Clinical Analysis Laboratory

Before undergoing blood testing, it is important that you are aware of some variables that may affect the accuracy of the results.
Factors such as fasting, diet, the medications you are taking, as well as your physical exercise/activity routine can affect the results.

• FASTING
  The patient must fast for at least 8 to 12 hours. Only small amounts of water can be drunk during this period. Sweetened beverages, alcohol, coffee, and smoking should be avoided entirely.
• DIET
  The patient should continue to follow his/her normal diet in the days preceding the sampling and should avoid making abrupt changes in caloric intake in either direction. Abrupt changes in diet quality, or in other words of the quantity of carbohydrates, proteins, and fats that the patient is eating, should also be avoided.
• MEDICATION
  A patient preparing for blood testing should avoid taking medications for as long as possible before the test date. The patient who is getting a checkup or is undergoing metabolic profiling or is asymptomatic should follow this rule scrupulously; instead, patients who have a specific pathology or who have been prescribed a specific medicine should not interrupt therapy.
• PHYSICAL EXERCISE
  Since strenuous, prolonged physical exercise can affect enzyme activity and the skeletal muscle, it should be avoided for 8 - 12 hours preceding blood testing. The rule also applies to individuals collecting urine for a creatinine clearance clearance test.

Blood samples are taken at the Quartesolo, Camisano Vicentino and Vicenza (Riviera Berica) facilities at the times indicated below. The average waiting time is about 10/15 minutes.
You will learn when the test results will be ready and you should be prepared to pay for the service at the time you come in to undergo testing.

Appropriate stool containers with paddles should be used for faecal collection. These are free at our laboratory or they can purchased at any pharmacy.
The patient should not be taking antibacterial or anthelmintic therapy when specimens for the Coproculture test or for the detection of parasites are collected.

• Standard faecal examination and ova and parasite exam.
  Use the paddle to collect a small amount of stool (about the size of a walnut or a few ml of liquid); place it in the container and close it carefully.
  Deliver the specimen to the laboratory within 2-3 hours of collection.
• Stool test for Helicobacter Pylori Antigen, Calprotectin, Rotavirus and Adenovirus I.
  Collect a small amount of stool (about the size of a walnut or a few ml of liquid), place it in the container and close it carefully.
  Deliver the sample to the laboratory the same morning it is collected.
• Fecal Occult Blood Test.
  The test does not require a meat-free diet as it is specific to human haemoglobin. Use the specimen collection container provided by the laboratory to collect the sample and carefully follow the instructions. Do not take the test during your menstrual period or if you are currently suffering from haemorrhoids. Avoid contaminating the stool with urine. The container can then be stored at low temperatures (2-8°C).
  If the prescription calls for multiple collections (usually three samples), stools should be collected on three different days.
• Coproculture Test.
  If possible, faeces should be collected at the onset of symptoms and before antibiotic therapy is begun. Using the paddle, collect faecal material; avoid contaminating it with urine. Deliver the specimen to the laboratory within 2 to 3 hours of collection.
  Please note that faecal material collected using a swab is not suitable for this test and will not be accepted by the laboratory.
• Pinworm Test.
  The patient should pick up the test kit and instructions for specimen collection from the laboratory.
  Immediately upon awakening, before urinating or defecating and before bathing, the patient should firmly press the sticky side of the tape over the anal orifice for a few minutes. Should there be any, the eggs or larvae deposited by the parasites that have migrated from the intestine to the anal opening during the night will stick to the tape. The tape should then be transferred to the glass slide, sticky side down. Put it in the container, seal it and deliver it to the laboratory the same morning it is collected.

Here below are some guidelines for carrying out bacteriological tests: It is important to remember that following these instructions incorrectly could invalidate the test and, in some cases, its outcome.

