pathology users guide

PATHOLOGY USER GUIDE

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Tameside and Glossop Integrated Care NHS Foundation TrustPathology User Guide

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of 81 If this is a printed copy, please check online for the latest version

INTRODUCTION This is the sixth edition (first amendment) of the Pathology User Guide

The information contained within this guide is intended for users of the Pathology Directorate at Tameside and

Glossop Integrated Care NHS Foundation Trust. Please contact the Pathology Quality Manager if you have any

comments or suggestions concerning this guide.

AUTHORITY FOR ISSUE This document has been authorised by the Pathology Management Team – See Q-Pulse for full details.

DATE OF ISSUE This version issued: 1st December 2017

DATE OF REVIEW To be reviewed by: 1st December 2021


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TABLE OF CONTENTS Introduction ............................................................................................................................................................ 2

Authority for Issue .................................................................................................................................................. 2

Date of Issue ........................................................................................................................................................... 2

Date of Review ........................................................................................................................................................ 2

Contact Details ........................................................................................................................................................ 7

Pathology Management Team ............................................................................................................................ 7

Pathology General ............................................................................................................................................... 7

Blood Sciences (Haematology, Biochemistry and Blood Transfusion) ................................................................ 7

Microbiology ....................................................................................................................................................... 7

Mortuary ............................................................................................................................................................. 7

General Information ............................................................................................................................................... 9

Location ............................................................................................................................................................... 9

Address ............................................................................................................................................................... 9

Internet ............................................................................................................................................................... 9

Complaints ........................................................................................................................................................ 10

Quality ............................................................................................................................................................... 10

Confidentiality ................................................................................................................................................... 10

Consent ............................................................................................................................................................. 10

Tests not present in User Guide ........................................................................................................................ 10

Reference Ranges .............................................................................................................................................. 10

Quality of results (The Uncertainty of Measurement) ...................................................................................... 11

Laboratory opening times ................................................................................................................................. 11

Blood Sciences & Transfusion ....................................................................................................................... 11

Microbiology ................................................................................................................................................. 11

Specimen Collection .......................................................................................................................................... 12

In-patients ..................................................................................................................................................... 12

Out-patients .................................................................................................................................................. 12

GP Patients .................................................................................................................................................... 12

Specimen Spillage ......................................................................................................................................... 12

Blood collection bottles available: ................................................................................................................ 13

Request Form and Specimen Labelling ......................................................................................................... 15

Consent ......................................................................................................................................................... 16

Requests for Blood Products: ........................................................................................................................ 16

High Risk Specimens ...................................................................................................................................... 17

Requesting and Reporting ................................................................................................................................. 17


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Ward Order Communications ....................................................................................................................... 17

GP Electronic Reporting ................................................................................................................................ 17

Distribution of printed reports ...................................................................................................................... 17

Transport of samples to laboratory .................................................................................................................. 18

Pneumatic Tube Delivery System (pod) ........................................................................................................ 18

From Wards and Out-patient Departments .................................................................................................. 18

GP's ............................................................................................................................................................... 18

Telephoned results........................................................................................................................................ 19

Referred investigations ..................................................................................................................................... 21

Requests for further tests on samples already held by laboratory ................................................................... 21

Biochemistry Department ..................................................................................................................................... 24

Contact Details .................................................................................................................................................. 24

Specimen collection .......................................................................................................................................... 24

Caution – EDTA Contamination ..................................................................................................................... 25

Faecal Occult Blood ....................................................................................................................................... 26

Biochemical Profiles .......................................................................................................................................... 27

Commonly requested tests – Sample requirements and reference ranges (adult) .......................................... 29

Paediatric Reference Ranges ............................................................................................................................. 42

Paracetamol Interpretation .............................................................................................................................. 44

Therapeutic Drug Monitoring ........................................................................................................................... 45

Acute Kidney Injury (AKI) Alerts ........................................................................................................................ 46

Interpretation of Vitamin D results ................................................................................................................... 46

POCT (Point of Care Testing) ............................................................................................................................. 47

POCT Policy ................................................................................................................................................... 47

POCT Committee ........................................................................................................................................... 47

POCT Devices currently within Tameside Hospital NHS Foundation Trust include:- .................................... 48

Training ......................................................................................................................................................... 48

Sample integrity and results ......................................................................................................................... 48

Pathology support ......................................................................................................................................... 50

Instrument failure ......................................................................................................................................... 50

Dynamic Function Tests and Special Tests ........................................................................................................ 51

Oral Glucose Tolerance test .......................................................................................................................... 51

Short Synacthen Test .................................................................................................................................... 54

Dexamethasone suppression test (low dose) ............................................................................................... 54

Renin and Aldosterone .................................................................................................................................. 55

Water Deprivation Test ................................................................................................................................. 56


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Tumour Markers ............................................................................................................................................... 58

NICE guidance on tumour markers ............................................................................................................... 58

Drugs of abuse .................................................................................................................................................. 60

Virology ............................................................................................................................................................. 60

Porphyrin Screen ............................................................................................................................................... 61

Cryoglobulins..................................................................................................................................................... 61

Haematology Department .................................................................................................................................... 62

Turnaround Times ............................................................................................................................................. 62

Note .............................................................................................................................................................. 62

Blood Count Requests ....................................................................................................................................... 62

ESR..................................................................................................................................................................... 64

Reticulocytes ..................................................................................................................................................... 64

Anticoagulants .................................................................................................................................................. 64

Therapeutic Range ........................................................................................................................................ 64

Coagulation Tests .............................................................................................................................................. 65

Indication ...................................................................................................................................................... 65

Coagulation test – sample requirements ...................................................................................................... 65

Haemoglobinopathies ....................................................................................................................................... 67

Haemoglobinopathy tests available: ............................................................................................................. 67

Antenatal screening .......................................................................................................................................... 67

Haemolytic disorders ........................................................................................................................................ 67

Haematinic assays ............................................................................................................................................. 67

Bone marrow aspirate and trephine bone biopsy ............................................................................................ 67

Haematology adult reference ranges................................................................................................................ 67

Other Haematological Investigations ................................................................................................................ 68

Sample storage times ........................................................................................................................................ 68

Referred investigations ..................................................................................................................................... 68

Blood Transfusion ................................................................................................................................................. 70

Contacts ............................................................................................................................................................ 70

Caution .............................................................................................................................................................. 70

Request Forms .................................................................................................................................................. 70

Specimen Requirements ................................................................................................................................... 71

Dextran .............................................................................................................................................................. 71

Routine Requests .............................................................................................................................................. 71

Reservation of cross-matched blood ............................................................................................................ 71

Group and Save Plasma................................................................................................................................. 72


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Issue of Blood .................................................................................................................................................... 72

Emergency Group O Negative Blood ................................................................................................................. 72

Immunology Services ............................................................................................................................................ 73

Contacts ............................................................................................................................................................ 73

Microbiology/Virology Department ...................................................................................................................... 74

Please note that the service has now moved to CMFT ..................................................................................... 74

Contacts ............................................................................................................................................................ 74

Microbiology Department ..................................................................................................................................... 74

Virology Department............................................................................................................................................. 76

Cellular Pathology ................................................................................................................................................. 77

Contact Details .................................................................................................................................................. 77

Mortuary Department – Tameside And Glossop Integrated Care ........................................................................ 79

NHS Foundation Trust Hospital ............................................................................................................................. 79

Mortuary Opening Hours .................................................................................................................................. 79

Contacts ............................................................................................................................................................ 79

Laboratories for referred investigation ................................................................................................................. 81


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CONTACT DETAILS

Directorate internal hospital numbers (prefix with 0161 922 if dialling from outside). If in doubt concerning who

part of the directorate to contact then please use General Enquiries on 6497 who will then be able to advise

and re-direct your call. Full list of phone numbers can be found on hospital intranet.

