STANDARDIZATION OF WORKLOAD DATA COLLECTION

4TH EDITION – 2009

INTRODUCTION

Workload of Pathology services forms the basis to assist Ministry of Health in the
planning for resource management ( manpower, budgeting, equipment ), policy decisions as
well as monitoring the utilization of pathology services.

The 1st guideline was introduced in 1999. A few discrepancies and alterations in the first
edition led to the 2nd edition ( August 2000 ) and 3rd edition ( January 2002 ) in quick succession.

7 years have passed since the 3rd edition and the range of tests in all Ministry of Health
laboratories have greatly expanded. Old tests/methods have been replaced by new ones and
increasing decentralization of many tests has made it necessary to review workload collection.

WORKING COMMITTEE FOR THIS HANDBOOK

Dato’ Dr. Norain Karim - Advisor

Datin Dr. Kalavathy Ramchandram - Co-ordinator & Compiler
Dr. Muhammad Arif bin Mohd Hashim - Chemical Pathology Activity Head
Dr. Roshida bt Hassan - Hematology Activity Head
Dr. Arni bt Talib - Anatomical Pathology Activity Head
Dr. Zubaidah bt Abd Wahab - Medical Microbiology Activity Head
Dr. S. Mangalam - Virologist
Mr. Yee Khee Wai - Medical Laboratory Technologist U38

REVIEW OF DATA COLLECTION

1. Include number of samples in data collection

Since the last edition in 2002, there has been marked progression from manual to
automation. There is almost full automation in Chemical Pathology, Hematology and Serology
in all hospitals and some of the larger health centers. Anatomical Pathology, Microbiology and
Transfusion have seen partial automation in most hospitals. Therefore a need to look at
samples and test data separately.

2. Update list of tests & method of collection

Activity heads reviewed the lists of tests in their respective areas and updated the lists.
These were circulated to all State Heads to discuss and review with their staff. The changes and
queries of the feedback were discussed at National meetings and the final draft was presented
at the “ Strategic Planning for Pathology Service 2010-2015 ” in A’Famosa Resort, Malacca held

1
from 16-18 June 2009. The feedback from this meeting was incorporated into the finalized
guidelines.

3. Review of MOH reporting form PER SS 206 ( Pin. 1/2000 )

Number of samples/ cases to be included. Forensic workload has been removed as it is now
separated from Pathology.

GENERAL PRINCIPLES OF DATA COLLECTION

1. All MOH laboratories in hospitals, institutions and public health facilities to continue
reporting workload data in the updated version of PER SS 206 and through the existing
channels.
2. The personnel responsible for providing data on the report shall be the Scientific Officer or
Medical Laboratory Technologist in charge in the hospitals and public health laboratories.
In the few smaller public health laboratories without Medical Laboratory Technologists, the
Junior Laboratory Assistant in-charge or Nurse where there is no laboratory personnel, shall
be responsible for providing the data.
3. State Pathologist is responsible to check and monitor data sent to MOH from all the
hospitals within the state.
4. All clerical work ( demography, typing, validating etc ) will not be included in workload
collection.
5. Collection of test data will follow the listing in this guideline. Variations to laboratory setup
in hospitals is not the deciding factor.
6. Data on outsourced samples and tests need to be collected. This information is needed in
policy making when planning centralization or decentralization of services.

PREPARATION & SUBMISSION OF REPORTS

MONTHLY REPORTS
The officer in-charge of collecting data at hospital and public health facilities will submit
through existing channels ie: district, state to IDS Unit, MOH.

BIANNUAL REPORTS
State Pathologists to collect and send the 6 monthly workload data according to disciplines
of every hospital in their state and send to JKK Bebankerja ( HTAA, Kuantan) by 1 st August for
Jan-June data and 1st February of following year for July-Dec data.
Eg: Jan-June 2009 by 1st Aug 2009; July-Dec 2009 by 1st Feb 2010.

ANNUAL REPORTS
At the end of the year, Officer in-charge will compile all the monthly data into an annual
report and submit copies through existing channels ie: district, state to IDS Unit, MOH. A copy
may also be sent to State Pathologist.

2
3
 CALCULATION OF WORKLOAD DATA

ANATOMICAL PATHOLOGY
Explanatory Notes:

1. Only total number of specimens and slides to be reported to MOH.

2. In addition, data on histopathology cases ( according to Category A,B,C ) and cytology
cases ( according to FNA, Gynae, Non-gynae ) to be submitted in the biannual report to
JKK Bebankerja.
3. The method of counting slides and classification of cases is as given in the list below.