• Pharyngeal and tonsil swab
  Swabs should be taken on an empty stomach and oral hygiene should be avoided before testing. Avoid taking antibiotics for the five days before testing.
• Ear swab
  Avoid taking antibiotics for the five days before testing and using ear drops the night before.
• Eye swab
  Avoid taking antibiotics for the five days before testing and eye drops before testing. Do not wash your face with cleaning agents.
• Nasal swab
  Avoid taking antibiotics for the five days before testing and using inhalant sprays or nasal drops before the exam. Do not wash your face with cleaning agents.
• Perianal swab
  Avoid taking antibiotics for five days before testing, and genital hygiene should be avoided the evening before testing.
• Urethral swab
  Abstain from sexual intercourse for 24 hours before testing.
  Do not urinate or perform genital hygiene for 3 hours before testing.
  Avoid taking any antibiotic therapy for at least one week.
• Balanopreputial adhesion swab
  Avoid taking any topical or systemic antibiotic or antifungal therapy for 3-4 days before testing.
• Vaginal swab
  Abstain from sexual intercourse for the 24 hours preceding the examination.
  Avoid taking any antibiotic therapy, even topical antibiotics (creams, candles, ovules and vaginal douches) for at least three days before testing.
  Testing cannot be carried out during menstruation, it can be performed 3-4 days after the end of menstruation.
• Cervical swab
  Please note tha this test is by appointment only.
  The instructions regarding vaginal swabs should be followed.
• Vaginal/rectal swab
  Test used to detect neonatal Streptococcus agalactiae.
  The swab should be taken at approximately 35-36 weeks of pregnancy.
• Dermatophyte test
  Both topical and systemic antibiotic therapy should be avoided for at least seven days before testing. The material to be analyzed may consist of:
  • Skin
  • Nails
  • Hair
  • Superficial mycoses

  Please note that you should not clean the area to be examined and, with regard to nails, do not cut them before sampling.

Collect a small amount of urine. The test result is generally reliable if testing is carried out no earlier than 8-10 days after conception.
The test result is available in the afternoon.

A small blood specimen is taken; fasting is not required. The result is available in the afternoon; in addition to a highly accurate diagnosis of pregnancy, it assesses the progress of the pregnancy.

The latest Italian guidelines regarding screening for gestational diabetes consider this test outdated and no longer recommend using it. A glucose load curve with 75 of glucose and 3 venous samples at 0- 60- 120 minutes is the test that is currently recommended (see Oral Glucose Tolerance Test = OGTT).

This exam is by appointment only.

The oral glucose tolerance test (OGTT) is able to identify individuals at risk of developing diabetes mellitus; it is generally performed:

• in patients with a fasting blood glucose value between 110 and 126 mg/dL
• in patients with a family history of Type 2 diabetes mellitus, a body mass index (BMI) higher than 25 kg/sqm, arterial hypertension or vascular disease conditions.
• in pregnant women whose fasting blood glucose value at the time of her first examination is lower than 92 mg/dl and/or who have no previous diagnosis of overt diabetes regardless of the presence of any risk factors for gestational diabetes. OGTT should be performed between the 24th and 28th weeks of gestation.

Over the three days before the test, the patient:

• should not be on a diet or eating large meals; instead, she should be following a free diet containing at least 150 grams of carbohydrates per day.
• should not be ill (from other causes) or bedridden for a long time and should not be taking medications that interfere with glucose tolerance.
• should be engaging in regular physical activity.

How the exam is conducted
The test takes place in the morning, after about a 12 hour fast, and lasts about 3 hours. The patient must leave the laboratory at any time during the test.
A small amount of blood will be collected from a finger to determine the patient’s capillary blood glucose and her suitability to undergo the test, which means handling drinking glucose solutions and undergoing venous sampling at scheduled intervals.
An OGTT will not be performed if the patient’s capillary blood glucose is higher than 135 mg/dL.
Once each glucose solution has been swallowed, samples will be taken at 30/60 minute intervals for a maximum of 5 times. Throughout the exam the patient should be sitting or lying down; she should not eat or smoke but she can drink a small quantity of water in the intervals between the glucose solutions.
If vomiting should occur, the test should be suspended and repeated at a later date.

