Lab Protocols

The following protocols have been developed by the British Columbia Medical Association (BCMA) and the Medical Services Commission of BC (MSC). Please note that protocols do not apply to children under the age of 17, unless otherwise indicated. Also view the Clinical Practice Guidelines and Protocols in British Columbia section of the Ministry of Health website.

Cholesterol Testing

Total cholesterol, HDL and triglyceride measurements are recommended for patients identified as having CAD or a risk factor for CAD, and for asymptomatic men aged 45 - 69 years and women aged 55 - 69 years. Patients outside of these guidelines are not eligible for MSP coverage of cholesterol testing.

Erythrocyte Sedimentation Rate

Erythrocyte sedimentation rate should not be used as a screening test in asymptomatic patients or in patients with vague symptoms. It will only be performed if a diagnosis is provided on the Standard Out-Patient Laboratory Requisition under the 'Diagnosis and Indications for Guideline Protocol and Special Tests' box shaded in blue.

Ferritin and Total Iron and Iron Binding Capacity

Where iron deficiency is suspected, serum ferritin is the test of choice and should be initially ordered. When both serum ferritin and total iron and iron binding capacity are ordered, only serum ferritin will be performed unless an applicable diagnosis is provided on the Standard Out-Patient Laboratory Requisition under the 'Diagnosis and Indications for Guideline Protocol and Special Tests' box shaded in blue.

Ova and Parasite Examination

One stool sample is recommended in initial ova and parasite examination. Two stool samples may be requested on the same requisition only in certain high risk cases. Once the results are known, additional samples may be requested according to the clinical situation.

Macroscopic and Microscopic Urinalysis

When ordered with a urine macroscopic, a urine microscopic exam will only be performed if a positive macroscopic result is obtained or if the applicable blue box is ticked under the Urinalysis/Urine Culture section on the Standard Out-Patient Laboratory Requisition combined with a diagnosis provided in the 'Diagnosis and Indications for Guideline Protocol and Special Tests' box shaded in blue.

Prostate Specific Antigen (PSA)

Prostate Specific Antigen testing is to be used for monitoring established metastatic disease, detecting early recurrence or a diagnostic adjunct in selected cases. Testing for “screening” purposes is not eligible for MSP coverage but is available by physician's request on a self-pay basis.

Thyroid Function Tests in Diagnosis and Monitoring of Patients with Thyroid Disease

Thyroid function testing is not recommended in asymptomatic adults. In most clinical situations, a single test of thyroid function is adequate to diagnose thyroid disease. More than one thyroid test will only be performed if indicated combined with a corresponding diagnosis provided on the Standard Out-Patient Laboratory Requisition under the 'Diagnosis and Indications for Guideline Protocol and Special Tests' box shaded in blue.

Viral Hepatitis Serology

Hepatitis tests can be ordered by indicating the suspected diagnosis (e.g. acute hepatitis, hepatitis B carrier, previous/chronic hepatitis, etc.) in which case, the laboratory will automatically perform appropriate tests according to the protocol. Hepatitis tests can also be ordered by writing the specific serology tests required. Orders for “hepatitis screen” or “hepatitis serology” or “hepatitis A, B and C” are unacceptable.

Genital Protocol

The tests performed by the laboratory are determined by the specimen site and diagnosis indicated on the requisition. The protocol does not apply to patients under 13 or over 70 years of age. Unless otherwise indicated, the protocol limits which tests can be performed on each type of specimen is limited to the following:

  • On a routine cervical swab or urethral swab: a culture for Neisseria gonorrhoeae (GC) will be done. Chlamydia will be sought only with submission of a suitable swab (e.g. ProbeTec).
  • On a routine vaginal swab: a smear for bacterial vaginosis (BV) and a yeast exam will be done.
  • On a vaginal swab noted as "chronic" or "recurrent" vaginitis: a smear for BV, an exam for trichomonas, plus culture for yeast and other pathogens will be performed. If the patient has self-medicated for vaginitis her condition qualifies as "chronic" or "recurrent".
  • For patients in whom you wish to test for both GC and yeast/BV, two swabs should be submitted (one from the cervix, the other from the vagina). Please ensure each swab is labelled with the specimen site.
  • For Group B Streptococcus (GBS) in pregnancy: a vagino-anorectal swab is the specimen of choice, but will only be tested for GBS. To search for both BV and GBS, both vaginal and vagino-anorectal swabs should be submitted. A search for other pathogens in pregnancy (e.g. Chlamydia or GC) will require the submission of additional samples from appropriate sites.

Physicians may request additional testing by specifying organisms of interest on the requisition.

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