PATHOLOGY MANAGEMENT TEAM

Clinical Director Dr Vicki Howarth 4003

Diagnostics Manager Mr Nigel Humble 6110

PA to Mr Humble 4412

IT & Quality Management System Manager Ms Nicola Bullough 6419

Administration and Clerical Manager Ms Alison Reece 6609

PATHOLOGY GENERAL

General Enquiries (non-results) 6393

General Enquiries (results) 6497

Laboratory Fax 6496

Blood Transfusion Fax 6504

BLOOD SCIENCES (HAEMATOLOGY, BIOCHEMISTRY AND BLOOD TRANSFUSION)

Blood Sciences Manager Ms Gillian Lewis 6318

POCT Manager Ms Alison Shanahan 4620

General Enquiries – Haematology & Biochemistry 6497

General Enquiries – Blood Transfusion 6391

Consultant Clinical Scientist (Biochemistry) Mr Tony Tetlow 6495

Consultant Haematologist 6501

Specialist Practitioner of Transfusion Ms Caroline Holt 5484

Advanced Biomedical Scientist Mr Andrew Blackburn

6391

MICROBIOLOGY

Consultant Microbiologist Dr P Unsworth 6500

Consultant Microbiologist / Infection control Dr H. Sacho 4086

Please note that laboratory services have now transferred to Manchester University NHS Foundation Trust (central site). Please see relevant part of user guide.

MORTUARY

Mortuary Manager Ms Sharon McMinn 6520

Mortuary Office 6059

On-call mortuary technician Via hospital switchboard

Histopathology

Please note that laboratory services have now transferred to Manchester University NHS Foundation Trust


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(UHSM site). Please see relevant part of user guide.


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GENERAL INFORMATION

LOCATION

The Directorate of Laboratory Medicine (Pathology) is located on Fountain Street opposite the Hartshead

Building. The post code suitable for a Sat. Nav. is OL6 9RW

ADDRESS

All Directorates in pathology can be contacted by post at the following address

Directorate of Laboratory Medicine New Fountain House Tameside and Glossop Integrated care NHS Foundation Trust Fountain Street Ashton-under-Lyne OL6 9RW

INTERNET

http://www.tamesidehospital.nhs.uk/


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COMPLAINTS

Complaints may be sent to departments by phone, email or mail. All complaints are dealt with using the Trust’s

complaints procedure to be found on the intranet or internet site. Initial contact may be by phone email or in

writing and attempts are made to deal with any complaint immediately and at the point of contact.

If the complainant is not satisfied with the response them they should ask to speak to a more senior member of

staff (see relevant section of User Guide). If the complainant is still not satisfied then they may be referred to

the Trust’s complaints procedure. The Complaints and Patients Advice and Liaison Service (Complaints and

PALS) should be contacted for advice. The contact details are:

Telephone: 0161 922 4466

Emails: [email protected]

Further details are available in the Patient Handbook which available on the Trust’s public site

(https://www.tamesidehospital.nhs.uk/) .

QUALITY

The directorate is currently UKAS (Blood Sciences) and HTA (Mortuary) accredited as appropriate. The

accreditation is in the process of conversion from the old Clinical Pathology Accreditation standards to ISO

15189:2012 Medical laboratories – Requirements for quality and competence standard administered by the

United Kingdom Accreditation Service (UKAS). Departments also take part in External Quality Assurance

schemes to ensure that we provide a high quality service to our users.

The Quality Policy and Quality Manual are available to service users on request. Please contact the IT & Quality

Manager for further information

CONFIDENTIALITY

The Trust follows the NHS code of conduct and is bound by the Data Protection Act. The Trust’s policies

regarding this can be obtained via the intranet site or contact any senior member of the directorate for a copy.

CONSENT

When a sample is taken then consent is implied. The responsibility for consent lies with the requesting

clinician. Investigations will only be undertaken for the diagnosis and/or monitoring of a particular condition at

the request of and with the authority of the requesting clinician or their nominated individual.

TESTS NOT PRESENT IN USER GUIDE

Please note that the User Guide does not mention all possible investigations for reasons of brevity, only the

most commonly requested tests are included. If an assay is required but is not in this document then please

contact the relevant department.

REFERENCE RANGES

All quoted reference ranges have been either:

Adapted from the Pathology Harmonisation program and checked against our current methodologies

using the distribution of results within the Tameside and Glossop area (a posteriori reference range

surveillance).

mailto:[email protected]

https://www.tamesidehospital.nhs.uk/


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Or a position of “best practice” is adopted in line with current guidelines. Reference ranges for

referred investigation are taken from the referral laboratory.

QUALITY OF RESULTS (THE UNCERTAINTY OF MEASUREMENT)

All analytical results are assessed via internal quality controls and external quality assurance. The interpretation

of all results is subject to an uncertainty due to inter and intra individual variability plus the analytical variability

which all assays are subject to. Data relating to this is available for all reported tests (“in house”) or can be

obtained for referred investigation. If you have any queries regarding the interpretation of results (biological,

analytical variation or reference ranges) then please contact a senior member of staff (contact details provided

in this guide).

LABORATORY OPENING TIMES

BLOOD SCIENCES & TRANSFUSION The Haematology/Blood Transfusion and Biochemistry Departments (Blood Sciences) operate a 24 hours

service; one qualified staff member is on duty in each of the 2 disciplines outside routine working hours. These

departments also operate a senior staff “on-call” rota in collaboration with neighbouring hospitals (contactable

via the Biomedical Scientist on duty for Biochemistry and via switchboard for Haematology).

MICROBIOLOGY The laboratory based service has now transferred to Manchester University NHS Foundation Trust (central

site). The consultant microbiologist service remaining at Tameside with two consultants (contactable via the

switchboard). Please see relevant section for further details.


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SPECIMEN COLLECTION

Phlebotomy within the trust is managed by the nursing directorate.

The service can be accessed by the following:

IN-PATIENTS Blood samples are normally taken by a phlebotomist, but if one is not available, the doctor or a trained support

worker may take the blood. Requests for phlebotomy may be made via Lorenzo and blood collected when the

phlebotomist visits the ward. A limited phlebotomy service is available on Saturdays, Sundays and Bank

Holidays.

The department has standardised on the "Monovette" blood collection system which acts as a combined

syringe/blood container, rather than the conventional syringe and needle.

OUT-PATIENTS Blood can be collected from out-patients by referring them to the phlebotomists at the Blue Suite Clinic

(internal 6637) between 9:00am and 4:30pm Mon-Fri.

GP PATIENTS Patients can be referred to the hospital for the collection of blood. The phlebotomists are present between

9.00 am and 4.30 pm at the Blue Clinic (as above).

SPECIMEN SPILLAGE

When spillages occur during transport of specimens then:

Ward and clinic areas – inform nursing staff and follow local policy.

Pneumatic tube system – inform maintenance (ext. 6999).

Laboratory areas – inform senior staff, policy for cleaning/decontamination to be found in Risk Management

Policy and Blood Sciences Health and Safety Policy. Consult Q-Pulse for relevant policy (Health and Safety

Procedures).

All other areas – contact laboratory for advice.


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BLOOD COLLECTION BOTTLES AVAILABLE:

ADULTS

The Monovette blood collection system is used throughout the hospital. Please read the instructions and types

of specimens required before collection. Paediatric sample tubes are also available (see over).

Please note that when the sample is taken then the tube should be mixed by a minimum of 12 inversions as

recommended by the supplier. This is necessary to ensure the quality of analytical data obtained.

Blood Transfusion

(esr only)


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PAEDIATRIC/MICRO BLOOD BOTTLES AVAILABLE:

1.3ml EDTA for full blood counts

And sample requiring ammonia. Please

ensure you use the designation tube to

avoid contamination via the o-ring

1.1ml serum gel – all tests requiring

serum

1.3ml citrate for coagulation tests

0.5ml lithium heparin

0.5ml lithium heparin


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REQUEST FORM AND SPECIMEN LABELLING Please note this is covered by the Trust’s Specimen Acceptance Policy and Patient Identification Policy

available from Trust’s intranet site or by contacting the laboratory.

