The RCPA is committed to educating medical practitioners about appropriate pathology test ordering.
The Manual offers extensive information on pathology investigation of known clinical problems.
The clinical case scenario complements existing information in the Manual.
The case scenario was developed with the University of Sydney Department of Medical Education.
The case scenario is a stand-alone, interactive online education module. A clinical case has been selected that offers specific diagnostic challenges. A problem solving process uses challenge questions and expert responses to help participants adopt appropriate, evidence based pathology ordering when faced with undiagnosed clinical problems. A review step and a cost comparison then helps to reflect on both diagnostic thinking and the cost implications of test ordering.
This educational framework seeks to stimulate a series of reflective responses in the context of authentic professional practice. Participants receive instant feedback that compares their responses to those of a pathologist with expertise in that area of clinical practice.
The RCPA believes that implementation of the clinical case scenarios offers a blueprint for the development of additional educational modules in the future.
Go to case scenario
(this will take you outside of the RCPA Manual site)
How to use the Manual
The main purpose of this Manual is to provide useful guidelines for the selection of pathology tests and to facilitate interpretation of results.
The Manual consists of several sections:
The clinical problems listing presents pathology tests in the context of the clinical problems which give rise to the need for diagnostic information. The tests listed are those likely to be useful, but consideration must always be given to the individual clinical situation. Where appropriate, the limitations of tests in providing definitive information are noted. Tests should never be ordered as a 'routine' or 'screen'; an important principle is to request tests only when the results will contribute to diagnosis and/or management.
The clinical problems section is organised in two columns; a line is inserted at the end of each entry.
- In the first column, the main headings, or primary entries, are the 'clinical problems'.
- Red dots are provided for ease of reading only.
- Subheadings indicate various categories, manifestations or complications.
- Where the clinical problem has an alternative name, or acronym, the column one entry may provide a cross-reference.
- There may be a general comment or a definition of the problem, followed by a discussion or listing of appropriate tests.
- Where comments or tests are appropriate only to the subsidiary entries, they appear across from those subsidiary entries.
- In general, the tests are described in the same form as they appear in the test listing. Exceptions to this are frequently used tests which are better known by their acronyms (eg, FBC, APTT). However, these appear under their full names in the test listing.
- If the nature of the specimen is not stated, the required specimen is blood, plasma or serum.
- When the test requires other body fluids or tissue eg, urine, sputum, CSF or a biopsy, the nature of the required specimen is stated.
- When different specimens or laboratories are involved in testing, the tests are separated by semi-colons.
- If a test is not described in the test listing, the comments 'specialised laboratory' or 'consult pathologist' (for further information) are used.
- If the test is described under a more general test description, a cross-reference to that test is provided.
- If there is no entry in column two, no useful or additional pathology tests are available.
- The pathology test listing includes most of the tests available to the clinician.
- Tests which are performed infrequently or only in specialised laboratories are not described.
- The entries are brief. Where further information is required consult the pathologist.
- Test names reflect common usage.
- Alternative names for tests are included as cross-references.
- Other relevant test entries are provided as cross-references.
- Each entry contains the following information:
Specimen: Comments on the type and volume of the specimen, special requirements and precautions. The specimen volume specified is usually the ideal, rather than the minimum. If multiple tests are being performed on one specimen, the volumes are not additive. Paediatric samples can often be smaller than those generally specified.
Method: A brief description of the methods used and/or the principles of the test.
Reference interval: The 'normal range' for results is provided where this is possible. Many are dependent on analytical method, age, gender and other variables; these variables are described. A therapeutic interval is provided for drug assays.
Application: The indications for performing the test and situations where useful information may be gained. For some tests, comment is made on situations where testing is inappropriate or an alternative test is of more value.
Interpretation: A description of the significance of test results, factors which may influence the result, interpretation of results in specific clinical situations, comment on test sensitivity and specificity and predictive value, where possible.
Reference: One or more books or journal articles which provide further information about the test and its clinical application.
The testing process section covers:
- Requests and collection
- Blood collection
- Anatomical pathology
- Unexpected results
These are a series of interactive online case scenarios to assist in diagnosis of complex clinical problems. They have been jointly developed with the University of Sydney's Department of Medical Education. Read More.
The test results section covers the variables that impact upon the validity of laboratory results. These include:
- Diagnostic tools
- Validity and reliability
- Predictive value
A discussion of the decline in autopsy rates and the importance of the autopsy to clinical practice. Read more.