Interpretation of results
According to the guidelines of numerous scientific societies, depending on the blood glucose value 2 hours after drinking the glucose solution, three results are possible:

1. Normality Blood glucose lower than 140 mg/dl
2. Impaired glucose tolerance Blood glucose between 140 and 199 mg/dl
3. Diabetes mellitus Blood glucose higher than 200 mg/dl.

A diabetic-type curve with initial hypoglycemia may indicate chronic hepatopathy:

• High blood glucose values one hour after the start of the test followed by low levels may indicate hypothyroidism;
• A curve with rapid elevation or two peaks may indicate hypothyroidism or intestinal malabsorption;
• A flat curve pattern, followed by hypoglycemia, may indicate an insulinoma.

Gestational diabetes is diagnosed when, after an OGTT with 75 grams of glucose, one or more glycemic values are equal to or superior to the threshold value:

• Fasting blood glucose (threshold values) 92 mg/dl
• Blood glucose at 1 hour (threshold values) 180 mg/dl
• Blood glucose at 2 hours (threshold values) 153 mg/dl

Patients with gestational diabetes should repeat an OGTT 8-12 weeks after delivery.

The patient who undergoes this type of test does not need to fast but should eat only a light breakfast.

A urine specimen, preferably an early morning one, should be collected and delivered to the laboratory as soon as possible.
A free urine specimen collection container can be collected at the laboratory or can be purchased from a pharmacy.

Oral anticoagulant treatments are drugs that act by interfering with the action of vitamin K necessary for blood coagulation. Oral anticoagulant therapy is used to treat or prevent numerous thromboembolic, cardiac and vascular diseases (venous or arterial) etc.
Their primary aim is to reduce, in a controlled and reversible manner, the formation of blood clots and to prevent thromboembolic incidents with a minimal risk of bleeding.
Crucially, these drugs should be administered at a correct dosage. In fact, an insufficient quantity of oral anticoagulants cannot prevent thrombosis, while bleeding can occur if the dosage is excessive. To optimize the efficacy and safety of oral anticoagulants, patients should be monitored periodically, both from laboratory (the drug’s biological effect) and clinical points of view.

What are oral anticoagulant medications?
Two anticoagulants are currently available in Italy: COUMADIN and SINTROM; both are rapidly absorbed in the gastrointestinal tract and reach maximum plasma concentration in 90 minutes.

How the effect of oral anticoagulants is controlled
Oral anticoagulants cannot be administered at a fixed dosage; the appropriate dosage depends on the result of a blood test, called prothrombin time (pt) or Quick Time and expressed as INR, which basically measures the time it takes for the blood to clot. It is used by haematologists to determine the appropriate dosage for a patient until he/she is seen at the next checkup.

The frequency for monitoring Quick Time
The frequency depends on the overall stability of the results. At the beginning, controls need to be more frequent; once the condition has been stabilized, frequent controls are no longer necessary, but the patient needs to be seen at least every 30 days. It is important to remember that every time there is a relevant change in the patient's life conditions (a medication is suspended, a new drug is introduced, there are dietary changes, the patient is ill, or hospitalized, or undergoes surgery, etc.), his/her response to the therapy may change and controls thereafter may initially need to be more frequent.

How Quick Time (pt) is expressed
Currently, Quick Time is calculated using the INR (international normalized ratio) system, which utilizes a universal scale to measure blood clotting time. The INR needs to fall within the therapeutic limits established by the specialist depending on the patient’s pathology.

How and when to take anticoagulants
It is best to take an anticoagulant in a single administration always at the same time preferably in the late afternoon. It should never be taken in the morning or if you are not being monitored.

What should you do if you make a mistake in taking an anticoagulant If you forget to take the anticoagulant at the usual time, you can take it before bedtime; otherwise, skip the dose and make sure you jot down the error on your therapy record sheet. Do not double the dose on the following day but schedule a new earlier date for your next examination. You should also make a new earlier appointment if you inadvertently take a double dose and you should contact your general practitioner.

