cause for Rejection: Clotted, hemolysis, or quantity notsufficient.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.

FLOW CYTOMETRY-HIV

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube3. Specimen and Volume Required: 4 mL whole blood4. Specimen Processing Instructions: Room temperature.5. Cause for Rejection: Improperly collected, labeled, or

stored incorrectly. Specimens that are clotted or exposed to extreme temperature.

6. Expected TAT: 24 hrs.7. Test performed in Immunology.8. Tests in Panel:

CD3+, CD4a, CD8a, CD19a, CD56+

FLOW CYTOMETRY -LEUKEMIA

1. Patient Preparation: Medical Record Consultation (SF513) and Tissue Report Form (SF 515) are required.

2. Collection Container:a. 1 Yellow Top Tube (ACD) for Bone Marrow Aspirate.b. Sterile Container with (RPMI) 1640 Cellgro for Tissue

or Lymph Node. Add heparin 1000unis/mL to RPMI.3. Specimen and Volume Required:

a. 3 – 5 cc in ACD tube for Bone Marrow.b. 3 mm or larger Fragment of Tissue or Lymph Node.4. Specimen Processing Instructions: Specimen

submissions require prior coordination with Pathologistand Immunology staff. Specimens must be received bythe laboratory prior to 1300 hours. Keep specimens atroom temperature. A patient history using SF 515 isrequired.

5. Cause for Rejection: Improperly collected, labeled, or

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TEST NAME SUBMITTING REQUIREMENTSstored incorrectly. Specimens that are bacteriallycontaminated, hemolyzed, clotted, exposed to extreme

temperature, or specimens with low viability. Specimensreceived after 1500 hours.

6. Expected TAT: 3-5 days.7. Test Performed by Reference Laboratory.8. Tests in Panel:

CD2; CD4a; CD5; CD 7; CD8a; CD10; CD11c; CD13;CD14a; CD15; CD19a; CD20; CD22; CD23; CD25;CD33; CD 34; CD61; FLOW KAPPA; FLOW LAMBDA;I3; FLOW IGM; FLOW IGD; FLOW IGG

FLOW CYTOMETRY -LYMPHOMA

1. Patient Preparation: Medical Record Consultation (SF513) and Tissue Report Form (SF 515) are required.

2. Collection Container:a. 1 Yellow Top Tube (ACD) for Bone Marrow Aspirate.b. Sterile Container with (RPMI) 1640 Cellgro for Tissue

or Lymph Node.3. Specimen and Volume Required:

a. 2 – 5 cc in ACD tube for Bone Marrow.b. 3 mm or larger Fragment of Tissue or Lymph Node.

4. Specimen Processing Instructions: Specimensubmissions require prior coordination with MedicalDirector or Flow Cytometry Technician. Specimens mustbe received by the laboratory prior to 1300 hours. Keep

specimens at room temperature. A patient history usingSF 515 is required.5. Cause for Rejection: Improperly collected, labeled, or

stored incorrectly. Specimens that are bacteriallycontaminated, hemolyzed, clotted, exposed to extremetemperature, or specimens with low viability. Specimensreceived after 1500 hours.

6. Expected TAT: 3-5 days.7. Test Performed by Reference Laboratory.8. Tests in Panel:

CD2; CD4a; CD5; CD 7; CD8a; CD10; CD11c; CD13;

CD14a; CD15; CD19a; CD20; CD22; CD23; CD25;CD33; CD 34; CD61; FLOW KAPPA; FLOW LAMBDA;I3; FLOW IGM; FLOW IGD; FLOW IGG

FOLATE 1. Patient Preparation: Fasting (12 hours).2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Frozen within 8

hours, protect serum from light.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: Hemolysis sample. Non-frozenspecimen from outside source. No Folate determination

should be performed on patients receiving methotrexatedue to cross-reactivity. In patients receiving therapy withhigh biotin doses (>5mg/day) no sample should be takenuntil at least 8 hours after the last administration.Erroneous findings may be obtained from samples takenfrom patients who have been treated with monoclonalmouse antibodies or who have received them for diagnostic purpose.


FRAGILE X 1. Patient Preparation: None.

2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 3 mL whole blood.4. Specimen Processing Instructions: Ship at room

temperature.5. Cause for Rejection: Call (915) 569-1220.6. Expected TAT: 3-4 weeks.7. Test Performed by Reference Laboratory.

FSH 1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: Frozen. Ship on dryice.5. Cause for Rejection: Non-frozen specimens from

outside source. Patients receiving therapy with highbiotin doses (>5mg/day) no sample should be taken untilat least 8 hours after the last biotin administration.Samples taken from patients who have been treated withmonoclonal mouse antibodies or have received them for diagnostic purpose.


FTA ABS 1. Patient Preparation: Aseptic technique, not performedon CSF or body fluids only.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Refrigerate.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed in Immunology.

FUNGAL BLOOD 1. Patient Preparation: Aseptic technique.

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TEST NAME SUBMITTING REQUIREMENTS2. Collection Container: BacT Alert SA/SN bottle. See

Blood culture instructions.

3. Specimen and Volume Required: 5-10 mL blood.4. Specimen Processing Instructions: Consult Infectious

Disease Service.5. Cause for Rejection: Less than 2 mL, leaking

specimens, or specimens over 24 hours old.6. Expected TAT: 6 weeks.7. Test Performed in Microbiology Section.

FUNGAL CULTURE 1. Patient Preparation: Aseptic technique.2. Collection Container: See number 3 below.3. Specimen and Volume Required:

a. 3-10 mL abscess, sterile tube.

b. Swab from deep woundc. 5-10 mL CSF, sterile tube.d. Eye, corneal, scrapings, submitted on specialized

fungal plated media, submitted in sterile containers.e. 3-10 mL fluid, sterile cup.f. Hair, skin, and nails, representative portion,

specialized fungal plated media, or sterile container.g. Oral thrush, submit portion, sterile cup.h. Lesion, place in 1 mL saline, sterile cup.i. 5-10 mL sputum, sterile cup.

j. Tissue/bone, sterile cup. Do not allow specimen to

dry out, small amount of saline may be added.4. Specimen Processing Instructions: Ship sample ASAP.Refrigerate if transport is delayed. Ship on wet ice.

5. Cause for Rejection: Transport delay more than 24hours for local specimens, and shipped specimens mustbe received within 72 hours.

6. Expected TAT: 6 weeks.7. Test Performed in Microbiology Section.

FUNGAL ANTIBODYPANEL

1. Patient Preparation: Aseptic technique.2. Collection Container: Red top tube or CSF tube.3. Specimen and Volume Required: 2.5 mL serum or CSF.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Less than 2 mL, leakingspecimens, or specimens over 24 hours old.

6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.8. Tests in Panel: ASPERGILLUS SP AB;

BLASTOMYCES ID; COCCIDIOIDES IMMITIS AB; HCAPSULATUM AB.

G-6-PDH DEFICIENCY 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTSSCREEN 2. Collection Container: EDTA lavender top tube.

3. Specimen and Volume Required: 4 mL whole blood.

4. Specimen Processing Instructions: Submit whole blood,do NOT separate cells or freeze specimen. Refrigerate.Ship on wet ice.

5. Cause for Rejection: Specimen cannot be analyzed if over 7 days old, separated, or frozen.

6. Expected TAT: 48 hours.7. Test Performed by Reference Laboratory.

G-6-PDHQUANTITATIVE

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 5 mL whole blood.4. Specimen Processing Instructions: Submit whole blood,

do NOT separate cells or freeze specimen. Refrigerate.Ship on wet ice.5. Cause for Rejection: Specimen cannot be analyzed if

over 7 days old, separated, or frozen.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

GASTRIN 1. Patient Preparation: Fasting.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship

on dry ice.5. Cause for Rejection: Gross hemolysis or lipemia. Non-frozen specimen from outside source.


GENITAL CULTURE(INCLUDESN. GONORRHOEAE)

1. Patient Preparation: None.2. Collection Container: Selective media. Submit selective

media to the laboratory in closed CO2 pouch.3. Specimen and Volume Required: Genital exudate.4. Specimen Processing Instructions: Inoculate specimen

using Dacron or Rayon swab onto selective media by

streaking the media by the swab in a "Z" pattern. Placein CO2 pouch and transport to Specimen Processingimmediately. Indicate source.

5. Cause for Rejection: Plate not delivered immediately;plate received cold to touch (refrigerated). Out-datedmedia.

6. Expected TAT: 72 hours.7. Test Performed in Microbiology Section.8. NOTE: GC/Chlamydia DNA Probe also available

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TEST NAME SUBMITTING REQUIREMENTSGENTAMICIN PEAK 1. Patient Preparation: For intravenous therapy, peak

concentrations occur 15 to 30 minutes following

completion of infusion. For intramuscular therapy, peakconcentration occurs 45 to 75 minutes followingadministration.


GENTAMICINRANDOM

1. Patient Preparation: None.2. Collection Container: Red top tube.

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

GENTAMICINTROUGH

1. Patient Preparation: For intravenous/ intramuscular therapy, trough concentration occurs not more than 30minutes before next dose.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.


GGT 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

GIARDIA EIA 1. Patient Preparation: None.2. Collection Container: Sterile screw-top cup. May be

submitted in a formalin O&P collection.3. Specimen and Volume Required: Stool, 1 gm.4. Specimen Processing Instructions: Transport directly to

the laboratory. If delay is anticipated, submit in aformalin O&P, SAF, or C&S collection kit.

5. Cause for Rejection: Items listed under the Microbiologygeneral rejection criteria.

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TEST NAME SUBMITTING REQUIREMENTS6. Expected TAT: 1 week.7. Test Performed by Reference Laboratory.

GLIANDINANTIBODIES (IgG, IgA)



GLUCOSE 1. Patient Preparation: None.2. Collection Container: Sodium fluoride (gray top), Mint

Green PST or Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: If utilizing any tube

other than a gray top, centrifuge within 30 minutes of collection.


GLUCOSETOLERANCE TEST(GTT)

1. Patient Preparation: Procedure must be scheduled.Patient is to follow a 150 carbohydrate meal for threeconsecutive days prior to the procedure. Patient isrequired to fast 10 to 14 hours prior to the start of this

test. Alcohol should not be consumed seven days prior.Smoking and mild exercise should be avoided during thetest.

2. Collection Container: Sodium fluoride (gray top tube).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: If utilizing any tube

other than a gray top, centrifuge within 30 minutes of collection. Procedure is halted if FBS is greater than 127mg/dL. Once FBS result is obtained, give pregnantpatient 100 grams of Glucola and all others 75 grams of Glucola.

5. Cause for Rejection: Hemolysis.6. Expected TAT: 30 minutes.7. Test Performed in Core Laboratory.

GLUCOSE,2 HOURPOST PRANDIAL

1. Patient Preparation: Patient is to eat 2 hours prior tohaving their blood drawn.

2. Collection Container: Sodium fluoride (gray top tube).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Draw 2 hours after

meal ingestion.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

7. Test Performed in Core Laboratory.GLUCOSE,CSF 1. Patient Preparation: None.

2. Collection Container: Sterile CSF collection container.3. Specimen and Volume Required: 1 mL CSF.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1 hour.7. Test Performed in Core Laboratory.

GRAM STAIN 1. Patient Preparation: Gram stains are normallyperformed as routine on sputum cultures, woundcultures, sterile body fluids (except those submitted in

blood bottles) and tissues. For optimal gram stain resultsa second swab or specimen should be submitted. Gramstains are not normally performed on urine, vaginal,catheter tips, or stool samples.

2. Collection Container: Transport swab or secondspecimen.

3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: Items listed under Microbiology

general rejection criteria 6.6. Expected TAT: 2 hours, STAT within 1 hour.

7. Test Performed in Microbiology Section. Test performedin Core Laboratory Section, as STAT, only whenMicrobiology Section is not available.

HAPTOGLOBIN 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma or

plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

7. Test Performed in Core Laboratory.HDL 1. Patient Preparation: None.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Normally performed

as part of Lipid Profile. Ship on dry ice.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

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HEAVY METALS

SCREEN, URINE(PANEL)

1. Patient Preparation: Instruct patient to keep 24-hour

urine collection refrigerated during collection period.2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: 50 mL aliquot of 24-





8. Tests in Panel: URINE TOTAL VOLUME; LEADSCREEN; MERCURY; ARSENIC

HELICOBACTERPYLORI ANTIGEN

1. Patient Preparation: NA.2. Collection Container: Sterile, leak-proof container.3. Specimen and Volume Required: 5 mL fresh stool.4. Specimen Processing Instructions: Deliver to laboratory

immediately. Specimens from off-post should be keptfrozen and shipped on ice.

5. Cause for Rejection: Specimens submitted on swabs.Preserved or formed stool specimens.

6. Expected TAT: 7 days

7. Test Performed by Reference Laboratory.HELICOBACTERPYLORI IgG

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled,

hemolyzed specimen.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HELICOBACTERPYLORI IgM

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Improperly collected and

improperly labeled.6. Expected TAT: 3-4 days.7. Test Performed by Reference Laboratory.

HEMATOCRIT BODYFLUID (SPUN)

1. Patient Preparation: None.2. Collection Container: Lavender top tube (EDTA). Gently

mix tube immediately after collection.

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TEST NAME SUBMITTING REQUIREMENTS3. Specimen and Volume Required: Body fluid, ½ volume

of tube.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Clotted specimen.6. Expected TAT: 1 hour.7. Test Performed in Core Laboratory Section.

HEMOGLOBIN A1C 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Refrigerate. Ship on

wet ice.5. Cause for Rejection: More than 7 days old, gross

lipemia, clots.

6. Expected TAT: 48 hrs.7. Test Performed in Core Laboratory.

HEMOGLOBINELECTROPHORESISPANEL

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Refrigerate. Ship on

wet ice.5. Cause for Rejection: Gross lipemia, more than 7 daysold, clots.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

8. Tests in Panel: HEMOGLOBIN A; HEMOGLOBIN S;HEMOGLOBIN C; HEMOGLOBIN OTHER;HEMOGLOBIN A2; HEMOGLOBIN F; PATH REVIEWELECTROPHORESIS

HEMOSIDERIN(URINE)

1. Patient Preparation: Follow clean catch urineinstructions.

2. Collection Container: Sterile urine container.3. Specimen and Volume Required: Minimum 10 mL urine.4. Specimen Processing Instructions: NA.5. Cause for Rejection: Specimen more than 48 hours old.6. Expected TAT: 7 days.

7. Test Performed by Reference Laboratory.HEPATIC PANEL 1. Patient Preparation: None.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory, 569-2533 and Troop

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TEST NAME SUBMITTING REQUIREMENTSMedical Clinic, 569-3080.

8. Tests in Panel: ALBUMIN; BILIRUBIN, TOTAL; ALK

PHOSPHATASE; AST; ALT; BILIRUBIN, DIRECT; GGTHEPATITIS AANTIBODY, TOTAL

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1-2 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 4 days.7. Test Performed in Immunology.

HEPATITIS A VIRUSANTIBODY IGM


4. Specimen Processing Instructions: Frozen.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HEPATITIS B COREANTIBODY IGM

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hours.7. Test Performed in Soldier Family Medical Clinic

Laboratory.HEPATITIS BSURFACE ANTIBODY


Laboratory.

HEPATITIS BSURFACE ANTIGEN

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hours.7. Test Performed in Soldier Family Medical Clinic

Laboratory.

HEPATITIS BeANTIBODY


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TEST NAME SUBMITTING REQUIREMENTS4. Specimen Processing Instructions: Frozen.5. Cause for Rejection: Improperly collected or labeled.


HEPATITIS BeANTIGEN

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Frozen.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HEPATITIS C RNA(QUALITATIVE)

1. Patient Preparation: None; this test is performed toconfirm positive HCV Ab.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1-2 mL serum4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled. No

record of a positive HCV Ab test. 6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HEPATITIS C VIRUSANTIBODY

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Frozen.

5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HEPATITIS SURFACEANTIGEN,CONFIRMATION(HBSAGCONFIRMATION)


Laboratory.

HERPES 1 & 2 IgG 1. Patient Preparation: Aseptic technique. Collect acutesample upon onset of illness and convalescent sample 2-4 weeks from onset.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected, labeled, or

hemolyzed specimen.6. Expected TAT: 7 days.

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HERPES CULTURE 1. Patient Preparation: Aseptic technique. Collect

specimens 1 to 3 days after onset of symptoms.2. Collection Container: Virocult swab or sterile container.3. Specimen and Volume Required: Body fluid or tissue

(except serum or plasma).4. Specimen Processing Instructions: Transport delays

over 48 hours, the sample should be frozen. Ship on dryice.

5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed in Microbiology.

HETEROPHILE AB

(INFECTIOIUSMONONUCLEOSISTEST)


2. Collection Container: SST tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis or quantity not sufficient.6. Expected TAT: 48 hours.7. Test Performed in Immunology.

HISTOPLASMAANTIGEN

1. Patient Preparation: None.2. Collection Container: Plastic vial.3. Specimen and Volume Required: 10 mL

urine/serum/CSF.4. Specimen Processing Instructions: Ship on wet ice.

5. Cause for Rejection: Improperly collected andimproperly labeled.


HIV-1/2 ANTIBODYSCREEN

1. Patient Preparation: None.2. Collection Container: Grenier Red top tube.3. Specimen and Volume Required: 5 mL serum, minimum

volume 2 mL.4. Specimen Processing Instructions: Draw separate tube

for this test. Ship refrigerated.5. Cause for Rejection: Improperly collected or labeled.

6. Expected TAT: 3 days.7. Test Performed by Reference Laboratory. HLA B27 1. Patient Preparation: None.

2. Collection Container: 2 ACD yellow top tubes.3. Specimen and Volume Required: 20 mL whole blood.4. Specimen Processing Instructions: Ship at room

temperature.5. Cause for Rejection: More than 48 hours old specimen.6. Expected TAT: 7-10 days.

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HOMOCYSTEINE 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship frozen.5. Cause for Rejection: Improperly collected or labeled.

Gross hemolysis or lipemia.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HUMAN GROWTHHORMONE (HGH)

1. Patient Preparation: Fasting. Patient must avoid stressand be at rest at least 30 minutes prior to specimencollection.

2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum.

Record patient age on request. Ship on dry ice.5. Cause for Rejection: Gross hemolysis or lipemia. Non-

frozen specimen from outside source.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

HUMAN PARVOVIRUSB19 ANTIBODY (IgG)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis, lipemia, or icteric.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

ICTOTEST 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 2 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in: Core Laboratory.

IMMUNOGLOBULIN A 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone


remove from clot within 4 hours of collection.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

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TEST NAME SUBMITTING REQUIREMENTSIMMUNOGLOBULIN E 1. Patient Preparation: None.

2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Freeze

serum/plasma. Ship on dry ice.5. Cause for Rejection: Gross hemolysis or lipemia. Non-

frozen specimen from outside source.6. Expected TAT: 48 hours.7. Test Performed by Reference Laboratory.

IMMUNOGLOBULIN G 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection.


IMMUNOGLOBULIN M 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone



INFANT STUDY 1. Patient Preparation: Aseptic technique.2. Collection Container: EDTA 6 mL Pink Top.3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

INFLUENZA A/BANTIGEN 1. Patient Preparation: None.2. Collection Container: Sterile container for nasal wash, or two sterile swabs.

3. Specimen and Volume Required: 2-3 mL nasal wash,nasal aspirate, or two sterile swabs. Pharyngeal swabsare less optimal.

4. Specimen Processing Instructions: Transport tolaboratory immediately.

5. Cause for Rejection: Bloody specimens.

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TEST NAME SUBMITTING REQUIREMENTS6. Expected TAT: During influenza season (January

through April), influenza antigens will be run within 1 hour

of arrival in lab, from 0730-1630, Monday-Friday and0730-1530 on Saturday and Sunday. Specimenssubmitted at other times will be run at the beginning of the next duty day.

7. Test Performed in Microbiology Section.8. Back-up viral culture recommended.

INSULIN 1. Patient Preparation: Fasting.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Separate serum from

cells ASAP and freeze serum. Ship on dry ice.5. Cause for Rejection: Hemolysis. Non-frozen specimenfrom outside source. Circulating anti-insulin antibodiesare often found in-patients who have been treated withnonhuman forms of insulin. If present, these antibodiesmay interfere with the assay. Patients receiving therapywith high biotin doses (>5mg/day) no sample should betaken until at least 8 hours after the last biotinadministration. Samples taken from patients who havebeen treated with bovine, porcine, or human insulinsometimes contain anti-insulin antibodies, which can

affect the results. Erroneous findings may be obtainedfrom samples taken from patients who have been treatedwith monoclonal mouse antibodies or have receivedthem for diagnostic purpose.


INSULIN-LIKEGROWTH FACTOR I

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Hemolysis or lipemia.

6. Expected TAT: 3-4 days.7. Test Performed by Reference Laboratory. IRON 1. Patient Preparation: None.

2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST)

3. Specimen and Volume Required: 2 mL serum/plasma.4. Specimen Processing Instructions: Refrigerate

serum/plasma. Ship on wet ice.5. Cause for Rejection: None.