A. HISTOPATHOLOGY

Tests Methods of Counting Factors

Block X no. of blocks X 1/block
X no. of levels if
H & E slides X no. of slides
applicable
Special stain :
● Histochemistry
● Immunohistochemistry X 1/test
X no. of slides (test + control)
● Immunoflouresence X 1/control
● Enzyme histochemistry

Data to be submitted to HTAA, Kuantan

Cases Methods of Counting Factors
Surgical specimen ( category A, B, C)
Autopsy ( category A, B , C)
Referral cases (including specimen,
blocks, slides for staining and second
opinion)
X no. of cases X 1/case
Outsourced cases ( category A, B, C
with or without grossing & processing). If
grossing & processing done state the
workload i.e. blocks, H & E slides &
special stains

DEFINITION
Category A: Skin biopsy/Renal biopsy/Fossa of Rosenmuller biopsy/Rectal biopsy/Oesophagus biopsy/Gastric biopsy/Duodenal biopsy
/Endometrial sampling/Liver biopsy/Product of conception sampling/Bony tissue/Trephine biopsy.
Category B: Spleen/Thyroid/Eye/Ovary without tube/Tonsil (single)/Appendix.

Category C: Total abdominal hysterectomy bilateral salphimgo oopherectomy/Mastectomy and axillary clearance/Colectomy and mesentery

4
 /Right and left Fallopian tubes.
Multiple specimen: Breast lump/Fossa of Rosenmuller biopsies/Rectal biopsies/Oesophagus gastro duodenal biopsies/Right and
left tonsils/Product of conception.
NOTE: All specimens received on the same day for 1 patient to be counted as 1 case (Category C)

TOTAL NUMBER OF CASES (SAMPLES) : ____________

TOTAL NUMBER OF TESTS (WORKLOAD) : ____________

B. CYTOLOGY

Tests Methods of Counting Factors

Smear
● Papanicolaou's stain
X no. of smears X 1/smear
● MGG

Special stain:
● Histochemistry X no. of slides (test + control)
● Immunohistochemistry

Data to be submitted to HTAA, Kuantan

Cases Methods of Counting Factors
Fine Needle Aspiration X 1/case
Gynaecological X no. of cases X 2/case
Non Gynaecological X 1/case

TOTAL NUMBER OF CASES (SPECIMENS) : _____________

TOTAL NUMBER OF TESTS (WORKLOAD) : _____________

C. CLINICAL AUTOPSY

Cases Methods of Counting Factors

PM performed by:
● Pathologist
X no. of cases X 1/PM
● Medical Officer

5
 HISTOPATHOLOGY

NEGERI :
HOSPITAL :
TAHUN :
BULAN :

NO.OF SPECIAL STAIN (No. of Slides + Control)

NO.OF NO.OF TOTAL
CATEGORY H&E Immuno- Immuno- Enzyme
CASES BLOCKS Histochemistry WORKLOAD
SLIDES histochemistry flouresence histochemistry

A
B
C
Frozen Section
Referral
RCPA
TOTAL
DEFINITION
Category A: Skin biopsy/Renal biopsy/Fossa of Rosenmuller biopsy/Rectal biopsy/Oesophagus biopsy/Gastric biopsy/Duodenal biopsy
/Endometrial sampling/Liver biopsy/Product of conception sampling/Bony tissue/Trephine biopsy.
Category B: Spleen/Thyroid/Eye/Ovary without tube/Tonsil (single)/Appendix.
Category C: Total abdominal hysterectomy bilateral salphimgo oopherectomy/Mastectomy and axillary clearance/Colectomy and mesentery
/Right and left Fallopian tubes.
Multiple specimen: Breast lump/Fossa of Rosenmuller biopsies/Rectal biopsies/Oesophagus gastro duodenal biopsies/Right and
left
tonsils/Product of conception.
NOTE: All specimens received on the same day for 1 patient to be counted as 1 case (Category C)

CYTOLOGY

SPECIAL STAIN
NO. OF SMEARS
NO.OF (slides) TOTAL
TYPE
CASES Immuno- WORKLOAD
PAP stain MGG stain Histochemistry
histochemistry

Fine Needle Aspiration

Gynaecological
Non-Gynaecological
TOTAL

NO.OF
Outsourced NO.OF NO.OF NO.OF NO. OF
H&E Outsourced Cytology
Histopathology CASES BLOCKS CASES SMEARS
SLIDES
Category A Fine Needle Aspiration
Category B Gynaecological
Category C Non-Gynaecological
TOTAL TOTAL

6
CHEMICAL PATHOLOGY

Explanatory Notes:

1. The number of samples to be recorded as a total number.

2. All Profile tests to be counted as individual parameters. However, calculated parameters
are not counted as tests eg. LDL, Indirect Bilirubin, Globulin, A/G ration, etc.
3. Urine chemistry by dipstick/automation is reported as 1 test regardless of whether it is 2
parameters, 5 parameters or 10 parameters.
4. Grand total of samples and tests to be reported to MOH & JKK Bebankerja.
5. The list of tests is given below according to sample received.