Diet
The nutritional intake of vitamin K plays an important role in the stability of anticoagulant therapy, and the patient’s dietary habits need to be evaluated if there is INR instability.
Vegetables and, to a lesser extent fruit, are the primary source of vitamin K. The percentage of vitamin K in nearly the same in vegetables that are consumed raw (e.g. salads, tomatoes, carrots, celery, onions, etc..) as well as in some that do not undergo significant changes in volume when they are cooked (zucchini, eggplant, potatoes, mushrooms, asparagus, artichokes, fennel, green beans, pumpkin, etc.). You can eat as much of these vegetables in the varieties that you prefer; if possible eat all of these varieties taking care to eat a constant total amount.
Cooked vegetables tend to have higher quantities of vitamin K as cooking causes reduction in volume and an elevation in vitamin K content. Eating these vegetables even occasionally can counteract the blood-thinning effects of an anticoagulant.
The following vegetables should be avoided: spinach, swiss chard, Savoy cabbage, Brussels sprouts, broccoli, turnip greens, chicory, agretti and wild herbaceous plants (dandelion, wild chicory, valerian, wild spinach, wild thistle, watercress etc.).

Drug interference
Many drugs interact with oral anticoagulants, either increasing or reducing the effect and determining changes in the INR and perhaps increasing thrombotic or hemorrhagic complications, sometimes even severely. Whenever the patient’s therapy is modified or a different medicine is prescribed the patient should reschedule his/her appointment with the anticoagulant specialist to adjust the drug dosage.

1. DRUGS THAT INTENSIFY THE EFFECT OF ANTICOAGULANTS
   Some antibiotics (Bactrim, Ciproxin, Erythrocin)
   Drugs prescribed to reduce cholesterol (Statins, Fulcro) and uricemia (Zyloric)
   Medications for cardiac arrhythmias (Amiodar, etc.)
   Medications against fungal infections
   Vitamin E, Vitamin A
   Anti-inflammatory drugs
   DO NOT take drugs such as ASPIRIN, INDOMETHACIN, VOLTAREN etc., without checking with your doctor because they can cause bleeding.
2. MEDICINES THAT DECREASE THE EFFECT OF ANTICOAGULANTS
   Barbiturates (Gardenal and antiepileptic drugs in general)
   Rifampin (Rifadin and others)
   Vitamin C
   Vitamin K
3. LOW-RISK DRUGS
   In the case of fever, bone pain, or headache, both paracetamol (Tachipirin) and Novalgina can be used. Do not use products in association with vitamin C that reduce anticoagulant effects. Oral cortisone drugs do not interfere with oral anticoagulants.
   Antibiotics such as Amoxicillin (Velamox, Zimox, etc.), also associated with Clavulanic acid (Augmentin, Clavulin, etc.), do not significantly interfere with therapy.

Other agents that may interfere with anticoagulants:

• Herbal products (laxative herbal teas, slimming preparations or sleeping aids) should not be taken because the extraction (through water and heat) of an unknown amount of vitamin K can drastically reduce the effect of an anticoagulant. Moreover, these products may contain components that potentiate anticoagulants.
• Royal Jelly: it contains high amounts of vitamin K.
• Homoeopathic products: No controlled studies examining their effect on anticoagulants have been carried out.
• Alcohol: a moderate, constant intake of alcohol seems to slightly reduce the effect of an oral anticoagulant. Avoid high alcohol intake because alcohol abuse dangerously potentiates the effect of an anticoagulant.

Conclusions
Oral anticoagulant therapy may expose the patient to hemorrhagic or thrombotic events linked to drug interference; any change or variation in the patient’s lifestyle or medications should be evaluated by the general practitioner, and unexpected effects on anticoagulant therapy should be
reported to the pharmaceutical company.

For optimal urine quality, the following is recommended:

• Do not engage in physical exertion and abstain from sexual relations for 12 hours before collection.
• For women of childbearing age, avoid collecting the sample during the menstrual period.
• Preferably collect first-morning urine or urine that has remained in the bladder for at least 4 hours.
• Observe fasting from midnight and collect urine upon awakening before breakfast and before engaging in any physical activity.
• Report any relevant diseases of the urinary system or urogenital interventions.
• After thoroughly washing your hands and external genitalia, collect the middle portion of the first-morning urination.
• The sample should be delivered to the laboratory on the same morning it is collected.