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IRON PANEL II 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Separate from cells,

transfer to transport tube, refrigerate. Ship on wet ice.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: IRON BINDING CAPACITY, UNSAT;

IRON BINDING CAPACITY, TOTAL; IRON; FERRITIN;

FE SAT%, TRANSFERRINIRRADIATED BLOODCOMPONENTS

1. Patient Preparation: Direct consultation with the MedicalDirector or Pathologist is required.

2. Collection Container: NA.3. Specimen and Volume Required: NA4. Specimen Processing Instructions: NA.5. Cause for Rejection: NA.6. Expected TAT: After component processing, irradiation

requires an additional 15-20 minutes.7. Test Performed in the Blood Bank.

LACTATE 1. Patient Preparation: Patient should avoid exercise of

arm prior and during collection.2. Collection Container: Sodium fluoride (gray top tube).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Submit on ice or

frozen. Centrifuge and separate cells from plasma within15 minutes of receipt.

5. Cause for Rejection: Submitted at room temperature or unfrozen.

6. Expected TAT: 1 hour.7. Test Performed in Core Laboratory.

LD 1. Patient Preparation: None.

2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge and

remove serum/plasma from clot within 1 hour of collection.


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TEST NAME SUBMITTING REQUIREMENTSaccompanying control smears. Sodium Heparin tubesubmitted more than 4 hours post collection. Frozen or

broken smears.6. Expected TAT: 7 days.7. Test performed by Reference Laboratory.

LH 1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Frozen. Ship on dry

ice.5. Cause for Rejection: Non-frozen specimens from

outside source. Patients receiving therapy with high

biotin doses (>5mg/day) no sample should be taken untilat least 8 hours after the last biotin administration.Samples taken from patients who have been treated withmonoclonal mouse antibodies or have received them for diagnostic purpose.


LIDOCAINE 1. Patient Preparation: Steady state is usually obtained 30to 90 minutes following the beginning of infusion if aloading dose is given and 5 to 10 hours without a loadingdose.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

LIPASE 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone


remove from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

LIPID 5 1. Patient Preparation: Patient should fast 12-14 hoursprior to collection.


3. Specimen and Volume Required: 1 mL serum/plasma.

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TEST NAME SUBMITTING REQUIREMENTS4. Specimen Processing Instructions: Refrigerate if

transport is delayed. Ship on wet ice.

5. Cause for Rejection: Patient must fast 12-14 hours.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: HDL/CHOL RATIO; CHOLESTEROL;

HDL; LOW DENSITY LIPOPROTEIN; TRIGLYCERIDE;CHOLESTEROL IN VLDL

LITHIUM 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Commonly drawn 12

hours after last dose. Centrifuge within 4 hours of

collection.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

LYME ANTIBODYPROFILE

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

8. Tests in Panel: LYME DISEASE AB SCREEN, TOTAL;B BURGDORFERI IGG BAND PAT (REFLEX); BBURGDORFERI IGM BAND PAT (REFLEX)

LYSOZYME 1. Patient Preparation: Avoid alcohol.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Hemolysis or lipemia.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

MAGNESIUM 1. Patient Preparation: None.



MALARIAIDENTIFICATION

1. Patient Preparation: Aseptic technique.2. Collection Container: Aseptically obtain capillary blood

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TEST NAME SUBMITTING REQUIREMENTS(SEE BLOODPARASITES)

from finger sticks for slide preparation, 3 thick and 3 thinsmears. For thick smears, place 2 drops of blood on a

slide and spread each drop out to the size of a dime. For thin smears, place a drop of blood on a slide and usinganother slide, streak out the blood as you would for adifferential slide. Allow both thick and thin smears to dry.Whole blood may also be submitted in an EDTA lavender top tube.

3. Specimen and Volume Required: Capillary blood or 3mL whole blood.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly labeled or collected.6. Expected TAT: 3 days.

7. Test Performed in Core Laboratory Section.MANUALDIFFERENTIAL

NOTE: Performedwhen indicated byautomated differentialflags or if authorized bysupervisor or medicaldirector of CoreLaboratory.

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Allow Vacutainer to

draw to the level of its vacuum, mix gently. Transport tolaboratory at room temperature. Must be received within8 hours.

5. Cause for Rejection: Clotted, hemolyzed, or quantity notsufficient, age of specimen more than 12 hours.


7. Test Performed in Core Laboratory Section.8. Tests in Panel: SEGS; BANDS; LYMPH; MONO; EOS;BASOPHIL; ATYPICAL LYMPHS; METAMYELOCYTES;PLATELET ESTIMATE; ANISOCYTOSIS;POIKILOCYTOSIS; MACROCYTES;POLYCHROMASIA; HYPOCHROMASIA;MICROCYTOSIS; RBC MORPH; NUCLEATED RBC/100WBC; BLASTS; PROMYELOCYTE; MYELO; OTHERWBC; BASO STI; TOXIC GRAN; CORRECTED WHITEBLOOD COUNT; ECHINOCYTES; DACROCYTES;ACANTHOCYTES; CODOCYTES; SCHISTOCYTES;

OVALOCYTES; STOMATOCYTES; SMUDGE CELLS;DOHLE BODIES; HOWELL JOLLY BODIES

METHOTREXATE 1. Patient Preparation: Collect 24, 48 or 72 hours after dose.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Protect from light.5. Cause for Rejection: None.6. Expected TAT: 7 days.

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METHYLMALONIC

ACID


2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Improperly collected and


MICROALBUMINPANEL(RANDOM OR TIMEDURINE)

1. Patient Preparation: None.2. Collection Container: Random or timed urine.3. Specimen and Volume Required: 10 mL urine, no

preservative.

4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: MICROALBUMIN, CREA FOR

MICROALBUMIN, MICROALBUMIN /CREA RATIO

MUMPS ANTIBODY 1. Patient Preparation: Aseptic technique. Collect acutesample upon onset and convalescent sample 2-4 weeksfrom onset.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

MYCOPLASMA IgGANTIBODY

1. Patient Preparation: Aseptic technique. Collect acutesample upon onset and convalescent sample 2-4 weeksfrom onset.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.


MYOGLOBIN 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Grossly Hemolyzed.6. Expected TAT: 1-4 hours.

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MYOGLOBIN, URINE 1. Patient Preparation: None.

2. Collection Container: Plastic vial.3. Specimen and Volume Required: 5 mL urine.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and


NASAL SMEAR 1. Patient Preparation: None.2. Collection Container: Nasal smear swab.3. Specimen and Volume Required: Nasal cellular material.4. Specimen Processing Instructions: Transport to

laboratory ASAP.5. Cause for Rejection: Dry swab.6. Expected TAT: 8 hours.7. Test Performed in Core Laboratory Section.

O&P (INTESTINALPARASITES)

1. Patient Preparation: One fresh stool each day for 3consecutive days.

2. Collection Container: PVA O&P Collection Kit.3. Specimen and Volume Required: Fresh stool in SAF

preservative.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.

Specimens from inpatients will not be accepted after thefourth hospital day without prior consultation.


OCCULT BLOOD 1. Patient Preparation: None.2. Collection Container: Hemocult card.3. Specimen and Volume Required: Fresh stool.4. Specimen Processing Instructions: Transfer fresh stool

from collection container to Hemocult card using a cleanwooden disposable applicator stick.

5. Cause for Rejection: Improperly collected or unlabeled.

6. Expected TAT: 1-4 hours.7. Test Performed in Microbiology Section.

OSMOLALITY 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST) or

urine collection container.3. Specimen and Volume Required: 2 mL serum or urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

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PARATHORMONE

PANEL (PTH)

1. Patient Preparation: Fasting.

2. Collection Container: Red top tube or Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Separate serum from

cells ASAP and freeze serum. Ship on dry ice.5. Cause for Rejection: Hemolyzed sample. Non-frozen

specimen from outside source. Patients receivingtherapy with high biotin doses (>5mg/day) no sampleshould be taken until at least 8 hours after the last biotinadministration. Samples taken from patients who havebeen treated with monoclonal mouse antibodies or have

received them for diagnostic purpose.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.8. Tests in Panel: PARATHYRIN INTACT; CALCIUM

PHENOBARBITAL 1. Patient Preparation: For periodic testing and insituations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.


PHLEBOTOMY,THERAPEUTIC

1. Patient Preparation: Specialized procedures that requirethe use, collection, or removal of blood and bloodproducts for therapeutic purposes require approval anddirect consultation with the Blood Bank Medical Director.A request for the therapeutic procedure must besubmitted by the requesting physician using the standardconsultation form SF 513, which summarizes all pertinentclinical information including diagnosis, type of procedure

requested, indications for therapy, suggested frequencyof the procedure, and anticipated benefits weighedagainst potential risks of the procedure.

2. Collection Container: NA.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: NA.6. Expected TAT: NA.7. Procedure Performed in the WBAMC Blood Donor

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TEST NAME SUBMITTING REQUIREMENTSCenter, Lazar St & Fred Wilson Gate 568-3365

PHOSPHORUS 1. Patient Preparation: None.


3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge and

remove plasma from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

PINWORMPREPARATION

1. Patient Preparation: Avoid fecal contamination.2. Collection Container: Pinworm paddle, clear Scotch tape

prep.

3. Specimen and Volume Required: Apply paddle toperianal area in the morning. Avoid fecal contamination.

4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 2 days.7. Test Performed in Microbiology Section.

PLASMA, FRESHFROZEN (FFP)

1. Patient Preparation: Completed SF 518. Patient mustmeet WBAMC Reg 40-5-7 criteria for blood usage.Otherwise, a Pathologist must be contacted bytransfusing physician. Current PT/PTT result (within past8 hrs). Current Type and Screen.

2. Collection Container: EDTA 6 ml Pink Top.3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: NA.5. Cause for Rejection: Incomplete SF 518.6. Expected TAT: 45-60 minutes.7. Test Performed in Blood Bank

PLATELETCONCENTRATE(Apheresis Platelet)

1. Patient Preparation: Patient must meet WBAMC Reg40-5-7 criteria for blood usage. Otherwise, a Pathologistmust be contacted by transfusing physician. Currentplatelet result (within past 8 hrs).

2. Collection Container: NA. Specimen not necessary if

Blood Bank has current history within past 30 days If not, EDTA 6 ml Pink Top with current Type & Screen.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: Incomplete requests (SF 518s).6. Expected TAT: 15 minutes.7. Test Performed in Blood Bank.

PLATELETS,APHERESIS,

1. Patient Preparation: Donors should be at least 18 yearsof age. Donors of age 17 must have parental consent.

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TEST NAME SUBMITTING REQUIREMENTSDONATION Donor should weigh at least 110 pounds, be in generally

good health, and afebrile. Donor must not have taken

aspirin or aspirin containing products within 72 hoursbefore donation.

2. Collection Container: NA.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: NA.5. Cause for Rejection: History of Clinical Chemistry,

intravenous drug use, high risk sexual behavior, andcoronary heart disease permanently disqualify potentialdonors. Temporary disqualifications includehypotension, hypertension, anemia, positive syphilisImmunology (STS), travel to malaria endemic areas,

travel to UK or European countries with vCJD risk,exposure to Clinical Chemistry, pregnancy, recentsurgery, transfusion/transplantation within 12 months,tattoo within 12 months, and certain other medicalconditions. Donors who have taken penicillin should beexcluded from donation for 7 days. Use of vitamins,thyroid preparations, or oral contraceptives does notdisqualify donors.See WBAMC Memo 40-38 for additional details.

6. Expected Procedure Time: 1.5 hours.7. Appointments can be made at the WBAMC Blood Donor

Center,.PORPHOBILINOGEN,URINE

1. Patient Preparation: None.2. Collection Container: Random urine container.3. Specimen and Volume Required: 25 mL random urine.4. Specimen Processing Instructions: Freeze immediately

and wrap in aluminum foil to protect from light. Ship ondry ice.

5. Cause for Rejection: Specimen received unfrozen or unprotected from light.


POTASSIUM 1. Patient Preparation: None.2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Centrifuge within 2

hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

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TEST NAME SUBMITTING REQUIREMENTSPOTASSIUM,URINE(RANDOM)

1. Patient Preparation: None.2. Collection Container: Urine collection container.

3. Specimen and Volume Required: 1 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

PREALBUMIN 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Grossly Hemolyzed.


PREGNANCY TEST(HCG), QUANT



PRENATAL SCREEN 1. Patient Preparation: Aseptic technique.

2. Collection Container: EDTA pink top tube.3. Specimen and Volume Required: EDTA 6 ml Pink Top4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled.

Hemolysis6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

PRIMIDONE 1. Patient Preparation: For periodic testing and insituations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.


PROGESTERONE 1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper

Tube (SST).

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TEST NAME SUBMITTING REQUIREMENTS3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Freeze serum. Ship


frozen specimen from outside source. Patients receivingphenylbutazone at therapeutic dosage levels showedinterference with the assay (below PGN levels). Inpatients receiving therapy with high biotin doses(>5mg/day) no sample should be taken until at least 8hours after the last administration. Erroneous findingsmay be obtained from samples taken from patients whohave been treated with monoclonal mouse antibodies or who have received them for diagnostic purpose.


PROLACTIN 1. Patient Preparation: None.2. Collection Container: Red top tube or Silicone Stopper


ice.5. Cause for Rejection: Non-frozen specimen from outside

source. Patients receiving therapy with high biotin doses(>5mg/day) no sample should be taken until at least 8

hours after the last biotin administration. Samples takenfrom patients who have been treated with monoclonalmouse antibodies or have received them for diagnosticpurpose.


PROSTATE SPECIFICANTIGEN (PSA)



ice.5. Cause for Rejection: Gross hemolysis. Non-frozenspecimen from outside source. Patients receivingtherapy with high biotin doses (>5mg/day) no sampleshould be taken until at least 8 hours after the last biotinadministration. Patients who have received preparationsof mouse monoclonal antibodies for diagnosis or therapymay contain human anti-mouse antibodies. Thesespecimens may show erroneous results in such assay.

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PSA (FREE ANDTOTAL) PANEL



ice.5. Cause for Rejection: Gross hemolysis. Non-frozen

specimen from outside source. Patients receivingtherapy with high biotin doses (>5mg/day) no sampleshould be taken until at least 8 hours after the last biotinadministration. Patients who have received preparations

of mouse monoclonal antibodies for diagnosis or therapymay contain human anti-mouse antibodies. Thesespecimens may show erroneous results in such assay.

6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.8. Tests in Panel: PSA, PSA FREE, % FREE

PROTEIN, TOTAL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Centrifuge within 4

hours of collection.


PROTEIN, URINE 1. Patient Preparation: Patient should be given instructionsto keep urine collection refrigerated during the collectionprocess.


hour urine collection.4. Specimen Processing Instructions: No preservative is

required. Mix 24-hour urine collection well. Aliquot 10

mL of the 24-hour urine collection into a separate labeledcontainer. Record 24-hour collection total volume anddate and time of collection on request. Refrigerate. Shipon wet ice.

5. Cause for Rejection: Acidified specimens cannot beanalyzed.


PROTEIN,CSF 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTS2. Collection Container: Sterile CSF collection container.3. Specimen and Volume Required: 1 mL CSF.

4. Specimen Processing Instructions: Transport to theLaboratory ASAP.


PT/INR 1. Patient Preparation: Coumadin patients only.2. Collection Container: Blue top tube (sodium citrate).3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fill


If blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.Do not force blood into tube.

4. Specimen Processing Instructions: Tube must be filledto fill line. The tube(s) must be mixed gently after collection. Avoid specimen hemolysis and clotting.Transport to the laboratory room temperature


6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.

PTT 1. Patient Preparation: None.2. Collection Container: Blue top tube (sodium citrate).3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fill

to line on tube that indicates "sodium citrate". CAUTION:A discard tube (without additives) must be used before acitrate tube is drawn with a winged blood collection set.If blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.Do not force blood into tube.

4. Specimen Processing Instructions: Tube must be filledto fill line. The tube(s) must be mixed gently after

collection. Avoid specimen hemolysis and clotting.Transport to the laboratory room temperature.5. Cause for Rejection: Clotted, hemolysis, or quantity not

sufficient.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.

PT/PTT (PANEL) 1. Patient Preparation: None.2. Collection Container: Blue top tube (sodium citrate).3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fill

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TEST NAME SUBMITTING REQUIREMENTSto line on tube that indicates "sodium citrate". CAUTION:A discard tube (without additives) must be used before a

citrate tube is drawn with a winged blood collection set.If blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.Do not force blood into tube.

4. Specimen Processing Instructions: Gently mix tube after collection to ensure effectiveness of anti-coagulant.


6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.8. Tests in Panel: PT; APTT; INR

QUINIDINE 1. Patient Preparation: For periodic testing and insituations of suspected inadequate dosage, samplingshould be performed just prior to the next dose. Insuspected toxicity, sampling is performed at any time.


RAPID PLASMA

REAGIN (RPR)


2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Refrigerate5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 3 days.7. Test Performed in Immunology, 569-2351.

RAST 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 10 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and


REDUCINGSUBSTANCES, STOOL

1. Patient Preparation: Aseptic technique.2. Collection Container: Sterile container.3. Specimen and Volume Required: Random,

unpreserved stool, minimum 1 gm.4. Specimen Processing Instructions: Refrigerate if

transport is delayed.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: Improperly collected, such as in

preservative or submission of diapers, or improperly

labeled.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

RENAL PANEL 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone


remove from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

7. Test Performed in Core Laboratory.8. Tests in Panel: CARBON DIOXIDE, CHLORIDE,CREATININE, GLUCOSE, POTASSIUM, SODIUM,UREA NITROGEN

RENIN 1. Patient Preparation: None.2. Collection Container: Pre-chilled EDTA lavender top

tube.3. Specimen and Volume Required: 2 mL plasma.4. Specimen Processing Instructions: Collect on ice,

separate cells from plasma, and freeze plasma ASAP.Ship on dry ice.

5. Cause for Rejection: Hemolyzed sample. Non-frozenspecimen from outside source.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

RESPIRATORYCULTURE (INCLUDESGRAM STAIN)

1. Patient Preparation: Lower respiratory sample isoptimal.

2. Collection Container: Sterile screw top container.3. Specimen and Volume Required: 1 mL sputum,

aspirate, or washing (for bronchial brush submit brush in1 mL of bronchial washing).

4. Specimen Processing Instructions: Transport ASAP,

refrigerate in delay of more than 2 hours. Requests for Corynebacterium diptheriae require special media andtransport. Coordinate with Bacteriology, MicrobiologySection.

5. Cause for Rejection: Inadequate sample. Oralcontamination noted.

6. Expected TAT: 48 hours.7. Test Performed in Microbiology Section.

RETICULOCYTE 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTSCOUNT 2. Collection Container: Lavender top tube (EDTA) or

pediatric bullet tube (EDTA). Gently mix sample

immediately following collection.3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Allow Vacutainer to

draw to the level of its vacuum, mix gently. Transport tothe laboratory at room temperature. Must be receivedwithin 8 hours.


6. Expected TAT: 4 hours.7. Test Performed in Core Laboratory Section.

RHEUMATOID

FACTOR, QUANT


2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Grossly Hemolyzed.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

RHO(D) IMMUNEGLOBULIN (HUMAN)

POST PARTUM RhIG

1. Patient Preparation: Aseptic technique. Patient requiresa current (less than 30 days old) ABO, Rh, and antibodyscreen to initiate the 28-week prophylactic immuneglobulin.

2. Collection Container: EDTA 6 ml Pink Top.3. Specimen and Volume Required: 6 mL whole blood4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled

specimen; no prescription.6. Expected TAT: 10-15minutes.7. Test Performed in Blood Bank.

ROTAVIRUS ANTIGEN 1. Patient Preparation: Fresh stool sample required.Collect specimens 1 to 3 days after onset of symptoms.

2. Collection Container: Sterile container.3. Specimen and Volume Required: More than 1 gram

fresh stool.4. Specimen Processing Instructions: Freeze sample if transportation is delayed.

5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 2 days.7. Test Performed in Microbiology.

RSV ANTIGEN 1. Patient Preparation: None.2. Collection Container: Sterile container or swab.3. Specimen and Volume Required: 2-3 mL

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TEST NAME SUBMITTING REQUIREMENTSnasopharyngeal washes or aspirates, or nasopharyngealswabs.

4. Specimen Processing Instructions: Transport tolaboratory immediately.

5. Cause for Rejection: Improper specimen submission.6. Expected TAT: 1 hour for STAT specimens. 4 hours

during normal operating hours. If sample is submitted atother times, sample will be tested next duty day.

7. Test Performed in Microbiology Section.

RUBELLA IgG 1. Patient Preparation: Aseptic technique. Collect acutesample upon onset and convalescent sample 2-4 weeksfrom onset.

2. Collection Container: Silicone Stopper Tube (SST).

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hours.7. Test Performed in Soldier Family Medical Clinic

Laboratory.

RUBEOLA IgG 1. Patient Preparation: Aseptic technique. Collect acutesample upon onset and convalescent sample 2-4 weeksfrom onset.


4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hours.7. Test Performed in Immunology.

SALICYLATE 1. Patient Preparation: For therapeutic monitoring, collect just prior to next dose.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

7. Test Performed in Core Laboratory.SEMEN ANALYSIS,COMPLETE

1. Patient Preparation: Abstain from sexual activity for 72hours. Patient should be instructed to schedule anappointment and report to the laboratory collectionprocessing area, third floor to receive specimencollection instructions.

2. Collection Container: Sterile urine cup.3. Specimen and Volume Required: Semen, representative

portion.

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TEST NAME SUBMITTING REQUIREMENTS4. Specimen Processing Instructions: The laboratory must

receive sample within 1 hour after collection.