Pathology reserves the right to refuse any specimen which has not been adequately labelled.

All specimens must be accompanied by a completed request form (Lorenzo, tQuest (GPs) or manual). Below

are the details required for satisfactory identification. We require 3 unique items of identification.

REQUEST FORM (MANUAL REQUESTS):

Full name (surname and forename)

Date of birth

District number (or first line of address plus postcode)

NHS number (if available)

Test(s) required.

Location for report

Name of Consultant or General Practitioner

Date and time of collection (this is critical for some tests) if the request has been pre-printed, please

write the actual collection time on the request and the sample as the electronic record will not be

accurate.

Name of the person collecting the sample (this may be automatically recorded by e.g. Lorenzo or

tQuest).

Clinical details.

REQUEST FORM (LORENZO REQUESTS) – HOSPITAL:

These are the request forms generated by the Lorenzo EPR and a barcode is used which contains all

data. These should be used unless extenuating circumstances exist (such as a failure of Lorenzo)..

REQUEST FORM (TQUEST REQUESTS) – GENERAL PRACTICE:

These are the request forms generated by the tQuest Order Communications software in use by GP

practices across the Tameside and Glossop CCG. These should be used whenever possible

SPECIMEN:

Full name (surname and forename)

Date of birth.

District number or NHS number (or other identifier from request form).

Requests for Blood Transfusion must be hand written and have the signature of the person taking

the sample plus the date and time.

Note: it is the responsibility of the Health Care Professional to establish the identity of the patient before the

sample is taken as stated in the Trust’s patient Identification Policy

Only under very exceptional circumstances when the specimen cannot be repeated will accepting

a mislabelled sample be considered. An explanation of what constitutes a “non-repeatable”

sample and the procedure for accepting such a sample are on the Trust’s intranet site or available

by contacting a senior staff member within pathology. Such a procedure may only be initiated

after discussion with a senior staff member.

Please note that there are NO exception for blood transfusion samples.


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INSTRUCTIONS FOR SUBMISSION OF SAMPLES

All sample bags have the following printed on:

It is essential that the instruction above are followed as following national guidelines if more than a single

patients sample in the specimen bag then this will be rejected. Not following the procedure for labell as in the

diagram may lead to significant delays in processing the sample and may have to lead to sample rejection.

CONSENT It is the responsibility of the requesting clinician to obtain consent for the collection of specimens from the

patient. For certain tests (e.g. genetic tests) a consent form may be required in addition to the request forms

REQUESTS FOR BLOOD PRODUCTS: All request forms must be signed by the requesting clinician. Additionally the sample tube must be hand

written, signed and dated.


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HIGH RISK SPECIMENS Specimens from a patient deemed to be high risk must be labelled and transported to the laboratory following

the Trust’s Policy for high risk specimens/patients. This is to comply with the responsibilities under the Control

of Substances Hazardous to Health regulations (COSHH) and national H&S alert.

Specimens are very high risk and requiring special precautionary measures (e.g. MERS and Ebola): It is the

responsibility of the clinician to inform the laboratory of suspected highly contagious sample required extra

PPE for handling. All such cases should be discussed with a Consultant Microbiologist prior to submission of

sample to lab. The laboratory required knowledge of such sample for analysis and transport to referral

laboratory and has policies and procedures for doing so.

REQUESTING AND REPORTING

WARD ORDER COMMUNICATIONS The hospital has an electronic link between the Patient Administration System (PAS) and the Pathology

Computer System. Specialised software (Lorenzo) allows pathology requests to be made electronically. The

system is available for Haematology, Transfusion, Microbiology and Biochemistry requests from

all wards and clinics; all requests for these departments must be made electronically. Please note the that

the label produced by Lorenzo for blood transfusion MUST NOT be attached to the sample, Sample must be

hand written as per previous section.

Medical staff training on this system is undertaken by the IT Department. All Haematology, Transfusion,

Biochemistry and Microbiology results are available on Lorenzo once they are released. Please look for the

results on Lorenzo before telephoning.

GP ELECTRONIC REPORTING GP practices are provided with tQuest an electronic order communications product that interfaces to the lab

system and the Practice Management System allowing electronic requesting of pathology tests.

The Pathology Directorate transfers results electronically to GP Practices. Results are sent continuously in order

that patients' results are available for viewing next morning on the GP's' own computer systems for those that

can accept standard transfer protocols for Pathology results. All common GP computer systems are capable of

receiving results.

GPs can access results for investigations done within the hospital via Review which works with tQuest.

For any query about pathology IT issues please contact the Pathology IT and Quality Management System

Manager

DISTRIBUTION OF PRINTED REPORTS In-patients: There are 2 report distributions per day, 12:30 and 17:30

GP patients: Reports are sent by transport (daily).

Please note the directorate operates a no-faxing policy unless the fax machine has been

established as a “safe haven”. Please see Trust’s data protection policy for further details or

contact laboratory for advice.


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TRANSPORT OF SAMPLES TO LABORATORY

PNEUMATIC TUBE DELIVERY SYSTEM (POD) Air tube stations are situated around the site. Full operating details are available at each station, and further

details can be obtained via Pathology or the Estates Department. Breakdowns and faults should be reported to

Estates Tel: 6999. Please note that the air tube system is NOT the responsibility of Laboratory Medicine.

Specimens for tests that are unstable (please refer to relevant section in user guide), blood

gas/CSF specimens and for requests which are very urgent then the pod system should NOT

be used. These specimens should be transported directly to the laboratory without delay.

FROM WARDS AND OUT-PATIENT DEPARTMENTS

Apart from the air tube system samples are also picked up from the following collection points.

Time Location

10:30am Ante Natal Clinic

Yellow Suite

Blue Suite

11:45am Ante natal Clinic

Yellow Suite

Blue Suite

2:00pm Occupational health

Ante Natal Clinic

Yellow Suite

Blue Suite

For urgent samples both during and after the working day, it is the responsibility of the originator of the

request to make arrangements for the transport of the sample to the laboratory by e.g. air-tube or portering

services. During the working day, samples should be brought direct to the laboratory or sent via the air-tube.

Outside working hours specimens should be sent via the air-tube or taken to the directorate (access is gained

via a buzzer/intercom system).

GP'S The laboratory provides a transport service which collects samples from GP surgeries in the Tameside and

Glossop district in the morning and afternoon, every day from Monday to Friday. Please contact laboratory for

collection times for each practice.


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TELEPHONED RESULTS It would be appreciated if telephone enquiries to the laboratory asking for results, could be kept to a minimum.

All results from pathology are electronically sent to the Lorenzo EPR, if the request is made electronically or the

rmp number is used on the request. So please check the Lorenzo system before telephoning for results.

If contacting the department by phone then please ensure you have full patient details, date of collection and

tests required.

