Test advice

Over the years, Melbourne Pathology has received many requests for advice on pathology tests appropriate to various clinical conditions. In response, we have compiled the following checklist for your consideration.

This list is neither exhaustive nor authoritative and should only be regarded as a prompt to assist the busy practitioner. Obviously, in individual and specific circumstances, some tests mentioned will be irrelevant. Conversely, other tests which do not appear on this list may be very appropriate.

To encourage appropriate ordering strategies, the tests are organised into 'first stage', 'second stage' and 'more specialised' tests.

We are always happy to help you choose the most appropriate tests to assist with your patient management and we welcome your feedback on this checklist.

To contact us for advice or to provide feedback please call (03) 9287 7700 or email enquiries@mps.com.au.

You may also refer to the Complete Clinical Problem Listing from The Royal College of Pathologists of Australasia manual for guidance in clinical scenarios.

 

Clinical condition or contextFirst stage test(s)Second stage test(s)More specialised test(s)
Acute inflammationFBE, ESR, C-reactive proteinUrine mcs, U&E, LFT 
AlopeciaTFT, iron studies, antinuclear factor, ESRFungal microscopy and cultureSkin biopsy
AmenorrhoeaQuantitative HCG, follicle stimulating hormone, luteinsing hormoneTFT, oestradiol, prolactin 
Antenatal screen (before 20 weeks)FBE, blood group & antibodies, Rubella, Syphilis, HIV, Hepatitis B & C serology, urine m/c/s, cervical cytology Maternal serum antenatal screening programme (triple test)
Antenatal screen (for 26 - 28 Weeks)Blood group & antibodies, glucose tolerance test  
Antenatal screen (for 30 - 36 Weeks)FBE, group B Streptococcus screen  
Anti-coagulant therapy (initial monitoring of warfarin therapy)INR  
ArthritisSerum uric acid, rheumatoid factor, antinuclear factor, extractable nuclear antigen, ESR, C-reactive proteinHLA B27, complement, faeces m/c/s, Ross River virus serology, Barmah Forest virus serology, Hepatitis C serologyPCR/serology for Bordetella pertussis, PCR/serology for influenza A & B & parainfluenza & respiratory syncytial virus, adenovirus PCR, Q Fever serology, Mycobacterium tuberculosis culture, iron studies
Atypical pneumonia/chronic coughSputum m/c/s, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & ChlamydiaPCR/Serology for Bordetella pertussis, PCR/serology for influenza A & B & parainfluenza & respiratory syncytial virus, adenovirus PCR, Q Fever serologyMantoux
Bleeding tendency (Clinical bleeding history is pivotal to appropriate interpretation)FBE, coagulation profile (APTT, PT, fibrinogen), renal and liver function, platelet function screen (PFA-100), von Willebrand disease screen, Blood GroupPlatelet function analysis, coagulation factor studies, platelet aggregation 
Chest painTroponin, creatine kinaseRepeat first stage tests 
DementiaFBE, ESR, U&E, TFTVitamin B12, red cell folate, Syphilis serology, blood lead 
DepressionFBE, fasting blood glucose, TFTSerum cortisol, urine drug screen 
Diabetes monitoringHBA1c, urine albumin, lipids, U&E  
DiarrhoeaFaeces m/c/s x2 (Due to HIC requirements only one culture and two microscopies can be performed in 7 days)Reducing substances, Clostridium difficile toxin, rotavirus, adenovirusVasoactive intestinal polypeptide, urine hydroxy indole acetic acid, bowel biopsy
Erectile dysfunctionTestosterone, luteinsing hormone, LFTFasting blood glucose, iron studies, lipids 
Fatigue/weaknessFBE, TFT, U&E, LFTSerum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serologyCreatine kinase, antinuclear factor, acetylcholine receptor antibody, short synacthen stimulation test
