CLINICAL IMMUNOLOGY SEROLOGY LAB

LOCATION:Rm 508, Clinical Pathology Building (CPB). [MAP]

PHONE NO.: 2855 4148

FAX NO.: 2818 1104

SERVICE HOURS:	Weekdays 8:00 a.m. - 5:00 p.m.
	Saturdays 8:00 a.m. - 1:00 p.m.

Acting Senior Medical Technologist: Mrs Josephine Jones

Medical Technologist: Mr Albert Tsai

Routine Serology Service

Commonly Requested Tests Replaced or Available Elsewhere

Specimen requirements

Main Clinical Indications for Performing Tests

Routine Serology Service

TEST	METHOD		TAT (DAYS)
1. AUTOANTIBODIES
Anti-nuclear antibodies (ANA)	inIn-house immunofluorescence		3
Anti-DNA	inIn-house ELISA		6
Anti-DNA (Crithidia)	In-house ELISA		16
Anti-extractable nuclear antibodies (ENA)	inCountercurrent immunoelectrophoresis		4
Anti-cardiolipin	inIn-house ELISA		10
Rheumatoid factor	Immunonephelometry		3
Anti-thymoglobulinthyroglobulin(TgATG) Anti/thymal thyroid microsomal (TmATM)	Gelatin agglutination Gelatin agglutination		4 4
Anti-neutrophil cytoplasmic antibodies (ANCA)	inIn-house immunofluorescence		7
Anti-Myeloperoxidase (MPO)	ELISA		9
Anti-Proteinase 3 (PR3)	ELISA		9
Anti-mitochondria	Immunofluorescence		8
Anti-smooth muscle	Immunofluorescence		8
Anti-parietal cell	Immunofluorescence		8
Anti-intrinsic factor	Immunofluorescence		8
Anti-striated muscle	Immunofluorescence		8
Anti-adrenal	Immunofluorescence		8
Anti-skin	Immunofluorescence		8
Anti-glomerular basal basement membrane	ELISA		8
Anti-acetylcholine receptor	inIn-house ELISA		14
Anti-endomesium	Immunofluorescence		16
Anti-gliadin	Immunofluorescence		16
Anti-islet cell	Immunofluorescence		16
Anti-liver-kidney microsomes	Immunofluorescence		16
Anti-ovary	Immunofluorescence		16
2. IMMUNOCHEMISTRY
IgG, IgA, IgM	Immunonephelometry		3
IgG (CSF)	Immunonephelometry		14
IgG subclasses	Radial immunodiffusion		28
IgD	Radial immunodiffusion		14
Secretory IgA	Radial immunodiffusion		7
C3, C4	Immunonephelometry		2
C-reactive protein	Immunonephelometry		1
High sensitivity C-reactive protein	Immunonephelometry		1
Factor B	Immunonephelometry		4
C1-inhibitor	Immunonephelometry		8
a1-antitrypsin	Immunonephelometry		8
b2-microglobulin	Immunonephelometry		8
Alpha-fetal fetoprotein (AFP)	Chemiluminescence		3
Carcinoembryonic antigen (CEA)	Microparticle enzyme immunoassay		3
Prostate specific antigen (PSA)	Chemiluminescence		4
Free PSA	Chemiluminescence		8
CA 15.3	Chemiluminescence		4
Serum protein electrophoresis	Electrophoresis		7
Urine protein electrophoresis	Electrophoresis		8
Serum Immunofixation	Immunofixation		7
Urine Immunofixation	Immunofixation		8
CSF oligoclonal protein	Isoelectrofocusing		14
Protein selectivity	Radial immunodiffusion		7
Cryoglobulin	Serum incubated at 4 S?C		8
3. ALLERGOLOGY*
Total IgE		Immunonephelometry	8
Allergen specific IgE		UNICAP	28
* All allergology tests require additional clinical information to support the request.
4. OTHER
Anti-tetanus		In-house ELISA	14 (after second sample)
Anti-pneumococcus		In-house ELISA
C1 inhibitor function		Binding to activated C1r	7
a1-antitrypsin clearance		Immunonephelometry	14
Complement function		Erythrocyte lysis in tubes, in-house	7

Turnaround time (TAT)

For commonly ordered tests, target TATs are essentially the time between receiving specimens and reporting results, that time including specimen storage (overnight or longer if received after 3:30 pm on weekdays or 11:30 am on Saturdays), registration and sample preparation. Times of storage may be even more prolonged during holiday periods. For less commonly ordered tests, extra storage time may accure accrue due to the more economical testing of batches of samples. Even uncommon and expensive tests will be performed immediately if the request is urgent. Please contact our immunologists for urgent request.

