Last Updated on August 19, 2026
u003cstrongu003ePre-Op Bloodu003c/strongu003e
• FBC Optimize: e.g. hypokalaemia may require potassium fast correction / symptomatic anaemia may require blood transfusion prior to operation / AKI may require urgent haemodialysis prior to operation etc.
• RP
• LFT
• Coag
• GSH / GXM
=====
💡Most of the time, patients planned for major operations should have these ‘Pre-op blood’ taken recently and
optimised
Anaemic workup
• Full blood picture
• Iron studies: serum iron, serum ferritin, TIBC, UIBC,
TSAT
• Transferrin saturation (TSAT) of <20% may indicate iron deficiency Abbreviation: LDH Lactate dehydrogenase ===== Notes: • Serum LDH is marker for haemolysis • LDH is part of Light's criteria in pleural effusion • LDH is also used as cardiac enzyme (together with CK + AST), especially in district hospitals where Troponin / CK-MB is not immediately available
• Formula of TSAT = 100 x serum iron / TIBC
• Vitamin B12
• Folate
=====
Other tests if indicated:
• Serum
LDH
• Serum bilirubin (if haemolysis is suspected)
• Reticulocytes (if haemolysis is suspected)
• Coombs test
Atypical pneumonia serology
• Chlamydia pneumoniae antibody
• Legionella pneumophilia antigen
• Anti-Mycoplasma pneumoniae IgM
Cerebrospinal Fluid (CSF) / Lumbar puncture-related
• Serum random blood sugar Sensitivity (in statistics) • Meaning: the proportion of people with the disease who have the sign (Example: test A has sensitivity of 80% — means performing test A will pick up 80% of the people with disease X)
—–
• FEME
• Culture and
sensitivity
• If a sensitive test is negative, it helps to rule out the disease
• Biochemistry
• MTB C&S
• AFB
Others (if indicated):
• Cytology
• Cryptococcal antigen
=====
💡CSF for FEME and C&S can be combined in 1 container + 1 lab form
Connective Tissue Disease screening
• CRP Done if ANA screening is positive Done if ANA screening is positive
• ANA
•
Anti-dsDNA
•
Extractable nuclear antigen (ENA)
• Anti-neutrophil cytoplasmic antigen (ANCA)
• Rheumatod factor
• C3, C4
Dementia workup
• Full blood count
• Thyroid function test
• Iron studies, vitamin B12, folate
• Renal profile, calcium, phosphate, magnesium
• Liver function test
• Fasting blood sugar
• Syphilis screening
Hepatitis B confirmed diagnosis 1st workup
• HbeAg
• HbeAb
• HBV viral load
• AFP
• USG HBS
Hepatitis C confirmed diagnosis 1st workup
• TFT
• Alpha fetoprotein (AFP)
• HCV viral load
• HCV genotype
• USG HBS
Hyponatraemia
Visit post: https://www.myhouseman.my/hyponatraemia/
Paired samples of:
• Serum osmolality
• Urine osmolality
• Serum sodium (send as renal profile)
• Urine sodium
• AM Cortisol
Infective screening
• HBsAg In HKL, we order as RPR, not VDRL
• Anti-HCV
• HIV combo Ab/Ag
• Rapid plasma reagin (
RPR
=====
💡There is NO indication to send HBs-antibody
Multiple myeloma workups
Non-invasive tests Skeletal Survey - A series of X-rays, performed systematically to cover the entire skeleton or the anatomic regions appropriate for the clinical indications - To look for bone lesions (lytic / sclerotic) & TRO fracture - Components depend on hospitals, e.g. skull, chest, bilateral hands, pelvis, lumbosacral ===== - Multiple myeloma: raindrop skull (in skull X-ray); lytic lesion
• Urine protein electrophoresis
• Serum protein electrophoresis
• Full blood picture
•
Skeletal survey
Invasive tests
• Bone marrow aspiration
• Bone marrow trephine biopsy
Peritoneal tapping
Blood:
• Liver function test
Peritoneal fluid: This test will include This test requires LFT (serum albumin) to be sent together. Thus it will show **SAAG formula: Serum albumin – fluid albumin level
• Biochemistry
– Protein
– pH
– Glucose
– LDH
– Serum albumin
– Fluid albumin
– SAAG
**High gradient (more than 11 g/L) e.g. Liver problem (cirrhosis, alcoholic hepatitis, Budd-Chiari syndrome), cardiac problem (congestive heart failure, constrictive pericarditis)
**Low gradient (less than 11 g/L) e.g. peritoneal carcinomatosis, peritoneal TB, pancreatitis, nephrotic syndrome
• C&S + FEME
• Cytology
• AFB
• MTB C&S
Pleural tapping
Blood: Abbreviation: LDH Lactate dehydrogenase ===== Notes: • Serum LDH is marker for haemolysis • LDH is part of Light's criteria in pleural effusion • LDH is also used as cardiac enzyme (together with CK + AST), especially in district hospitals where Troponin / CK-MB is not immediately available
• Liver function test
• Serum
LDH
Pleural fluid: This test will include
• Biochemistry
– Protein
– pH
– Glucose
– LDH
• C&S + FEME
• Cytology
• AFB
• MTB C&S
=====
Further reading:
• Light’s criteria
Pulmonary TB confirmed first workup
Blood HIV is a risk factor for TB as a baseline for liver function because anti-TB may cause transaminitis Ethambutol can cause optic neuritis
•
HIV
• Fasting blood sugar
•
Liver function test
Referral
• Refer ophthalmology for
formal eye assessment
Septic workup
• Full blood count (FBC) Abbreviation: ESR • Erythrocyte Sedimentation Rate ===== Upper limit of normal ESR value: • Male: Age / 2 • Female: [Age + 10]/2 especially if suspect patient has pneumonia
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (
ESR
• Blood C&S
• Urine FEME
• Urine C&S
•
Sputum C&S
• Chest X ray
Stroke workup
Blood
• Fasting blood sugar (FBS)
• Fasting serum lipid (FSL)
Imaging
• Echo
• USG carotid doppler
TB workup
Blood Abbreviation: ESR • Erythrocyte Sedimentation Rate ===== Upper limit of normal ESR value: • Male: Age / 2 • Female: [Age + 10]/2 In the Plan, can write as ’Sputum AFB x1, x2, x3’ * Result will only be available after 6 weeks time. Therefore please do not write in the progress note as ’MTB C&S so far no growth’ In this case, write in the lab form as ’gastric lavage for AFB x1 or gastric lavage for AFB x1 x2 or gastric lavage for AFB x1 x3’
•
ESR
• FBC
Sputum samples
• Sputum AFB
day 1 , day 2, day 3
•
Sputum Mycobacterium C&S
* Culture in Löwenstein Jensen medium takes at least 6 weeks for mycobacterial growth to be detectable
Imaging
• Chest X ray
Others
• Mantoux test
=====
💡If patient unable to produce sputum, can take specimen via
gastric lavage
Young hypertension workup
these tests can also be done at primary care / district hospital prior to referral to tertiary center to look for abnormal renal function to look for hyperthyroidism to look for proteinuria, haematuria to rule out renal artery stenosis
• Serum random cortisol
•
Renal profile
•
Thyroid function test
•
UFEME
the more advanced tests that may be only available in tertiary center and if indicated from first line tests
• 24H-urine cortisol
• 24H-urine
VMA
Imaging
• USG KUB +
doppler
=====
📑 Urine VMA: In lab form label as urine catecholamine