CHEMICAL PATHOLOGY

_____________ (Month) __________ (Year)

STATE :
HOSPITAL :

A) BLOOD
Total Number of Specimens :

I) GENERAL CHEMISTRY

TOTAL NO. OF
NO. TEST
TESTS*
1 Acetaminophen
2 Alanine Transaminase
3 Albumin
4 Alcohol
5 Alkaline Phosphatase
6 Amikacin
7 Ammonia
8 Amylase
9 Aspartate Transaminase
10 Benzodiazepines
11 Bicarbonate
12 Bilirubin, Direct
13 Bilirubin, Total
14 Blood Gases
15 Calcium
16 Carbamazepine
17 Chloride
18 Cholesterol
19 Cholinesterase
20 Clinical Toxicology Screening
21 Cocaine
22 Complement C3
23 Complement C4

7
24 Copper
25 C-Reactive Protein
26 Creatine Kinase
27 Creatine kinase isoenzyme (CK-MB)
28 Creatinine
29 Cyclosporin
30 Digoxin Level Assay
31 Gamma Glutamyl Transaminase
32 Gentamicin Assay
33 Glucose
34 HbA1C
35 High Density Lipoprotein
36 Immunoglobulin A (IgA)
37 Immunoglobulin G (IgG)
38 Immunoglobulin M (IgM)
39 Iron
40 Lactate
41 Lactate Dehydrogenase
42 Lithium
43 Lipoprotein
44 Magnesium
45 Methotrexate Level Assay
46 Netilmicin
47 Osmolality
48 Phenotoin Level Assay
49 Phophatase, Acid
50 Phosphate, Inorganic
51 Plumbum
52 Potassium
53 Protein Electrophoresis
54 Protein
55 Pyruvate
56 Salicylate
57 Sirolimus
58 Sodium
59 Tacrolimus
60 Theophyline
61 TIBC
62 Triglycerides, Total
63 Urea
64 Uric Acid
65 Valporic Acid
66 Vancomycin
67 Vitamin B12
**

8
 II) IMMUNOCHEMISTRY

TOTAL NO. OF
NO. TEST
TESTS*
1 Adrenocorticotrophic (ACTH)
2 Alpha-1-Acid glycoprotein
3 Alpha-1-Antitrypsin
4 Alpha-2-Microglobulin
5 Alpha-Feto Protein (AFP)
6 Beta-Human Chorionic Gonadotrophin
7 Cancer Antigen 125 Tumour Marker
8 Cancer Antigen 15-3
Carbohydrate Antigen 19-9 Tumour
9 Marker
10 Carcinoembryonic Antigen (CEA)
11 Ceruloplasmin
12 Cortisol
13 C-Peptide
Dehydroxyepiandrosterone Sulphate
14
(DHEAS)
15 Estradiol
16 Ferritin
17 Folate
18 Follicle Stimulating Hormone (FSH)
19 Growth Hormone
20 Haptoglobin
21 Homocysteine
22 IPTH
23 Insulin
24 Luteinising Hormone (LH)
25 Progesterone
26 Prolactin
27 Prostate Specific Antigen, Free
28 Prostate Specific Antigen, Total
29 Testosterone
30 Parathyroid Hormone
31 Thyroid Function Test
32 Thyroid Stimulating Hormone (TSH)
33 Thyroxine, Free (FT4)
34 Tri-Iodothyronine free (FT3)
35 Transferin
**

B) URINE
Total Number of Specimens :

TOTAL NO. OF
TEST
NO. TESTS*
1 Acetone

9
 Ammonium Chloride Test (for urinary
2
acidification)
Amphetamine Type Stimulant
3 (Confirmation)
4 Amylase
5 Barbiturate
6 Benzodiazepine
7 Biochemistry (dipstick)
8 Calcium
9 Cannabis (Confirmation)
10 Catecholamines
11 Chloride
12 Chondroitin Sulphate (qualitative)
13 Cortisol
14 Copper
15 Creatinine Clearance (urine 24 hours)
16 Cystine (qualitative)
17 Drug of Abuse Screening (Morphine)
18 Drug of Abuse Screening (Cannabis)
19 Drug of Abuse Screening (ATS)
20 Glucose (qualitative)
21 Homogentisic Acid, fresh urine
22 Ketone
23 Microalbumin
24 Microscopy (casts / crystals)
25 Morphine / Codine (Confirmation)
26 Mucopolysacharide
27 Myoglobin (urine) qualitative
28 Osmolality
29 Paraquat Level Assay
30 PH
31 Phosphate, Inorganic
32 Porphobilinogen
33 Porphyrins
34 Potassium
35 Protein (qualitative)
36 Protein Electrophoresis
37 Protein Creatinine Index
38 Protein, Total
39 Sodium
40 Urea
41 Uric Acid
42 Urobilinogen & Bilirubin
**

10
C) BODY FLUIDS
Total Number of Specimens :

TYPES OF TOTAL NO. OF

BIL TESTS SPECIMENS TESTS*
1 Augmented Histamine Test Gastric Aspirates
2 Chloride CSF
3 Chloride Sweat
4 Glucose CSF
5 Glucose Fluid
6 LDH Fluid
7 Protein CSF
8 Protein Fluid
9 Globulins, qualitative CSF
10 Lactate CSF
**

D) STOOL
Tota Number of Specimens :

TOTAL NO. OF
TEST
NO. TESTS*
1 Stool occult blood
**

* Daily QC runs are included in the total number of tests done.