GynaecomastiaLFT, U&E, TFTTestosterone, luteinsing hormone, follicle stimulating hormoneUrine drug screen (especially THC), prolactin, fine needle aspiration
Hepatomegaly +/- Liver dysfunctionFBE, LFT, Hepatitis A, B & C screenIron studies, CMV serology, EBV serologyFasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, Malarial parasites, Hydatid serology, Q Fever serology
HirsutismTestosterone, free testosterone, follicle stimulating hormone, luteinsing hormoneUrine cortisol, 17 hydroxyprogesterone 
HyperlipidaemiaLipids, HDL cholesterol, fasting blood glucoseLFT, TFT, U&E 
HypertensionUrine m/c/s, fasting blood glucose, U&ETFT, urine catecholamines, urine cortisolAldosterone/renin
Infertility – femaleOestradiol, progesterone, follicle stimulating hormone, luteinsing hormoneProlactin, TFT, serum cortisolTestosterone, free testosterone, 17 hydroxy progesterone, chromosome studies (blood)
Infertility – maleSemen analysisTestosterone, follicle stimulating hormone, luteinsing hormone, fasting blood glucose, prolactinChromosome studies (blood), iron studies, sperm antibodies, testicular biopsy
LymphadenopathyFBE, ESR, EBV serology, CMV serology, Toxoplasma serologyAngiotensin converting enzyme, Syphilis serology, HIV serologyChlamydia serology, fine needle aspiration +/- flow cytometry, tissue culture
Malabsorption, failure to thriveFBE, urine m/c/s, reducing substances, faeces mcs (including fat globules)Vitamin B12, LFT, HIV serology, iron studiesImmunoglobulin A & G & M, serum carotene, GAD antibodies, endomysial antibody, small bowel biopsy
ObesityFasting blood glucose, TFT, urine cortisolLipidsDexamethasone suppression test
Peripheral neuropathyVitamin B12, fasting blood glucose, U&ELFT, porphyrin screen (urine or faeces)Heavy metals (lead, arsenic, thallium)
PharyngitisThroat swab, FBE, monospotEBV serologyStreptococcal serology
PolyuriaFasting blood glucose, U&E, urine m/c/sOsmolality (serum and urine)Water deprivation test
Pyrexia of unknown originFBE, ESR, C-reactive protein, LFT, urine m/c/sBlood cultures, angiotensin converting enzyme, malarial parasites, faeces m/c/sCMV serology, EBV serology, Brucella serology, Q Fever serology, Toxoplasma serology, Syphilis serology, Dengue Fever serology, HIV serology, Leptospirosis serology, Beta-2 microglobulin
Recurrent/persistent infections (immune deficiency)FBE, ESR, immunoglobulin A & G & M, protein EPG, HIV serologyFasting blood glucose, complement, lymphocyte surface markers (blood) 
Renal impairment/failureUrine m/c/s, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acidCreatinine clearance, urine protein, prostatic specific antigenAntinuclear factor
SplenomegalyFBE, ESR, LFT, rhematoid factorHepatitis B & C serology, INR, APTT, fibrinogen, angiotensin converting enzyme, antinuclear factor, EBV serology, CMV serology, HIV serologyMalarial parasites, Mantoux test, flow cytometry (blood), osmotic fragility
Suspected illicit drug usageUrine drug screen, LFTHepatitis B & C serology, HIV serology 
Thrombotic tendency/Venous Thromboembolism
(Hx of anticoagulants & thrombosis, incl FHx, essential)
FBE, coagulation profile (APTT, PT, fibrinogen). lupus anticoagulant, anticardiolipin antibodies, Protein C&S, Antithrombin, APCR (activated protein C resistance), prothrombin gene mutation, Factor VIII, fasting homocysteineFactor V Leiden, beta-2 glycoprotein 1, HITT (heparin induced thrombotic thrombocytopenia) screen, PNH (paroxysmal nocturnal haemoglobinuria) screen 
Tumour markersCarcinoembryonic antigen, CA 125, CA 19-9Serum alpha-foetoprotein, HCG (tumour marker), CA 15.3BRCA2 (breast cancer gene)
UrethritisUrethral swab, PCR for Chlamydia and GonorrhoeaeSyphilis serology, HIV serology 
Weight lossFBE, TFT, U&ELFT, fasting blood glucoseShort synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9