Note: in line with the Royal College of Pathology’s guideline (2010):

“Out-of-hours reporting of markedly abnormal laboratory test results to primary care: Advice to pathologists”

and in consultation with service users the following limits for telephoning seriously abnormal results have been

agreed:

BIOCHEMISTRY

Analyte Units Action limits

Below Above

Pro

file

Co

mp

on

ents

Sodium mmol/l <120 >160

Potassium mmol/l 2.5 6.0*

Urea mmol/l - 30

Creatinine mol/l 250

Glucose mmol/l 2.5 20**

Calcium (corrected) mmol/l 1.80 3.00

Magnesium mmol/l 0.4 -

Phosphate mmol/l 0.3 -

NTproBNP Pg/ml - >400

AKI - AKI stage 1 and 2

Enzy

mes

AST U/L - 750

ALT U/L - 750

CK U/L - 5000

Amylase U/L - 500

Ther

apeu

tic

Dru

gs

Carbamazepine mol/l - 60

Digoxin nmol/l - 3.5

Theophylline mol/l - 150

Phenytoin mol/l - 150

Lithium mmol/l - 1.5

Valproate mmol/l - 1500

*Check sample is not haemolysed (sample quality check), EDTA contaminated (check magnesium, calcium and

alkaline phosphatase) or if there has been a delay in separation (check phosphate)

** >30 mmol/l if known diabetic


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HAEMATOLOGY

Analyte Units Action limits

below Above

Pro

file

co

mp

on

ents

Haemoglobin g/L 80

Total White Cell Count 109/L 2

Absolute Neutrophil Count 109/L 1

Platelet Count 109/L 30

INR 5.0

APTTR 3.0

Fibrinogen g/L 1.0

Newly presenting leukaemia

Newly presented malaria

Positive Sickle Cell Haemoglobin in patients about to undergo anaesthesia

ADDITIONALLY

Troponins (GP only) If >0.07 µg/l

Paracetamol Always treat as urgent and potentially life threatening

CSF (total protein and glucose) If not requested by ward order coms (WOC).

Blood gases If not requested by WOC.

The directorate will make every endeavour to communicate any results requiring immediate attention to the

initiator of the request. If there are insufficient details on the request form this may be impossible outside of

core laboratory hours and may cause delays in these results being transmitted.


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REFERRED INVESTIGATIONS

Not all investigations requests are performed in the Pathology Directorate at Tameside General. Specialist

investigations and the less requested investigation may be referred to other more specialist laboratories in the

region or throughout the country. These investigations may take longer to be reported. The directorate does

audit these tests and in the event of an excessive delay, please contact the laboratory for help and/or advice.

An indication of turnaround time is made for many tests in this handbook but this can only act as a guide.

A list of laboratories used for referred tests is available later in the user guide. Should you need

to contact an external laboratory we strongly recommend you discuss this with the laboratory

first. This will save time and confusion.

REQUESTS FOR FURTHER TESTS ON SAMPLES ALREADY HELD BY LABORATORY

It is occasionally possible for further testing to be done on samples held by the laboratory. Samples are held for

a minimum of 5 calendar days by Biochemistry and a minimum of 2 calendar days (minimum 2 day) by

Haematology (for Microbiology and Histology please contact relevant department). Requests for further tests

are possible after considerations of:

If there is sufficient sample remaining.

If the requested analyte is stable under the storage conditions.

The sample is the correct type.


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BIOCHEMISTRY DEPARTMENT


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BIOCHEMISTRY DEPARTMENT

CONTACT DETAILS

General Enquiries – Haematology & Biochemistry Results 6497

Blood Sciences Manager Mrs Gillian Lewis 6318

Point of Care Manager Ms Alison Shanahan 4620

Consultant Clinical Scientist (Biochemistry) Mr Tony Tetlow 6495

When phoning from outside the hospital use 0161-922 then the extension number.

SPECIMEN COLLECTION

Please note the following pre-laboratory errors frequently occur but may be avoided by –

Correct sample for relevant test.

Insufficient mixing of blood sample with contents of blood collection tube (minimum of 12 full

inversions).

Prompt delivery to the department.

The most common reasons for pre-analytical factors affecting results are:-

Problem Common causes Consequences

Delay in separation Overnight storage. Delay in transit

Increased K+, PO4, ALT, LDH.

Decreased HCO3-, (Na

+ occasionally)

Storage Storing at 4oC Increased K

+

Decreased HCO3-

Haemolysis Expelling blood through needle into tube Over vigorous mixing of specimen Storing specimen in freezer (-20

oC)

Excessive delay in transit Leaving specimen in hot environment. Difficulties encountered when accessing suitable vein.

Increased K+, PO4, ALT, LDH.

Inappropriate sampling site

Specimen taken from drip arm Increased drip analyte e.g. glucose, K+,

Mg2+

(dilutional effect)

Incorrect container or anticoagulant

No enzyme inhibitor, EDTA tube or transferring blood from one tube to another

Low glucose Increased K

+, Na

+

Decreased Ca2+

, ALP, Mg2+

Lipaemia Specimen taken after a fatty meal. Decreased Na+


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CAUTION – EDTA CONTAMINATION Plasma or serum samples (white, brown or orange tubes) must be taken before EDTA sample

(yellow or red).

Contamination of blood specimens with potassium EDTA is a major problem for the Biochemistry department

and the following will explain why.

Q. What are the effects of EDTA contamination?

Increased potassium - leading to an incorrect interpretation of potassium levels.

Decreased calcium, magnesium and alkaline phosphatase.

Q. Why use EDTA if it is such a problem?

Potassium EDTA is the anticoagulant primarily used by the Haematology department because the cellular

components and morphology of the blood cells are preserved and it is the recommended anticoagulant for

haematology.

Q. How does it work?

EDTA inhibits clotting by chelating calcium and magnesium which inhibits several calcium and magnesium

dependent enzymes critical to the clotting cascade.

Q. Can it be spotted by the lab?

Gross contamination can be spotted by the lab due to unbelievable levels of calcium (and/or magnesium),

potassium and alkaline phosphatase. It only takes a trace of EDTA to alter the results and this may not be

obvious. THE LABORATORY CAN NOT RELIABLY IDENTIFY EDTA CONTAMINATION. The safe practice is to avoid

contamination in the first place and that is the responsibility of the person taking the blood sample.

Q. How can contamination be avoided?

When taking a series of blood specimens, it is essential that specimens for biochemistry (e.g. urea and

electrolytes) are taken first and EDTA samples are taken last.

If you have any doubts about the accuracy of a potassium e.g. if it does not agree with the

patient’s condition or with previous results then obtain a fresh sampl e (of which you are sure of

the integrity) and have it analysed as an emergency.


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FAECAL OCCULT BLOOD We use the hema-screen™ kit for faecal occult blood testing – the following text is taken from the package

insert.

SPECIMEN COLLECTION AND PREPARATION

The hema-screen™ test requires only a small faecal specimen. The specimen is applied to the guaiac paper of

the hema-screen™ slide as a thin smear using the applicator stick provided. The tests may be prepared and

developed immediately, or prepared and stored at room temperature, protected from heat and light for up to

twenty one (21) days before developing. Keep testing area, hands, etc. clean and free of blood to avoid false

positive results.

It is recommended for screening of asymptomatic persons that stool smears for testing be collected from at

least three consecutive bowel movements (i.e. hema-screen™ Patient Packs) since bleeding from

gastrointestinal lesions may be intermittent. Greegor recommends two samples per stool, with each test site (I,

II) prepared from a different part of each day's stool to increase the probability of detecting occult blood in each

stool.

INTERFERING SUBSTANCES

There are some oral medications such as aspirin, corticosteroids, reserpine phenylbutazone, indomethacin, etc.

that can cause gastrointestinal irritation and occult bleeding in some patients. Ascorbic acid (Vitamin C) taken

in units greater than 250 mg per day may cause false negative results. Iron or preparations containing Iron may

cause false positive results. Two days prior to and during the test period such medications should be avoided.

Patients with bleeding from other conditions such as haemorrhoids, dental work, constipation or menstrual

bleeding should not be tested while such conditions are present. Do not collect a specimen if patient is using

rectal preparations. The patient's physician should be consulted when discontinuing prescription medications.