** Other tests

TOTAL NO. OF CHEM PATH SPECIMENS : (A+B+C+D)

TOTAL NO. OF CHEM PATH TESTS : (A+B+C+D)

E) OUTSOURCED TESTS

TOTAL NO. OF
NO. TESTS SPECIMENS
REFERRAL CENTRE

11
HAEMATOLOGY

Explanatory Notes:

1. The number of samples to be recorded as a total number.

2. Blood counts in profiles ( Hemoglobin Analysis, DIVC screening etc.) is counted under
FBC in routine hematology. In almost all laboratories, the blood count in the profile
request is done on the same routine FBC hematology analyzer. This is to avoid
duplication of data and to capture the true FBC workload.
3. List of tests and method of calculating workload is as below.

Test Request Method of Counting Factor

A. Routine Haematology

Blood Count ● Hb X1
● Automated Full Blood Count (FBC) X1
● Reticulocyte count X1
● Blood Film Review of Abnormal X1
Blood Counts

Erythrocyte Sedimentation Rate X1

G6PD screening X1

Full Blood Picture ● Automated Full Blood Count (FBC) X1

(Internal cases) ● Reticulocyte count X1
● Peripheral Blood Film Morphology X1

Full Blood Picture ● Automated Full Blood Count (FBC) X1

(External cases / Referred cases) ● Reticulocyte count X1
● Peripheral Blood Film Morphology X1

Full Blood Picture ● Automated Full Blood Count (FBC) X1

(Outsource) ● Reticulocyte count X1
● Peripheral Blood Film Morphology X1

Bone marrow aspiration Smear / Trephine roll X1

Routine stain : ● Romanowsky stain e.g MGG X1
● Perl X1

Cytochemistry : ● Peroxidase X1
● PAS X1
● Acid phosphatase X1
● Dual esterase X1
● LAP score X1

CSF cytospin Under Cytology (Non-Gynae) workload

12
 B. Haemostasis and Thrombosis
Bleeding time X1
Prothrombin time ( PT) / International X1
normalized ratio ( INR )
Activated partial thromboplastin time X1
( APTT )
DIVC screening ● PT X1
Test profile consist of PT,
● A PTT
APTT, X1
Fibrinogen, FDP/D-Dimer & ● Fibrinogen X1
FBC (Hb/Platelet) ● FDP/D-Dimer X1
● Hb/Platelet (count under automated
FBC)
APTT substitution test (Mixing Test) X1
Thrombin time ( TT ) X1
Fibrinogen X1
FDP / D-dimer X1
C. Haemoglobin Disorders

Haemoglobin Analysis ● Automated Full Blood Count

(Basic Screening) (count under automated FBC) X1
● Reticulocyte count (if manual, to be X1
counted separately; if automated
to be counted as FBC
● Peripheral Blood Film Morphology X1
● Hb A2 / Hb F quantitation X1
● H inclusion X1

Haemoglobin Analysis
Hb electrophoresis X1
(Additional Tests)
Kleihauer Test X1
D. Red Cell Disorder
G6PD assay X1
Meth-Hb reductase X1
Pyruvate kinase assay X1
Sucrose lysis test X1
Autohaemolysis X1
Osmotic Fragility Test X1
Schumm's test X1
Heinz bodies X1
Ham test X1
E. Immunophenotyping
Single platform method
Lymphocyte subset enumeration
CD3/CD4/CD8 enumeration ● CD3 X1
T & B enumeration ● CD4 X1
● CD8 X1

13
 ● CD19 X1
● CD16/CD56 X1
Dual platform method
CD3/CD4/CD8 enumeration ● FBC (count under automated FBC)
T & B enumeration ● CD3 X1
● CD4 X1
● CD8 X1
● CD19 X1
● CD16/CD56 X1
Leukaemia / Lymphoma ● Blood or Bone Marrow Film X1
Immunophenotyping ● Cell Viability X1
(Basic screening)
Leukaemia Immunophenotyping ● FBC (count under automated FBC)
(Diagnostic panel) ● Peroxidase X1
● As per antigen to be detected e.g.
CD45 X1
CD33 X1
CD19 X1
PNH As per antigen to be detected e.g.
● CD45 X1
● CD55 X1
● CD59 X1
F. Molecular Diagnosis
Molecular tests for Thalassaemia / As per type of genetic defect e.g.
Haemoglobinopathy ● SEA deletion X1
● FIL deletion X1
Molecular tests for G6PD
genotyping As per type of genetic defect e.g.
(Not available in KKM laboratories
yet) ● Viangchan variant X1
● Canton variant X1
● Mahidol variant X1
● Kaiping variant X1
Molecular tests for Leukaemia As per type of genetic defect e.g.
● BCR-ABL X1
● PML-RARA X1
● TEL-AML X1
Molecular tests for Lymphoma As per type of genetic defect e.g.
● BCL2 rearrangement X1
● MYC translocation X1
Molecular tests for Haemophilia As per type of genetic defect e.g.
● Intron 1 inversion X1
● Intron 22 inversion X1

Molecular tests for Von

Willebrands's disease As per type of genetic defect e.g.

