Special chemistry

1. Provide clinical history & patient's current drug history.
2. 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 VMA levels; to be done by the patient in consultation with the attending clinician).
4. 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.
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. 10mL 6M HCl).
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 https://www.youtube.com/watch?v=HjF-9n0FOrw video
SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Frozen ANALYTE STABILITY Room Temperature: 7 DAYS at 20-25°C │ Refrigerated: 7 DAYS at 2-8°C │ Frozen: 12 MONTHS at -20°C

Serum in plain tube (red top) or SST tube (yellow top) or in a separation vial. Centrifuge tubes within 1 hour. Separate centrifuged serum in plain tubes within 1 hour. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Frozen ANALYTE STABILITY Room Temperature: 30 minutes at 20-25°C │ Refrigerated: 1 day at 2-8°C │ Frozen: 8 weeks at -20°C

Draw baseline AM cortisol sample. Patient takes 1mg oral dexamethasone at 11p.m. then ADDITIONAL AM cortisol sample is drawn at 8a.m. on the following morning. Label pre- and post-dexamethasone samples clearly. Cost is exclusive of dexamethasone (drug) cost.

Patient preparation FASTING IS REQUIRED. Sample type EDTA PLASMA (FASTING SAMPLE IN A PRE-CHILLED EDTA TUBE, CENTRIFUGE IMMEDIATELY & FREEZE SPECIMEN IN PLASTIC TUBE). Container/ preservative PURPLE TOP Sample volume 2ML EDTA PLASMA Rejection criteria LABELING ISSUE (UNLABELED/ MISLABELED); MISSING REQUEST FORM; MISMATCH BETWEEN REQUEST FORM & SAMPLE DETAILS; MISSING AGE/ GENDER; WRONG SAMPLE TYPE; INSUFFICIENT SAMPLE; SAMPLES WHICH ARE NOT FROZEN. Other Instructions PROMPTLY SEPARATE EDTA PLASMA AND IMMEDIATELY FREEZE. LABEL OF SEPARATION VIAL MUST INCLUDE SAMPLE TYPE.

Serum 2ml, 2–8 °C for up to 48 hours; freeze at −20 °C (or −70 °C) for longer storage, Special requirements are overnight fasting recommended; morning collection preferred and AVOID hemolysis and repeated freeze–thaw cycles. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 6 days at 20-25°C │ Refrigerated: 2 months at 2-8°C │ Frozen: 2 years at -20°C

Sample collection is NOT random; Collect a trough (pre-dose) serum sample. TDM request form details should be captured & filled out in entirety. AVOID gel (SST) tubes.

TOTAL 24 hour urine volume (mL) required; add 10-30ml 6M HCl to the 24 hour urine container; explain collection instructions [refer to relevant phlebotomy aid (Phleb/Aid7) or lab handbook section on 24 hour urine collection or https://www.youtube.com/watch?v=HjF-9n0FOrw video]. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 2 DAYS at 20-25°C │ Refrigerated: 4 DAYS at 2-8°C │ Frozen: 1 MONTHS at -20°C

Serum in plain tube (red top) or SST tube (yellow top) or in a separation vial. Centrifuge tubes within 1 hour. Separate centrifuged serum in plain tubes within 1 hour. SHIPPING/ TRANSPORTATION REQUIREMENTS Shipping Temperature: Refrigerated ANALYTE STABILITY Room Temperature: 3 days at 20-25°C │ Refrigerated: 7 days at 2-8°C │ Frozen: 3 months at -20°C

PATIENT PREPARATION: Diet and medication: Avoid high sodium intake and certain medications (e.g., diuretics, ACE inhibitors, beta-blockers) as instructed by a healthcare provider. POSTURE: Supine (lying down) for at least 30 minutes if resting conditions are required. Upright (standing or seated) for at least 2 hours if posture effect is being measured. Test components: Aldosterone, Renin (plasma renin activity or direct renin), Aldosterone/Renin ratio BLOOD COLLECTION: Serum in SST or red top vacutainer (for aldosterone). EDTA tubes (purple top) (for renin activity). Volume: 5 mL each of blood. HANDLING (SERUM): Allow serum sample to clot. Centrifuge to separate serum. Transfer serum in red top vacutainer to a plastic vial without disturbing blood cells. Label properly with 2 patient identifiers and sample type i.e. serum. HANDLING (EDTA PLASMA): Keep chilled e.g. keep samples on ice slurry immediately after collection. Centrifuge within 30 minutes to separate plasma. Transfer EDTA plasma to a plastic vial without disturbing blood cells. Label properly with 2 patient identifiers and sample type i.e. EDTA plasma. TRANSPORT AND STORAGE (SERUM): Transport: Refrigerated (with frozen ice packs) or frozen (in dry ice). Record relevant patient information on the TRF i.e. posture (MANDATORY), medications. TRANSPORT AND STORAGE (EDTA PLASMA): Freezing: Freeze EDTA plasma immediately at -20°C or lower. Transport: Refrigerated (with frozen ice packs) or frozen (in dry ice). Record relevant patient information on the TRF i.e. posture (MANDATORY), medications.

10-12 hr fasting preferred. Serum in plain tube (red top) or SST tube (yellow top) or in a separation vial. Centrifuge tubes within 1 hour. Separate centrifuged serum in plain tubes within 1 hour. TEMPERATURE SENSITIVE ANALYTE. Frozen (preferred). Ambient (room) temperature not acceptable.