Special chemistry

PATIENT PREPARATION: 12 hour fast (for infants collect immediately before next feed); avoid vitamin C supplements and vitamin C rich foods for at least 24 hours prior to testing. Testing of non-fasting specimens or the use of vitamin supplementation can result in elevated plasma vitamin C concentrations. SAMPLE TYPE: 1mL serum or heparin (green top) plasma. SAMPLE HANDLING: Unstable photosensitive analyte. Separate ASAP, protect from light by covering in aluminium foil and freeze. Transport frozen and light protected. Samples which are at room temperature or are not protected from light will be rejected.

SAMPLE COLLECTION: Sample collection is usually TIMED e.g. a trough (pre-dose/ immediately before next dose) sample OR a peak sample (1 hour post-dose/ after infusion complete). TDM request form details should be captured & filled out in entirety. MUST specify whether trough or peak collection has been done. SAMPLE TYPE: Serum required (collection in red top tube is preferred). SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Refrigerated temperature: 14 days at 20-25°C │ Frozen: 1 year at -20°C

1. Provide clinical history & patient's current drug history. 2. 10mL aliquot of 24 hour urine (preferred if transporting/ shipping) or entire 24 hour urine volume collection is required. TOTAL 24 hour urine volume (mL) is MANDATORY (if an aliquot is submitted). 3. Discontinue antihypertensive drugs if feasible (multiple drugs can increase or decrease metanephrine levels; to be done by the patient in consultation with the attending clinician). If possible, patient should abstain from drugs from 72 hours prior to collection and during collection. Tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, labetalol & sotalol should be discontinued at least 1 week prior. 4. Avoid stimulating drinks (coffee, tea) bananas, pineapples from 48 hours prior to and during collection. 5. Accurately timed 24 hour collection (e.g. 6a.m., day 1 to 6a.m., day 2) is crucial for result accuracy. Collect urine in a clean wide mouth container & transfer entire collection into the container that was provided by the lab. Refrigerate during collection. Keep container supplied by the lab out of reach of children (contains corrosive substances i.e. 10-30ml 6M HCl). Do not consume foods rich in serotonin (e.g. bananas, pineapple, cereals, potatoes, coffee, tea, chocolate, vanilla etc.) For 72 hours prior to sample collection. Avoid strenuous exercise. 6. Patients must be furnished with sufficient instructions prior to collection: refer to relevant phlebotomy aid (Phleb/Aid7) or lab handbook section on 24 hour urine collection or video available at https://www.youtube.com/watch?v=HjF-9n0FOrw

Sample type: 2mL serum. Stability: Room temperature: Stable for 8 hours; Refrigerated (2-8°C): Stable for 7 days; Frozen (-20°C or below): Stable for 3 months. Avoid repeated freeze-thaw cycles. Shipping Temperature: Refrigerated [samples may be shipped refrigerated (2-8°C) on cold packs if they will be received and tested within the 7-day stability window] or frozen.

Sample collection is NOT random; Collect a trough (pre-dose) sample. TDM request form details should be captured & filled out in entirety. EDTA whole blood required. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 7 days at 20-25°C │ Refrigerated: 14 DAYS at 2-8°C

Refer to lab handbook (specimen management guidelines) for detailed instructions. Test components: BASAL (PRE-DEXAMETHASONE) 8AM & POST DEXAMETHASONE 8AM CORTISOL LEVELS.

TWO samples COLLECTED AT THE SAME TIME required i.e. concurrently collected CSF (1-2mL; in sterile plastic vial) AND serum (2mL). 3rd or 4th CSF collection tube is preferred to minimize CSF contamination with blood. Transport both samples refrigerated. Test components: CSF/Serum Immunofixation Electrophoresis, CSF/serum IgG Oligoclonal Bands, CSF/Serum Albumin and IgG Levels, CSF/Serum IgG Synthesis Rate, Albumin/IgG Index SAMPLE TYPE: If multiple CSF tests are required, minimum is 5ml divided between 3-4 sequentially labelled tubes. When this is done, tube 2 is used for microbiological tests. Further details on this can be found at: https://www.youtube.com/watch?v=MrqeWtceFek&t=14s

10 mL aliquot of 24 hour urine in 6M HCL preservative. Collect 24 hour urine sample and send 10 ml of 24 hour urine In dark container. Protect from light by collecting and aliquoting in dark colored container or container covered in aluminium foil. Test components: Porphobilinogen, Delta-Aminolevulinic Acid (ALA), Total Urinary Porphyrins, Urine Porphyrin Fractionation (HPLC) Test includes porphobilinogen (PBG) and aminolevulinic acid (ALA). SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 4 DAYS at 20-25°C │ Refrigerated: 7 DAYS at 2-8°C │ Frozen: 1 MONTH at -20°C

Collect a trough (pre-dose) serum sample. If patient has been on the same dose of the drug for at least 6 days, a random collection can be done. TDM request form details should be captured & filled out in entirety. AVOID gel (SST) tubes. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 2 days at 20-25°C │ Refrigerated: 1 month at 2-8°C │ Frozen: 5 months at -20°C

Fluid type: various e.g. pleural, peritoneal, pericardial fluid, or pancreatic/other cyst aspirates. Specify fluid type on requisition. Record collection date/time. Volume: 1-2 mL in sterile container without preservative. Stability: Room temperature: Stable 8 hours; Refrigerated (2-8°C): Stable 2-7 days; Frozen (-20°C or below): Stable 6 months Avoid repeated freeze-thaw cycles Shipping: Ship refrigerated (2-8°C) with cold packs if tested within 2-7 days; Ship frozen if longer transport time is expected.