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«Published–2012 Edited by Christina Vett-Joice Printed by Buckner Printing Company i Table of Contents Acknowledgements iii Foreword iv How to use ...»

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PATHOLOGY

HANDBOOK

Capital Pathology ABN 49 452 500 422

2 Makin Place, Deakin, ACT, 2600, Australia

All rights reserved. No part of this manual may be reproduced,

stored in a retrieval system, or transmitted in any form or any

means without Capital Pathology’s written consent.

This Handbook has been prepared by Capital Pathology and every

care has been taken in its compilation. Capital Pathology shall not be liable for any error or omission contained herein or arising from usage of material contained in this Handbook.

This Handbook remains the property of Capital Pathology.

Published–2012 Edited by Christina Vett-Joice Printed by Buckner Printing Company i Table of Contents Acknowledgements iii Foreword iv How to use this handbook v General information Pathologists vi Overview xvi Services xvii Contact Us xviii Doctors Service Centre xx Collection Centres xxi Specimen Collection xxiii Courier Services xxiv Requesting Pathology Tests xxv Laboratories xxvii Results xxviii Reports xxix Billing Policy xxxi Education xxxiv Publications and website xxxv Other Services xxxvi Corporate services xxxvii A–Z Listings ii Acknowledgements This is the fifth edition of the Capital Pathology handbook, and the production of each new edition is a huge task. Also, each edition builds on the contributions that others have made to earlier editions so that the current handbook is a testament to the hard work of many teams of people over many years.

There have been champions of the fifth edition handbook within Capital Pathology, just as there were champions of its predecessors.

Dr Paul Whiting, Director of Clinical Pathology has again been passionate about the urgency of keeping the handbook relevant and current for our referring doctors and both myself and Dr Jane Twin, Director of Cytology have also contributed extensively to our relevant sections.

Christina Vett–Joice (CV) has once again been the driving force behind the fifth edition.

She has been cheerfully assisted by the scientific and administration staff of Capital Pathology, many of whom have helped produce parts of this handbook in their own precious non-work time.

Many people throughout Sonic Healthcare have been incredibly generous in their contributions to both this and earlier editions. They have shared their knowledge, experience and advice with us and we thank you. It is wonderful to have a large team of world experts at our disposal at Capital Pathology and we will continue to test the limits of your kindness and availability!

I would also like to thank the companies who have sponsored the fifth edition. Without your generosity, we would not have been able to produce a reference work of such quality and scope, and we appreciate your faith in our handbook and your support to us.

Finally I would like to sincerely thank those who have fundamentally made this handbook possible through their ongoing support and loyalty to Capital Pathology – the doctors, nurses and patients who daily trust us with the privilege of being part of their health care team. I assure you that we take our responsibilities to you very seriously. In fact “We Take it Personally”.

Dr Ian ClarkM.B., B.S., F.R.C.P.A., M.I.A.C., F.A.S.C.P., F.A.I.C.D.Chief Executive Officer

iii Foreword We are constantly reminded that we are in the midst of an explosion of knowledge and information. This is nowhere typified better than in the ever-changing field of pathology.

This is the fifth edition of the handbook provided by Capital Pathology to medical practitioners, nurses, practice managers, receptionists, hospital staff and others who use our practice. The handbook provides a concise guide to the range of services provided by Capital Pathology, as well as assisting to answer some of the clinical questions we are so often asked.

Capital Pathology has a long history, over 40 years, of providing pathology services to the ACT and surrounding districts. We are very aware of the privilege and responsibility associated with being an integral part of the medical community in our region, and this can be summarised in our motto “We take it personally”.

For us in the potentially rarefied atmosphere of an efficient modern pathology laboratory, this means that we constantly remind ourselves that associated with every specimen, every report, every piece of anonymous data, every phone query, there is a person who rightfully expects us to treat them “personally”.

This also means that our supporting doctors and their teams can rely on each of us at Capital Pathology, irrespective of our role, to behave as part of a medical practice where we are each known by you, and are personally committed to ensuring the best possible service for you and your practice.

