TOXICOLOGY REFERENCE LABORATORY
Laboratory User Guide
ROOM 708, BLOCK P
PRINCESSMARGARETHOSPITAL
2-10 Princess Margaret Hospital Road
Lai Chi Kok
Tel: 2990 1941
Fax: 2990 1942
Version 1.0
Effective date: 1/1/09
Contents
CONTENTS...... 2
INTRODUCTION...... 3
STAFF...... 4
How to MAKe LABORATORY REQUEST...... 5
Instruction for Referring Clinician
Instruction for Referring Laboratory
Specimen Collection & Handling
Specimen Reception Hours
Rejection of Requests
Reporting of Results
ALPHABETICAL LIST OF LABORATORY TESTS...... 8
General unknown screening
Heavy metal analysis
Herb and TCM formula identification
Quantitative toxic alcohol analysis
Quantitative cyanide analysis
Quantitative vitamin A analysis
Target screen for animal thyroid tissue
Target screen for corticosteroids
Target screen for erectile dysfunction drug and analogues
Target screen for oral hypoglycemic agents
Target screen for tetramine
Target screen for toxic plant / herbal alkaloids
Target screen for warfarin and superwarfarins
Introduction
Background
There are six toxicology laboratories within the Hospital Authority (HA) and on average each serving the needs of a cluster. Details on distribution and the role of cluster toxicology laboratories (CTLs) are listed in Appendix A. To better align service arrangement and enhance quality of service, HA has established a Toxicology Reference Laboratory (TRL) at PMH since March 2004 to support the cluster toxicology laboratories (CTLs), and in conjunction with the CTLs to cater for the toxicology needs in HA.
Objectives of TRL
The HA TRL is set up as a tertiary service to serve the following purposes:
(i)As a toxicology reference laboratory for HA
(ii)To establish a laboratory for herbal products poisoning
(iii)To provide diagnostic services for new or uncommon toxin / substances of abuse
(iv)In conjunction with the CTLs, to set up a network to cater for toxicology needs in HA
Services provided by TRL
The menu of services will be updated from time to time. For suspected toxin not on the list, clinicians are welcome to discuss the needs with TRL. The laboratory request form is shown as per Appendix B.
Referral System
The TRL works as a team with the CTLS. The CTLs serve to provide the initial screening and supporting on site, with the TRL functions as a back up to the CTLs and provided a referral service. Clinicians are therefore advised to discuss with their corresponding CTLs which will address the clinical needs according to the facility available at the CTL. Cases that required the support of TRL will be directed to TRL accordingly.
TRL Consultation / Enquiry
General enquiry – Tel 2990 1941Fax: 29901942
Intranet website –
Medical Staff
PostTelephoneE-mail address
Dr Albert ChanDirector & Consultant2990
Chemical Pathologist
Dr Tony MakDeputy Director & Consultant2990
Chemical Pathologist
Dr WT PoonAssociate Consultant2990
Dr Doris ChingResident2990
Dr Hencher LeeResident2990
Dr Wendy ChanResident2990
Dr Sammy ChenResident2990
Scientific Staff
Mr CK Lai(Honorary) Scientific Director2990
Ms SW NgScientific Officer (Medical)2990
Mr YH LamScientific Officer (Medical)2990
Mr ML ChenScientific Officer (Medical)
DrMagdaleneTangScientific Officer (Medical)2990 1982
Technical Staff
Mr Watson Wong Senior Medical Technologist2990
Ms Suzanne ChanMedical Technologist2990
Ms Vanessa LoMedical Technologist2300 7083
Ms. Karen ChungAssociate Medical Technologist
Ms. Jessica LauAssociate Medical Technologist
Ms. Pauline LeungAssociate Medical Technologist
Mr. Simon PoonAssociate Medical Technologist
Mr. WK CheungAssociate Medical Technologist
Ms. Fannie LeeTechnical Service Assistant
Ms. XL YangGeneral Service Assistant
How to Make Laboratory Request
Instruction for Referring Clinician
- TRL request form is available for download at
- The following information are required:
(a)Patient’s name / HKID / Sex / Age / DOB / Hospital Encounter Number
(b)Requesting location(hospital ward, out-patient clinic etc)
(c)Name and contact number of referring clinician
(d)Relevant clinical and drug history
(e)Date and time of specimen collection
(f)Specimen type(s)
(g)Test(s) requested
(h)Signature of referring clinician
- Send the request form andlabeled specimens to the Chemical Pathology laboratory in your hospital who will direct the specimens to TRL
Instruction forReferring Laboratory
- The following information are to be provided by the referring laboratory:
(a)Report copy to ______laboratory (If the field is not specified, a report copy will be sent to Chemical Pathology laboratory of the requesting location),
(b)Specimen laboratory number assigned by the referring laboratory
- For drug confirmation request, please provide information of the patient and attending clinician as above together with the name and signature of referring laboratory personnel making the request
- Send the TRL request form andlabeled specimens, to the following address:
Chemical PathologyLaboratory, 11/F, Block G, PrincessMargaretHospital, Kwai Chung
Withattentionto “Toxicology Reference Laboratory”
SpecimenCollection and Handling
Different laboratory tests require specific specimen containers. Consult this guide for the appropriate specimen containers for a particular test
All specimensshould be tightly capped, checked for leakage and properly labeled with patient’s name and HKID
For non-biological samples, different specimens should be placed in individual container bagsPlease stick the patient’s gum label on the individual container bags instead of the specimens
For drug products, please provide product packaging, insert and multiple pills if available
For herb/plant, please provideunused herbs, herbal broth, remnant and herbal formula if available
All the specimensshould be put together into a secondary container bag.TRL request form should be placed in the carrying pocket of secondary container bag
Do not stick thespecimen onto paper or TRL request form
Specimen Reception Hours
Monday – Friday9:00am –5:30pm
Saturday9:00am – 1:00pm
In case a typhoon signal No. 8 or above, or a ‘Black’ rainstorm warning is hoisted, laboratory service will be suspended. Please contact us for the availability of service before sending specimens.