14
 ● Single cytosine deletion in exon 18 X1
● Nonsense mutation in exons 28 X1
● Nonsense mutation in exons 15 X1
Molecular tests for Thrombophilia As per type of genetic defect e.g.
● FV Leiden mutation X1
● PT20210A mutation X1
G. Stem Cell Transplant
CD34 enumeration of Bone
Marrow, ● FBC (count under automated FBC) X1
PBSC, Cord blood ● Film Morphology X1
● CD34 X1
● Cell Viability X1
CD3 X1
Cryopreservation of Bone Marrow,
X1
PBSC, Cord blood
Buffy coat preparation of Bone
X1
Marrow harvest
Plasma depletion X1
Stem cell selection X1
Cord blood collection X1
Donor chimerism studies X1

HLA typing IMR calculation

● Class I HLA typing
Low / medium resolution X1
High resolution X1
● Class II HLA typing
Low / medium resolution X1
High resolution X1

H. Special Haemostasis and Thrombosis

Count as 1 test per factor assay e.g.
Factor assays ● FV X1
● FVLL X1
● FVIII X1
● FIX X1
Factor inhibitor assay ● Screening for presence of inhibitor X1
● Bethesda Assay for specific factor
inhibitor
Factor VIII inhibitor X1
Factor IX inhibitor X1
VWD As per test performed e.g.
● APTT X1
● Mixing Test X1
● VWF:CB X1
● VWF:Ag X1
● RiCOF X1

15
 Lupus anticoagulant As per test performed e.g.
● APTT X1
● Mixing Test X1
● APTT- LA
Screening X1
Confirm X1
● DRVVT
DRVVT screening X1
DRVVT confirm X1
● Kaolin Clottting Time
KCT screening X1
KCT confirm X1
● Anticardiolipin antibody
Anticardiolipin IgM/IgG X1
Anti-β2 glycoprotein X1
Platelet aggregation test As per agonist used
● ADP X1
● Collagen X1
● Ristocetin 1.5 X1
● Ristocetin low dose X1
● Arachidonic acid X1
Antithrombin III X1
Protein C X1
Protein S X1
APCR X1
Reptilase time X1
ADAMTS 13 X1
HIT (Heparin Induced
X1
Thrombocytopenia)
Anti-Xa X1

Take into account the number of levels and

Quality Control runs
(applicable for all tests)
frequency of run according to requirement
of specific tests
No.of
e.g. 1) For FBC test in a 24 hour
levels X
laboratory where 3 levels of QC
no.of run
reagents are run 2 times/day
X count
= 1 X ( 3 levels X 2 runs)
as per
specific
e.g. 2) For batch testing as CD 34 test
enumeration, 2 levels of QC
reagents are run per batch
= (monoclonal antibodies X 2)
per batch

NOTE: If the test is a component of a profile and is performed in a separate section, please ensure that
there is no double counting of this test e.g. Hb/platelet in DIVC screening should only be counted once

16
by the FBC section or coagulation section.

I. Outsourced Tests
Tests Total No. of Specimens Referral Centre

TOTAL NUMBER OF SAMPLES : _______________ (A+B+C+D+E+F+G+H)

TOTAL NO. OF TESTS (WORKLOAD) : _______________ (A+B+C+D+E+F+G+H)

17
 HAEMATOLOGY

Routine Haematology Samples Tests

Blood Count
● Hb
● Automated Full Blood Count (FBC)
● Reticulocyte count
● Blood Film Review of Abnormal
Erythrocyte Sedimentation Rate
G6PD screening
Full Blood Picture (Internal cases)
● Automated Full Blood Count (FBC)
● Reticulocyte count
● Peripheral Blood Film Morphology
Full Blood Picture (External cases / Referred cases)
● Automated Full Blood Count (FBC)
● Reticulocyte count
● Peripheral Blood Film Morphology
Full Blood Picture (Outsource)
● Automated Full Blood Count (FBC)
● Reticulocyte count
● Peripheral Blood Film Morphology
Bone marrow aspiration
Smear / Trephine roll
● Romanowsky stain e.g MGG
● Perl
Cytochemistry :
● Peroxidase
● PAS
● Acid phosphatase
● Dual esterase
● LAP score
CSF cytospin (Romanowsky stain)
Haemostasis and Thrombosis Samples Tests
Bleeding time
Prothrombin time (PT) / International normalized ratio (INR)
Activated partial thromboplastin time ( APTT )
DIVC screening
APTT substitution test (Mixing Test)
Thrombin time ( TT )
Fibrinogen
FDP / D-dimer
Haemoglobin Disorders Samples Tests
Haemoglobin Analysis
● Hb electrophoresis
● Reticulocyte count
● Peripheral Blood Film Morphology