Pathology Decision Support Tools
Pathology Decision Support Tools (PDSTs) help guide referring practitioners requesting pathology tests for the diagnosis and ongoing management and monitoring of patients. A PDST template titled ‘PDST example’ explains the colours used to identify different decision steps in PDSTs. These are:
- Clinical information
- Further clinical information
- Result option
- No further action required
- No immediate treatment
- Regular review suggested
- Diagnosis AND/OR
- Treatment AND/OR
PDST’s can be downloaded as a JPEG image by using the side bar buttons on the right hand side. .The side bar also contains further explanatory notes on the contents of the PDST. Inside the PDST boxes are numbers linking to clinical information in the side bar
Abbreviations have been used for convenience and have been selected on the basis of ease of understanding, common usage and convention. Read more.
In 1990, the College, in conjunction with the then Commonwealth Department of Health and Aged Care, developed and published the Manual of Use and Interpretation of Pathology Tests, now known more familiarly as 'the Manual'.
In 1997 a much enlarged second edition was published and as with the previous edition, this appeared in printed format only.
The third edition of the Manual was produced in 2001 in response to continued demand for information on pathology testing. In order to provide more ready access to target groups, this edition was produced in electronic format which also permitted low level web access.
As part of the ongoing evaluation of the Manual, an independent survey was commissioned by the Commonwealth in 2001. This survey not only afforded objective evidence as to the value of the Manual to hospital and community practitioners, but also provided guidance as to how the format and content of the publication could be improved.
With the support of funding from the Department of Health and Aged Care, a fourth edition of the Manual was released in 2004 as an on-line publication. The electronic format of the fourth edition facilitated review and revision of content, and regular updating of individual test entries has been undertaken in response to scientific developments and changes in medical practice.
Since the on-line publication of the fourth edition, the Editorial Committee has met formally to review and update the total content of the publication on three occasions. The most recent review occurred in August 2007 and the major revisions recommended at this meeting have now been incorporated into this fifth edition of the Manual. Routine updating of Manual content on the web continues as previously.
The most recent Manual initiative funded by the Department of Health and Ageing, is the development of the Pathology Decision Support Tool (PDST) section of the Manual website. Here we have taken the concepts of improved decision making embedded in the rest of the Manual and devised a series of flowcharts for difficult and common clinical situations. It is hoped that this is the first step on a pathway to integrated decision support and electronic requesting to assist further in optimal patient care. We are grateful to our PDST authors for their valuable input.
Ongoing evaluation of Manual usage by pathologists, other health practitioners and the general public has confirmed the value of the publication to the profession and its importance to the College. Website activity was in the order of 20,000 to 25,000 downloads per month during 2007, while detailed enquiries regarding tests continued to be answered by members of the Editorial Board on a regular basis. A recent analysis of website activity indicates that the Manual now has about 5,000 unique visitors, 8,500 visits and 36,000 page views monthly.
Professor Brett Delahunt, Chairman, Manual Editorial Board
Dr. Debra Graves, Chief Executive Officer, The Royal College of Pathologists of Australasia
RCPA Manual Update 2010
Steering Committee On Line Manual: Prof Brett Delahunt (Chair), Dr John Burnett,Dr Nelson Tang, Dr Benedict Carnley, Dr David Gillis, Dr Gillian Wood, Dr Bronwen Ross
PDST Authors:Dr Paul Glendenning, Prof Samuel D. Vasikaran, Dr David Gillis, Dr Narelle Hadlow, Dr Penelope Coates, Dr Claire Dendle, Dr Maryza Graham, A/Prof Christopher Florkowski, Prof Kris Barlow-Stewart, Dr Graham Jones, Dr Robert Norton, Dr Joan Faoagali, Dr Lisa-Ann Koe, Dr Gillian Wood, Prof Frank Bowling, Dr Vanessa Clifford, Dr Katherine Nicholls, Dr Anja Werno, Dr Ee Mun Lim, A/Prof Huy Tran, Dr Chiyan Lau, A/Prof David Sullivan, Dr Rosemary Miller, Dr Kenneth Sikaris, Dr John Duley, Dr Melissa Gillett, Dr Alan McNeil, Prof William Rawlinson and Dr Louise McCormack
Acknowledgements: Prof Brett Delahunt, Dr Gillian Wood, Dr John Burnett, Dr Benedict Carnley, Dr David Gillis, Prof Nelson Tang and Dr Lisa Parker.
The RCPA wishes to acknowledge the Australian Government Department of Health and Ageing for their generous support for the update and transforming of the RCPA Manual.