5. Cause for Rejection: Quantity not sufficient.6. Expected TAT: 72 hours.7. Test Performed in Core Laboratory Section.8. Tests in Panel: COLOR; VOL; PH; SPERM COUNT;

MOTILITY; MORPH; OTHER

SEMEN ANALYSIS,POST VAS

1. Patient Preparation: Abstain from sexual activity for 72hours. Patient should be instructed to schedule anappointment and report to the laboratory collectionprocessing area, third floor to receive specimencollection instructions.

2. Collection Container: Sterile urine cup.

3. Specimen and Volume Required: Semen, representativeportion.4. Specimen Processing Instructions: The laboratory must

receive sample within 1 hour after collection. Performedonly between 0700 and 0930 on Thursday only.

5. Cause for Rejection: Quantity not sufficient.6. Expected TAT: 72 hours.7. Test Performed in Core Laboratory Section.

SICKLE CELL SCREEN 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 4 mL whole blood.

4. Specimen Processing Instructions: Mix well to avoidclots. Ship on wet ice.5. Cause for Rejection: Gross hemolysis, clots.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

SODIUM 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.


SPECIFIC GRAVITY,FLUID (SP,F)

1. Patient Preparation: None.2. Collection Container: Sterile cup.3. Specimen and Volume Required: 1 mL fluid.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in: Core Laboratory.

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TEST NAME SUBMITTING REQUIREMENTSSTERILITY TEST 1. Patient Preparation: NA.

2. Collection Container: NA

3. Specimen and Volume Required: Spore strip or ampule.4. Specimen Processing Instructions: Label with autoclave

location and transport to laboratory ASAP.5. Cause for Rejection: Ampule not crushed.6. Expected TAT: 3-7 days.7. Test Performed in Microbiology Section.

STONE RISKANALYSIS (URORISK)

1. Patient Preparation: Mission Pharmacal request formmust be completed and submitted with sample.

2. Collection Container: 24 hour special container.3. Specimen and Volume Required: 24-hour urine.4. Specimen Processing Instructions: Call (915) 569-1220.

5. Cause for Rejection: Improperly collected andimproperly labeled.6. Expected TAT: 7-10 days.7. Test Performed by Reference Laboratory.

STOOL CULTURE(Salmonella andShigella)

1. Patient Preparation: Pass specimen directly into clean,dry container. Do not contaminate with urine, barium, or toilet paper. For rectal swabs, carefully insert transportswab 2.5 cm beyond anal sphincter, gently rotate swabto sample crypts. Test should not be requested onpatients hospitalized for more than 3 days.

2. Collection Container: Leak-proof, wide month container

or rectal swab.3. Specimen and Volume Required: Greater than 2 gramfresh sample or rectal swab.

4. Specimen Processing Instructions: Transport to thelaboratory within 1 hour. Requests must be madeother bacterial agents, such as Vibrio, Yersinia,Campylobacter, E Coli O157H7, or VRE must benoted in comment section of test request. Consider ordering a C. difficile toxin request if patient has beenhospitalized for over 3-day duration.

5. Cause for Rejection: Formed or preserved specimen or

items listed under Microbiology general rejection criteria.6. Expected TAT: 72 hours.7. Test Performed in Microbiology Section.

STOOL pH 1. Patient Preparation: Aseptic technique.2. Collection Container: Sterile container.3. Specimen and Volume Required: Fresh stool.4. Specimen Processing Instructions: Refrigerate if

transport is delayed.5. Cause for Rejection: Improperly labeled. Specimen

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THROAT CULTURE

(N. GONORRHOEAE)


2. Collection Container: Selective media. Submit selectivemedia to the laboratory in closed CO2 pouch.

3. Specimen and Volume Required: Throat swabs.4. Specimen Processing Instructions: Inoculate specimen

using Dacron or Rayon swab onto selective media bystreaking the media by the swab in a "Z" pattern. Placein CO2 pouch and transport to Specimen Processingimmediately. Indicate source.

5. Cause for Rejection: Plate not delivered immediately;plate received cold to touch (refrigerated). Out-datedmedia.

6. Expected TAT: 72 hours.7. Test Performed in Microbiology Section.

THROAT CULTURE(STREPTOCOCCALGROUP A CULTURE)

1. Patient Preparation: None.2. Collection Container: Swab transport device.3. Specimen and Volume Required: NA.4. Specimen Processing Instructions: Transport to

laboratory immediately, store at room temperature if delay occurs.a. This request is to rule out beta-hemolytic group A

streptococci, (Streptococcus pyogenes). ContactChief, Microbiology for special requests.

b. A request to rule out Neisseria gonorrhoeae requiresspecial media and transport and should becoordinated with Bacteriology prior to request.Inoculate specimen using Dacron or Rayon swabonto selective media by streaking the media by theswab in a "Z" pattern. Place in CO2 pouch andtransport to Specimen Processing immediately.

c. Requests for Corynebacterium diptheriae requirespecial media and transport. Coordinate withBacteriology, Microbiology Section.

5. Cause for Rejection: Items listed under Microbiology

general rejection criteria.6. Expected TAT: 24-48 hours.7. Test Performed in Microbiology Section, 569-2210.

THROMBIN TIME 1. Patient Preparation: None.2. Collection Container: Blue top tube (sodium citrate).3. Specimen and Volume Required: 1.8 mL or 2.7 mL, fill


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TEST NAME SUBMITTING REQUIREMENTSIf blood is drawn with a syringe, allow the tube to drawthe blood from the syringe, using a blood transfer device.

Do not force blood into tube.4. Specimen Processing Instructions: Tube must be filledto fill line. The tube(s) must be mixed gently after collection. Avoid specimen hemolysis and clotting.Transport to the laboratory room temperature.


6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory Section.

THYROGLOBULINANTIBODY PANEL

1. Patient Preparation: None.2. Collection Container: Red top tube.

3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Refrigerate.5. Cause for Rejection: Hemolysis, lipemic, icteric6. Expected TAT: 4 days.7. Test Performed in Immunology.8. Tests in Panel: Thyroglobulin, Thyroid Peroxidase Ab

THYROIDMICROSOMALANTIBODIES

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected, labeled or

hemolyzed specimens unsuitable for testing.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

THYROIDSTIMULATINGHORMONE (TSH)


Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

THYROIDSTIMULATINGIMMUNOGLOBULIN



TOBRAMYCIN PEAK 1. Patient Preparation: For intravenous therapy, peak

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TEST NAME SUBMITTING REQUIREMENTSconcentration occurs 15 to 30 minutes followingcompletion of infusion. For intramuscular therapy, peak

concentration occurs 45 to 75 minutes followingadministration.


TOBRAMYCINRANDOM

1. Patient Preparation: None.2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

TOBRAMYCINTROUGH

1. Patient Preparation: For intravenous therapy andintramuscular, trough concentration occurs not more than30 minutes before next dose.

2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.

6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory. TOTAL COMPLEMENT(CH 50)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Improperly collected and


TOTAL EOSINOPHIL

COUNT, AUTOMATED


2. Collection Container: EDTA lavender top tube or pediatric bullet tube. Gently mix immediately followingcollection.

3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Allow Vacutainer to

draw to the level of its vacuum, mix gently. Transport tolaboratory at room temperature. Must be received within8 hours.

5. Cause for Rejection: Hemolysis, clots, or quantity not

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TEST NAME SUBMITTING REQUIREMENTSsufficient.


7. Test Performed in Core Laboratory Section.TOXICOLOGYSCREEN(SERUM)


improperly labeled.6. Expected TAT: 1-4 hours7. Test Performed in Core Laboratory.8. Tests in Panel: ETHANOL; SALICYLATES;

ACETAMINOPHEN

TOXICOLOGYSCREEN(URINE)

1. Patient Preparation: None.2. Collection Container: Plastic vial.3. Specimen and Volume Required: 20 mL urine.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and

improperly labeled.6. Expected TAT: 1-4 hours7. Test Performed in Core Laboratory.8. Tests in Panel: BARBITUATES; BENZODIAZEPINES;

COCAINE; OPIATES; CANNABINOIDS;AMPHETAMINES.

TOXOPLASMOSISPANEL

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 48 hrs.7. Test Performed in Microbiology, 569-2210.8. Tests in Panel: TOXOPLASMOSIS IgG;

TOXOPLASMOSIS IgM

TRANSFERRIN 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone


TRANSFUSIONREACTIONEVALUATION

1. Patient Preparation: Aseptic technique.2. Collection Container:

a. EDTA 6 ml Pink Top

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TEST NAME SUBMITTING REQUIREMENTSb. Urine cup.

3. Specimen and Volume Required:

a. 6 mL whole blood.b. 3-5 mL random urine.

4. Specimen Processing Instructions: Transport thefollowing to the Blood Bank:a. 2nd copy of completed SF 518.b. One EDTA properly labeled 6 ml Pink Top blood

specimen.c. A container with first available urine sample.d. The discontinued blood bag, IV set, and any attached

solutions.5. Cause for Rejection: NA.

6. Expected TAT: 30 minutes.7. Test Performed in Blood Bank 569-2219 / 2388 & UA

TRICYCLICANTIDEPRESSANTS

1. Patient Preparation: Sampling should be performedduring the elimination phase of the drug, which is aminimum of eight hours after the last dose.


TRIGLYCERIDE 1. Patient Preparation: Patient should fast 12-14 hoursprior to collection.2. Collection Container: Mint Green PST or Silicone

Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum/plasma.4. Specimen Processing Instructions: Refrigerate serum.

Ship on wet ice.5. Cause for Rejection: Non-fasting specimen.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

TRIPLE MARKER

PROFILE

1. Patient Preparation: Complete IERA Form 03 and

submit with sample.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Ship on wet ice.5. Cause for Rejection: Improperly collected and


TROPONIN I 1. Patient Preparation: None.

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TEST NAME SUBMITTING REQUIREMENTS2. Collection Container: Mint Green PST or SiliconeStopper Tube (SST).

3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

TYPE ANDCROSSMATCH

1. Patient Preparation: Aseptic technique. Appropriatelycompleted SF 518.

2. Collection Container: EDTA 6 ml Pink Top3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled;

incomplete requests (SF 518s); hemolysis.6. Expected TAT: 4 hours.7. Test Performed in Blood Bank.

TYPE AND SCREEN 1. Patient Preparation: Aseptic technique. Appropriatelycompleted SF 518.

2. Collection Container: EDTA 6 ml Pink Top3. Specimen and Volume Required: 6 mL whole blood.4. Specimen Processing Instructions: None.5. Cause for Rejection: Improperly collected or labeled;

incomplete requests (SF 518s); hemolysis.6. Expected TAT: 2 hours.

7. Test Performed in Blood Bank.UREA NITROGEN 1. Patient Preparation: None.



URIC ACID 1. Patient Preparation: None.2. Collection Container: Mint Green PST or Silicone



URIC ACID,URINE(RANDOM)

1. Patient Preparation: None.2. Collection Container: Urine cup.

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TEST NAME SUBMITTING REQUIREMENTS3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: NO preservative.

Refrigerate if transport delayed. Ship on dry ice.5. Cause for Rejection: Acidified specimens cannot be

analyzed.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

URINE ANALYSIS 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: Urine samples received more than

4 hours from collection time.

6. Expected TAT: 1-4 hours.7. Test Performed in: Core Laboratory.8. Tests in Panel: URN:GLUCOSE; URN:COLOR;

URN:APPEARANCE; URN:BILIRUBIN; URN:KETONES;URN:SPECIFIC GRAVITY; URN:BLOOD; URN:PH;URN:PROTEIN; URN:UROBILINOGEN; URN:NITRITE;URN:LEUKOCYTE ESTERASE; MIC:RBC; MIC:WBC;MIC:BACTERIA; MIC:YEAST; MIC:EPITHELIAL CELLS;MIC:MUCUS; MIC:TRICHOMONAS; MIC:CASTS;MIC:CRYSTALS

URINE CULTURE 1. Patient Preparation: Obtain a clean catch, midstream

urine (CCMS) specimen, after cleaning the externalgenitalia. First morning specimens are preferred.Catheterized and bladder samples may also besubmitted. Identify the specific source when ordering.Do NOT submit Foley catheter tips.

2. Collection Container: Sterile urine cup, screw topcontainer, or urine transport kit.

3. Specimen and Volume Required: Greater than 1 mLurine.

4. Specimen Processing Instructions: Transport specimento laboratory within 2 hours of collection for unpreserved

specimen. Store refrigerated or use appropriatetransport devise, if transport is delayed.5. Cause for Rejection: Specimens not properly preserved.

Preserved specimens more than 24 hours old. Pooled24-hour sample. Urine submitted from catheter bag or Foley catheter tip. Urine contaminated with stool. Itemslisted under Microbiology general rejection criteria.

6. Expected TAT: 24-48 hours.7. Test Performed in Microbiology Section.

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TEST NAME SUBMITTING REQUIREMENTSURINE PROTEINELECTROPHORESIS

(UPEP)Immunofixationavailable if necessary.

1. Patient Preparation: None.2. Collection Container: 24-hour urine container.

3. Specimen and Volume Required: 25 mL urine wellmixed.4. Specimen Processing Instructions: NO preservatives

added. Aliquot 25 mL urine from the total volume of the24-hour collection. Record total volume on laboratoryrequest. State if other than 24-hour urine sent. Notifylaboratory if request is accompanied by serum proteinelectrophoresis request. Ship on wet ice.

5. Cause for Rejection: NA.6. Expected TAT: 14 days (TAT may vary depending on

results obtained).

7. Test Performed in Immunology.8. Tests in Panel: UA/ALBUMIN; URINE ALPHA-1; URINEALPHA-2; URINE BETA; URINE GAMMA; IGG HEAVYCHAIN AG; IGM HEAVY CHAIN AG; IGA HEAVY CHAINAG; KAPPA LIGHT CHAIN FREE; LAMBDA LIGHTCHAIN FREE.

URINE TOTALVOLUME

1. Patient Preparation: Instruct patient to empty bladder first thing in the morning. All future urine voids should becollected in a clean 24-hour urine collection container.Final collection is made when patient empties their bladder the next morning at the same time. Keep 24-

hour urine collection refrigerated during collection period.2. Collection Container: 24-hour urine container.3. Specimen and Volume Required: Not applicable.4. Specimen Processing Instructions: No preservative

required. Record total volume and enter result in thecomputer.


VALPROIC ACID 1. Patient Preparation: Blood samples should be drawnimmediately prior to the next dose. A prerequisite for

monitoring serum levels is that dosage must be stable for at least two days; doses should not be changed or missed.


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TEST NAME SUBMITTING REQUIREMENTSVANCOMYCIN PEAK 1. Patient Preparation: Peak serum levels should be

obtained one to two hours after intravenous

administration.2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.7. Test Performed in Core Laboratory.

VANCOMYCINRANDOM

1. Patient Preparation: None.2. Collection Container: Red top tube.3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: None.


VANCOMYCINTROUGH

1. Patient Preparation: Trough levels are reflected bysamples obtained immediately prior to the next dose.


VANILLYLMANDELICACID (VMA)

1. Patient Preparation: Patient should be given instructionsto keep urine collection refrigerated during the collectionprocess.





6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.8. Tests in Panel: VOLUME 24H; VANILLYLMANDELATE

24H, VANILLYLMANDELATE UA

VARICELLAANTIBODY

1. Patient Preparation: Aseptic technique. Collect acutesample upon onset and convalescent sample 2-4 weeksfrom onset.


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TEST NAME SUBMITTING REQUIREMENTShours, protect serum from light.5. Cause for Rejection: Hemolysis sample. Non-frozen

specimen from outside source. No Folate determinationshould be performed on patients receiving methotrexatedue to cross-reactivity. In patients receiving therapy withhigh biotin doses (>5mg/day) no sample should be takenuntil at least 8 hours after the last administration.Erroneous findings may be obtained from samples takenfrom patients who have been treated with monoclonalmouse antibodies or who have received them for diagnostic purpose.


VITAMIN D (1,25DIHYDROXY) 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on dry ice.5. Cause for Rejection: Hemolysis.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

VITAMIN D (25HYDROXY)

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.4. Specimen Processing Instructions: Ship on dry ice.

5. Cause for Rejection: Hemolysis or lipemia.6. Expected TAT: 7 days.7. Test Performed by Reference Laboratory.

WOUND CULTURE,DEEP(INCLUDES GRAMSTAIN)

1. Patient Preparation: Remove surface exudate by wipingwith sterile saline or 70% alcohol. For superficial and/or open wounds aspirate or swab deep into lesion at thelesion’s advancing edge. For deep or closed wounds,aspirate material with a needle and syringe andaseptically transfer all material into anaerobic transportdevice or vial.

2. Collection Container: Sterile container with aspirate,

swab, anaerobic transport device for anaerobes whenrequired.3. Specimen and Volume Required: Representative

portion.4. Specimen Processing Instructions: Deliver promptly to

the laboratory. Indicate source of specimen and whenappropriate type of infection and/or organism suspected.Please note if wound is from a bite. For optimal Gramstain results, request a separate swab be submitted.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: See Microbiology Section, general

rejection criteria.

6. Expected TAT: 72 hours aerobic culture (7 days for anaerobic culture).7. Test Performed in Microbiology Section.

WOUND CULTURE,SUPERFICIAL(INCLUDES GRAMSTAIN)

1. Patient Preparation: Remove surface exudate by wipingwith sterile saline or 70% alcohol. For superficial and/or open wounds aspirate or swab deep into lesion at thelesion’s advancing edge. For deep or closed wounds,aspirate material with a needle and syringe andaseptically transfer all material into anaerobic transportdevice or vial.

2. Collection Container: Sterile container with aspirate,

swab, anaerobic transport device for anaerobes whenrequired.3. Specimen and Volume Required: Representative

portion.4. Specimen Processing Instructions: Indicate site. Please

note if wound is from a bite. For optimal Gram stainresults, request a separate swab be submitted.

5. Cause for Rejection: See Microbiology Section, generalrejection criteria.

6. Expected TAT: 72 hours aerobic culture (7 days for anaerobic culture).

7. Test Performed in Microbiology Section.ZINC 1. Patient Preparation: None.2. Collection Container: Royal blue acid-washed tube.3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: After drawing in royal

blue acid-washed tube, separate cells from serumpromptly and transfer serum into another labeled royalblue acid-washed tube.

5. Cause for Rejection: Serum must have been collectedand stored in royal blue acid-wasted tube. Storerefrigerated. Ship on wet ice.


ZINCPROTOPORPHYRIN

1. Patient Preparation: None.2. Collection Container: Lavender top tube EDTA, 4 mL

tube or capillary.3. Specimen and Volume Required: Whole blood, entire

collection.4. Specimen Processing Instructions: Store refrigerated.

Ship on wet ice.

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TEST NAME SUBMITTING REQUIREMENTS5. Cause for Rejection: Serum, frozen, or clotted whole

blood cannot be used for analysis.


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APPENDIX F

Laboratory Request Forms

*WBAMC Form 1107 Hematology

*WBAMC Form 1122 Authorization for Autologous Donation

*WBAMC Form 1107 Urinalysis

WBAMC Form 14-45 Blood or Blood Component Pickup

WBAMC OP 02-040 Emergency/Massive Release of Blood

*DD Form 572 Blood Donation Record

*Standard Form 513 Consultation Sheet

*Standard Form 515 Tissue Examination

Standard Form 518 Blood or Blood Component Transfusion

*Standard Form 541 Gynecologic Cytology*Standard Form 546 Chemistry I

*Standard Form 548 Chemistry III (Urine)

*Standard Form 549 Hematology

*Standard Form 551 Immunology

*Standard Form 552 Parasitology

*Standard Form 553 Microbiology I

*Standard Form 556 Immunohematology

*Standard Form 557 Miscellaneous

* Forms to be used when tests/procedures are not available on CHCS.

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APPENDIX G

Names and Synonyms of Laboratory Tests

11-DEOXYCORTISOLCOMPOUND SDESOXYCORTISOL11-DESOXYCORTISOL

17-A HYDROXYPROGESTERONE17-ALPHA HYDROXYPROGESTERONE

17-HYDROXYCORTICOSTEROIDS

17 HYDROXYSTEROIDS17OH17OH-CORTICOSTEROIDS

17-HYDROXYPROGESTERONE17-OH PROGESTERONE17 OH PROGESTERONE17OHPG

17-KETOSTEROIDS17-KETOS

18-HYDROXYCORTICOSTERONE18 OHCORTICOSTERONE18 OH-CORTICOSTERONE18 HYDROXYCORTICOSTERONE

1:1 MIX PT RM TEMPPT MIXING STUDYMIXING STUDY,PTMX STDY PT

1:1 MIX PTT RM TEMPMXPTTMIXING STUDY, PTTMX STDY PTT

2-AMINOBUTYRATE2-AMINOBUTYRIC ACIDAAS-2-AMINOBUTYRIC ACID

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24 HOUR URINE LYTES24 HR URINE LYTESURINE LYTES,24 HR

LYTES,24 HR URINE

24 HR URINE METANEPHRINE PANELMETANEPHRINE, URINE 24 HR

3-METHOXYTYRAMINE 24H3-METHOXYTYRAMINE 24HR3-METHOXYTYRAMNE 24H

3-METHOXYTYRAMNE CONC UA3-METHOXYTYRAMINE,CONC

URN 3-METHOXYTYRAMNE CONCTYRAMINE 3-METHOXY UR

5-HYDROXYINDOLEACETATE5-HIAASEROTONIN METABOLITE24 HR 5-HIAA5 HYDROXYINDOLEACETIC ACID

5-HYDROXYTRYPTOPHAN5-HTP

68KD ABANTI-68 KD (HSP-70) ANTIBODIES

A FLAVUS ABASPERGILLUS FLAVUS ANTIBODYASPERGILLUS FLAVUS AB

A FUMIGATUS ABASPERGILLUS FUMIGATUS ANTIBODYASPERGILLUS FUMIGATUS AB

A NIGER ABASPERGILLUS NIGER ANTIBODYASPERGILLUS NIGER AB

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ACID FAST CULTURETB CULTURE

TB CULTURE & SMEARAFB SMEAR & CULTURETB SMEAR & CULTUREAFB CULTUREMYCOBACTERIAL CULTUREAFB CULTURE & SMEARACID FAST CULTUREACID-FAST CULTURE

ACID FAST STAINTB SMEAR

TB STAINAFB STAINMYCOBACTERIAL STAINACID FAST SMEARAFB SMEAR

ACTHADRENOCORTICOTROPIC HORMONE

ACTIVATED PROTEIN C RESISTANCEAPC-R

ACYLCARNITINE LONG-CHAINLONG-CHAIN ACYLCARNITINE

ADRENAL ABADRENAL ANTIBODIES, SERUMADRENAL CORTEX ANTIBODIESANTIADRENAL ANTIBODIES, QUANT.