18
 ● Hb A2 / Hb F quantitation
● H inclusion
Kleihauer Test
Red Cell Disorder Samples Tests
G6PD assay
Meth-Hb reductase
Pyruvate kinase assay
Sucrose lysis test
Autohaemolysis
Osmotic Fragility Test
Schumm's test
Heinz bodies
Ham test
Immunophenotyping Samples Tests
(Single platform method)
● CD3
Lymphocyte subset enumeration ● CD4
CD3/CD4/CD8 enumeration ● CD8
T & B enumeration ● CD19
● CD16/CD56
Samples Tests
(Dual platform method)
● CD3
CD3/CD4/CD8 enumeration ● CD4
T & B enumeration ● CD8
● CD19
● CD16/CD56
Leukaemia Immunophenotyping
● Blood or Bone Marrow Film
● Cell Viability
● Peroxidase
● CD45
● CD33
● CD19
Special Haemostasis and Thrombosis Samples Tests
Factor assays
● FV
● FVLL
● FVIII
● FIX
Factor inhibitor assay
● Screening for presence of inhibitor
● Factor VIII inhibitor
● Factor Factor IX inhibitor
VWD

19
 ● APTT
● Mixing Test
● VWF:CB
● VWF:Ag
● RiCOF
Lupus anticoagulant
● APTT
● Mixing Test
● APTT- LA
Screening
Confirm
● DRVVT
DRVVT screening
DRVVT confirm
● Kaolin Clottting Time
KCT screening
KCT confirm
● Anticardiolipin antibody
Anticardiolipin IgM/IgG
Anti-β2 glycoprotein
Platelet aggregation test
● ADP
● Collagen
● Ristocetin 1.5
● Ristocetin low dose
● Arachidonic acid
Antithrombin III
Protein C
Protein S
APCR
Reptilase time
ADAMTS 13
HIT (Heparin Induced Thrombocytopenia)
Anti-Xa

Total No. of
Outsourced Tests Referral Centre
Specimens

TOTAL NUMBER OF SAMPLES :

TOTAL NO. OF TESTS (WORKLOAD) :

20
MEDICAL MICROBIOLOGY

Explanatory Notes:

1. Not all specimens will grow pathogens as some may be contaminated or have no
growth.
2. Workload calculation will only include actual tests done ie: stains, culture, identification
& sensitivity.
3. Number of stains will be actual stains done.
4. Culture, identification and sensitivity will each be counted as 1 test irrespective of the
number of media, plates or chemical tests used.
eg: Blood culture if negative - samples X 1
If positive - samples X 4 (Gram’s stain, culture,
Biochemistry, sensitivity)
5. In Virology, the factor for workload calculation depends of the number of antibodies
used.
eg: Dengue IgG & IgM will have factor X2
CMV if IgM only done, factor X1
6. Total number of specimens and tests to be reported to MOH & JKK Bebankerja.
7. List of tests and method of calculating workload is as below.

Tests Methods of Counting Factors

A. BACTERIOLOGY
CSF
Cell count X1
ZN X1
Indian Ink X1
Gram stain X1
Culture X1
Biochemical X1
Latex agglutination X1
Sensitivity I X1
Sensitivity II X1
Peritoneal fluid C & S
Cell count X1
ZN X1
Indian Ink X1
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Aspirate C & S
Cell count X1
ZN X1
Gram stain X1

21
 Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Pus C & S
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Genital swab C&S
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Tissue C & S
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Helicobacter
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Respiratory C & S
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Mycobacterium culture
AFB stain X1
Culture X1
NAP X1
Sensitivity I X1
Sensitivity II X1
Blood C & S : aerobic / anaerobic
Gram stain X1
Bottle X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Stool C & S

22
 Culture X1
Biochemical X1
Serotyping no. of isolates serotyped X4
Serotyping no. of isolates serotyped X4
Sensitivity
Urine C & S
Microscopy X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Sterility C & S
Gram stain X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Biological Indicator for sterility (Attest)
Culture X no. of samples
Air Sampling
Culture X no. of samples
In use testing
Culture X no. of samples

Environment screen
Culture X no. of samples
R.O. water / Endotoxin X no. of tests
B. MYCOLOGY
Fungal Blood C & S
Gram stain X1
Bottle X1
Culture X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Fungal C & S
Culture X1
Wet mount X1
Biochemical X1
Sensitivity I X1
Sensitivity II X1
Cryptococcal Ag (serology) X1
Histoplasma Antibody (serology) X1
Candida Ag (serology) X1
Aspergillus Ag (serology) X1
C. SEROLOGY
Clostridium difficile toxin X1
Chlamydia trachomatis IF X1