RCPA Manual 5th edition authors
Steering Committee On Line Manual: Prof Brett Delahunt (Chair), Dr John Burnett,Dr Nelson Tang, Dr Benedict Carnley, Dr David Gillis, Dr Gillian Wood, Dr Tamsin Waterhouse
RCPA Manual 4th edition
Authors: Professor Brett Delahunt, Professor Peter George, Dr David Gillis, Dr Debra Graves, Dr Michael Harvey, Dr Christine Johnson, Mr Andrey Zheluk, Dr Diane N Kenwright, Dr Peter Bethwaite, Dr Harold J Neal, Dr Alexa M J Kidd, Dr Jeremy Touhy, Dr Emmanuel J Favaloro, Dr Elizabeth Todorova, Dr Elizabeth Bernal-Hoyos, Dr Lucinda Wallman, Dr David Mitchell
Acknowledgements: Dr David Smith, Dr Gary Lum, Ms. Belinda Neil, Ms. Maddeson Lavers, Mr. Roman Danylak, Ms. Rebecca Havey, Ms. Lara Mc Laughlin, Mr. Abishek Kumar, Ms. Susan Mildenhall, Mr. Peter Youll.
The RCPA wishes to acknowledge the Australian Government Department of Health and Ageing for their generous support of the RCPA Manual 4th edition.
Acknowledgement for previous editions of RCPA Manual
The concept of producing a manual to guide clinicians in the use and interpretation of pathology tests originated with Professor Ernest Finckh during his time as President of the College (1979-1981). Professor David Thomas was responsible for the initial work done to translate the concept into reality and was co-editor of the first edition. Dr Eva Raik, as Honorary Secretary (1981-1986) and as Vice President/President (1991-1997) has provided support and, at times, much-needed encouragement throughout. The task has been actively supported by Council through almost two decades. Dr Jack Hamer (President 1997-1999) and the immediate past President, Professor David Davies actively supported the production of a third edition.
The College remains indebted to previous Editors, for their assistance in a difficult process and their commitment to the principles underlying this publication. Dr Jean McPherson, Dr Vera Stoermer, Dr Alan Clague, Dr Virginia Billson, Dr David Gillis, Dr Christine Johnson and Dr Mark Pilbeam, as past and/or present members of the Board of Education, have contributed to both the second edition and to the third edition. Dr Wendy Erber, Dr Ross Bradbury and A/Professor Ron Walls, and Professor Ron Trent and Dr Yiu-Lam Kwan were also contributors to the second edition.
Professor Stephen Cordner provided the section on the autopsy. Dr Allan Lloyd and Dr Michael Gribble contributed to the section on the reliability of test results. Written material, editorial comment and/or advice over the previous three editions was provided by a number of other colleagues. These individuals are listed below and are thanked for their contributions:
Dr Bentley Atcheson, Dr Gordon Baker, Dr Paul Bedford, A/Professor Thomas Boogert, Dr Michael Boyle, Ms Joan Brick, Dr Nigel Brown, Dr Ian Chambers, Mr Gary Clarke, Dr Peter Coleman, Ms Margaret Collecutt, Professor David Davies, A/Professor Olaf Drummer, Dr Geoffrey Forbes, A/Professor Margaret O Garson, Dr Maree Gleeson, Ms Irene Goodhew, Dr Michael Gribble, Dr Michael Guerin, Dr Leigh Hammond, Dr Gary Hoffman, Ms Linda Hueston, Ms Rebecca Jansma, Professor Geoffrey Kellerman, Mr John Lowan, A/Professor James McCluskey, Dr Richard McMullin, Dr Gabrielle Medley, Dr Matthew Meerkin, Dr Cliff Meldrum, Dr Howard Morris, Dr Nick Mulvany, Dr Stan Pilbeam, Dr Joanne Pink, Dr Bob Pritchard, Dr Eva Raik, A/Professor William Rawlinson, Dr Glen Reeves, A/Professor Peter Roberts-Thompson, Dr Arabella Smith, Ms Greta Spall, A/Professor Alison Street, Dr Graeme Suthers, Dr Amanda Thomson, A/Professor John Turnidge, Dr Philip Tynan, Dr Dakshesh Vakil, Professor John Vince, Dr David Williams and Ms Norma Worswick.
The technical infrastructure and design were developed by Hothouse Interactive. The RCPA wishes to acknowledge the contribution of Mr Simon Monk, Mr Simon Van Wyk and Mr Chris Noble.
The clinical algorithms were developed by the University of Sydney Department of Medical Education. The RCPA wishes to acknowledge the contribution of Dr Greg Ryan, Dr Tim Shaw, Dr Stewart Barnet and Mr Conor McCormick.
The RCPA Manual is electronically available via the Royal College of Pathologists of Australasia website. Printed editions are no longer available.
The Royal College of Pathologists of Australasia ABN 52 000 173 231
Durham Hall, 207 Albion Street
Surry Hills NSW 2010 Australia
First Edition published 1990
Second Edition published 1997
Third Edition published 2001
Fourth edition published March 2004
Fifth edition published April 2009