PATIENT PREPARATION

For three days (3) before and during the stool collection period, avoid red meats (Beef, Lamb and Liver). Eat a

well-balanced diet including fibre such as bran cereals, fruits and vegetables. Raw fruits and vegetables which

contain peroxidase-like substances (turnips, broccoli, horseradish, cauliflower, cantaloupe, parsnips, red radish

etc.) should be avoided during the test period. A diet such as this helps reduce the number of false positive test

results and at the same time provides roughage to help uncover silent lesions which may bleed only

intermittently. If any of the above foods are known to cause patient discomfort, patient should be instructed not

to eat them or to make appropriate substitutions. In an initial three-test series, the patient may disregard the

recommended diet. If patient has one or more positive tests, then he or she should be placed on the above

suggested diet and retested for another three-test series. However it should be remembered that bleeding may

be intermittent and no positive test result should be disregarded.

For further advice or information, please contact the laboratory.


PATH.QM.003.0


BIOCHEMICAL PROFILES

These are tests groups together to simplify requesting. All profiles require 5ml sample (minimum) the only

exception is the paediatric profile which requires a full microtainer.

All profiles will be analysed the same day and if indicated as urgent, within 1 hour.

The common profiles are:-

Profile Tests Reference Range

Routine profile (GP only)

Sodium Potassium Chloride Urea Creatinine Calcium (adjusted calcium) Albumin

133 – 146 mmol/l 3.5 – 5.3 mmol/l 95 – 108 mmol/l 2.5 – 7.8 mmol/l 41 – 110 µmol/l 2.12 – 2.63 mmol/l 31 – 45 g/l

U&E

Sodium Potassium Chloride Urea Creatinine

133 – 146 mmol/l 3.5 – 5.3 mmol/l 95 – 108 mmol/l 2.5 – 7.8 mmol/l 41 – 110 µmol/l

A&E (must reach laboratory within 30min or it will be replaced by U&E profile)

Sodium Potassium Chloride Urea Creatinine Glucose

133 – 146 mmol/l 3.5 – 5.3 mmol/l 95 – 108 mmol/l 2.5 – 7.8 mmol/l 41 – 110 µmol/l 2.6 – 7.8 mmol/l (non fasting)

Liver profile Total Protein Albumin Globulin Bilirubin Alkaline Phosphatase (ALP) Alanine Transaminase

Glutamyl Transpeptidase (GGT)

62 – 80 g/l 31 – 45 g/l 24 – 43 g/l 3 – 21 µmol/l 20 – 125 IU/l <60 IU/l <50 IU/l

Bone Profile Calcium (adjusted calcium) Albumin Phosphate Alkaline Phosphatase (ALP) Total Protein

2.12 – 2.63 mmol/l 31 – 45 g/l 0.8 – 1.5 mmol/l 25 – 125 IU/l 62 – 80 g/l

Nutritional Marker Magnesium Prealbumin C-Reactive Protein (CRP)

0.7 – 1.0 mmol/l 150 – 350 mg/l <8.0 mg/l

Thyroid profile Thyroid Stimulating Hormone Free Thyroxine

0.4 – 4.5 mU/l 7 – 17 pmol/l

Drug Profile (urine) Opiates Benzodiazepines Amphetamines Cocaine metabolite Methadone metabolite Creatinine

Not detected Not detected Not detected Not detected Not detected >1.8 mmol/l

Lipid Profile Cholesterol (total) HDL Cholesterol LDL Cholesterol Triglycerides (fasting)

<5.0 mmol/l >1.2 mmol/l <3.0 mmol/l <1.8 mmol/l

Androgen Profile (Male) Testosterone 10 – 28 nmol/l


PATH.QM.003.0


Profile Tests Reference Range

Androgen Profile (female)

Testosterone Sex Hormone Binding Globulin Androstenedione Free Androgen Index (calculated) Androstenedione

<1.6 nmol/l 18 – 114 nmol/l <6.0 nmol/l < 4.5 <6 nmol/l


PATH.QM.003.0


COMMONLY REQUESTED TESTS – SAMPLE REQUIREMENTS AND REFERENCE RANGES (ADULT)

Due to the large number of possible requests not all assays are listed. If you require a non-listed test, please

contact the laboratory for an estimated turnaround time. We will contact the referral laboratory on your

behalf.

The turn-around times are when we expect at least 90% of assays to be completed. If result has not been

returned within the quoted time then please contact the laboratory who will then investigate.

Test Specimen Type

Volume Required

Turn Around

Reference Range

Adrenocorticotrophin (ACTH). Second line test for adrenal dysfunction.

plasma (send to lab on ice)

10ml Referred test – 12 days

0 – 46 ng/l

Alanine Aminotransferase (ALT). Increased levels indicate liver cell damage of any cause.

serum 5ml <24hr <60 IU/l

Albumin Low levels due to renal/GI loss, low synthesis, dietary, over hydration of redistribution.

serum 5ml <24hr 31 – 45 g/l

Alcohol (blood) blood (fluoride)

5ml <24hr Not Detected

Alcohol (urine) random urine

5ml <24hr Not Detected

Aldosterone Measured with renin for diagnosis of Conn’s Syndrome. See page 55 Renin and Aldosterone

plasma 10ml Referred test – 21 days

See report

Aldosterone: renin ratio random sampling of these hormones gives a ratio used as an initial screen for primary hyperaldosteronism. The sample must be immediately taken to the laboratory would must be notified if impending arrival. See renin. See page 55 Renin and Aldosterone

plasma (send to lab on ice)

10ml Referred test – 21 days

<630 pmol/l

Alkaline Phosphatase Elevated in bone and liver disease (naturally elevated in children and pregnancy).

serum 5ml <24hr 25 – 125 IU/l

Alpha-1-antitrypsin Evaluation of COAD, emphysema and liver disease. Acute phase reactant.

serum 5ml referred test – 14 days

1.1 – 2.1 g/l

Alpha-1-antitrypsin (phenotyping) Evaluation of low alpha-1-antitrypsin levels


see report

Alpha-fetoprotein Tumour marker for hepatocellular carcinoma

serum 5ml <24hr <5 KU/l


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

17-alpha-Hydroxyprogesterone Diagnosis of CAH due to 21-hydroxylase deficiency. 3

rd line

investigation of hirsutism (late onset CAH). Monitoring of CAH patients

serum 5ml referred test - 14 days

<10 nmol/l

Amino acids (urine). Disorders of amino acid metabolism

urine 10ml referred test – 28 days

Normal pattern

Ammonia Paediatric disorders e.g. urea cycle disorders. Contact lab before sending. Sample must be received in ice immediately. Please contact laboratory before sending.

plasma 1ml <1hr Sick/prem = <150 mol/l

neonate = <100 mol/l

<16 yr. = <50 mol/l

Amylase Raises in acute pancreatitis


Amylase (urine) Investigation of macroamylasaemia. Comparison with serum, paired sample should be taken at same time

urine 10ml <24hr <35 IU/mmol creatinine. Amylase:creatinine clearance ratio: 0.02 – 0.05

Amino Acids Investigation of inherited defects of amino acid metabolism


see report

Androstenedione Investigation of hirsutism


<6.0 nmol/l

Angiotensin converting enzyme (ACE) Monitoring sarcoidosis


15 – 55 IU/l

Antiepileptic drugs Monitoring therapy and toxicity. See page 45 Therapeutic Drug Monitoring.

serum 5ml <24hr see individual drugs. See also page 45 Therapeutic Drug Monitoring.

Anti-Mullerian Hormone Assessment of ovarian reserve. Note: consultant request only.