I hope that this Handbook will help us improve our service to you. I also hope it will assist you and your staff to achieve the ultimate aim of us all: to improve the health of our patients and our community.

Dr Ian Clark M.B., B.S., F.R.C.P.A., M.I.A.C., F.A.S.C.P., F.A.I.C.D.

Chief Executive Officer iv How to use this handbook All listings are in alphabetical order, whether analyte, test name, disease, clinical topic, procedure, drug name, specimen type or pathogen.





Reference Ranges For some common analytes the reference ranges are similar throughout Australia (e.g. sodium, potassium). For hormones and other tests where methodology can vary from one laboratory to another, the reference ranges can differ quite markedly. Even in the same laboratory, ranges may change from time to time as new methods are introduced. In this handbook you are provided with common reference ranges.

For other tests, please consult the reference ranges provided with all reports.

Please note reference ranges are correct at time of printing.

A reference range can be defined as a range derived from measuring an analyte in a reference population using a reference method. The reference interval then is usually taken to include the mean +/–2 SD i.e. 95th percentile. This implies that 5% of the normal population will fall outside these limits.

In clinical practice, a patient’s results can be examined in different ways, either by comparison to a reference interval, by comparison to their own known previous values, or by consideration of desirable goals, e.g. aiming for a cholesterol of X since this has been shown to have benefit in terms of mortality / morbidity from cardiovascular disease. Some useful ranges are not reference ranges at all, but rather therapeutic ranges, e.g. warfarin control by INR.

UnitsS.I. units are used throughout.

Notes on Interpretation Comments in this handbook are intended as a guide only. Any additional queries may be directed to the appropriate pathologist.

Brief clinical details help immeasurably with interpretation, e.g. routine, wt–loss 1/12, pale and tired 3/12, on T4, on phenytoin, ? hepatitis.

vPathologists

In my opinion, pathologists are undoubtedly the central focus of a successful pathology practice.

At Capital Pathology, specialist pathologists are not only responsible for management decisions, but are intimately involved in all clinical and ethical matters. Our pathologists pride themselves on their close clinical relationship with our referring doctors, and they recognise the importance of providing a comprehensive consultative and educational service. This is exemplified on a day-to-day basis by an expanding range of interpretive comments on reports. In order to optimise patient care, we understand the importance of discussion with clinicians through phone calls as well as providing advice and feedback at personal visits. Capital Pathology’s specialist pathologists have a long history of commitment to continuing education for family doctors and specialists through educational seminars and regular newsletters.

Even more importantly, the continual guidance provided by our pathologists determines the quality and integrity of our whole service. Although our practice obviously must remain commercially viable, the medical influence provided by our pathologists ensures that purely commercial considerations never take precedence over ethical and professional standards.

Dr Ian Clark M.B., B.S., F.R.C.P.A., M.I.A.C., F.A.S.C.P., F.A.I.C.D.

Chief Executive Officer vi Dr Ian Clark M.B., B.S. (Hons), F.R.C.P.A., M.I.A.C., F.A.S.C.P., F.A.I.C.D.

Chief Executive Officer Director of Histopathology Ian graduated with first class honours from Sydney University in 1984. He was full–time Senior Tutor in the Pathology Department of Sydney University before commencing his Registrarship in Histopathology at the Royal North Shore Hospital of Sydney, where he also developed expertise in fine needle aspiration cytology. He completed his Fellowship examinations in 1990, after which he joined the Douglass Laboratories practice in Sydney as a full–time specialist pathologist.

In 1996 Ian was appointed Deputy Director of Histopathology of the newly merged Douglass Laboratories and Hanly Moir Pathology. He joined Capital Pathology in July 1998 as Director of Histopathology, was appointed Medical Director in 2001 and became CEO in 2007. In 2005 Ian was appointed Senior Clinical Lecturer at the ANU Medical School.

Ian is a Histopathologist and Cytopathologist with keen special interests in dermatological, gastrointestinal, gynaecological and genito–urinary pathology. He also oversees the application of flow cytometry to cytological and histological specimens.