AEROBIC CULTURECULTURE, BODY FLUIDBF CULTUREFLUID CULTURECULTURE, FLUIDBODY FLUID CULTURE

AFPAFP (TRIPLE SCREEN)DM-AFPDM:AFP

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AFP, TUMOR MARKERAFP (AMNIO FLUID)

AFP,AMNIOTIC FLUID PANELAMNIOTIC FLUID AFPAFP,AMNIOTIC FLUID

ALANINE AMINOTRANSFERASEALANINE AMINATRANSFERASESGPTALT

ALDOLASE

ALDO

ALDOSTERONEALDS

ALDOSTERONE/CREATININE24 HR URINE ALDOSTERONE

ALK PHOS ISOENZYMEALK PHOS ISOENZYMESALK PHOS ISOENZYMES 10/00

ALKALINE PHOSPHATASEALKPALK PHOS

ALPHA 2 ANTIPLASMINALPHA-2 ANTIPLASMINA-2 ANTIPLASMINA 2 ANTIPLASMINA2A

ALPHA PGHALPHA SUBUNIT OF PITUITARY GLYCOPROTEIN HORMONEA-PGH@-PGHA PGH SUBUNITALPHA SUBUNIT OF PGH

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ALPHA-1-ANTITRYPSIN PHEN.AATPALPHA 1 ANTITRYPSIN PHENOTYPE

AMIKACIN RANDOM 10/00AMIKINAMIKACINAMIKACIN RANDOM

AMINO ACID PROFILEAAS-PROFILE

AMINOLEVULINATE DEHYDRATASALA DEHYDRATASE

AMINOLEVULINIC ACID DEHYDRATAS

AMINOLEVULNATE UAALA 24HR URINEAMINOLEVULINIC ACID, 24HRURINEAMINOLEVULNIC ACID, URINE

AMIODARONECORDARONE

AMITRIPTYLINEELAVILENDEPETRAFONTRIAVIL

AMMONIANH3

AMOEBIC TITERAMOEBAMOEBIC AB TITERAMOEBIC ANTIBODY TITER

AMPHETAMINESSPEED

AMYLASE 24 HOUR URINE24 HOUR URINE AMYLASE24 HR URINE AMYLASE

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AMYLASE ISOENZYMES 10/00AMYLASE FRACTIONATEDISOAMYLASE

MACROAMYLASEAMYLASE, ISOENZYMESAMYLASE ISOENZYMES

ANAEROBIC CULTURECULTUREANA

ANCA PANELANTINEUTROPHIL CYTOPLASMIC ANTIBODYANCA

ANDROSTENEDIONEANDROSTENE3,17 DIONEANDROSTENDIONE

ANGIOTENSIN CONVERTING ENZYMEACE

ANTI GLIADIN ANTIBODY PANELGLIADIN AB PANEL

ANTI-JO ANTIBODIES 10/00T-RNA SYNTHETASEPOLYMYOSITISANTI-JO-1ANTI-JO 1ANTI-JO ANTIBODIES

ANTI-PM-1 10/00POLYMYOSITISANTI PM-1 ABSANTI-PM-1

ANTI-SCL-70 05/01ANTI-SCL 70SCL 70ANTI-SCL-70

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ANTI-SMITH 05/01ANTI SMITHSM

ANTI-SMITH

ANTI-SMOOTH MUSCLE AB 05/01ASMAANTISMOOTHANTI SMOOTH MUSCLE ABSMOOTH MUSCLE ABANTI-SMOOTH MUSCLE ANTIBODIESANTI-SMOOTH MUSCLE ANTIBODY

ANTIBODY IDENTIFICATION

ABIDIDENTIFICATION, ANTIBODY

ANTIBODY SCREEN - CHCSCOOMBS,INDIRECTINDIRECT COOMBSAB SCREENIATANTIBODY SCREEN

ANTICARDIOLIPIN AB IGG,IGMCARDIOLIPIN ABACAANTIPHOSPHOLIPIDS

ANTIDIURETIC HORMONEARGINIAL VASOPRESSINAVPADH

ANTINUCLEAR ANTIBODY PATTERNANTINUCLEAR AB (ANA) PATTERNANA PATTERN

ANTINUCLEAR ANTIBODY SCREENANAAUTOIMMUNE SCREENSLELUPUS ANTIGENANTINUCLEAR ANTIBODY (ANA)ANA SCR

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ANTINUCLEAR ANTIBODY TITERANTINUCLEAR ANTIBODY TITER

ANA TITER

ANTITHROMBIN III ACTIVITYATIIIHEPARIN COFACTOR ACTIVITYANTITHROMBIN III, FUNCTIONALAT III,ACTIVITYANTI-THROMBIN IIIANTI THROMBIN III ACTIVITYTHROMBIN III AB ACTIVITY

ANTITHROMBIN III ANTIGENATII,ANTIGENAT III,ANTIGENATIII, ANTIGENANTITHROMBIN III, ANTIGENANTI THROMBIN III ANTIGENTHROMBIN III ANTIGEN AB

ARSENICARSU

ARYLSULFATASEARYLSUFATASE A, LEUKOCYTES

ASO PANELASO

ASPARTATE AMINOTRANSFERASEASPARATED AMINATRANSFERASESGOTAST

ASPARTIC ACID 10/00AAS-ASPARTIC ACIDASPARTIC ACID

ASPERGILLUS SP ABASPERGILLUS TITERASPERGILLUS ANTIBODIES

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AUTOANTIBODY PROFILEAUTO ANTIBODY PROFILEAUTO-ANTIBODY PROFILE

AV ENCEPHALOMYELITIS VIRUS ABARBOVIRAL ENCEPHALITIS AB IGM

B BURGDORFERI ABLYME ANTIBODYB BURGDORFERI ABB. BURGDORFERI AB

B BURGDORFERI CSF INDEXCSF LYME

LYME DISEASE,CSFB BURGDORFERI CSF INDEXB. BURGDORFERI CSF INDEX

B HENSELAE IGGBARTONELLA HENSELAE IGG

B HENSELAE IGMBARTONELLA HENSELAE IGM

B QUINTANA IGGBARTONELLA QUINTANA IGG

B QUINTANA IGMBARTONELLA QUINTANA IGM

B-2-MICROGLOBULIN 10/02MICROGLOBULIN BETA 2B-2 MICROGLOBULINBETA-2 MICROGLOBULINB2MBETA 2 MICROGLOBULINBETA-2-MICROGLOBULINBETA 2-MICROGLOBULIN

B-2-TRANSFERRINBETA-2-TRANSFERRINBETA-2 TRANSFERRIN

B-TYPE NATRIURETIC PEPTIDEBNP

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B2-GLYCOPROTEIN I (IGG,IGM,IGABETA 2 GLYCOPROTEIN PANEL (IGG,IGA,IGM)

BARTONELLA ANTIBODIES,IGG&IGMCAT SCRATCH DISEASE

BASOPHILSSBASOBASO,STOOL

BETA INTERFERON NEUTRALZING ABNAbs

BILIRUBIN DIRECTDIRECT BILIRUBINDBILD BILIDBILIBILIRUBIN,DIRECT

BILIRUBIN UAUBILBILI,UURN:BILIRUBIN

BILIRUBIN,NEONATALNEONATAL BILIRUBINNBILN BILINBILI

BILIRUBIN,TOTALTOTAL BILIRUBINT BILITBILBILIRUBIN

BLADDER TUMOR ANTIGENBTA

BLOOD CULTUREBCBACTECCULTURE,BLOOD

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BLOOD SMEAR,FOR PICKUPSLIDE FOR REVIEW (ONCOLOGY ONLY)

SMEAR FOR REVIEW (ONCOLOGY ONLY)

BLOOD UAUHGBBLOOD,UURN:BLOOD

BONE MARROW BIOPSYBMBONE MARROW

C BOTULINUM TOXIN 10/02CLOSTRIDIUM BOTULINUM TOXIN

C DIFFICILE TOXIN AC.DIFF TOXIN TESTANTIBIOTIC ASSOCIATED COLITIS (AAC)PSEUDOMEMBRANOUS COLITIS TESTCLOSTRIDIUM DIFFICILE TOXIN ACLOSTRIDIUM DIFF TOX A 10/00

C-PEPTIDECPEP

C-REACTIVE PROTEINC-REACTIVE PROTEINPROTEIN C-REACTIVEC REACTIVE PROTEINCRPH

C.PSITTACI IGM/G/A AB PANELCHLAMYDIA PSITTACI ANTIBODY PANEL

C1 ESTERASE INHIB,QUANTITATIONC1 ESTERASE INHIBITOR,PROTEIN QUANTITATION

C1 ESTERASE INHIBITORC1 ESC1 ESTERASE INHIBC1 ESTERASE INHIBITOR, FUNCTIONAL

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CALCITONINTHYROCALCITONIN

CALCIUM,24 HOUR URINEURINE CALCIUM24 HOUR URINE CALCIUMCALCIUM, 24 HOUR URINE24 HR URINE CALCIUM

CAMPYLOBACTER CULTURECAMPY STOOL CULTURESTOOL CAMPY CULTURE

CANCER AG 125

CA125CA-125

CANCER AG 15-3CA 15-3

CANCER AG 27-29TRUQUANT BR CA27.29 ANTIGENCA27.29

CANNABINOIDSTETRAHYDROCANABINOLTHCCANNABINOID

CARBAMAZEPINETEGRETOL

CARBOHYDRATE ANTIGEN 19-910/00CA 19-9CA19-9CA199CARBOHYDRATE 19-9CARBOHYDRATE ANTIGEN 19-9

CARCINOEMBRYONIC AGCEACARCINOEMBRYONIC ANTIGEN

CARDIOLIPIN IGGANTICARDIOLIPIN AB,IGG

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CARDIOLIPIN IGMANTICARDIOLIPIN AB,IGM

CATECHOLAMINES,FRAC+TOT,PLASPLASMA CATECHOLAMINES

CATECHOLAMINES,FRACTIONATED,UFRACTIONATED CATECHOLAMINES,U

CATECHOLAMINES,URINE,FRACTIONACATECHOLAMINES,FRACTIONATED,U

CBC ONLY

BLOOD COUNTCOMPLETE BLOOD COUNTWHOLE BLOOD COUNTCBC

CBC/DIFF PROFILECBCCBC/D

CELL COUNT, BODY FLUIDSBODY FLUIDS,CELL COUNTFLUID COUNTFLUID CELL COUNT

CELL COUNT, CSFCSF CELL COUNTFLUID CELL COUNT

CELL COUNT, SYNOVIALSYNOVIAL FLUID, CELL COUNTFLUID CELL COUNT

CHARCOT-MARIE TOOTH TESTCMT1ACHARCOT MARIE TOOTH TYPE 1ACMT2

CHLAMYDIA PROBEGC/DNA PROBEGCCHLAMYDIA/GONORRHEA DNA SCREEN

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CHLAMYDIA PSITTACI IGACHLAMYDIA PSITTACI AB IGA

CHLORAMPHENICOLCHLOROMYCETIN

CHLORIDE,24 HR URINE24 HR URINE CHLORIDE24 HR UCL

CHLORIDE,SERUMSERUM CHLORIDECL

CHOLESTEROLCHOL

CHORIONIC VILLUS SAMPLINGCVS

CHROMOSOME ANALYSISCHROMO. ANALY. SOLID TISSUE

CITRATEUCIT

CK ISOENZYMES 10/00CK-ISOENZYMESCREATINE KINASE ISOENZYMESCK ISOENZYMES

CK-MBCREATINE PHOSPHOKINASECK MB FRACTIONCREATINE KINASE-MBMB FRACTIONCKMBCK MBCK-MB

CLOMIPRAMINE+DESMETHYLCLOMANAFRANIL

CLONAZEPAMKLONOPIN

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141

CLORAZEPATETRANXENE

CMV ANTIBODY PANELCYTOMEGALOVIRUS ANTIBODY PANEL

COAG RUSSELL VIPER VENOM INDRVVTSTYPVEN TIMERUSSELL'S VIPER VENOM

COCAINECOKE

COCCIDIOIDES ANTIBODIESCOCCI AB

COCCIDIOIDES IMMITIS IGGCOCCIDIODES F (IgG)

COCCIDIOIDES IMMITIS IGMCOCCIDIOIDES AB TP (IgM)

COMPLEMENT CH50COMPLEMENTTOTAL HEMOLYTICCH 50TOTAL COMPLEMENTCH50

COOXYMETRY PANELCOOX

COPPERCuCU

COPROPORPHYRINCOPUCOPROTETRACARBOXYPORPHYRINCOPROPORPHYRINS

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142

CORTISOL FREEUCORTCORTISOL FREE URINE

FREE CORTISOLCORTISOL.FREE

CREAT FOR MICROALBCREATININE FOR MICROALBUMIN PANEL

CREATINE KINASECREATINE KINASECK

CREATININE

CREAT

CREATININE CLEARANCECREAT CLCLEARANCE

CREATININE,24 HOUR URINEURINE CREATININEUCRUCREAT24 HOUR URINE CREATININE24 HR URINE CREATININE

CRYOGLOBULINCRYOG

CRYPTOCOCCUS SP AGCRYPTO ANTIGENCSF CRYPTOCOCCAL ANTIGENSPINAL FLUID CRYPTOCOCCAL AGSERUM CRYPTOCOCCAL ANTIGEN TESTCRYPTOCOCCAL ANTIGEN TEST

CRYPTOSPORIDIUM STAINMODIFIED AFB STAIN

CRYSTAL EXAM ONLY, SYNOVFLUID CELL COUNT

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143

CYCLIC CITRULINATED PEPTIDE ABANTI-CCPCCP ANTIBODY

CYSTINE 24HCYSTCYSTINE URINECYSTINE 24HR

CYTOLOGIC GYNGYNPAP SMEAR

CYTOMEGALOVIRUS DNA

CMV DNA

DATANTI-IGGDIRECT ANTIGLOBULIN TESTCOOMBS

DEHYDROEPIANDROSTERONEDHEADEHYDROEPIANDROSTERONE SERUM

DEOXYCHOLATEDEOXYCHOLIC ACID

DEOXYRIBONUCLEOPROTEIN ABANTI-DNPLUPUS ANTIGEN(RESEARCH ONLY)LE FACTOR ANTIBODIESANTI DNP

DHEA SULFATEDHEA-SDHEASDHEA-SO4DEHYDROEPIANDROSTERONE SULFATEDHEA-SULFATE

DIGITOXINDIGITALISCRYSTODIGIN

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144

DIGOXINLANOXIN

DIPHENHYDRAMINEBENADRYL

DIPHTHERIA TOXOID IGGDIPHTHERIA ANTITOXOIDDIPHTHERIA TOXOID AB IGG

DISOPYRAMIDENORPACE

DNA DOUBLE STRAND AB

DOUBLE STRANDED DNA SCREENDS-DNADSDNADNA SCREEN

DNASE B AB STREPTOCOCCAL 10/00DEOXYRIBONUCLEASE ABSTREPTONASE BANTI-DNASE BANTI DNASE BDNASE B AB STREPTOCOCCAL

DOXEPINSINEQUAN, SERUMADAPIN

DRUG SCREENDRUG PROFILETOXICOLOGY SCREENURINE DRUG SCREENDAU

E CHAFFEENSIS ABE CHAFFEENSISEHRLICHIA CHAFFEENSIS SEROLOGYEHRLICHIA CHAFFEENSIS AB

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145

E. COLI O:157 CULTUREO:157 CULTUREO157 CULTURE

E. COLI O157CULTURE, O157

EMETINEIPECAC

ENAEXTRACTABLE NUCLEAR ANTIGENENA PANEL

ENDOMYSIUM IGAENDOMYSIAL ANTIBODY IGA

ANTI ENDOMYSIALANTI-ENDOMYSIALENDOMYSIAL AB IGAtTG AB,IGATISSUE TRANSGLUTAMINASEENDOMYSIUM AB IGACELIAC ANTIBODY

EOS COUNT, ABSABSOLUTE EOSINOPHIL COUNT

EOSINOPHILSSEOSEOS,STOOL

EPIDERMAL ABANTI SKIN ANTIBODIESCUTANEOUS IMMUNOFLOURESCENCE,INDIRECTANTISKIN ABSANTI-SKIN ABS QNANTI-EPIDERMAL ANTIBODY

EPSTEIN BARR VIRUS CAPSID IGGEBV IgGEPSTEIN BARR VIRUS IgG AB

EPSTEIN BARR VIRUS CAPSID IGMEBV IgMEPSTEIN BARR VIRUS IgM AB

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WBAMC Pam 40-4

146

EPSTEIN BARR VIRUS DNAEPV DNA BY PCREPSTEIN BARR VIRUS DNA BY PCR

EPSTEIN BARR VIRUS EARLY ABEBV-EAEPSTEIN BARR VIRUS EARLY AG

EPSTEIN BARR VIRUS NUCLEAR AGEBV NA

ERYTHROPOIETINEPOERYTHROPOIETIN,EIA

ESRWESTERGREN SEDIMENTATION RATEWSRSED RATE (WSR)

ESTRIOLESTRSERUM ESTRIOLTOTAL ESTRIOL

ETHANOLETOHALCOHOL

ETHYLENE GLYCOLANTIFREEZE

FACTOR IX ACTCHRISTMAS FACTORANTIHEMOPHILIC FACTOR BFACTOR 9FACTOR IX ACTFACTOR IX ACTIVITY

FACTOR V ACTFACTOR 5FACTOR V ACTFACTOR V ACTIVITY

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147

FACTOR V LEIDEN MUTATIONFACTOR V MUTATIONLEIDEN,FACTOR V MUTATION

FACTOR VIISTABLE FACTORAUTOPROTHROMBIN IPROCONVERTINSERUM PROTHROMBIN CONVERSION ACCELERATOR (SPCA)SPCAFACTOR 7

FACTOR VIII ACTANTIHEMOPHILIC FACTOR

AHFFACTOR 8FACTOR VIII

FACTOR VIII INHIBITORBETHESDA INHIBITORFACTOR 8 INHIBITOR

FACTOR X ACTSTUART FACTORSTUART PROWER FACTORAUTOPROTHROMBIN CAUTOPROTHROMBIN IIIFACTOR 10

FACTOR XI ACTFACTOR 11

FACTOR XII ACTHAPEMAN FACTORFACTOR 12

FACTOR XIII ASSAYFIBRIN STABILIZING FACTORFACTOR 13

FATTY ACIDS NONESTERIFIED FREEFATTY ACIDSFATTY ACID, FREE (NONESTER)

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148

FECAL FAT PANELLIPIDS,FECES

FECAL FAT,QUANTSTOOL FATFECAL LIPIDSFECAL FAT QUANTITATIVE

FETAL MATERNAL HEMORRHAGEFMH

FISHFLUORESCENCE IN SITU HYBRIDIZATION

FLECAINIDETAMBOCOR

FLOW CYTOMETRY HIV T&B SUBSETSPANEL AT AND B SUBSETS

FLOW CYTOMETRY LYMPHOMA PANELLYMPHOMA PANELPANEL C

FLOW CYTOMETRY MYELOID PANELMYELOID PANELPANEL D

FLOW CYTOMETRY- HIVPANEL AT&B SUBSETST AND B SUBSETS

FLOW CYTOMETRY- LEUKEMIAPANEL BLEUKEMIA FLOW PANEL

FLOW CYTOMETRY- LYMPHOMALYMPHOMA FLOW PANEL

FLUOXETINEPROZAC

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149

FLUVOXAMINELUVOX

FOLLICLE STIMULATING HORMONEFSHFOLLITROPIN

FRANCISELLA TULARENSIS ABTULAREMIA AB

FRIEDREICH ATAXIA DNAFRDA1ATAXIAFRIEDREICH ATAXIA

FUNGAL CULTUREFUNGUS CULTUREYEAST CULTUREDERMATOPHYTE TEST DTMTHRUSH CULTUREMONILIA CULTUREMOLD CULTURECULTURE FUNGAL

G-AMINOBUTYRATEAAS-GAMMA-AMINO-BUTYRIC ACIDGAMMA AMINOBUTYRATE

G-GLOBULINGAMMA/ELECTROGAMMA GLOBULIN

G-GLUTAMYL TRANSFERASEGAMMA GTGTGGTGAMMA GLUTAMYL TRANSFERASE

G-HYDROXYBUTYRATEGHBGAMMA HYDROXYBUTYRATE

G6PDG-6-PDH SCREENG6PD SCREEN

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150

G6PD QNG6PD QUANTITATIVEG6PD,QUANT

G-6-PDH QUAN

GANGLIOSIDE GM1 ABANTI GM1GM1 GANGLIOSIDE ANTIBODIESANTIBODY TO GANGLIOSIDE GM1

GASESABGARTERIAL BGBLOOD GAS

CORD ARTERIALCORD BGCORD VENOUSVENOUS BG

GENETIC SEQUENCINGDNA SEQUENCEMELASMERRFMECP2GJB2

GENITAL CULTUREENDOCERVICAL CULTUREURETHRAL CULTUREVAGINAL CULTURELABIAL CULTUREUROGENITAL CULTURECERVICAL CULTURERECTAL/GC CULTUREGCGENITAL CULTUREGENTIAL CULT