A standard urine test
Preferably collect early morning urine and deliver it to the laboratory as soon as possible. A container can be collected free of charge from the laboratory or purchased from a pharmacy.

A urine culture
Taking the test during antibiotic therapy is not recommended because antibiotics can interfere with the outcome of the test.
The container for the urine sample must be sterile and can be collected free of charge at the laboratory or purchased at a pharmacy.
It is advisable to collect the first morning urine immediately after getting out of bed, following these instructions carefully:

1. Carefully wash your external genitalia;
2. Discard the first stream of urine;
3. Collect the urine directly in the container taking care not to touch the inner walls;
4. Close the container tightly and deliver it to the lab as soon as possible.

Please advise us if your urine was collected via a catheter.

Urine collection for urine culture in infants
Use the sterile anatomical bags available in pharmacies to collect urine from infants. Proceed as follows:

• Wash the area with soap and water, rinse well with water and dry.
• Fit the bag over the infant’s genital area.
• Check for urine output after approximately 30 and 60 minutes.
• If the infant has not urinated within an hour, the bag should be removed, the area washed again and a new bag applied.
• Once the infant has urinated remove the bag.
• Pour the contents into a sterile container and deliver it to the lab as soon as possible.

24-hour urine collection
Use a 2.5 litre container which can be picked up free of charge at the laboratory.
Proceed as follows:

1. Discard the first-morning urine;
2. Collect all the urine produced from that point on for the next 24 hours, including the first one of the following day;
3. Keep the container in a cool place for the entire collection;
4. Deliver the container to the laboratory by 9:30 a.m. on the same day the urine collection is completed.

Please note that when Vanillylmandelic acid and catecholamines are being determined, the patient should not be taking aspirin or psychotic drugs or eating bananas, vanilla sweets, tea, chocolate, throughout the time urine is being collected.

Urinary cytology
A urine cytology investigation is usually performed on a second morning urine specimen collected in a sterile container.
The examination can be performed on a single sample or on those of three consecutive days, in the latter case, the urine samples should be collected on Monday, Tuesday and Wednesday and delivered to the laboratory on Wednesday morning; the samples of the two previous days (Monday and Tuesday) should be stored in the refrigerator.

Immunological detection of pregnancy
The test is preferably performed on a morning urine sample.
The test can be considered reliable if least 8-10 days have gone by following presumed conception. When performed on blood (plasma BETA-HCG test), the test is even more sensitive.

The sputum culture test can detect bacteria or microorganisms that may be causing infections of the lungs or lower airways. Before the culture test is performed, the sample is checked at the laboratory for suitability via microscopic observation. The sample is considered acceptable if it contains abundant leukocytes (an index of inflammation) and some cells from the oropharyngeal region, a sign that the sample contains appropriate material.
The patient should follow the directions below to collect a sputum sample.

• COLLECTION METHOD
  Sputum should be collected in the morning on an empty stomach on the same day it is delivered to the laboratory:
  • Obtain a sterile wide-mouth container (from a pharmacy or free of charge from the laboratory).
  • Rinse your mouth and gargle with water (do not use disinfectant solutions).
  • Spit the sputum directly into the container after a few forceful coughs to increase the amount of bronchial secretion coming up (the material must come from the lower airways and not contaminated by saliva).
  • Be careful to put the lid on the container and close it tightly.

  Please note that if there should be difficulty in expectorating, coughing can be induced by performing an aerosol with physiological saline solution (do not use drugs). Do not smoke to cause coughing.

• DELIVERY METHOD
  The sample must be delivered to the laboratory within 2 hours of collection. • Please note:
  In the absence of a specific request by the attending doctor, should you be taking antibiotics, it is best to complete the therapy and to wait at least seven days before taking the test.