Rejection of Requests
Specimens with one or more of the following conditions will be rejected:
Spilt specimens or soiled request forms
Biological specimens without specimen collection date
Specimens stuck on request form
Unlabelled or mislabeled specimens
Specimens in wrong containers
Mishandled specimens that are not suitable for processing, e.g. improper transport conditions or outdated specimens
Specimens with insufficient quantity
Requests with insufficient information to identify the patient and the authorized requester
Tests requested not available
Empty or broken containers
Remarks:
Difficult to replace or critical specimens will be processed but results not released until the problem has been resolved
Reporting of results
Most results are reported within 7 – 14 days
A hardcopy of report will be printed, at the requesting location and referring laboratory respectively, when results are ready
Patient’s results can be assessed fromelectronic patient recordunder “toxicology” directory
Specimens will be kept for three months after analysis
Alphabetical list of laboratory tests
General unknown screening
Specimen: Urine / Clotted blood
Container: Plain bottle
Volume: Urine (30 mL); Clotted blood (4 mL)
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:For comprehensivedrug screen and confirmation
Notes: 1. Avoid using blood tubes with gel separators
2. Do not add any preservatives (e.g. boric acid) to urine collection containers
3. Non-biological samples can be accepted for analysis
Heavy metal analysis
Specimen:Facial cream / drug product
Container:Acid-washed bottle
Availability: Monthly
Turnaround time:1 month
Indications:To detect exogenous exposure in confirmed heavy metal poisoning
Metals covered:Aluminium, Arsenic, Cadmium, Copper, Lead, Manganese, Mercury, Selenium,
Zinc
Herb and herbalformula identification
Specimen:Herbs / herbal formula
Availability:Daily
Turnaround time:1 to 2 weeks
Indications:For suspected herb related toxicity
Quantitative toxic alcohol analysis
Specimen:Clotted blood
Container: Plain bottle
Volume: 4 mL
Availability: Special arrangement
Turnaround time:1 day
Indications:For confirmation of toxic alcohol ingestion
Blood toxiclevel:Methanol: 6.24 mmol/L (20 mg/dL)
Ethanol:17.36 mmol/L (80 mg/dL)
Isopropanol:6.66 mmol/L (40 mg/dL)
Acetone:3.44 mmol/L (20mg/dL)
Notes:1. Prior arrangement with the laboratory is necessary
2. Avoid using blood tubes with gel separators
3. Non-biological samples can be accepted for analysis
Quantitative cyanide analysis
Specimen:Fluoride blood
Container: Special fluoride bottlecontainer
Volume: 2 mL (Fill to the blue line mark)
Availability: Special arrangement
Turnaround time:1 day
Indications:For suspected cyanide poisoning
Blood toxic level:> 0.5 mg/L
Notes:1. Prior arrangement with the laboratory is necessary
2. Contact your cluster toxicology laboratory to obtainthespecial fluoride bottle
3. See the following instruction for sample collection
Instruction for the use of pre-treated bottle for Cyanide determination/ ** This is a pre-treated fluoride bottle dedicated for the determination of Cyanide. Please do not use it for glucose assay.