GIARDIA LAMBLIA AGGIARDIA SPECIFIC ANTIGEN

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151

GLOMERULAR BASEMENT MEMB ABANTI-GBM ABSANTI GBM ANTIBODIES

ANTI GLOMERULAR ANTIBODIESGBM ANTIBODIESGOOD PASTURE'S SYNDROMEANTIGLOMERULAR BASEMT MEMBRANEANTIGLOMERULAR BASEMENT MEMB

GLUCAGONPANCREATIC GLUCAGON

GLUCOSE 1H PT GLUC PO 10/001 HR PP

DEXTROSE SCREENPOSTPRANDIAL 1 HR1 HR, GLUCOSEGLUCOSE 1HR PT CHALGLUCOSE 1H PT GLUC PO

GLUCOSE 2H PT GLUCOSEPO10/002 HR PPPOSTPRANDIAL 2 HR2 HRS, GLUCOSEGLUCOSE 2H PT GLUC POGLUCOSE 2H PT GLUCOSE PO

GLUCOSE 30M PT GLUCOSEPO10/001/2 HR, GLUCOSEGLUCOSE 30M PT GLUCOSE PO

GLUCOSE 3H PT GLUCOSE PO10/003 HRS, GLUCOSEGLUCOSE 3H PT GLUC POGLUCOSE 3H PT GLUCOSE PO



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152

GLUCOSE BS 10/000 HR. GLUCOSE

GLUCOSE BS

GLUCOSE UAUGLGLUCOSE,URINEURN:GLUCOSE

GLUCOSE,FLUIDFLUID GLUCOSEFGLUCSF GLUCOSE

GLUCOSE,SERUMFBSFASTING BLOOD SUGARSUGARGLUCOSE,FASTINGSERUM,GLUCOSE

GLUCOSE1.5H POSTGLUCOSEPO10/001.5 HR, GLUCOSEGLUCOSE 1.5H POST GLUCOSE PO

GLUTAMATE DECARBOXYLASE 65 ABGAD65 AB

GLYCOSAMINOGLYCANSGAGS

GRAM STAINGRAM SMEARBACTERIAL SMEAR

GRANULOCYTE ABANTI GRANULOCYTE ANTIBODIES

H CAPSULATUM ABHISTOPLASMA CAPSULATUM AB

H CAPSULATUM AGHISTOPLASMA CAPSULATUM AG

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153

H INFLUENZAE LATEXH FLU LATEX

H PYLORI ABH PYLORI ANTIBODIESHELICOBACTOR PYLORIPYLORIH.PYLORI

HAEMOPH INFLUENZAE B AG 07/01HAEMOPHILUS INFLUENZAE B ANTIGENINFLUENZAE B ANTIGENH INFLUENZAE B ANTIGENHAEMOPH INFLUENZAE TYPE B AG

HAEMOPHILUS INFLUENZAE B IGGHIB TITER

HANTAVIRUS ABSIN NOMBRE VIRUSPUUMALA VIRUS

HAPTOGLOBINHPT

HBCOCOHbBG:HBCO

HCGCHORIOGONADOTROPIN

HCG QNHCG,QUANTITATIVE (WBAMC ONLY)HCG, BETA (WBAMC ONLY)

HCG QUALITATIVE, CTMC ONLYHUMAN CHORIONIC GONADOTROPIN,QUAL

HCT,SPUNHCTSHCT, SPUNSPUN CRITSPUN HEMATOCRIT

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154

HDLHIGH DENSITY LIPOPROTEINHDL CHOLESTEROL

HEMOCHROMATOSIS HLAHereditary Hemochromatosis

HEMOGLOBIN A1CGLYCATED HEMOGLOBINA1C HEMOGLOBINHGB A1CHA1C

HEMOGLOBIN ELECTROPHORESIS

HGBELEHGBEP

HEMOGLOBIN H;SCREENUNSTABLE HEMOGLOBINHEMOGLOBIN,UNSTABLE,SCREENHGB H

HEP,FIBHEPASORB, FIB

HEP,PTHEPASORB, PT

HEP,PTTHEPASORB, PTT

HEPARIN ANTI-XA ASSAYANTI-FACTOR 10A

HEPATIC PANELLIVER PANELLFTSLIV1

HEPATITIS A AB, TOTALHEPATITIS A IGG/IGM ABHEPATITIS A VIRUS AB(TOTAL)

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155

HEPATITIS A IGMHAVab,IgMANTI-HAV,IgM

ANTIBODY TO HEP A VIRUS,IgMHEPATITIS A ANTIBODY, IGMHEPATITIS A VIRUS IGMHEPATITIS A IGM

HEPATITIS B CORE IGMANTI-HBC,IgMHBcAB,IgMHBCABHEPATITIS B CORE ANTIBODY,IgMHEPATITIS B VIRUS CORE IGM

HEPATITIS B DNAHBV DNAHEPATITIS B VIRUS DNA

HEPATITIS B SURFACE ABANTI-HBSHBsABHBsANTIBODYHEP Bs ANTIBODYAB TO HEP B SURFACE ANTIGENHBSABHEPATITIS B SURFACE ANTIBODYHEPATITIS B VIRUS SURFACE AB

HEPATITIS B SURFACE AGHBSAGHEP B SURFACE ANTIGENHEPATITIS B SURFACE ANTIGENHEPATITIS B VIRUS SURFACE AG

HEPATITIS B VIRAL LOADHEPATITIS B VIRAL DNA QUANT,PCR

HEPATITIS BE ABANTI-HBEHBEABANTIBODY TO HEP BE ANTIGENHEPATITIS BE ANTIBODY

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156

HEPATITIS BE AGHEPATTIS BE AGBEAG

HEPATITIS BE ANTIGEN

HEPATITIS C ABHCV AbHCABHEPATITIS C VIRUS ANTIBODYHEPATITIS C VIRUS AB

HEPATITIS C GENOTYPINGHCV GENOTYPING

HEPATITIS C RIBAHCV-RIBARIBAHEP C RIBA

HEPATITIS C RNAHEPTIMAXHEPATITIS C VIRUS RNAHCV RNA

HEPATITIS D ABANTI-HDVHDV ANTIBODYHEPATITIS D ANTIBODYHEPATITIS, DELTA ANTIBODYHEPATITIS D VIRUS AB

HERPES ANTIBODY I&IIHSVAB

HERPES CULTUREHEREPS SIMPLEX VIRUS TESTHSV TEST

HERPES SIMPLEX AGHSV ANTIGEN TESTHERPES SIMPLEX ANTIGEN TESTHERPES SIMPLEX VIRUS AG

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157

HETEROPHILE ABMONOSPOTHETEROPHILE ANTIBODY

MONOTEST

HGB ELECTROPHORESIS PNL(BAMC)HEMOGLOBIN ELECTROPHORESIS

HGB/HCT PANELHEMOGLOBIN/HEMATOCRITH/HHHHGBH&H

HISTONE ABD16DRUG INDUCED LUPUS ANTIBODIESHISTONE DIMER AUTOANTIBODIESANTIHISTONE ANTIBODIESANTIHISTONE ANTIBODIES 05/01

HIVHIV-ELISAHIV PANELZZHIV

HIV-1 VIRAL LOADHIV-1 GENOTYPE

HLA-B27HLAB27HLAB 27

HLA-DR PHENOTYPEHLA DR PHENOTYPEHLA PHENOTYPE DR

HOMOGENTISATEHOMOGENTISIC ACID

HPV TYPING HIGH RISKBHPVHPV TYPING, HIGH RISK

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WBAMC Pam 40-4

158

HSV ENCEPHAL DETECT.PCR,CSFHERPES SIMPLEX VIRUS ENCEPHALITIS DETECTION BY PCR

HUMAN GROWTH HORMONEHGHSOMATOTROPIC HORMONESOMATOTROPINSTHGROWTH HORMONE SERUM

HYDROXYPROLINE 24HOHPLHYDROXYPROLINE 24HR

HYPERSENS PNEUMONITIS PANELHYPERSENSITIVITY PNEUMONITIS QL

IBUPROFENMOTRINADVILNUPRINIBUPRO

IGDIMMUNOGLOBULIN D

IGEIMMUNOGLOBULIN E

IGF BINDING PROTEIN-3 1/02IGF-BP3IGF BINDING PROTEIN-3

IMIPRAMINETOFRANIL

IMIPRAMINE+DESIPRAMINETOTAL (IMI+DES)

IMMUNE COMPLEXES, C1q BINDINGC1q BINDING TESTC1Q

IMMUNOFIXATIONIFE

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WBAMC Pam 40-4

159

IMMUNOGLOBULIN AIGA

IMMUNOGLOBULIN GIGG

IMMUNOGLOBULIN G, QUANT CSFCSF IGGIGG CSF

IMMUNOGLOBULIN MIGM

INFLUENZA VIRUS A/B AGPROJECT GARGLEINFLUENZA VIRUS A+B AG

INRINTERNATIONAL NORMALIZED RATIO

INSULIN ABINSULIN ANTIBODIES

INTERLEUKIN 5IL5

IRONFE

IRON BINDING CAPACITY TOTALTOTAL IRON BINDING CAPACITYTIBC

IRON BINDING CAPACITY UNSATUNSATURATED IRON BINDING CAPACITYUIBC

IRON PANELFEPRFE PANELIRON

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160

IRON SATURATIONSAT% TRANSFERRIN SATURATION

% SATURATION%SATURATION

KAPPA LIGHT CHAIN FREEIKAPPA

KETONESUKETKETONES,U

KLEIHAUER-BETKE

KB

KOH PREPKOH WET PREPFUNGAL WET PREP

L PNEUMOPHILA ABDFA LEGIONELLALEGIONELLA DIR. FLUORESCENT ABLEGIONELLA PNEUMOPHILA AB

L PNEUMOPHILA AGLEGIONELLA ANTIGENLEGIONELLA PNEUMOPHILA AG

LA CROSSE VIRUS ABCALIF ENCEPH AB IGGCALIFORNIA ENCEPHALITIS AB IGG

LACTATELACTIC ACID

LACTATE DEHYDROGENASELDH

LACTOSE 1H PT 50G LACT PO 1/02LACTOSE 60 MINLACTOSE 1H PT 50 G LACTOSE PO

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LACTOSE 2H PT 50G LACT PO 1/02LACTOSE 120 MINLACTOSE 2H PT 50 G LACTOSE PO

LACTOSE 30M PT 50G LACT 1/02LACTOSE 30 MINLACTOSE 30M PT 50 G LACTOSE PO

LACTOSE 90 MIN90 MIN LACTOSE

LAMOTRIGINELAMICTAL

LD FRACTION 1LACTATE DEHYDROGENASE 1 ISOENZYMELD 1 ISOENZYME





LD ISOENZYMES 10/00LDH ISOENZYME (TOTAL)LD ISOENZYMES

LD ISOENZYMES.LACTATE DEHYDROGENASE ISOENZYMESLDH ISOENZYMES

LDLLOW DENSITY LIPOPROTEIN

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162

LEAD, BLOODBLOOD LEADBLEAD

PEDIATRIC LEAD

LECITHIN/SPHINGOMYELINLECITHIN/SPHINGOMYELIN RATIOL/S RATIO

LEGIONELLA SP ABLEGIONELLA ANTIBODYLEGIONARIESLEGIONNARIES ANTIBODY

LEPTOSPIRA SP ABLEPTOSPIROSIS ANTIBODIESFT BRAGG FEVERSWAMP FEVERSWINEHERD'S DISEASEWEIL'S DISEASECANICOLA FEVERLEPTOSPIRAL ANTIBODIES

LEUKOCYTE ACID PHOSPHATASETRAP

LEUKOCYTE ALKALINE PHOSPHATASELAP

LEUKOCYTE ESTERASEULELEUK ESTERASE,U

LEVETIRACETAMKEPPRA

LIDOCAINEXYLOCAINE

LIVER KIDNEY MICROSOMAL ABLKMLIVER/KIDNEY MICROSOME TYPE 1

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163

LUPUS ANTICOAGULANTACQUIRED ANTICOAGULANTCAC

INHIBITOR SCREEN, COAGULATION

LUTEINIZING HORMONELH

LYSOZYMEMURAMIDASE

LYTESELECTROLYTE PROFILE

M PNEUMONIAE IGGMYCOPLASMA PNEUMONIAE IGG

M PNEUMONIAE IGMMYCOPLASMA PNEUMONIAE IGM

MAGNESIUM,24 HOUR URINE24HR URINE MAGNESIUM24HR UR MAGNESIUM24HR UMGURINE MAGNESIUM 24HR24 HR UMG24HRMG 24 HR URINE

MALARIA/BLOOD PARASITE 10/00MALARIA SMEAR (THICK/THIN)MALARIA EXAMMALARIA/BLOOD PARASITE

MCHMEAN CORPSCULAR HEMOGLOBIN

MCVMEAN CORPUSCULAR VOLUME

MDMA AND METABOLITE SCREENECSTASYMETHYLENEDIOXYMETHAMPHETAMINE

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164

MELANIN QUALITATIVE URINEMELANOGEN

MENINGITIS PANELBACTERIAL MENINGITIS PANELLATEX MENINGITIS PANEL

MEPERDINE,QUALITATIVEDEMEROL

METANEPHRINE TOTAL 24HTOTAL METANEPHRINE,URINE(24HR)

METANEPHRINES, PHEO. SCREEN

PHEOCHROMOCYTOMA SCREEN

METHOTREXATEMEXATEMTX

METHYLMALONIC ACID 10/00METHYMALMETHYLMALONIC ACID

MEXILETINEMEXITIL

MITOCHONDRIAL ABAMAANTIMITOCHONDRIAL ABAMATANTI MITOCHONDRIAL ABMITOCHONDRIAL ABANTI-MITOCHONDRIAL ANTIBODY

MRSA CULTUREMRSA SURVEILLANCE CULTUREMETHICILLIN RESISTANT STAPH. AUREUS CULTURE

MUCIN CLOTMUCINRPOES TEST

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165

MUMPS VIRUS IGGMUMPS ABMUMPAB

MUMPS ANTIBODY TITER

MYELIN ASS GLYCOPROTEIN ABMAG ANTIBODY

MYELIN BASIC PROTEINMBP

MYOGLOBINSERUM MYOGLOBINMYOGLOBIN,SERUM

MYOGLOBIN UAURINE MYOGLOBINMYOGLOBIN,URINEMYOGOLOBIN UA

N-ACETYLGALACTOSAMINE-6-SULFSULFATE FIBROBLAST

N-ACETYLPROCAINAMIDENAPA

N-TELOPEPTIDECROSS-LINKED N-TELOPEPTIDETELOPEPTIDE,N

N-TELOPEPTIDE COLLAGEN XLINKEDN-TELOPEPTIDENTXCOLLAGEN XLINKED N-TELOPEPTIDE

NAPHTHOL CHLOROACETATE ESTER.SPECIFICLEDERCHLOROACETATE

NAPHTHYL BUTY. ESTERASEBUTYRATENON-SPEC

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166

NEURONAL NUCLEAR TYPE 1 ABANNA-1HU ANTIBODY

ANTI-NEURONAL ANTIBODY TYPE 1

NEURONAL NUCLEAR TYPE 2 ABANNA-2ANTI-NEURONAL ANTIBODY TYPE 2

NEUT CYTOPLASMICAB C-ANCA10/00C-ANCAANCA-CYTOPLASMICNEUT CYTOPLASMIC AB C-ANCA

NEUT CYTOPLASMICAB P-ANCA10/00P-ANCAANCA-PERINUCLEARNEUT CYTOPLASMIC AB P-ANCA

NORTRIPTYLINEAVENTYLPAMELOR

O&P PARASITE TESTOVA & PARASITE TESTO&P EXAMO/P EXAMPARASITE EXAMSTOOL FOR GIARDIAGIARDIA STOOL EXAM

OCCULT BLOODSTOOL GUAIACGUAIACOCCULT BLOOD TEST

OLIGOCLONAL BANDSBANDING,OLIGOCLONALOLIGOCLONAL BANDING

ONTD RISKOPEN NEURAL TUBE DEFECT RISKDM:ONTD RISK

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167

PASPERIODIC ACID-SCHIFF

PATH REVIEW CBCSLIDEBLOOD SMEAR,PATH CONSULTATIONCONSULT

PENTACARBOXYLPORPHYRINSPENTACARBOXYPORPHYRIN

PERIFERAL BLOOD, FRAGILE XBLDFXFRAGILE X

PGPG SPOT

PHENCYCLIDINEPCP

PHENYLKETONURIAPKU

PHENYTOINDILANTINPTN

PHOSPHORUSPO4INORGANIC PHOSPHORUSPHOSPHATESERUM PHOSPHORUSSERUM PO4

PHOSPHORUS,24 HOUR URINE24 HOUR URINE PHOSPHORUS24 HR UPO424 HR URINE PO4PO4 24 HR URINEPHOSPHATE 24 HR URINE24 HR URINE PHOSPHATE24HR

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168

PLATELET AB DIRECTANTIPLATELETANTI PLATELET ANTIBODY

CIRCULATING PLATELET ANTIBODIESANTIPLATELET ANTIBODYANTI-PLATELET AB DIRECT

PNEUMOCYST DFADFA PNEUMOCYSTISPNEUMOCYSTIS D.FLUORESCENT AB

PORPHOBILINOGEN DEAMINASEPbG DEAMINASEPBG DEAMINASE

POTASSIUM,SERUMSERUM POTASSIUMK+

PREALBUMINPAB

PRIMIDONEMYSOLINE

PROSTATE SPECIFIC AGPSAPROSTATE SPECIFIC ANTIGEN

PROSTATIC ACID PHOSPHATASEPAPACID PHOSPHATASE PROSTATIC

PROTEIN, URINETP URINEURINE PROTEINTOTAL PROTEIN,URINE

PROTOPORPHYRIN ZINCZPPZINC PROTOPORPHYRIN

PSEUDOCHOLINESTERASECHOLINESTERASE,PLASMA

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169

PTPROTHROMBIN TIMEPROTIME

PTTPARTIAL THROMBOPLASTIM TIME

PURKINJE CELLS ABYO ANTIBODIESPURKINJE CELL (YO) ANTIBODIES

PYRUVATEPYRUVIC ACID

QUINIDINECARDIOQUINQUINIDEXDURAQUINQUINORAQUINAGLUTE

RABIES VIRUS ABANTI-RABIES TITERRABIES ANTIBODYANTIRABIES TITERRABI ABANTI RABIES TITER

RAPID PLASMA REAGINRPR

RBC MORPHMORPHOLOGY

RENAL PANELCHEM7CHEM 7SMA7SMA 7PANEL7PANEL 7P7C7

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RENAL STONE ANALYSISKIDNEY STONE ANALYSISCALCULI, URINARY

URINARY CALCULI

RESP SYNCYTIAL VIRUS AGRSV ANTIGENRESPIRATORY SYNCYTIAL VIRUS

RESPIRATORY CULTURECULTURE RESPIRATORYSPUTUM CULTURE

RETICULIN IGA

RETIC ABRETICULIN IGA ANTIBODYRETICULIN AB IGA

RETICULOCYTESRETICULOCYTE COUNTRETRETIC COUNT

RETINOLVITAMIN A

REVERSE T3 10/00T3 REVERSEREVERSE TRI-IODOTHYRININEREVERSE T3

RHEUMATOID FACTOR, QUANTRARHEUMATOID ARTHRITIS TEST

RICKETTSIA AB PROFILE IGMROCKY MOUNTAIN SPOTTED FEVERTYPHUS

ROHYPNOL SCREENFLUNITRAZEPAM SCREEN

ROTAVIRUS AGROTAVIRUS ANTIGEN DETECTION

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RUBELLA VIRUS ABHAIRUBELLA

RUBEOLA VIRUS IGGMEASLES IgG ANTIBODYRUBEOLA IgGRUBEOLA ANTIBODYMEASLES IgG

SALICYLATESASPIRINSALICYLIC ACIDSALICYLATE

SEROTONIN5-HT,PLATELETPLATELET SEROTONIN5 HYDROXYTRYPTAMINE, PLATELET

SERUM DRUG SCREENTOXICOLOGY SERUM SCREENDSS

SERUM PROTEIN ELECTROPHORESISSPEPELECTROPHORESIS

SEX HORMONE BINDING GLOBULINSHBGTEBGTESTOSTERONE BINDING GLOBULIN

SGPG AUTOANTIBODIESSULFOGLUCURONYL PARAGLOBOSIDE AUTO ANTIBODIES

SICKLE CELL SCREENSICKLING SCREENHGB S SCREEN

SMALLPOXVACCINIA

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SOMATOMEDIN CGROWTH FACTOR I INSULIN-LIKESM-C/IGF-1

SOMATOMEDIN-CSULFATION FACTORIGF-1

SPOROTRICHOSIS ABSPOROTHRIX AB

STOOL CULTURESTOOL FOR SALMONELLASTOOL FOR SHIGELLASTOOL FOR ENTERIC PATHOGENS

STOOL FOR YERSENIASTOOL FOR CAMPYLOBACTERRECTAL SWAB FOR ENTERIC PATHOGENSSALMONELLA CULTURESHIGELLA CULTUREENTERIC PATHOGENS STOOL CULTURESC