<6.0 pmol/l low

6-24.pmol/l reduced

24 – 70 pmol/l optimum

>70 pmol/l PCOS

Aspartate aminotransferase Raised in liver and muscle damage


Bence-Jones Protein Monoclonal immunoglobulin free light chains in urine

urine 20ml 14 days not detectable

Beta-2-microglobulin prognostic indicator in myelomatosis

serum 5ml 14 days 0.9 – 2.5 mg/l

Bicarbonate acid-base status

serum 5ml <24hr 22 – 29 mmol/l

Bile acid cholestasis of pregnancy

serum 5ml <24hr <14 µmol/l

Bilirubin Raised in haemolysis, hepatocellular damage or biliary obstruction

serum 5ml <24hr 3 – 21 mol/l (adult)


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

Bilirubin (neonate) Spectrophotometric analysis only suitable if <3 months old.

serum 0.5ml <24hr see paediatric ranges

Blood gases Acid – base status – must be received by lab within 30min of sampling. Blood gas analysers available on ITU. CCU and A&E. Please note that the sample must NOT contain any air gaps and must have been thoroughly mixed.

heparinised arterial blood or capillary sample (on ice)

2 ml <0.5hr see report

BNP (NTproBNP) Use to identify patients with left sided heart failure who may require echo ECG and in diagnosis of acute heart failure.

Whole blood (EDTA)

5ml <4hr reported as NTproBNP, normal <400 ng/l.

Ca125 – see special tests section Please see section on Tumour Markers page 58.

Ca19-9 – see special tests section

Ca15-3 – see special tests section

Caeruloplasmin Copper binding serum protein, decreased in Wilson’s Disease


0.20 – 0.45 g/l

Calcitonin Useful in diagnosis and monitoring of medullary carcinoma of the thyroid. May require a pentagastrin stimulation test for diagnosis.


<18.9ng/l

Calcium Report value corrected for albumin

serum 5ml <24hr 2.12 – 2.63 mmol/l

Calcium (urine) urine collected in acid

<24hr Female = <6.5 mmol/24hr Male = <7.5 mmol/24hr

Calculi Identify component of renal, biliary or bronchial stones

- Complete sample sent

referred test – 14 days

see report

Calprotectin Differentiation of IBD and IBS

faeces 1g Referred test – 14 days

<60g/g

Carbamazepine Anticonvulsant drug monitoring. See page 45 Therapeutic Drug Monitoring.

serum (pre-dose)

5ml <24hr therapeutic range: 20-40 µmol/l

Carboxyhaemoglobin Measure % of carbon monoxide bound to haemoglobin

heparinised sample (orange top)

5ml <24hr up to 10% in smokers, normally <2%

Carcinoembryonic antigen (CEA) Monitoring of colonorectal cancer, of no use for diagnosis.

serum 5ml <24hr <3 U/l (up to 10 in smokers)

C1-esterase inhibitor hereditary angioneurotic oedema (type 1). C4 should be requested at the same time, C1-esterase will not be measured if C4 normal.


0.21- 0.50 g/l


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

Catecholamines Investigation of hypertension, suspected phaechromocytoma.

urine (collected into acid)

24hr collection


see report

CCP (anti-) raised in rheumatic disease, more sensitive than rheumatoid factor

serum 5ml referred tests – 21 days

<10 U/ml

Chloride serum 5ml <24hr 95 – 108 mmol/l

Cholesterol Coronary artery disease

serum 5ml <24hr <5 mmol/l or <4 mmol/l if in high risk group

Cholesterol - HDL Inverse association between HDL cholesterol levels and coronary artery disease.

serum 5ml <24hr Female = >1.1 mmol/l male = >0.9 mmol/l

Cholesterol - LDL Calculated parameter from cholesterol and HDL cholesterol. Cannot be calculated if triglyceride greater than 2.4mmol/l

- - <24hr <3.0 mmol/l or <2.0 mmol/l if high risk

Cholinesterase Anaesthetic sensitivity and organophosphate poisoning. If deficiency detected then whole required for genotyping.

serum (plus whole blood (EDTA))

5ml referred test – 27 days

see report

Chromium Required to assess MoM joint wear according to MHRA alert.

whole blood 5ml referred test – 21 days

see report

Clozapine Anti-psychotic drug requiring monitoring. See page 45 Therapeutic Drug Monitoring.


see report

Cobalt Required to assess MoM joint wear according to MHRA alert. Measured with chromium (see above)


see report

Complement C3 and C4 assay for monitoring inflammatory and autoimmune conditions. Single point determinations of limited value


see report

Copper Reduced in Wilson’s Disease. Increased in many inflammatory disorders, pregnancy and OCP. Also request Caeruloplasmin.


13 – 26 µmol/l

Copper (urine) Increased in Wilson’s Disease.

24hr urine collection (acid washed container)

- referred test – 14 days

<1.0 µmol/24hr


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

Cortisol Investigation of adrenal function. Important to note time of specimen as reference ranges relate to 09:00. Hydrocortisone, prednisone and prednisolone will interfere with this test but not dexamethasone.

serum 5ml <48hr 09:00h ref. range: 140 - 500 nmol/l

Cortisol (urinary free) First line investigation for Cushing’s Syndrome

24hr urine collection (plain container)


<180 nmol/l

Creatinine Assessment of renal function. Affected by muscle breakdown and diet as well as renal function

serum 5ml <24hr 40 – 110 µmol/l (age and muscle mass dependent)

Creatinine (urine) See above. Used for calculation of creatinine clearance.

24hr urine collection

- <24hr see report

C-reactive protein Acute phase reactant.

serum 5ml <24hr <8 mg/l

Creatine Kinase (CK) Muscle enzyme, cardiac and skeletal

serum 5ml <24hr F = <145 IU/l M = <170 IU/l

Cryoglobulin Essential to keep sample at body temperature on way to lab. Please contact lab before taking sample, see Cryoglobulins section of user guide.

serum 5ml 10 days See report

CSF (Xanthochromia) Estimation of haemoglobin and bilirubin in (xanthochromia) CSF for investigation of SAH. Sample must be taken >12hr post event and may remain abnormal for up to 10 days. Do not send sample by “air tube” as this may affect result.

CSF 1ml (min) – sample less than 1ml cannot be processed

<2 hr see report

Cyclosporine Monitoring immunosuppressant therapy. Trough level taken although 2hr level often used as better indication of therapy. See page 45 Therapeutic Drug Monitoring.

Whole blood (EDTA)


see report

Digoxin To assess compliance and toxicity. Levels cannot be interpreted if sample taken less than 6 hr post dose – pre-dose levels recommended. See page 45 Therapeutic Drug Monitoring.

serum 5ml <24hr 1.0 – 2.6 nmol/l

Down’s Screening Pre-natal detection of Down’s Syndrome.

serum 5ml Reported directly from screening service at Royal Bolton Hospital to ANC.


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

Drug Screen Screening for detection and monitoring of drug abuse – opiates, benzodiazepines, cocaine, amphetamines, methadone metabolite. Cannabis, buprenorphine and ethanol can be added on request. Please see Drugs of abuse page 60.

urine 15ml <24hr not detected

Dehydroepiandrosterone (DHAS) Investigation of hirsutism.


<12 µmol/L (female)

Electrophoresis Detection of paraproteins, immune deficiency and non-specific acute and chronic phase deficiency.

serum 5ml <14 days see report

Erythropoietin Investigations of rbc production

serum 5ml 28 days 3 – 18 mIU/ml

Ethanol To identify intoxication

Plasma (fluoride oxalate, yellow tube)

5ml <24hr not detected

Ethylene Glycol (and methanol) For identification of ethylene glycol poisoning. All requests must be discussed with Consultant Clinical Scientist first as this requires urgent referral.

Plama (lithium heparin, serum gell samples are not suitable)

5ml <4hr not detected

Faecal Elastase Measure of exocrine pancreatic function.

faecal sample

1g referred test – 14 days

see report

Faecal Occult Blood Identification of blood in faeces.

Please see page 26

Faecal Occult Blood

Faecal sample

1g <24hr negative

Faecal Reducing Substances Malabsorption/digestion of carbohydrates (of paediatric interest). Please note that samples more than 1hr old will not be processed,

faecal sample (must be delivered to lab immediately

1g referred test – 14 days

not detected

Ferritin Assessment of iron stores

serum 5ml <24hr M = 24 – 337 g/l

F = 11 – 307g/l

Folate (serum) Investigation of anaemia and neuropathy.

serum 5ml <24hr 3.0 – 19.9 ng/l

Folate (red cell) Investigation of anaemia and neuropathy

Whole blood (EDTA, red)

2.7ml <48hr 140 – 836 ng/l

Free Androgen Index Ratio of testosterone to SHBG expressed as a percentage. Investigation of Hirsutism.