- Label clearly on the tube with patient’s name, identity card number and collection date
- Fill about 2 mL blood up to the blue line marked on the bottle
- Invert mix gently for 30 seconds
- Send in ice bath immediately to the chemical pathology laboratory in your hospital
- Upon receipt of blood sample by the local laboratory, store the whole blood sample frozen and arrange transport with Toxicology Reference Laboratory
- ** Sample with even minor clots will affect Cyanide result
Quantitative vitamin A analysis
Specimen:Clotted blood
Container: Plain bottle
Volume: 4 mL
Availability: Special arrangement
Turnaround time:1 – 2 weeks
Indications:For suspectedvitamin A poisoning
Blood ref range: 1-6 y0.70-1.51mol/L
7-12 y0.91-1.71mol/L
13-19y0.91-2.51mol/L
Adult1.05-2.80mol/L
Notes:1. Prior arrangement with the laboratory is necessary
2. Avoid using blood tubes with gel separators
3. Fasting sample is required
4. Protect sample from light
Target screen for animal thyroid tissue
Specimen:Drug product
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:To detect the presence of animal thyroid tissue adulteration
Target screen for corticosteroids
Specimen:Drug product
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:To detect the presence of corticosteroid adulteration
Drugs included:Alclometasone Diproprionate, Beclomethasone, Betamethasone, Betamethasone Diproprionate, Betamethasone Valerate, Budesonide, Clobetasol Proprionate, Clobetsone Butyrate, Cortisone Acetate, Dexamethasone, Dexamethasone Acetate, Dexamethasone Phosphate, Diflucortolone Valerate, Flucinolone Acetonide, Flucinonide, Fludrocortisone Acetate, Flumethasone, Fluorometholone, Fluticasone Proprionate, Hydrocortisone, Hydrocortisone Acetate, Methylprednisolone, Mometasone Furoate, Prednisolone, Prednisolone Acetate, Prednisone, Prednisone Acetate, Triamcinolone Acetonide and Triamcinolone
Target screen for erectile dysfunction drug/ related analogue
Specimen:Drug product
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:To detect the presence of erectile dysfunction drug / related analogue adulteration
Drugs included:Sildenafil, Homosildenafil, Tadalafil, Vardenafil, Acetildenafil,
Hydroxyacetildenafil,Hydroxyhomosildenafil, Piperidenafil, Aminotadalafil,2-(2-ethoxy-phenyl)-5-methyl-7-propyl-3H-imidazo[5,1-f]-[1,2,4]triazin-4-one (vardenafil analogue)
Target screen for oral hypoglycemic agents
Specimen:Spot urine / Clotted blood
Container: Plain bottle
Volume: Urine (30 mL); Clotted blood (4 mL)
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:To detect the presence of oral hypoglycemic agents in unexplained hypoglycemia
Drugs included:Glibenclamide, Gliclazide, Glimepiride, Glipizide, Glibornuride, Gliquidone,
Chlorpropamide, Tolbutamide, Acetohexamide, Carbutamide, Tolazamide, Nateglinide and Repaglinide
Target screen for tetramine
Specimen: Spot urine / Clotted blood
Container: Plain bottle
Volume: Urine (30 mL); Clotted blood (4 mL)
Availability: Special arrangement
Turnaround time:1 day
Indications:For suspected tetramine poisoning
Notes:1. Prior arrangement with the laboratory is necessary
2. Non-biological samples can be accepted for analysis
Target screen for toxic plant / herbal alkaloids
Specimen: Spot urine / Clotted blood
Container: Plain bottle
Volume: Urine (30 mL); Clotted blood (4 mL)
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:To detect the commonly encountered toxic plant / herbal alkaloids
Toxins included:Aconitine and related toxins, Anti-cholinergics, Matrine and related toxins, Ephedrine and related toxins, Strychnine and brucine, Tetrahydropalmatine, Podophyllotoxin, Atractyloside, Cardiac glycosides, Gelsemine and related toxins, Grayanotoxin, Ricinine
Notes:1. Non-biological samples can be accepted for analysis
Target screen for warfarin and superwarfarins
Specimen: Clotted blood
Container: Plain bottle
Volume: 4 mL
Availability: Weekly
Turnaround time:1 – 2 weeks
Indications:For suspected anticoagulant rat poison overdose
Drugs included:Brodifacoum, Bromadiolone, Chlorphacinone, Coumachlor, Coumafuryl, Coumatetralyl, Difenacoum, Difethalone, Diphacinone, Flocoumafen, Pindone and Warfarin
Notes:1. Non-biological samples can be accepted for analysis
Appendix A
Cluster Toxicology Laboratories
Distribution
ClusterSite of CTLContact PersonsTelephone Numbers
HKWQMHDrSidney Tam28553249
HKEPYNEHMr Y C Lo25955108
NTEPWHDr Michael Chan26322326
NTWTMHMs Judy Lai24685304
KWPMHMr C K Lai29901875
KC & KEQEHDr Anthony Shek29586784
Role
Emergency toxicology services
Broad spectrum toxicology screening
Common substance of abuse analysis service
Consultation and interpretation related to the above services
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