STRIATED MUSCLE ABANTISKELETAL MUSCLE ANTIBODIESSTRIATED MUSCLE ANTIBODY

T4 BY DIALYSISEQUILIBRIUM DIALYSIS, SERUMT4

T4 FREEFREE THYROXINET4FREE T4

TACROLIMUSFK506

TAY-SACHSHEXOSAMINIDASE A & TOTAL ANALYSIS

TETANUS ANTITOXIN IGGTETANUS ANTIBODYANTI TETANUS TOXOIDANTI-TETANUS TOXOID

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ANTITETANUS TOXOID IGGTETANUS ANTITOXIN AB IGG

THIAMINE PYROPHOSPHATEB1VITAMIN B1-THIAMINEVITAMIN B1

THIOPURINE METHYLTRANSFERASEPRO-PREDICTR TPMTTPMT

THROMBIN TIMET TIME

TT

THYROID MICROSOMAL ABTHYROID AUTOANTIBODIESTPO ANTIBODIESANTI-MICROSOMAL ANTIBODYANTIMICROSOMAL ANTIBODY

THYROTROPIN BINDING INHIB IGBTBII

THYROXINE ABANTI-T4 AUTOANTIBODY

THYROXINE, TOTALTOTAL T4

TOCAINIDETONOCARD

TRANSCOBALAMINVITAMIN B12 UBCVITAMIN B-12 UNSAT BIND CAPVITAMIN B12 UNSAT BIND CAPVIT B12 BINDING CAP UNSAT

TRAZODONEDESYREL

TRH-TSH STIMULATION PANELSTIMULATION PANEL

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TSH STIMULATION PANEL

TRICHROME STAIN

PARASITE STAIN

TRIIODOTHYRONINET3TOTAL T3

TRIPLE SCREENTRIPLE MARKER PROFILETSS

TSH AUTOANTIBODY

ANTI THYROTROPIN ABTHYROTROPIN AUTO ABANTI-TSH AUTOANTIBODY

TSH, SENSITIVETHYROID STIMULATING HORMONETSH

TYPE & CROSSMATCH PACKED CELLST&CCROSSMATCHTYPE

TYPE & CROSSMATCH,AUTOLOGOUSCROSSMATCHT&C

TYPE & SCREENT&STYSC

TYPE & SCREEN CONVERT TO XMCROSSMATCHTYSCTYPE

UREA NITROGENBUNBLOOD UREA NITROGENUREA NITROGEN, BLOOD

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URINE CULTURECULTURE URINEUC

URINE MUCOPOLYSACCHARIDESUMPLY

URINE ORGANIC ACIDSORGANIC ACIDS, URINE

URINE PROTEIN ELECTROPHORESISUPEP

URISTIX

URINE GLUCOSE/PROTEIN

UROPORPHYRINOGEN I SYNTHASEUPG-S

VAGINAL/RECTAL GpB STREP CXGENITAL CULTURE

VALPROATEDEPAKENEVALPROIC ACID

VITAMIN B6B 6 VITAMINPYRIDOXINEPYRIDOXAL 5-PHOSPHATE

VITAMIN EALPHA TOCOPHEROL

VMA,24HR URINEVANILLYLMANDELIC ACID,24HRVMA

VON WILLEBRAND FACTOR AGVWF ANTIGENVON WILLIBRAND FACTOR ANTIGEN

WARFARINCOUMADIN

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YERSINIA CULTURE

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DEPARTMENT OF THE ARMYSOLDIER FAMILY MEDICAL CLINIC, WBAMC

Building 2496, Ricker Rd., Ft Bliss, El Paso, TX 79916

WBAMC PAMPHLET 40-4 2 March 2005



Purpose 1 176Applicability 2 176References 3 176

Explanation of Abbreviations and Terms 4 176Background 5 177Responsibilities 6 177General Information 7 177Anatomic Pathology Service 8 186Clinical Pathology Service 9 186Appendix A Explanation of Abbreviations and Terms 187

B Telephone Numbers 190C Emergency (STAT) Test Menu 191D Tube Requirements for Laboratory Specimen Submission 192E Clinical Pathology Service Test Manual 193F Names and Synonyms of Laboratory Tests 206

1. PURPOSE. This pamphlet is designed to assist the medical staff of the Soldier Family Medical Clinic, WBAMC (SFMC) and outside submitting stations in utilizinglaboratory resources.

2. APPLICABILITY. This pamphlet applies to all direct Health Care Providers (HCP)assigned or attached to WBAMC and to all submitting stations requesting services or support from the Department of Pathology and Area Laboratory Services (DPALS) atWBAMC.

3. REFERENCES.




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5. BACKGROUND.

a. The Department of Pathology and Area Laboratory Services is responsible for providing responsive, high quality laboratory testing in support of patient care.Use of this pamphlet will reduce ordering errors and conserve resources.


a. Chief, DPALS will develop, maintain, and implement guidance for HCP to obtainlaboratory support, WBAMC Pamphlet 40-4.

b. Department/Division/Service Chiefs and Clinic/Hospital staff will familiarizethemselves with the WBAMC Pamphlet 40-4, and obtain laboratory support and

service using guidelines found within the pamphlet.

c. DPALS staff will monitor current laboratory practices and when technical and/or procedural guidance change, they will develop and broadcast LaboratoryBulletins updating HCP to the new laboratory guidance.


a. Location. SFMC Laboratory is located in Building 2496, SFMC, Fort Bliss,Texas. Ambulatory patient specimen collection and processing service is locatedacross from the wellness center and next to radiology.




(1) The laboratory maintains 0700-1700, Monday-Friday, as normal duty hours.Routine services (outpatient specimen collection, processing, and testing) areoffered during these times. Routine services are NOT offered on weekends,Federal holidays, and designated training holidays.

(2) Core Laboratory services are offered 24 hours a day, 7 days a week at theWBAMC main lab. When laboratory testing is required during a time other thannormal duty hours, the specimen is to be collected by the requesting serviceand brought to the WBAMC main laboratory for processing and testing.

(3) Emergency (STAT) testing is performed during normal duty hours. HCP are

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given the opportunity to order a laboratory test using the STAT priority if the testis found on the DPALS Emergency (STAT) Test Menu (Appendix C) or anyother assay after seeking Pathologist’s approval.


(1) Outpatient Collection. Ambulatory patient specimen collection andprocessing service is staffed by phlebotomists and processing personnel0700-1700, Monday through Friday to support outpatient clinic/serviceoperations. This service is NOT offered on weekends, Federal holidays, andtraining holidays. When the specimen collection service is closed, therequesting clinic/service is responsible for the collection and transportation of the sample to the main laboratory, WBAMC.

(2) Reference/Commercial Laboratory Service. The laboratory has a variety of military and commercial laboratory services for those tests not performed in-house. All specimens submitted to the laboratory processing section for acivilian referral laboratory other than the reference contracted laboratory willrequire a properly completed DD Form 2161, Referral for Civilian MedicalCare. Failure to correctly fill out the DD Form 2161 may result in shippingdelays. In order to ship out a specimen on the same day received thespecimen must be submitted prior to 1200.


(1) CHCS is the primary means by which HCP submit laboratory orders. HCPsubmitting laboratory orders for outpatients, PreOp patients, and patientsbeing seen in the clinic or service will use CHCS order entry.

(2) Whenever the Hospital Information System (CHCS) is inoperative it isnecessary for the HCP to submit the appropriate laboratory request slip, SF557. All specimens and accompanying request slips must be clearly andappropriately labeled. All request slips MUST be printed legibly and MUSTinclude the following:



(c) Ward, clinic, or requesting location, to include the MEPR location code.

(d) Date/time collected.

(e) Test(s) requested.

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(f) Priority (ROUTINE, ASAP, PREOP, STAT).

(g) Physician's full name (name stamp if available) and physician’s

clinic/ward/pager telephone number.

(h) Pertinent clinical information for assays requiring laboratory interpretation.

(i) Cultures must show specimen source.

(3) For wards/units without CHCS Order Entry capability (i.e. SRP site),laboratory personnel place clinical laboratory test orders into the computer from the appropriate laboratory requisition slips. All outpatient or referrallocations that have CHCS Order Entry capability will place the order in CHCSprior to sending a sample or patient to the SFMC Laboratory for collection and

processing.

(4) Decentralized Order Entry using CHCS allows HCP to enter orders for ALLclinical laboratory tests, cytology tests, surgical specimens, and limited bloodbank procedures.

(a) The appropriate laboratory requisition slips must be used for ordering allprocedures whenever the computer system is inoperative and patient carewould be compromised by waiting until the system is again available for use. If the computer downtime is known to be one hour or less, pleaserefrain from placing manual orders unless absolutely necessary for patientcare.

(b) A DD Form 2161, Referral for Civilian Medical Care, must be submittedwhen ordering tests which are not in the automated Laboratory Test Fileand the testing is only performed by a commercial reference laboratory.The DD Form 2161 will be completed and submitted by the requestingHCP. DPALS will review and validate the request and coordinate therequest with the appropriate commercial laboratory.

g. Laboratory Priorities. The following four processing priorities are used by theSFMC Laboratory:

(1) STAT. The priority STAT will be used ONLY when a patient's life is in danger,or in a situation wherein immediate life-saving treatment is pending thelaboratory result. This priority should rarely be used. Rule of thumb: Thepatient's status should be that or equal to being on the SI or VSI (seriously illor very seriously ill, respectively) list or in an unstable state in the ED(Emergency Department). Test results submitted with STAT priority will berigidly managed with a goal to keep turnaround-time (TAT) to one hour or less. ONLY the tests listed in Appendix C may be ordered in CHCS with a

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adhered to for all patients. These precautions, called Standard Precautions,will be followed regardless of any lack of evidence of the patient's infectivestatus.

(4) The practice of Standard Precautions eliminates the need for using specificwarning labels on specimens obtained from patients infected with Hepatitis Bvirus or Human Immuno-deficiency Virus (HIV). All specimens must betreated as if infectious and capable of transmitting a serious infectiousdisease.

(5) Upon being collected from the patient, all specimens should be placed into aleak-proof primary container with a secure closure. Care must be taken bythe person collecting the specimen not to contaminate the outside of theprimary container.

(6) Before being transported to the laboratory, the primary container must beplaced into a secondary container that will contain the specimen if the primarycontainer breaks or leaks in transit to the laboratory. Plastic bags withzip-lock or twist-tie closures may be used as secondary containers.

(7) Laboratory requisition slips (or computer-generated orders) should beprotected from contamination and separated from the primary container.Contaminated requisition slips will not be accepted. The submitting locationwill be notified and requested to replace any contaminated slip.

(8) Preparation. Prior to each collection, review the laboratory's specimenrequirement(s). (See Clinical Pathology Service Test Manual, Appendix E.)Note the proper specimen to be collected, the amount, the procedure to beused, the collection material, and the storage and handling requirements.

(a) Preparing the Patient. Provide the patient in advance with appropriatecollection instructions and information on fasting, diet, and medicationrestrictions when necessary. These instructions are also available at thelaboratory.

(b) Preparing the Specimen. To avoid incorrect identification, label thespecimen container using an adhesive specimen label immediatelyfollowing the collection. Confirm the accuracy of identification of thespecimen in the presence of the patient. Process the specimen asrequired and store properly. During specimen collection, preparation, andsubmission, there is a much greater possibility of clerical error than duringthe actual testing or examination of the specimen. Errors in storage andhandling compromise the integrity of the specimen and, thus, the testresults.

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(c) One specimen should be submitted for each test requested. However, asingle tube for a multiple test request may be drawn when a large number of tests are being ordered on a particular patient and the tests are

performed on the same test specimen (e.g., serum or plasma). Drawing atube for multiple test requests helps to ensure that blood draws are limitedto the least amount of blood possible, which benefits the patient. When asingle tube is collected for a multiple test request, laboratory SpecimenProcessing personnel will split the specimen and ensure patientdemographics are accurately transcribed to each aliquot tube. Theindividual overseeing the specimen collection must ensure sufficientspecimen is provided for performing the requested tests. (NOTE: Serumor plasma normally makes up approximately 40% - 45% of a bloodcollection. Of this amount, about 75% can be removed from theclot/sedimented cells, i.e., only about 3 mL of serum/plasma can be

obtained from a full 7-mL tube.)

(9) Specimen Rejection (General Guidelines). The rejection of unacceptablespecimens and the special handling of sub-optimal specimens will beconsidered very carefully and on a case-by-case basis by the sectionsupervisor. If a specimen must be rejected, the requester will be notified andadvised of the reason(s) and a comment will be entered in the laboratoryreport. Specimens may be rejected in the following situations:

(a) Mismatched specimen and slip - submitting service will be notified andgiven the opportunity to correct this situation.

(b) Unlabeled specimens - submitting service will be notified and given theopportunity to resubmit.

(c) Contaminated specimen or slip - submitting service will be contacted andgiven the opportunity to provide a new specimen or slip.


(10) Avoid Common Errors. Careful attention to routine procedures caneliminate most of the errors outlined in this section. The complete bloodcollection system and other collection materials provided by the laboratorycan maintain the integrity of the specimen only when they are used in strictaccordance with instructional materials. The following are General SpecimenCollection Errors:


• Insufficient quantity (ensure collection container is filled to theappropriate level).


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• Inaccurate/incomplete patient instructions prior to collection.



• Failure to provide legible physician's full name (name stamp if available), physician’s last four of SSN or unique provider number, andphysician’s clinic/ward/pager telephone number so that results can besent to the proper provider.


• Failure to separate serum from red cells within 30 to 45 minutes after venipuncture.

• Hemolysis - RBC’s damaged and intracellular components spilled into

serum.• Turbidity - cloudy or milky serum sometimes due to patient's diet.







• Failure to obtain a clean-catch, midstream specimen.

• Failure to refrigerate specimen.

• Failure to provide a complete 24-hour collection or other timedspecimen.

• Failure to add proper preservative to the urine collection container after receipt of the specimen, prior to aliquotting.

• Failure to provide a sterile collection container and to refrigeratespecimen when bacteriological examination of the specimen isrequired.



(e) Hemolysis. In general, grossly or even moderately hemolyzed bloodspecimens are not acceptable for testing. Hemolysis occurs when the redblood cells rupture and hemoglobin and other intracellular components

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spill into the serum/plasma. Hemolyzed serum/plasma is pink or red,rather than the normal, clear, straw color.




• To ensure adequate mixing of blood with anticoagulant or preservative,use a slow, rolling wrist motion to invert the tube gently five or sixtimes. Rapid wrist motion or vigorous shaking contributes either tosmall clot formation or hemolysis and fails to initiate proper mixingaction.

• Check to see that all the preservative or anticoagulant is dissolved. If any preservative powder is visible, continue inverting the tube slowlyuntil the powder is dissolved.


(g) Vacuum Tubes Without Anticoagulants. Permit the tube to completely fillwhen using vacuum tubes not containing anticoagulants or preservatives.

(h) Turbidity (Lipemic Serum). Lipid-containing serum/plasma may not be atrue indicator of the patient's physiological state. It is important to obtain a

representative specimen that will help the physician differentiate betweentransient dietary lipemia and chronic lipemia caused by other factors. Toavoid dietary induced high lipid levels prior to testing, many physiciansrequire patients to exclude the high fat foods from their diets or to fast 10to 14 hours prior to specimen collection. For morning specimen collection,the laboratory recommends that the patient be required to fast from 8 P.M.on the previous evening.

j. Laboratory Critical (Panic) Values.

(1) A critical laboratory value is defined as, "a value at such variation with normal

as to present a pathophysiologic state that is life-threatening unless someaction is taken in a very short time and for which an appropriate action ispossible." It is a laboratory's responsibility to communicate these valuesimmediately and flawlessly to the responsible clinician(s).

(2) Whenever possible, CHCS will be programmed to identify and report criticalvalues. Tests whose results are critical will cause a PRIORITY RESULTBULLETIN to be automatically generated. The bulletin is sent to the HCPentered in CHCS as the ordering physician.

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(3) Telephonic notification of critical values will also be made. CHCS does notrelieve the laboratory of its responsibility to ensure that all critical values are

reported. Whenever possible, the requesting physician will be contacted. If that person is unavailable, another clinician or nurse from the requestinglocation will be notified. After hours, the MOD, on call physician for thatservice, or POD will be notified.

k. Retrieval of Laboratory Results.

(1) All results for tests ordered STAT, ASAP, all tests whose certified resultsexceed laboratory "CRITICAL VALUES", and all results that are amendedcause a PRIORITY RESULT BULLETIN to be automatically generated inCHCS. The bulletin is sent to the HCP entered in the system as the ordering

physician. The bulletin informs the user that Priority Laboratory Results arewaiting and instructs the user to use the RNR option to retrieve the results.

(2) Results for tests ordered with PREOP, ASAP, or ROUTINE priorities are NOTautomatically printed at the ordering location.

(3) The electronic patient file is considered the official file. HCP should reviewpatient results in CHCS. There are no laboratory cumulative reports printed.

l. Misrouted Laboratory Results.

(1) HCP who receive laboratory results that they have not ordered should notdiscard/toss the results until contact is made to the DPALS computer systemsanalyst.

(2) HCP who receive critical laboratory results that they have not ordered shouldbring the issue to the immediate attention of the pathology resident on call.The pathology resident will take appropriate steps to notify the correctprovider of the critical laboratory results. The pathology resident will pass theinformation to the DPALS computer systems analyst on the next normal dutyday.

(3) HCP who receive routine non-critical laboratory results that they have notordered should bring the issue to the attention of the DPALS computer systems analyst.

(4) The DPALS computer systems analyst will take appropriate steps todetermine the correct ordering HCP/department/service from which the order originated. The analyst will then contact the HCP originally receiving theresults and request that he/she forward the results to the correct HCP. If thatHCP cannot forward the results for whatever reason, the analyst will forward

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a hard copy of the results to the HCP who originated the orders or to his/her department/service chief. The HCP originally receiving the results may thendiscard/toss the results.

8. ANATOMIC PATHOLOGY SERVICE. The Anatomic Pathology Serviceencompasses the sections of Cytology, Surgical, and Autopsy Pathology. Theservice is in the Department of Pathology on the 3rd floor of WBAMC and is openroutinely 0730-1630 Monday through Friday. A staff pathologist is on call for problems arising during non-duty hours. A pathology on call roster is distributedmonthly to all clinical services.

The SFMC laboratory will only receive and transport specimens for these sections.If specimens are received by 1200 hrs, they will be transported the same day. If specimens are received after 1200, they will be transported on the following

business day. See the WBAMC handbook for specimen criteria.

9. CLINICAL PATHOLOGY SERVICE. The SFMC offers clinical pathology services toFt. Bliss and WBAMC using qualified professionals and state of the art methods andinstrumentation. Clinical Pathology Service consists of the following services:Hematology, Chemistry, and Urinalysis. Specimens will also be received by thislaboratory and transported to the main lab, WBAMC for microbiology, blood bank,anatomic pathology, and shipping. See the WBAMC guide for specimenrequirements. Quality is the top priority and will not be compromised in any situation.Test results from all sections are continuously monitored for reliability, precision, andaccuracy by both internal and external quality control programs. The laboratory isdirected by board-certified pathologists. The laboratory’s accreditation, licensure,and other inspections include: Joint Commission for the Accreditation of HealthcareOrganizations (JCAHO); College of American Pathologists (CAP); Inspector General; DoD Center for Clinical Laboratory Management (CCLM); U.S. ArmyEnvironmental Hygiene Agency; and Occupational, Safety and Health Administration(OSHA).