F = <4.5


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

FSH Assessment of ovarian failure, infertility, pituitary dysfunction.

serum 5ml <24hr F = cyclical (see report) M = 1 -7 IU/l

Gamma Glutamyl Transpeptidase (GGT) Sensitive indicator of liver disease. Increased after exposure to enzyme inducing drugs (including ethanol)

serum 5ml <24hr M = <50 IU/l F = <32 IU/l

Gastrin Diagnosis of gastrinomas. Patient must be fasted and have not received omeprazole for at least 2 weeks or H2 blockers for 3 days.

plasma (must be delivered to lab on ice).


<40 pmol/l

Gentamicin Therapeutic drug monitoring is essential to prevent complications of therapy. See page 45 Therapeutic Drug Monitoring.

Serum 5ml <24hr See Trust guidelines for antibiotic prescribing and sampling

Globulins Elevated in myeloma, infections and autoimmune disorders

calculated result

5ml <24hr 24 – 43 g/l

Glucose Primarily measured in DM.

Plasma (fluoride oxalate, yellow tube)

1ml <24hr 3.0 – 6.0 mmol/l (fasting)

Glucose Tolerance Test Diagnosis of DM. See page 51 Oral Glucose Tolerance test

This test is no longer performed within the Pathology Directorate. Phone Phlebotomists (6637) for appointment. For interpretation see relevant section in user guide.

Growth Hormone Measured in acromegaly, pituitary gigantism and dwarfism. Random levels are of little value and secretion is best assessed by stimulatory or suppressive testing


see report

Gut Hormone Profile (gastrin, VIP, PP, glucagon, neurotensin, somatostatin, chromogranin A&B) Diagnosis of neuroendocrine tumours of the alimentary tract. Contact lab before taking sample – sample must be received within 10minutes of being taken

Plasma 10ml referred test – 25 days

see report

Haptoglobin Intravascular haemolysis, haemolytic anaemia

Serum 5 ml <24hr 100 – 300 g/dl

HbA1c Diagnosis and monitoring of diabetes

EDTA. Whole blood

1ml <24hr DCCT 4.5 – 5.9 % IFCC 26 – 41 mmol/mol


PATH.QM.003.0


Test Specimen Type

Volume Required

Turn Around

Reference Range

Human Chorionic Gonadotrophin (HCG) Increased in pregnancy, ectopic pregnancy, hydatidiform mole, seminoma, testicular and ovarian teratomas


HCG (urine) Pregnancy test, only performed if POCT devices are not available

urine (random)

5ml <24hr see report

5-Hydroxyindole-acetic acid (HIAA) Detection and monitoring of carcinoid tumours. Some foods (bananas, pineapples) can cause increased levels.

24hr urine collection into acid


<50 µmol/24hr

Immunoglobulins Autoimmune disorders, liver disease, infection and genetic deficiencies.

serum 5ml <48hr IgG = 6.0 – 16.0 g/l IgA = 0.8 – 4.0 g/l IgM = 0.5 – 2.0 g/l

Immunoglobulin subclasses Investigation of recurrent infection in children


IgG1 = 2.4 – 12.6 g/l IgG2 = 0.6 – 2.3 g/l IgG3 = 0.2 – 1.4 g/l IgG4 = 0.02 – 1.8 g/l

Immunoglobulin E Allergic and atopic disease.


Age related – see report

Iron Studies Investigation of deficiency and overload.

serum 5ml <24hr

Iron 13 – 32 umol/l

Iron binding capacity 45 – 70 umol/l

% saturation 20 – 55 %

Transferrin 1.8 – 3.5 g/l (male) 2.0 – 3.6 g/l (female)

Insulin Detection of insulinoma, Sample must be taken during a hypoglycaemic attack. Glucose must be assayed at same time.

serum (sample must be sent to lab on ice)


see report

Insulin Growth Factor–1 (IGF-1) Investigation of acromegaly and growth disorders.


see report

Lactate Dehydrogenase (LDH) Measured in megablastic and pernicious anaemias, leukaemias, lymphomas and liver disease.


Lamotrigine Anticonvulsant drug, TDM not recommended. See page 45 Therapeutic Drug Monitoring.


3 – 15 mg/l


PATH.QM.003.0


Lead Monitoring environmental exposure.

whole blood EDTA


see report

LH Assessment of ovarian failure, infertility, pituitary dysfunction.

serum 5ml <24hr F = cyclical (see report) M = 3 – 12 IU/l

Lithium Monitoring of lithium therapy. Sample should be taken 12hr post dose. See page 45 Therapeutic Drug Monitoring.

serum 5ml <24hr 0.4 – 1.0 mmol/l (0.4 – 0.8 mmol/l if >65yr)

Magnesium Measured in case of hypocalcaemia and hypoparathyroidism. Low levels commonly seen due to intestinal losses and diuretic therapy.


Mast Cell Tryptase Suspected acute allergic reaction. Sample should be taken at up to 3hr post even and after 6 and 24hr.


<12.9 g/l

Microalbumin (urine albumin) Measured in diabetes as an indicator of the development of renal disease. Ratio to creatinine

urine (random)

5ml <24hr <3.5 mg/mmol (male) <2.5 mg/mmol (female)

Oestradiol Investigation of female infertility and monitoring of oestrogen implants.

serum 5ml <48hr cyclical, see report

Organic Acids Investigation of inherited defects in organic acid metabolism.


see report

Osmolality Estimation of “osmolar gap”. Investigation of hyponatraemia.

serum 5ml <24hr 285 – 295 mOsm/kg

Osmolality (urine) Investigation of SIADH (with serum osmolality)

urine 5ml <24hr 40 – 750 mOsm/kg. Needs to be interpreted with serum osmolaity

Oxalate (oxalic acid) Investigation of renal stones


see report

Oxalate (urine) Investigation of renal stones

urine (acidified)


see report

P3NP (Procollagen Peptide) Monitoring fibrogenic activity in the liver of patients receiving long term methotrexate


see report

Paracetamol Paracetamol overdose, to assess need for antidote. Sample must not be taken less than 4hr since the overdose. See Paracetamol Interpretation page 44

serum 5ml <24hr Normal <5mg/l. For overdose please see chart.


PATH.QM.003.0


Parathyroid Hormone (PTH) Investigation of hypo- and hypercalcaemia. Sample must be analysed within 4hr of being taken

serum 5ml <48hr 19 – 67 pg/ml

Phenobarbitone Check for toxicity and compliance. See page 45 Therapeutic Drug Monitoring.


15 – 50 mg/l

Phenytoin Check for toxicity and compliance. See page 45 Therapeutic Drug Monitoring.

serum 5ml <24hr 30 – 70 µmol/l

Phosphate Investigation of calcium abnormalities.


Porphyrin Screen Detection of porphyrias. Investigation of such symptoms as abdominal pain and skin photosensitivity. All samples must be kept in the dark. See Porphyrin Screen page 61.

plasma red cells urine faeces

5ml 2ml 20ml 10-15g


see report

Potassium Seasonal and diurnal variation observed. Old or haemolysed samples are not suitable for analysis. Please note that the reference range applies to serum samples only.