23
CSF VDRL X1
Indirect Immunoperoxidase
Rickettsial X dilution
Leptospira IgM X1
Mycoplasma pneumoniae Ab X dilution
TPHA X1
VDRL / RPR Serology X dilution
CSF Bacterial Antigen X1
Chlamydia pneumoniae IgM / IgA /
IgG X no. of Ab types
Chlamydia psittaci IgM / IgA / IgG X no. of Ab types
Legionella pneumophilia Ag X no. of Ab types
Brucella abortus Ag X no. of Ab types
Brucella militensis Ag X no. of Ab types
Borrelia burgdorferi IgM / IgG X no. of Ab types
Coxiella burnetti IgM / IgG X no. of Ab types
Chlamydia pneumoniae IF X1
Chlamydia psittaci IF X1
Semen Analysis X no. of tests
Pregnancy Test X dilution
D. IMMUNOLOGY
Anti-ds DNA X1
Allergy Screening Test X no. of allergens tested
Allergy Specific Test X no. of allergens tested
Anti-Nuclear Antibodies X dilution
Anti-Streptolysin O X dilution
Anti-Thyroglobulin Antibody X dilution
Extractable Nuclear Antigen ( ENA ) X dilution
ENA profile X no. of antibodies
ANCA IF X1
MPO ANCA X1
PR3 ANCA X1
Rheumatoid Factor X dilution
Thyroid Microscomal Antibody X dilution
Complement C3 X1
Complement C4 X1
C- reactive protein (CRP) X1
Immunoglobulin A ( IgA) X1
Immunoglobulin G ( IgG) X1
Immunoglobulin M ( IgM) X1
Thyroid receptor antibody X1
Anti-gastric parietal cell X1
Anti-liver autoantibody X1
Anti M2 Antibody X1
Other specific liver antibodies
X1
(LCI, SLA, LP)
Anti-parietal X1
Anti-LKM X1
Anti-CCP X1

24
Acetylcholine-receptor Antibody X1
HLA Typing X1
Phagocytic function X1
Neutrophil function X1
Anti-cardiolipin IgG & IgM X Ab type
Anti-smooth muscle antibody X1
Anti-mitochondrial antibody X1
E. PARASITOLOGY
Cryptosporidium IF X1
Cryptosporidium Modified ZN X1
Microfilaria X1
Malaria parasite ( BFMP ) X1
Malaria parasite MP 1 (Serology) X1
Isospora belli X1
Stool Ova & Cyst X1
Stool for occult blood X1
Toxoplasma gondii IgM / IgG X no. of Ab types
Pneumocystis carinii IF X1
Pneumocystis Giemsa X1
Entomoeba histolytica Ab X1
Giardia microscopy X1
Leishmania spp ( Giemsa) X1
Trichomonas vaginalis microscopy X1
Acanthamoeba microscopy X1
F. VIROLOGY
Anti-HIV X1
HIV Supplementary (Serodia) X1
HIV Confirmatory (Innolia) X1
Anti-HCV X1
HCV Supplementary (Serodia) X1
HCV Confirmatory (Innolia) X1
HBsAg X1
HBsAg Confirmatory X1
Anti-HBs antibody X1
HBe Antigen X1
HBe Antibody X1
Anti-HBc IgM X1
HBc Total Antibody X1
HAV IgM / IgG X no. of Ab types X1
HDV IgM / IgG X no. of Ab types
HEV IgM / IgG X no. of Ab types
Dengue NS 1 Antigen X1
Dengue IgM & IgG X no. of Ab types
HSV IgM / IgG X no. of Ab types
VZV IgM / IgG X no. of Ab types
Rotavirus Antigen Latex Test X1
EBV IgM / IgG X no. of Ab types
HTLV Ab X1

25
 Parvovirus B 19 IgM / IgG X no. of Ab types X1
Japanese encephalitis IgM X no. of Ab types X1
Chikungunya IgM X no. of Ab types X1
Hantavirus IgM / IgG X no. of Ab types X1
VZV IFAT X2
HSV IFAT X2
Adenovirus IFAT X2
Influenza A IFAT X2
Influenza B IFAT X2
RSV IFAT X2
Parainfluenza 1 IFAT X2
Parainfluenza 2 IFAT X2
Parainfluenza 3 IFAT X2
CMV IgM / IgG X no. of Ab types
Rubella IgM / IgG X no. of Ab types
Mumps IgM / IgG X no. of Ab types
Measles IgM / IgG X no. of Ab types
HHV6 IgG / IgM X no. of Ab types
G. MOLECULAR PCR
JE X1
Dengue X1
CMV X1
HIV X1
HBV X1
HCV X1
HSV 1 / 2 X1
VZV X1
Enterovirus X1
Rubella X1
HIV Viral Load X1
A(H1N1)

H. OUTSOURCED TESTS
TOTAL NO. OF
TESTS REFERRAL CENTRE
SPECIMENS

TOTAL NUMBER OF SAMPLES: _________________ (A+B+C+D+E+F+G)

TOTAL NO. OF TESTS (WORKLOAD): __________________ (A+B+C+D+E+F+G)

26
 MICROBIOLOGY

A. BACTERIOLOGY Samples Tests

CSF
Cell count
ZN
Indian Ink
Gram stain
Culture
Biochemical
Latex agglutination
Sensitivity I
Sensitivity II
Peritoneal fluid C & S
Cell count
ZN
Indian Ink
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Aspirate C & S
Cell count
ZN
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Pus C & S
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Genital swab C&S
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Tissue C & S
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II