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APPENDIX A


AF Air Force

ALK Alkaline



AP Anatomic Pathology



BAMC Brooke Army Medical Center

BASO Basophile

BATT Battery

BBF Blood Body FluidBC Blood Culture

BUN Blood Urea Nitrogen

CA Calcium



cc cubic centimeter




CCLM Center for Clinical Laboratory ManagementCO2 Carbon Dioxide

COAG Coagulation

COMP Complete


CULT Culture

dL deciliter





ED Emergency DepartmentEDTA Ethylenediaminetetraacetate



EOS Eosinophil




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GGT Gamma Glutamyltransferase

gm gram


HCT HematocritHDL High Density Lipoprotein


HGB Hemoglobin


HR Hour



IRR Immediate Result Reporting







mg milligrams

MI Middle Initial

mL milliliter


mm millimeter

MONO Monocyte

MPV Mean Platelet VolumeMTF Medical Treatment Facility

NCOIC Non Commissioned Officer in Charge

NLT Not Later Than




PAN Panel

Ped Pediatric

PERI Peripheral

PLT Platelet

POD Pathologist-of-the-Day

PREOP Preoperative

QUAL Qualitative

QUANT Quantitative

R/O Rule Out

RBC Red Blood Cells



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SCR Screen

SI Seriously Ill


SST Silicone (Serum) Separator TubeSTAT Emergency, Request Priority

SUM Summation


TOT Total

UA Urinalysis

URN Urine



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APPENDIX B

SFMC Laboratory Telephone Numbers

Civilian Supervisor…………………………………………………………………. 568-4107NCOIC………………………………………………………………………………. 569-1481Front Desk…………………………………………………………………………..Hematology…………………………………………………………………………

568-3080569-4300

Chemistry……………………………………………………………………………FAX…………………………………………………………………………………..

569-4334569-3530

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APPENDIX C

Emergency (STAT) Test Menu

Procedures authorized to be ordered and performed as Emergency (STAT)

The tests listed in this appendix may be ordered STAT, individually. If other tests areordered on the same laboratory specimen, the request will automatically be reprioritizedto an ASAP request. ASAP turnaround time is within 2 hours.

CHEMISTRY SECTIONBasic Metabolic Panel (BMP): BUN, Calcium, Chloride, CO2, Creatinine, Glucose,Potassium, Sodium

Albumin Gamma-Glutamyl Transferase

Amylase HCG, serum, qualitativeAlkaline Phosphatase High Density Lipo-Protein

Alanine Aminotransferase Lactate Dehydrogenase

Aspartate Aminotransferase Phosphorus

Calcium Total Bilirubin

Cholesterol Triglyceride

Direct Bilirubin Uric Acid

HEMATOLOGY SECTION

CBC with automated differential Sickle Cell Screen

Monospot

URINALYSIS SECTION

Urinalysis, macroscopic

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APPENDIX D


The following table lists the collection tubes that should be used when drawing and/or submitting specimens. Point of contact for questions or additional guidance is thelaboratory at 915-568-3080.

Test Tube(s) Other InstructionsHematology CBC BD Lavender, 4 mL

ChemistryGold, Red, or Marble BD with or without

gel

Lipid ProfilesGold/Marble/Red BD with or without gel

Or Plain Red Glass

Must be fastingspecimen

Hormone and Cancer Markers Plain Red BD GlassBlood Bank Pink BD, 6 mL

Immunology/Serology Gold/Marble/Red BD with or without gel

Thyroid Panel Gold/Marble/Red BD with or without gel

Sed Rates BD Lavender, 4 mL Fill completely

Urine Cultures 5 oz Sterile Urine Cup

Urinalysis 4.5 oz non-sterile urine cup

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APPENDIX E



1HR GLUCOSECHALLENGE,PREGNANT

1. Patient Preparation: None.2. Collection Container: Sodium Fluoride tube (gray top).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Give patient 50

grams Glucola. Draw 1 hour after ingestion. If utilizingany tube other than a gray top, centrifuge and removefrom clot within 30 minutes of collection.

5. Cause for Rejection: Hemolysis.


2HR POSTPRANDIALGLUCOSE


2. Collection Container: Sodium Fluoride tube (gray top).3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Draw 2 hours after

meal. If utilizing any tube other than a gray top,centrifuge and remove from clot within 30 minutes of collection.

5. Cause for Rejection: Hemolysis.


ACETEST 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

ALBUMIN 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)

3. Specimen and Volume Required: 1 mL serum or plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

ALK PHOSPHATASE 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

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plasma.4. Specimen Processing Instructions: Centrifuge and

remove from clot within 4 hours of collection.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

ALT 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

AMYLASE 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or


remove from clot within 4 hours of collection.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

AST 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

BASIC METABOLICPANEL

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 2 mL serum or

plasma.

4. Specimen Processing Instructions: Centrifuge andremove from clot within 2 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Tests in Panel: GLUCOSE; UREA NITROGEN;

CREATININE; SODIUM; POTASSIUM; CHLORIDE;CARBON DIOXIDE; ANION GAP (NA-CL-CO2);CALCIUM

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BILIRUBIN, DIRECT 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)

3. Specimen and Volume Required: 1 mL serum or plasma.

4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection. Protectfrom light.


BILIRUBIN, INDIRECT 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST) or

Lithium Heparin tube (green top).

3. Specimen and Volume Required: 1 mL serum or plasma.4. Specimen Processing Instructions: Centrifuge and

remove from clot within 4 hours of collection. Protectfrom light.


BILIRUBIN, TOTAL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection. Protectfrom light.


CALCIUM 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.

4. Specimen Processing Instructions: Maintain integrity of sample by keeping sample container closed until testing.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

CARBON DIOXIDE 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.

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4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection. Maintain

integrity of sample by keeping sample container closeduntil testing.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

CBC PROFILE 1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube or


draw to the level of its vacuum, mix gently. Transport

sample to the laboratory at room temperature. Must bereceived by the laboratory within 8 hours of collection.5. Cause for Rejection: Hemolysis, clots, or quantity not

sufficient.6. Expected TAT: 1-4 hours.7. Tests in Panel: HGB; HCT; WBC; RBC; MCV; MCH;

MCHC; RDW; PLT; MPV; %:NEUTRO; %:LYMPH;%:MONO; %:EOS; %:BASO; EOS; BASO; NEUTRO;LYMPH; MONO

CHLORIDE 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or plasma.

4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection.


CHOLESTEROL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 1 mL serum.

4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection.5. Cause for Rejection: None.6. Expected TAT: 48 hours.

CLINITEST 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.

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COMP METABOLICPANEL (NEW)



remove from clot within 2 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Tests in Panel: ALK PHOSPHATASE; ALBUMIN;

BILIRUBIN, TOTAL; CALCIUM; CHLORIDE;

CREATININE; GLUCOSE; POTASSIUM; PROTEINTOTAL; SODIUM; AST; CARBON DIOXIDE; UREANITROGEN; ALT

CREATININE 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or




ELECTROLYTESPANEL



remove from clot within 2 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Tests in Panel: SODIUM; POTASSIUM; CHLORIDE;

CARBON DIOXIDE; ANION GAP (NA-CL-CO2)

ERYTHROCYTESEDIMENTATIONRATE (ESR)

1. Patient Preparation: None.2. Collection Container: 4 mL EDTA purple top tube.3. Specimen and Volume Required: EDTA whole blood.4. Specimen Processing Instructions: Gently mix tube

after collection to ensure anti-coagulant is effective.5. Cause for Rejection: Under filled tubes.6. Expected TAT: 4 hours.

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FECAL LEUKOCYTE 1. Patient Preparation: None.

2. Collection Container: Sterile jar-type container.3. Specimen and Volume Required: Fresh, unpreserved

stool. Routine requests may be submitted in PVA.4. Specimen Processing Instructions: Do NOT preserve.


Presence of preservative. Contaminated with urine.6. Expected TAT: 1-4 hours.

G-6-PDHQUALITATIVE

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube.

3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Submit whole blood,

do NOT separate cells or freeze specimen. Refrigerate.5. Cause for Rejection: Specimen cannot be analyzed if

over 7 days old, separated, or frozen.6. Expected TAT: 48 hours.

GGT 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.

4. Specimen Processing Instructions: Centrifuge andremove from clot within 4 hours of collection.


GLUCOSE 1. Patient Preparation: None.2. Collection Container: Sodium fluoride (gray top) or

Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

plasma.4. Specimen Processing Instructions: If utilizing any tube

other than a gray top, centrifuge and remove from clotwithin 30 minutes of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

GLUCOSE,2 HOURPOST PRANDIAL


2. Collection Container: Sodium fluoride (gray top tube).3. Specimen and Volume Required: 1 mL plasma.

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4. Specimen Processing Instructions: Draw 2 hours after meal ingestion.


HDL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: Normally performed

as part of Lipid Profile. Ship on dry ice.5. Cause for Rejection: None.6. Expected TAT: 48 hours.

HEPATIC FUNCTIONPANAL



remove from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Tests in Panel: ALBUMIN; BILIRUBIN, TOTAL; ALK

PHOSPHATASE; AST; ALT; BILIRUBIN, DIRECT;TOTAL PROTEIN

HIV ANTIBODYSCREEN

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 5 mL serum,

minimum volume 2 mL.4. Specimen Processing Instructions: Draw separate tube

for this test. Ship refrigerated.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 7 days.7. Test Performed by Viromed Laboratories

ICTOTEST 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

KETONE BODIES 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)

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4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

LD 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or


remove serum from clot within 1 hour of collection.5. Cause for Rejection: Hemolysis.


LIPID PROFILE 1. Patient Preparation: Patient should fast 12-14 hoursprior to collection.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Refrigerate if

transport is delayed.5. Cause for Rejection: Patient must fast 12-14 hours.6. Expected TAT: 48 hours.7. Tests in Panel: CHOL:HDL RATIO; CHOLESTEROL;

HDL; LOW DENSITY LIPOPROTEIN; TRIGLYCERIDE

MANUALDIFFERENTIAL

NOTE: Performedwhen indicated byautomated differentialflags or if authorized bysupervisor or medicaldirector of hematology.


draw to the level of its vacuum, mix gently. Transport tolaboratory at room temperature. Must be receivedwithin 8 hours.

5. Cause for Rejection: Clotted, hemolyzed, or quantitynot sufficient, age of specimen more than 12 hours.

6. Expected TAT: 8 hours.1. Tests in Panel: SEGS; BANDS; LYMPH; MONO; EOS;BASOPHIL; ATYPICAL LYMPHS;METAMYELOCYTES; PLATELET ESTIMATE;ANISOCYTOSIS; POIKILOCYTOSIS; MACROCYTES;POLYCHROMASIA; HYPOCHROMASIA;MICROCYTOSIS; RBC MORPH; NUCLEATEDRBC/100 WBC; BLASTS; PROMYELOCYTE; MYELO;OTHER WBC; BASO STI; TOXIC GRAN; CORRECTED

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WHITE BLOOD COUNT; ECHINOCYTES;DACROCYTES; ACANTHOCYTES; CODOCYTES;

SCHISTOCYTES; OVALOCYTES; STOMATOCYTES;SMUDGE CELLS; DOHLE BODIES; HOWELL JOLLYBODIES

MONOSPOT 1. Patient Preparation: None.2. Collection Container: Red top tube.3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: None.5. Cause for Rejection: Hemolysis or quantity not

sufficient.6. Expected TAT: 24-48 hours.

OCCULT BLOOD 1. Patient Preparation: None.2. Collection Container: Hemoccult card.3. Specimen and Volume Required: Fresh stool.4. Specimen Processing Instructions: Transfer fresh stool

from collection container to Hemoccult card using aclean wooden disposable applicator stick.

5. Cause for Rejection: Improperly collected or unlabeled.6. Expected TAT: 2 days.

PHOSPHORUS 1. Patient Preparation: None.

2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or


remove plasma from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

POTASSIUM 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or



PREGNANCY TEST,QUAL

1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum.

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4. Specimen Processing Instructions: None.5. Cause for Rejection: None.


PROTEIN TOTAL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or


remove serum from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.

RAPID PLASMAREAGIN

1. Patient Preparation: Aseptic technique.2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 3 mL serum.4. Specimen Processing Instructions: Centrifuge and

remove serum from clot within 4 hours of collection.5. Cause for Rejection: Improperly collected or labeled.6. Expected TAT: 3 days.

RENAL PANEL 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 2 mL serum or


remove from clot within 4 hours of collection.5. Cause for Rejection: Hemolysis.6. Expected TAT: 1-4 hours.7. Tests in Panel: ALBUMIN, CALCIUM, CARBON

DIOXIDE, CHLORIDE, CREATININE, GLUCOSE,PHOSPHORUS, POTASSIUM, SODIUM, UREANITROGEN

SICKLE CELL 1. Patient Preparation: None.

2. Collection Container: EDTA lavender top tube.3. Specimen and Volume Required: 5 mL whole blood.4. Specimen Processing Instructions: Mix well to avoid

clots.5. Cause for Rejection: Gross hemolysis, clots.6. Expected TAT: 24-48 hrs.

SODIUM 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)

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4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

SPECIFIC GRAVITY 1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

SULFOSALICYLICACID

1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: None.6. Expected TAT: 1-4 hours.

TOTAL EOSINOPHILCOUNT(Absolute EO)

1. Patient Preparation: None.2. Collection Container: EDTA lavender top tube or

pediatric bullet tube. Gently mix immediately followingcollection.

3. Specimen and Volume Required: 4 mL whole blood.4. Specimen Processing Instructions: Allow Vacutainer to




TRIGLYCERIDE 1. Patient Preparation: Patient should fast 12-14 hoursprior to collection.

2. Collection Container: Silicone Stopper Tube (SST).3. Specimen and Volume Required: 2 mL serum.4. Specimen Processing Instructions: Refrigerate serum.5. Cause for Rejection: Non-fasting specimen.6. Expected TAT: 48 hours.

UREA NITROGEN 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or

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URIC ACID 1. Patient Preparation: None.2. Collection Container: Silicone Stopper Tube (SST)3. Specimen and Volume Required: 1 mL serum or





4 hours from collection time.6. Expected TAT: 1-4 hours.7. Tests in Panel: URN:GLUCOSE; URN:COLOR;

URN:APPEARANCE; URN:BILIRUBIN;

URN:KETONES; URN:SPECIFIC GRAVITY;URN:BLOOD; URN:PH; URN:PROTEIN;URN:UROBILINOGEN; URN:NITRITE;URN:LEUKOCYTE ESTERASE; MIC:RBC; MIC:WBC;MIC:BACTERIA; MIC:YEAST; MIC:EPITHELIALCELLS; MIC:MUCUS; MIC:TRICHOMONAS;MIC:CASTS; MIC:CRYSTALS

URINE CULTURE 1. Patient Preparation: Obtain a clean catch, midstreamurine (CCMS) specimen, after cleaning the externalgenitalia. First morning specimens are preferred.

2. Collection Container: Sterile urine cup, screw topcontainer, or urine transport kit.3. Specimen and Volume Required: Greater than 1 mL

urine.4. Specimen Processing Instructions: Transport specimen

to laboratory within 2 hours of collection for unpreservedspecimen. Store refrigerated or use appropriatetransport devise, if transport is delayed.

5. Cause for Rejection: Specimens not properly

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preserved. Preserved specimens more than 24 hoursold. Pooled 24-hour sample. Urine submitted from

catheter bag or Foley catheter tip.6. Expected TAT: 24-48 hours.

URINEMACROSCOPIC ONLY

1. Patient Preparation: None.2. Collection Container: Urine collection container.3. Specimen and Volume Required: 10 mL urine.4. Specimen Processing Instructions: None.5. Cause for Rejection: Urine samples received more than

4 hours from collection time.6. Expected TAT: 1 hour.7. Tests in Panel: URN:COLOR; URN:GLUCOSE;

URN:APPEARANCE; URN:BILIRUBIN;URN:KETONES; URN:SPECIFIC GRAVITY;URN:BLOOD; URN:PH; URN:PROTEIN;URN:UROBILINOGEN; URN:NITRITE;URN:LEUKOCYTE ESTERASE

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APPENDIX F


ABO/RHBB ABO/RHRH TYPING

ALANINE AMINOTRANSFERASEALT

ALK PHOSALPALK PHOPHATASE

ALKALINE PHOS ISOENZYMESISOENZYME PATTERNBOTH

ASPARTATE AMINOTRANSFERASEISR ASTASTSGOT

BASIC METABOLIC PANELCHEM 8

BILIRUBINTOTAL BILIRUBINT BILITBILBILIRUBIN TOTAL

BILIRUBIN CONJUGATEDCONJUGATED BILIRUBINBILIRUBIN,CONJUGATEDDIRECT BILIRUBIN

BILIRUBIN DIRECTDBILD BILIDIRECT BILIRUBIN

BILIRUBIN UNCONJUGATEDINDIRECT BILIRUBINUNCONJUGATED BILIRUBIN

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BILIRUBIN,UNCONJUGATEDBILIRUBIN, INDIRECTBILIRUBIN

CBC PROFILEBLOOD COUNTCOMPLETE BLOOD COUNT

CBC/DIFF PROFILE (HEM/ONC)

CLINITEST

ELECTROLYTES PANELELECTROLYTES

LYTES

ESRSED RATEERYTHROCYTE SEDIMENTATION RATEERYTHROCYTE SED RATE

GAMMA GLUTAMYL TRANSFERASEGAMMA GTGAMMA GLUTAMYL TRANSPEPTIDASEGTT

GLUCOSEFBSFASTING GLUCOSE

GLUCOSE 2H PT MEAL2HR PP2 HR PPGTT 2HR PP2HR POSTPRANDIAL GLUCOSE2HR POST MEAL GLUCOSE

HEPATIC FUNCTION PANELLFTCHEM HEPATIC PANELLIVER FUNCTION TEST

HIV 1/2 ABFORCE HIVHIV-1/2 AB SCREEN

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HIV AB SCR (WH/BAMC/BAFB)HIV-1+2 AB


MONOSPOTHETEROPHILE ANTIBODYMONO SCREENINFECTIOUS MONONUCLEOSIS AB

PHOSPHORUSINORGANIC PHOSPHORUSPHOSPHATE

PREGNANCY TEST,QUALHCGHCG,SCREENBHCG, QUALBETA HCG, QUALITATIVE

RAPID PLASMA REAGINSYPHILLISRPRNONTREPONEMAL TESTSYPHILIS SEROLOGY

RENAL FUNCTION PANELPROFILE RENALCHEM RENAL PANELCHEM 10

SULFOSALICYLIC ACIDSSA

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DEPARTMENT OF THE ARMYMcAfee US Army Health Clinic

530 Rock Island

White Sands Missile Range, NM 88002

WBAMC PAMPHLET 40-4 02 March 2005



Purpose 1 209Applicability 2 209

References 3 209Explanation of Abbreviations and Terms 4 209Background 5 210Responsibilities 6 210General Information 7 210Anatomic Pathology Service 8 217Clinical Pathology Service 9 217Appendix A Explanation of Abbreviations and Terms 219

B Telephone Numbers 222C Tube Requirements for Laboratory Specimen Submission 223D Clinical Pathology Service Test Manual 224E Names and Synonyms of Laboratory Tests 228

10. PURPOSE. This pamphlet is designed to assist the medical staff of the McAfee USArmy Health Clinic and outside submitting stations in utilizing laboratory resources.

11. APPLICABILITY. This pamphlet applies to all direct Health Care Providers (HCP)assigned or attached to McAfee US Army Health Clinic and to all submitting stationsrequesting services or support from the Department of Pathology and AreaLaboratory Services (DPALS) at MUSAHC.

12. REFERENCES.




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14. BACKGROUND.

a. The Department of Pathology and Area Laboratory Services is responsible for

providing responsive, high quality laboratory testing in support of patient care.Use of this pamphlet will reduce ordering errors and conserve resources.


a. Department/Division/Service Chiefs and Clinic/Hospital staff will familiarizethemselves with the MUSAHC Pamphlet 2004, and obtain laboratory support andservice using guidelines found within the pamphlet.


a. Location. McAfee US Army Health Clinic Laboratory is located in Building 530,White Sands Missile Range, NM. Ambulatory patient specimen collection andprocessing service is located across from radiology and next door to PreventiveMedicine.




(1) The laboratory maintains 0800-1200 and 1300-1700 hrs Monday-Thursdayand 0800-1200 on working Fridays and closed on compressed Fridays, asnormal duty hours. Routine services (outpatient specimen collection,processing, and testing) are offered during these times. Routine services areNOT offered on weekends, Federal holidays, compressed Fridays, andtraining Fridays after 1200 hrs.

(2) Emergency lab services are offered 24 hours a day, 7 days a week. Thespecimen will be collected by the requesting service once the lab tech onduty arrives at the clinic.


(1) Outpatient Collection. Ambulatory patient specimen collection andprocessing service is staffed by Medical Laboratory Technicians 0800-1200and 1300-1700 hrs, Monday through Thursday and 0800-1200 on workingFridays and closed on compressed Fridays to support outpatient clinic/serviceoperations. This service is NOT offered on weekends, Federal holidays, and

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training holidays.

(2) Reference/Commercial Laboratory Service. The laboratory has a variety of

military and commercial laboratory services for those tests not performed in-house. In order to ship out a specimen the same day it must be received inthe lab before 1100 hrs.


(1) CHCS is the primary means by which HCP submit laboratory orders. HCPsubmitting laboratory orders for outpatients and patients being seen in theclinic or service will use CHCS order entry.

(2) Whenever the Hospital Information System (CHCS) is inoperative it is

necessary for the HCP to submit the appropriate laboratory request slip, SF557. All specimens and accompanying request slips must be clearly andappropriately labeled. All request slips MUST be printed legibly and MUSTinclude the following:



(c) Date/time collected.

(d) Test(s) requested.

(e) Physician's full name (name stamp if available).

(f) Pertinent clinical information for assays requiring laboratory interpretation.

(g) Cultures must show specimen source.

(3) Decentralized Order Entry using CHCS allows HCP to enter orders for ALLclinical laboratory tests, cytology tests, surgical specimens, and limited bloodbank procedures.