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Commonly Requested Tests Replaced or Available Elsewhere

TEST	REMARKS
Bence Jones protein	Replaced by urine protein electrophoresis
Urine free light chain	Replaced by urine protein electrophoresis
Serum immunoelectrophoresis	Replaced by serum protein electrophoresis
CA 125	Done by O&G
bHCG	Done by O&G
CA 19.9	Done by Clinical Biochemistry
Lupus anticoagulant	Done by Haematology
Anti-platelet antibodies	Done by Haematology
Anti-histone antibodies	Not available in QMH Pathology Labs
Cold agglutinin	Done by Blood Bank
Protein C	Done by Haematology
Protein S	Done by Haematology
Tryptase	Done by Clinical Chemistry Lab, Pamela Youde Hospital
HLA typing	Done by Tissue Typing Lab

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Specimen requirements

TEST	SPECIMEN TYPE	MINIMUM SAMPLE VOLUME*
Autoantibodies, Immunochemistry, Allergology	Clotted blood (red cap tube without bead)	6 ml
Serum protein electrophoresis, immunofixation	Clotted blood (red cap tube without bead)	6 ml
Urine protein electrophoresis	Fresh mid stream urine	10 ml
CSF oligoclonal protein	CSF (plain bottle) and Clotted clotted blood (red cap tube without bead)	0.4 ml 3 ml

*Smaller volume may be sufficient for paediatric patients. Please contact laboratory for details.

Clotted blood samples must reach the laboratory within 72 hours of collection.

Special arrangements are required for the following tests:

1. Cryoglobulin - Please notify our lab before blood taking. 6 ml clotted blood is required, which must be collected in a pre-warmed tube. Our staff will bring pre-warmed tubes to the ward/clinic to collect the blood. Alternatively the patient can be bled in our lab.

2. IgG subclasses - prior consultation with immunologists is required. 6 ml clotted blood is needed.

3. Complement function test - prior consultation with immunologists is required. 6 ml clotted blood is needed. The blood sample must arrive in the laboratory within two hours of venepuncture. (Please write down the time of blood taking on the tube.)

4. C1-inhibitor function - 3 ml blood taken into sodium citrate is required and must arrive in the laboratory within two hours of venepuncture. (Please write down the time of blood taking on the tube.)

5. a1-antitrypsin clearance test

S@ Prior consultation with immunologists is required.

S@ Powder milk cans are normally used as containers. The empty weight of each can is measured and written on the containers.

S@ Stool is collected from the patient for 5 consecutive days. ALL stool of from each day is placed in one container. The 5 containers must which should be labeled with the day (1-5) of collection day 1,2,3,4 or 5.

S@ If stool sample is not sent for analysis in on the same day of collection, it should be kept at about -20 ° C.

S@ Clotted blood samples are needed on day1 and day 5.

S@ Use the usual orange immunology request form and write the test name “Stool x a1-antitrypsin clearance?

S@ Watery stool cannot be processed. Defer sample collection if the patient has watery diarrhoea.

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Main Clinical Indications for Performing Tests

Anti-nuclear factor	Non-specific screen in rheumatic diseases
Anti-DNA	SLE
Anti-ENA	SLE, MCTD, Sjogren's, dermatomyositis, polymyositis, scleroderma, etc
Anti-cardiolipin	SLE, APS, recurrent abortion, thrombosis
Rheumatoid factor	Various, including rheumatoid arthritis
Anti-mitochondria	Primary biliary cirrhosis
Anti-smooth muscle	Chronic active hepatitis
Anti-striated muscle	Myasthenia gravis with thymoma
Anti-adrenal gland	Addison's
Anti-parietal cells/ intrinsic factor	Pernicious anemia
Anti-endomesium, anti-gliadin	Coeliac disease
Anti-islet cell	Diabetes
Anti-liver-kidney microsomes	Juvenile hepatitis
Anti-ovary	Female infertility
Anti-thyroglobulin /anti-thyroid microsomal	Autoimmune thyroid disease
Anti-acetylcholine receptor	Myasthenia gravis
ANCA/ MPO-ANCA/PR3-ANCAANCA, AMPO, APR3	Small vessel vasculitides e.g. Wegener's polyarteritis
Anti-glomerular basement membrane	Goodpasture's
Anti-skin	Pemphigus, pemphigoid
C3, C4, factor B	Various
IgG, IgA, IgM	Various
C1 inhibitor (quantitation and function)	Hereditary angioedema
IgD	Non-IgG/A/M myeloma
IgG subclasses	IgG subclass deficiency
Secretory IgA	IgA deficiency
a1-antitrypsin	Young emphysema, neonatal hepatitis
a1-antitrypsin clearance	Protein-losing enteropathy
C-reactive protein	Various
b2 microglobulin	B-lymphoid malignancy, HIV
Serum protein electrophoresis	Myeloma
CSF oligoclonal protein	Demyelinating diseases
Cryoglobulin	cryoglobulinemia
Urine protein electrophoresis	Myeloma, proteinuria
Alpha fetal fetoprotein	Liver cancer, germ cell cancer, suspected birth defects, HBV/HCV infection
CEA	Colon cancer
PSA	Prostate cancer
CA15.3	Breast cancer
IgE	Hyper-IgE syndrome, allergic bronchopulmonary aspergillosis
Allergen-specific IgE	Allergy
Anti-tetanus, anti-pneumococcus	Humoral immunodeficiency

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