Ian is an active member of many medical associations and societies, including the Australian Society for Colposcopy and Cervical Pathology, the Australasian Society for Breast Disease and the Australian Dermatopathology Society. He holds Membership of the International Academy of Cytology and is a Foreign Fellow of the American Society of Clinical Pathologists.

He has participated in a number of research projects, and has spoken at many conferences, including the International Academy of Pathology. Ian was President of the Australian Association of Pathology Practices from 2007 to 2009 and is the Honorary Secretary of the Royal College of Pathologists of Australia. He is also the Pathology craft representative on the ACT AMA.

The fundamental importance of medical leadership underpins Ian’s role as Chief Executive Officer, and he is committed to maintaining the high quality and ethical standards for which the practice is renown.

If you have any enquiries for Ian, please do not hesitate to contact him on 02 6285 9800.

vii Dr Jane Twin M.B., B.S., F.R.C.P.A., F.I.A.C., Dip. Cytopath.

Director of Cytopathology Jane is a graduate of the University of Tasmania and undertook her Pathology training at Royal Hobart Hospital.

Following attainment of the Fellowship of the Royal College of Pathologists of Australasia in 1983, Jane worked as a researcher and lecturer at the University of Tasmania with an appointment to the Royal Hobart Hospital as a provider of Cytology Services. After training with Dr Svante Orell in Adelaide, Jane moved to Hobart Pathology in 1989 to set up a Fine Needle Aspiration Service. This service grew rapidly and was augmented by provision of FNA and Histopathology to BreastScreen Tasmania. Other involvement in BreastScreen Tasmania included her appointment as Tasmania’s representative on the National Pathology Q– group and a long term role as Pathology adviser and auditor.

Jane was also involved in the setting up of the Tasmanian Cervical Cytology Register and continued on the Technical Working Party until leaving Tasmania in December 2001.

Other achievements include attainment of further qualifications in Cytopathology by examination, including Fellowship of the International Academy of Cytology (1992) and the Royal College of Pathologists of Australasia Diploma of Cytopathology (1997). Jane has been involved with the Australian Society of Cytology at a National Level since 1991 as a Councillor and on the Board of Examiners, and has a strong interest and experience in Gynaecological Pathology.

Jane is a member of the advisory committee for the Cytology Quality Assurance Program and is also a member of the RCPA cytology discipline advisory committee. She is also a member of the ACT Papsmear Register management committee. At Capital Pathology, Jane continues her interests in cytology and the histological aspects of gynaecological and breast pathology while contributing generally to the histology department.

If you have any enquiries for Jane, please do not hesitate to contact her on 02 6285 9867.

viiiDr Paul WhitingM.B., B.S., F.R.C.P.A., M.A.S.M.Director of Clinical Pathology

Paul studied for his medical degree at the University of Melbourne, graduating in 1987. After residency and a year in General Practice, Paul commenced his pathology training at Geelong Hospital. He moved to Canberra in 1996 where he completed his general pathology training. He was admitted as a Fellow of the Royal College of Pathologists of Australasia ( RCPA ) before joining Capital Pathology as the Director of Clinical Pathology in 1998. In this role, he supervises the haematology, biochemistry, immunology and microbiology laboratories, and is responsible for ensuring that the highest quality standards are always met. Paul encourages consultation on the wide variety of problems in clinical medicine, and is always available to discuss pathology results.

Paul is involved with many professional associations and is on several hospital advisory committees. He is a member of the Haematology Society of Australia, the Australian Association of Clinical Biochemists, the Australian Society for Microbiology and is also a member of the American Society of Clinical Pathologists. Paul is active with many quality assurance interests, and acts as a referee in the RCPA external quality assurance programs. In Canberra he maintains a continuing interest in medical education and regularly presents to local specialist and general practitioner audiences.

If you have any enquiries for Paul, please do not hesitate to contact him on 02 6285 9895.

ix Dr John Docker M.B., B.S., D.C.P. (London),.D.R.C. Path (UK), F.R.C.P.A.



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