(a) The appropriate laboratory requisition slips must be used for ordering allprocedures whenever the computer system is inoperative and patient carewould be compromised by waiting until the system is again available for use. If the computer downtime is known to be one hour or less, pleaserefrain from placing manual orders unless absolutely necessary for patientcare.

g. Laboratory Priorities. The following priority is used by the McAfee US Army

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Health Clinic Laboratory:

ROUTINE. This is the usual category for most laboratory orders. Specimens

with this priority will be managed in the most efficient way possible. ExpectedTAT for this priority is 24 hours or less.

h. CHCS Order Entry. See Online User's Manual (OLUM) provided within theComposite Health Care System.

i. Specimen Collection, Handling, and Transport.

(1) Laboratory tests reveal and contribute vital information about a patient'shealth. Correct diagnostic and therapeutic decisions rely, in part, on theaccuracy of test results.

(2) Unlabeled samples will not be tested. The accuracy of test results isdependent on the integrity of the specimen (patient preparation, specimencollection, and handling). In all settings in which specimens are collected andprepared for testing, laboratory and health care workers must follow OSHAand local infectious disease regulations and policies. The specimencollection container should be labeled with the following information:

(a) Patient's complete name.

(b) Patient's complete SSN with FMP.

(c) Patient’s date of birth.

(d) Date and time of specimen collection.

(3) Because the potential for infectivity of any patient's blood and body fluids isunknown, Blood and Body Fluid Precautions required by OSHA will beadhered to for all patients. These precautions, called Standard Precautions,will be followed regardless of any lack of evidence of the patient's infectivestatus.

(4) The practice of Standard Precautions eliminates the need for using specificwarning labels on specimens obtained from patients infected with Hepatitis Bvirus or Human Immuno-deficiency Virus (HIV). All specimens must betreated as if infectious and capable of transmitting a serious infectiousdisease.

(5) Upon being collected from the patient, all specimens should be placed into aleak-proof primary container with a secure closure. Care must be taken bythe person collecting the specimen not to contaminate the outside of the

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primary container.

(6) Laboratory requisition slips (or computer-generated orders) should be

protected from contamination and separated from the primary container.Contaminated requisition slips will not be accepted. The submitting locationwill be notified and requested to replace any contaminated slip.

(7) Preparation. Prior to each collection, review the laboratory's specimenrequirement(s) or check with the laboratory personnel. (See ClinicalPathology Service Test Manual, Appendix E.) Note the proper specimen tobe collected, the amount, the procedure to be used, the collection material,and the storage and handling requirements.

(a) Preparing the Patient. Provide the patient in advance with appropriate

collection instructions and information on fasting, diet, and medicationrestrictions when necessary. These instructions are also available at thelaboratory.

(b) Preparing the Specimen. To avoid incorrect identification, label thespecimen container using an adhesive specimen label immediatelyfollowing the collection. Confirm the accuracy of identification of thespecimen in the presence of the patient. Process the specimen asrequired and store properly. During specimen collection, preparation, andsubmission, there is a much greater possibility of clerical error than duringthe actual testing or examination of the specimen. Errors in storage andhandling compromise the integrity of the specimen and, thus, the testresults.

(c) One specimen should be submitted for each test requested. However, asingle tube for a multiple test request may be drawn when a large number of tests are being ordered on a particular patient and the tests areperformed on the same test specimen (e.g., serum or plasma) only whenabsolutely necessary. Authorization will be obtained by the MedicalLaboratory Technicians prior to drawing patients’ blood. Drawing a tubefor multiple test requests helps to ensure that blood draws are limited withthe least amount of blood possible, which benefits the patient. When asingle tube is collected for a multiple test request, laboratory SpecimenProcessing personnel will split the specimen and ensure patientdemographics are accurately transcribed to each aliquot tube.

The individual overseeing the specimen collection must ensure sufficientspecimen is provided for performing the requested tests. (NOTE: Serumor plasma normally makes up approximately 40% - 45% of a bloodcollection.

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Of this amount, about 75% can be removed from the clot/sedimented cells,i.e., only about 3 mL of serum/plasma can be obtained from a full 7-mLtube.)

(8) Specimen Rejection (General Guidelines). The rejection of unacceptablespecimens and the special handling of sub-optimal specimens will beconsidered very carefully and on a case-by-case basis by the laboratorypersonnel. If a specimen must be rejected, the requester will be notified andadvised of the reason(s) and a comment will be entered in the laboratoryreport. Specimens may be rejected in the following situations:

(a) Mismatched specimen and slip - submitting service will be notified andgiven the opportunity to correct this situation.

(b) Unlabeled specimens - submitting service will be notified and given theopportunity to resubmit.

(c) Contaminated specimen or slip - submitting service will be contacted andgiven the opportunity to provide a new specimen or slip.


(9) Avoid Common Errors. Careful attention to routine procedures can eliminatemost of the errors outlined in this section. The complete blood collectionsystem and other collection materials provided by the laboratory can maintainthe integrity of the specimen only when they are used in strict accordancewith instructional materials. The following are General Specimen CollectionErrors:


• Insufficient quantity (ensure collection container is filled to theappropriate level).


• Inaccurate/incomplete patient instructions prior to collection.



• Failure to provide legible physician's full name (name stamp if available).


• Failure to separate serum from red cells within 30 to 45 minutes after venipuncture (laboratory function). The requesting service mustimmediately bring the specimen to the laboratory.

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• Hemolysis - RBC’s damaged and intracellular components spilled intoserum.

• Turbidity - cloudy or milky serum sometimes due to patient's diet.







• Failure to obtain a clean-catch, midstream specimen.• Failure to refrigerate specimen.

• Failure to provide a complete 24-hour collection or other timedspecimen.

• Failure to add proper preservative to the urine collection container after receipt of the specimen, prior to aliquotting (laboratory function).

• Failure to provide a sterile collection container and to refrigeratespecimen when bacteriological examination of the specimen isrequired.



(e) Hemolysis. In general, grossly or even moderately hemolyzed bloodspecimens are not acceptable for testing. Hemolysis occurs when theblood cells rupture and hemoglobin and other intracellular componentsspill into the serum/plasma. Hemolyzed serum/plasma is pink or red,rather than the normal; clear or straw color.




• To ensure adequate mixing of blood with anticoagulant or preservative,use a slow, rolling wrist motion to invert the tube gently five or six

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times. Rapid wrist motion or vigorous shaking contributes either tosmall clot formation or hemolysis and fails to initiate proper mixingaction.

• Check to see that all the preservative or anticoagulant is dissolved. If any preservative powder is visible, continue inverting the tube slowlyuntil the powder is dissolved.


(g) Vacuum Tubes Without Anticoagulants. Permit the tube to completely fillwhen using vacuum tubes not containing anticoagulants or preservatives.

(h) Turbidity (Lipemic Serum). Lipid-containing serum/plasma may not be atrue indicator of the patient's physiological state. It is important to obtaina representative specimen that will help the physician differentiatebetween transient dietary lipemia and chronic lipemia caused by other factors. To avoid dietary induced high lipid levels prior to testing, manyphysicians require patients to exclude the high fat foods from their dietsor to fast 10 to 14 hours prior to specimen collection. For morningspecimen collection, the laboratory recommends that the patient berequired to fast from 8 P.M. on the previous evening.

j. Laboratory Critical (Panic) Values.

(1) A critical laboratory value is defined as, "a value at such variation with normalas to present a pathophysiologic state that is life-threatening unless someaction is taken in a very short time and for which an appropriate action ispossible." It is a laboratory's responsibility to communicate these valuesimmediately and flawlessly to the responsible clinician(s).

(2) Whenever possible, CHCS will be programmed to identify and report criticalvalues. Tests whose results are critical will cause a PRIORITY RESULTBULLETIN to be automatically generated. The bulletin is sent to the HCPentered in CHCS as the ordering physician.

(3) Telephonic notification of critical values will also be made. CHCS does notrelieve the laboratory of its responsibility to ensure that all critical values arereported. Whenever possible, the requesting physician will be contacted. If that person is unavailable, another clinician or nurse from the requestinglocation will be notified.

k. Retrieval of Laboratory Results.

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(1) Results for tests ordered with ROUTINE priorities are NOT automaticallyprinted at the ordering location.

(2) The electronic patient file is considered the official file. HCP should reviewpatient results in CHCS. There are no laboratory cumulative reports printed.

l. Misrouted Laboratory Results.

(1). HCP who receive laboratory results that they have not ordered should notdiscard/toss the results until contact is made to the DPALS computer systems analyst.

(2). HCP who receive critical laboratory results that they have not ordered shouldbring the issue to the ordering provider. The provider will pass the

information to the DPALS computer systems analyst on the next normal dutyday.

(3) HCP who receive routine non-critical laboratory results that they have notordered should bring the issue to the attention of the DPALS computer systems analyst.

(4) The DPALS computer systems analyst will take appropriate steps todetermine the correct ordering HCP/department/service from which the order originated. The analyst will then contact the HCP originally receiving theresults and request that he/she forward the results to the correct HCP. If thatHCP cannot forward the results for whatever reason, the analyst will forwarda hard copy of the results to the HCP who originated the orders or to his/her department/service chief. The HCP originally receiving the results may thendiscard/toss the results.

17. ANATOMIC PATHOLOGY SERVICE. The Anatomic Pathology Serviceencompasses the sections of Cytology, Surgical, and Autopsy Pathology. Theservice is in the Department of Pathology on the 3rd floor of WBAMC and is openroutinely 0730-1630 Monday through Friday. A staff pathologist is on call for problems arising during non-duty hours. Pathology on call roster is distributedmonthly to all clinical services.

The McAfee US Army Health Clinic laboratory will only receive and transportspecimens for these sections. If specimens are received by 1100 hrs, they will betransported the same day. If specimens are received after 1100, they will betransported on the following business day. See the WBAMC handbook for specimencriteria.

18. CLINICAL PATHOLOGY SERVICE. McAfee US Army Health Clinic Laboratoryoffers clinical pathology services to White Sands Missile Range, WBAMC, and

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outside providers using qualified professionals and state of the art methods andinstrumentation. Clinical Pathology Service consists of the following services:Hematology, Chemistry, and Urinalysis.

Specimens will also be received by this laboratory and transported to the main lab,WBAMC for microbiology, blood bank, anatomic pathology, and shipping. See theWBAMC guide for specimen requirements. Quality is the top priority and will not becompromised in any situation. Test results from all sections are continuouslymonitored for reliability, precision, and accuracy by both internal and external qualitycontrol programs. The laboratory is directed by board-certified pathologists. Thelaboratory’s accreditation, licensure, and other inspections include: JointCommission for the Accreditation of Healthcare Organizations (JCAHO); College of American Pathologists (CAP); Inspector General; DoD Center for Clinical LaboratoryManagement (CCLM); U.S. Army Environmental Hygiene Agency; and

Occupational, Safety and Health Administration (OSHA).

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APPENDIX A


AF Air Force

ALK Alkaline



AP Anatomic Pathology



BAMC Brooke Army Medical Center

BASO Basophile

BATT Battery

BBF Blood Body FluidBC Blood Culture

BUN Blood Urea Nitrogen

CA Calcium



cc Cubic centimeter




CCLM Center for Clinical Laboratory ManagementCO2 Carbon Dioxide

COAG Coagulation

COMP Complete


CULT Culture

dL Deciliter





ED Emergency DepartmentEDTA Ethylenediaminetetraacetate



EOS Eosinophil




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GGT Gamma Glutamyltransferase

gm Gram


HCT HematocritHDL High Density Lipoprotein


HGB Hemoglobin


HR Hour



IRR Immediate Result Reporting







mg Milligrams

MI Middle Initial

mL Milliliter


mm Millimeter

MONO Monocyte

MPV Mean Platelet VolumeMTF Medical Treatment Facility

NCOIC Non Commissioned Officer in Charge

NLT Not Later Than




PAN Panel

Ped Pediatric

PERI Peripheral

PLT Platelet

POD Pathologist-of-the-Day

PREOP Preoperative

QUAL Qualitative

QUANT Quantitative

R/O Rule Out

RBC Red Blood Cells



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SCR Screen

SI Seriously Ill


SST Silicone (Serum) Separator TubeSTAT Emergency, Request Priority

SUM Summation


TOT Total

UA Urinalysis

URN Urine



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APPENDIX B

MUSAHC Laboratory Telephone Numbers

NCOIC………………………………………………………………………………. 678-8429Laboratory Front Desk…………………………………………………………….. 678-3831Specimen Processing/Testing……………………………………………………. 678-1516

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APPENDIX C


The following table lists the collection tubes that should be used when drawing and/or submitting specimens. Point of contact for questions or additional guidance is thelaboratory at 678-3831.

Test Tube(s) Other Instructions

Hematology CBC BD Lavender, 4 mLFill completely, inverttube

Chemistry Gold/Red/Marble BD with or without gel

Lipid Profiles

Gold/Marble/Red BD with or without gel

Or Plain Red Glass

Must be fastingspecimen

Urine Cultures 5 oz Sterile Urine CupPatient followinstructions

Urinalysis Clean-catch specimen cupPatient followinstructions

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APPENDIX D



ACETEST

NOTE: Performed onlyas a back-up test for apositive ketones.


CBC PROFILE 8. Patient Preparation: None.

9. Collection Container: EDTA lavender top tubeSpecimen and Volume Required: 4 mL whole blood.10. Specimen Processing Instructions: Allow Vacutainer to



12. Expected TAT: 1-4 hours.13. Tests in Panel: HGB; HCT; WBC; RBC; MCV; MCH;

MCHC; RDW; PLT; MPV; %:NEUTRO; %:LYMPH;

%:MONO; #NEUTRO; #LYMPH; #MONO

CLINITEST

NOTE: Performed onlyas a back-up test for apositive glucose.


CREATININE

NOTE: Performed onthe I-Stat

1. Patient Preparation: None.2. Collection Container: Green top tube

3. Specimen and Volume Required: 1 mL plasma.4. Specimen Processing Instructions: Deliver to labimmediately


GLUCOSE, 2 HOURPOST PRANDIAL


8. Collection Container: Green top tube

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9. Specimen and Volume Required: 1 mL plasma.10. Specimen Processing Instructions: Draw 2 hours after

meal ingestion.11. Cause for Rejection: Hemolysis.12. Expected TAT: 1-4 hours.

ICTOTEST

NOTE: Performed as aback up for a positivebilirubin.


MANUALDIFFERENTIAL

NOTE: Performedwhen indicated byautomated differentialflags or if authorized bysupervisor or medicaldirector of hematology.



11. Cause for Rejection: Clotted, hemolyzed, or quantitynot sufficient, age of specimen more than 12 hours.

12. Expected TAT: 8 hours.2. Tests in Panel: SEGS; BANDS; LYMPH; MONO; EOS;

BASOPHIL; ATYPICAL LYMPHS;METAMYELOCYTES; PLATELET ESTIMATE;ANISOCYTOSIS; POIKILOCYTOSIS; MACROCYTES;POLYCHROMASIA; HYPOCHROMASIA;MICROCYTOSIS; RBC MORPH; NUCLEATEDRBC/100 WBC; BLASTS; PROMYELOCYTE; MYELO;OTHER WBC; BASO STI; TOXIC GRAN; CORRECTEDWHITE BLOOD COUNT; ECHINOCYTES;DACROCYTES; ACANTHOCYTES; CODOCYTES;SCHISTOCYTES; OVALOCYTES; STOMATOCYTES;SMUDGE CELLS; DOHLE BODIES; HOWELL JOLLY

BODIES

OCCULT BLOOD 7. Patient Preparation: None.8. Collection Container: Hemoccult card.9. Specimen and Volume Required: Fresh stool.10. Specimen Processing Instructions: Transfer fresh stool

from collection container to Hemoccult card using aclean wooden disposable applicator stick. This is doneby the patient.

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11. Cause for Rejection: Improperly collected or unlabeled.12. Expected TAT: 2 days.

PREGNANCY TEST,QUAL

NOTE: 1ST morningspecimen preferred.

7. Patient Preparation: None.8. Collection Container: Urine9. Specimen and Volume Required: 10mL.10. Specimen Processing Instructions: None.11. Cause for Rejection: None.12. Expected TAT: 1-4 hours.

SULFOSALICYLICACID

NOTE: Performed as aback up for a positiveprotein.

7. Patient Preparation: None.8. Collection Container: Urine collection container.9. Specimen and Volume Required: 10 mL urine.

10. Specimen Processing Instructions: None.11. Cause for Rejection: None.12. Expected TAT: 1-4 hours.


4 hours from collection time.13. Expected TAT: 1-4 hours.

14. Tests in Panel: URN:GLUCOSE; URN:COLOR;URN:APPEARANCE; URN:BILIRUBIN;URN:KETONES; URN:SPECIFIC GRAVITY;URN:BLOOD; URN:PH; URN:PROTEIN;URN:UROBILINOGEN; URN:NITRITE;URN:LEUKOCYTE ESTERASE; MIC:RBC; MIC:WBC;MIC:BACTERIA; MIC:YEAST; MIC:EPITHELIALCELLS; MIC:MUCUS; MIC:TRICHOMONAS;MIC:CASTS; MIC:CRYSTALS

URINE CULTURE 7. Patient Preparation: Obtain a clean catch, midstream

urine (CCMS) specimen, after cleaning the externalgenitalia. See patient instructions. First morningspecimens are preferred.

8. Collection Container: Sterile urine cup, screw topcontainer, or urine transport kit.

9. Specimen and Volume Required: Greater than 1 mLurine.

10. Specimen Processing Instructions: Transport specimento laboratory within 2 hours of collection for unpreserved

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specimen. Store refrigerated or use appropriatetransport devise, if transport is delayed.

11. Cause for Rejection: Specimens not properlypreserved. Preserved specimens more than 24 hoursold. Pooled 24-hour sample. Urine submitted fromcatheter bag or Foley catheter tip.


URINEMACROSCOPIC ONLY

8. Patient Preparation: None.9. Collection Container: Urine collection container.10. Specimen and Volume Required: 10 mL urine.11. Specimen Processing Instructions: None.12. Cause for Rejection: Urine samples received more than

4 hours from collection time.13. Expected TAT: 1 hour.14. Tests in Panel: URN:COLOR; URN:GLUCOSE;

URN:APPEARANCE; URN:BILIRUBIN;URN:KETONES; URN:SPECIFIC GRAVITY;URN:BLOOD; URN:PH; URN:PROTEIN;URN:UROBILINOGEN; URN:NITRITE;URN:LEUKOCYTE ESTERASE

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APPENDIX E


ABO/RHBB ABO/RHRH TYPING

ALANINE AMINOTRANSFERASEALT

ALK PHOSALPALK PHOPHATASE

ALKALINE PHOS ISOENZYMESISOENZYME PATTERNBOTH

ASPARTATE AMINOTRANSFERASEISR ASTASTSGOT

BASIC METABOLIC PANELCHEM 8

BILIRUBINTOTAL BILIRUBINT BILITBILBILIRUBIN TOTAL

BILIRUBIN CONJUGATEDCONJUGATED BILIRUBINBILIRUBIN, CONJUGATEDDIRECT BILIRUBIN

BILIRUBIN DIRECTDBILD BILIDIRECT BILIRUBIN

BILIRUBIN UNCONJUGATEDINDIRECT BILIRUBINUNCONJUGATED BILIRUBIN

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BILIRUBIN, UNCONJUGATEDBILIRUBIN, INDIRECTBILIRUBIN

CBC PROFILEBLOOD COUNTCOMPLETE BLOOD COUNT

CBC/DIFF PROFILE (HEM/ONC)

CLINITEST

ELECTROLYTES PANELELECTROLYTES

LYTES

ESRSED RATEERYTHROCYTE SEDIMENTATION RATEERYTHROCYTE SED RATE

GAMMA GLUTAMYL TRANSFERASEGAMMA GTGAMMA GLUTAMYL TRANSPEPTIDASEGTT

GLUCOSEFBSFASTING GLUCOSE

GLUCOSE 2H PT MEAL2HR PP2 HR PPGTT 2HR PP2HR POSTPRANDIAL GLUCOSE2HR POST MEAL GLUCOSE

HEPATIC FUNCTION PANELLFTCHEM HEPATIC PANELLIVER FUNCTION TEST

HIV 1/2 ABFORCE HIVHIV-1/2 AB SCREEN

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HIV AB SCR (WH/BAMC/BAFB)HIV-1+2 AB


MONOSPOTHETEROPHILE ANTIBODYMONO SCREENINFECTIOUS MONONUCLEOSIS AB

PHOSPHORUSINORGANIC PHOSPHORUSPHOSPHATE

PREGNANCY TEST, QUALHCGHCG, SCREENBHCG, QUALBETA HCG, QUALITATIVE

RAPID PLASMA REAGINSYPHILLISRPRNONTREPONEMAL TESTSYPHILIS SEROLOGY

RENAL FUNCTION PANELPROFILE RENALCHEM RENAL PANELCHEM 10

SULFOSALICYLIC ACIDSSA

SIGNATURE DATE

QI OIC

QI COORDINATORAPPROVAL

LAB MANAGERAPPROVAL

CHIEF, DPALSAPPROVAL

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The proponent of this regulation is the Department of Pathology.Users are invited to send comments and suggested improvementsOn DA Form 2028, (Recommended Changes to Publications and

Blank Forms) to Commander, William Beaumont Army MedicalCenter, ATTN; MCHM-DPL, 5005 N. Piedras Street, El Paso, TX79920-5001.

FOR THE COMMANDER:

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