27
Helicobacter
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Respiratory C & S
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Mycobacterium culture
AFB stain
Culture
NAP
Sensitivity I
Sensitivity II
Blood C & S : aerobic / anaerobic
Gram stain
Bottle
Culture
Biochemical
Sensitivity I
Sensitivity II
Stool C & S
Culture
Biochemical
Serotyping
Serotyping
Sensitivity
Urine C & S
Microscopy
Culture
Biochemical
Sensitivity I
Sensitivity II
Sterility C & S
Gram stain
Culture
Biochemical
Sensitivity I
Sensitivity II
Biological Indicator for sterility
(Attest)
Culture
Air Sampling
Culture
In use testing

28
 Culture
Environment screen
Culture
R.O. water / Endotoxin
B. MYCOLOGY Samples Tests
Fungal Blood C & S
Gram stain
Bottle
Culture
Biochemical
Sensitivity I
Sensitivity II
Fungal C & S
Culture
Wet mount
Biochemical
Sensitivity I
Sensitivity II
Cryptococcal Ag (serology)
Histoplasma Antibody (serology)
Candida Ag (serology)
Aspergillus Ag (serology)
C. SEROLOGY Samples Tests
Clostridium difficile toxin
Chlamydia trachomatis IF
CSF VDRL
Indirect Immunoperoxidase
Rickettsial
Leptospira IgM
Mycoplasma pneumoniae Ab
TPHA
VDRL / RPR Serology
CSF Bacterial Antigen
Chlamydia pneumoniae IgM / IgA /
IgG
Chlamydia psittaci IgM / IgA / IgG
Legionella pneumophilia Ag
Brucella abortus Ag
Brucella militensis Ag
Borrelia burgdorferi IgM / IgG
Coxiella burnetti IgM / IgG
Chlamydia pneumoniae IF
Chlamydia psittaci IF
Semen Analysis
Pregnancy Test
D. IMMUNOLOGY Samples Tests
Anti-ds DNA
Allergy Screening Test
Allergy Specific Test

29
Anti-Nuclear Antibodies
Anti-Streptolysin O
Anti-Thyroglobulin Antibody
Extractable Nuclear Antigen ( ENA )
ENA profile
ANCA IF
MPO ANCA
PR3 ANCA
Rheumatoid Factor
Thyroid Microscomal Antibody
Complement C3
Complement C4
C- reactive protein (CRP)
Immunoglobulin A ( IgA)
Immunoglobulin G ( IgG)
Immunoglobulin M ( IgM)
Thyroid receptor antibody
Anti-gastric parietal cell
Anti-liver autoantibody
Anti M2 Antibody
Other specific liver antibodies
(LCI, SLA, LP)
Anti-parietal
Anti-LKM
Anti-CCP
Acetylcholine-receptor Antibody
HLA Typing
Phagocytic function
Neutrophil function
Anti-cardiolipin IgG & IgM
Anti-smooth muscle antibody
Anti-mitochondrial antibody
E. PARASITOLOGY Samples Tests
Cryptosporidium IF
Cryptosporidium Modified ZN
Microfilaria
Malaria parasite ( BFMP )
Malaria parasite MP 1 (Serology)
Isospora belli
Stool Ova & Cyst
Stool for occult blood
Toxoplasma gondii IgM / IgG
Pneumocystis carinii IF
Pneumocystis Giemsa
Entomoeba histolytica Ab
Giardia microscopy
Leishmania spp ( Giemsa)
Trichomonas vaginalis microscopy

30
Acanthamoeba microscopy
F. VIROLOGY Samples Tests
Anti-HIV
HIV Supplementary (Serodia)
HIV Confirmatory (Innolia)
Anti-HCV
HCV Supplementary (Serodia)
HCV Confirmatory (Innolia)
HBsAg
HBsAg Confirmatory
Anti-HBs antibody
HBe Antigen
HBe Antibody
Anti-HBc IgM
HBc Total Antibody
HAV IgM / IgG
HDV IgM / IgG
HEV IgM / IgG
Dengue NS 1 Antigen
Dengue IgM & IgG
HSV IgM / IgG
VZV IgM / IgG
Rotavirus Antigen Latex Test
EBV IgM / IgG
HTLV Ab
Parvovirus B 19 IgM / IgG
Japanese encephalitis IgM
Chikungunya IgM
Hantavirus IgM / IgG
VZV IFAT
HSV IFAT
Adenovirus IFAT
Influenza A IFAT
Influenza B IFAT
RSV IFAT
Parainfluenza 1 IFAT
Parainfluenza 2 IFAT
Parainfluenza 3 IFAT
CMV IgM / IgG
Rubella IgM / IgG
Mumps IgM / IgG
Measles IgM / IgG
HHV6 IgG / IgM
G. MOLECULAR PCR Samples Tests
JE
Dengue
CMV
HIV

31
 HBV
HCV
HSV 1 / 2
VZV
Enterovirus
Rubella
HIV Viral Load

TOTAL NO. OF
H. OUTSOURCED TESTS REFERRAL CENTRE
SPECIMENS

TOTAL NO. OF SPECIMENS : (A+B+C+D+E+F+G)

TOTAL NO. OF TESTS (WORKLOAD) : (A+B+C+D+E+F+G)

32