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 context First stage test(s) Second stage test(s) More specialised test(s)
Acute inflammation FBE, ESR, C-reactive protein Urine mcs, U&E, LFT  
Alopecia TFT, iron studies, antinuclear factor, ESR Fungal microscopy and culture Skin biopsy
Amenorrhoea Quantitative HCG, follicle stimulating hormone, luteinsing hormone TFT, 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    
Arthritis Serum uric acid, rheumatoid factor, antinuclear factor, extractable nuclear antigen, ESR, C-reactive protein HLA B27, complement, faeces m/c/s, Ross River virus serology, Barmah Forest virus serology, Hepatitis C serology PCR/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 cough Sputum m/c/s, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & Chlamydia PCR/Serology for Bordetella pertussis, PCR/serology for influenza A & B & parainfluenza & respiratory syncytial virus, adenovirus PCR, Q Fever serology Mantoux
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 Group Platelet function analysis, coagulation factor studies, platelet aggregation  
Chest pain Troponin, creatine kinase Repeat first stage tests  
Dementia FBE, ESR, U&E, TFT Vitamin B12, red cell folate, Syphilis serology, blood lead  
Depression FBE, fasting blood glucose, TFT Serum cortisol, urine drug screen  
Diabetes monitoring HBA1c, urine albumin, lipids, U&E    
Diarrhoea Faeces 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, adenovirus Vasoactive intestinal polypeptide, urine hydroxy indole acetic acid, bowel biopsy
Erectile dysfunction Testosterone, luteinsing hormone, LFT Fasting blood glucose, iron studies, lipids  
Fatigue/weakness FBE, TFT, U&E, LFT Serum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serology Creatine kinase, antinuclear factor, acetylcholine receptor antibody, short synacthen stimulation test
Gynaecomastia LFT, U&E, TFT Testosterone, luteinsing hormone, follicle stimulating hormone Urine drug screen (especially THC), prolactin, fine needle aspiration
Hepatomegaly +/- Liver dysfunction FBE, LFT, Hepatitis A, B & C screen Iron studies, CMV serology, EBV serology Fasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, Malarial parasites, Hydatid serology, Q Fever serology
Hirsutism Testosterone, free testosterone, follicle stimulating hormone, luteinsing hormone Urine cortisol, 17 hydroxyprogesterone  
Hyperlipidaemia Lipids, HDL cholesterol, fasting blood glucose LFT, TFT, U&E  
Hypertension Urine m/c/s, fasting blood glucose, U&E TFT, urine catecholamines, urine cortisol Aldosterone/renin
Infertility – female Oestradiol, progesterone, follicle stimulating hormone, luteinsing hormone Prolactin, TFT, serum cortisol Testosterone, free testosterone, 17 hydroxy progesterone, chromosome studies (blood)
Infertility – male Semen analysis Testosterone, follicle stimulating hormone, luteinsing hormone, fasting blood glucose, prolactin Chromosome studies (blood), iron studies, sperm antibodies, testicular biopsy
Lymphadenopathy FBE, ESR, EBV serology, CMV serology, Toxoplasma serology Angiotensin converting enzyme, Syphilis serology, HIV serology Chlamydia serology, fine needle aspiration +/- flow cytometry, tissue culture
Malabsorption, failure to thrive FBE, urine m/c/s, reducing substances, faeces mcs (including fat globules) Vitamin B12, LFT, HIV serology, iron studies Immunoglobulin A & G & M, serum carotene, GAD antibodies, endomysial antibody, small bowel biopsy
Obesity Fasting blood glucose, TFT, urine cortisol Lipids Dexamethasone suppression test
Peripheral neuropathy Vitamin B12, fasting blood glucose, U&E LFT, porphyrin screen (urine or faeces) Heavy metals (lead, arsenic, thallium)
Pharyngitis Throat swab, FBE, monospot EBV serology Streptococcal serology
Polyuria Fasting blood glucose, U&E, urine m/c/s Osmolality (serum and urine) Water deprivation test
Pyrexia of unknown origin FBE, ESR, C-reactive protein, LFT, urine m/c/s Blood cultures, angiotensin converting enzyme, malarial parasites, faeces m/c/s CMV 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 serology Fasting blood glucose, complement, lymphocyte surface markers (blood)  
Renal impairment/failure Urine m/c/s, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acid Creatinine clearance, urine protein, prostatic specific antigen Antinuclear factor
Splenomegaly FBE, ESR, LFT, rhematoid factor Hepatitis B & C serology, INR, APTT, fibrinogen, angiotensin converting enzyme, antinuclear factor, EBV serology, CMV serology, HIV serology Malarial parasites, Mantoux test, flow cytometry (blood), osmotic fragility
Suspected illicit drug usage Urine drug screen, LFT Hepatitis 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 homocysteine Factor V Leiden, beta-2 glycoprotein 1, HITT (heparin induced thrombotic thrombocytopenia) screen, PNH (paroxysmal nocturnal haemoglobinuria) screen  
Tumour markers Carcinoembryonic antigen, CA 125, CA 19-9 Serum alpha-foetoprotein, HCG (tumour marker), CA 15.3 BRCA2 (breast cancer gene)
Urethritis Urethral swab, PCR for Chlamydia and Gonorrhoeae Syphilis serology, HIV serology  
Weight loss FBE, TFT, U&E LFT, fasting blood glucose Short synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9