Potassium (urine) Investigation of hypokalaemia

urine (random)


Progesterone Detection of ovulation and evaluation of corpus luteum function

serum 5ml <48hr Luteal Peak: 18 – 72 nmol/l

Prolactin May cause infertility, amenorrhaoea and galactorrhoea when increased.

serum 5ml <48hr F = 102-426 mU/l M = 86 - 324 mU/l

Prostate Specific Antigen (PSA) Detection and treatment of prostatic cancer,

serum 5ml <48hr <2.5 ng/ml (18 -50 yr) <3.5 ng/ml (50 – 60 yr) <4.5 ng/ml (60 – 70 yr) <6.5 ng/ml (over 70 yr)

Protein (Total) Relates to liver function, state of hydration and is part of myeloma screening

serum 5ml <24hr 62 – 80 g/l

Protein (urine) Renal protein loss.

urine (24hr or random)

5ml <24hr 50 – 80 mg/24hr <20 mg/mmol (random)

Protein (CSF) Increased in meningitis or tumours of the CNS

CSF 1ml <24hr <0.45g/l

RAST Allergen specific IgE. Must include clinical details to ensure correct allergen screened for.


see report


PATH.QM.003.0


Urine reducing substances Screening for presence of sugars in urine

Urine (random)


Renin Diagnosis of primary hyperaldosteronism (Conn’s). Sample must be taken to laboratory immediately on ice. Inform laboratory before sample is taken. See page 55 Renin and Aldosterone

plasma (on ice)


0.3 – 2.2 nmol/l/hr

Rheumatoid Factor Diagnosis of rheumatoid arthritis and Sjogren’s Syndrome


Salicylate Investigation of salicylate poisoning.

serum 5ml <24hr not detected

Selenium Nutritional monitoring..


0.9 –

Sex Hormone Binding Globulin (SHBG) Part of androgen profile. HRT and OCP raise SHBG and obesity lower it. Not indicated in males.


F: 18 – 114 nmol/l

Sodium Main use is state of hydration.

serum 5ml <24hr 133-146 mmol/l

Sodium (urine) Measure of sodium excretion in investigation of hyponatraemia.

urine (random or 24hr)

5ml <24hr 40 – 220 mmol/24hr

Tacrolimus Immunosuppressant therapy. Trough level or 2hr post dose. See page 45 Therapeutic Drug Monitoring.

whole blood (EDTA)

5ml referred test – <7 days

see report

T3 (free) May be added to thyroid profile. Used to monitor treatment of thyrotoxicosis in first few months post diagnosis. Occasionally for detection of T3 toxicosis (free T4 and TSH suppressed)

serum 5ml <24hr 3.9 – 6.9 pmol/l

T4 (free) Part of thyroid profile for the investigation of thyroid disorders

serum 5ml <24hr 7 – 17 pmol/l

Testosterone Investigation of androgen disorders in male and female


F: <1.5 nmol/l M: 10 – 28 nmol/l

Theophylline Assayed to check compliance and therapeutic levels. See page 45 Therapeutic Drug Monitoring.


Thiopurine Methyl Transferase (TPMT) Deficiency is a cause of intolerance to azathioprine or 6-mercaptopurine

Whole blood (EDTA)


see report


PATH.QM.003.0


Thyroid Peroxidase Antibodies (TPO) Diagnosis of pre-clinical hypothyroidism


Thyroglobulin This is used as a tumour marker, post thyroidectomy only.

serum 5ml Referred test – 21 days

See report

Thyroid Stimulation Hormone (TSH) Raised in hypothyroidism.

serum 5ml <48hr 0.4 – 4.5 IU/l

Transthyretin (pre-albumin) Nutritional assessment, always measured with CRP to aid interpretation.

serum 5ml <48hr 150 – 350 mg/l

Triglycerides Measured as part of lipid investigation

plasma 5ml <24hr <1.8 mmol/l

Troponin I Currently best marker for cardiac damage. Sample needs to be taken >12 hours post suspected cardiac event. Remains elevated for up to 10 days.

serum 5ml <24hr <40 ng/l

Urate Raised in gout, renal failure, malignancy and several other conditions.

serum 5ml <48hr 200 – 430 µmol/l (male) 140 – 360 µmol/l (female)

Urea Indication of renal function and hydration. Low levels seen in starvation and advanced liver disease.


Valproate Useful to check compliance or overdose, little use for therapeutic drug monitoring. See page 45 Therapeutic Drug Monitoring.


Vancomycin Therapeutic drug monitoring is essential to prevent complications of therapy. See page 45 Therapeutic Drug Monitoring.

serum 5ml <24hr See Trust guidelines for antibiotic prescribing and sampling or contact Microbiology Department

VitaminB12 Investigation of anaemia

serum 5ml <24hr 145 – 910 ng/l

Vitamin D Investigation of hypocalcaemia and nutritional assessment. See page46 Interpretation of Vitamin D results

serum 5ml <24hr see report and section in user guide

White cell enzymes Investigation of suspected inborn errors.

whole blood (EDTA)


see report

Xanthochromia (CSF) See CSF scan

Zinc Nutritional assessment


12 – 22 mmol/l


PATH.QM.003.0



PATH.QM.003.0


PAEDIATRIC REFERENCE RANGES

The following reference ranges are adapted from those in use at Royal Manchester Children’s’ Hospital (with

permission). They have been checked for consistency with the methods used within this trust but have not

been rigorously evaluated. This is not a complete list, please contact laboratory if further information required.

Please interpret results with this in mind. All reports for the following have age adjusted ranges.

Analyte Sample type Age Reference Range

Alanine Aminotransferase plasma up to 1 month > 1month

<90 IU/l <45 IU/l

Albumin plasma up to 1 month 1 to 6 months Child

25 – 35 g/l 28 – 44 g/l 30 – 45 g/l

Alkaline Phosphatase (ALP) plasma 1 - 30 days 1 – 12 months 1 - 2 years 2 – 8 years Pubertal Adult

60 – 240 IU/l 52 – 444 IU/l 60 – 370 IU/l 60 – 320 IU/l 60 – 400 IU/l 20 – 125 IU/l

Ammonia (Please ensure laboratory is aware the sample is being taken and transport to laboratory immediately).

plasma

<16 yr.

Bicarbonate plasma 20 – 26 mmol/l

Bilirubin, total plasma Full term infant Child

Levels will rise from birth to approximately 150 µmol/l at 5-6 days and then fall to normal childhood levels by day 10. <17mmol/l

Bilirubin, conjugated plasma neonate up to 30µmol/l

Calcium plasma premature up to 2 weeks child

1.50 – 2.5 mmol/l 1.90 – 2.80 mmol/l 2.12 – 2.63 mmol/l

Chloride plasma 98 – 110 mmol/l

Cholesterol, total plasma up to 1 month 1m to 2 years 2 – 16 years

1.1 - 2.6 mmol/l 1.2 – 4.7 mmol/l <5.0 mmol/l

Creatinine Kinase plasma up to 2 weeks up to 1 month up to 1 year adult male adult female

<600 IU/l <400 IU/l <300 IU/l <170 IU/l <145 IU/l


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Analyte Sample type Age Reference Range Creatinine plasma <1 week

1 – 2 weeks 2 – 4 weeks 1 month – 1 year 1 - 3 years 4 – 6 years 7 - 9 years 10 - 12 years 13 - 15 years 16 years - adult

<100 µmol/l <80 µmol/l <55 µmol/l <40 µmol/l <40 µmol/l <46 µmol/l 10 - 56 µmol/l 30 - 60 µmol/l 40 - 96 µmol/l Males 40 - 96 µmol/l Females 26 - 86 mol/l

C-Reactive Protein plasma <8 mg/l

Gamma Glutamyl Transpeptidase

plasma 0 – 1 month 1 – 3 months 3 – 6 months Adult

10 – 270 IU/l 10 – 155 IU/l 10 – 93 IU/l 10 – 50 IU/l

Glucose (fasting) plasma (fluoride)

up to 1 month child

2.5 – 6.5 mmol/l 3.0 – 6.5 mmol/l

Urea plasma 1 month 1 year child teens

2.0 – 5.0 mmol/l 2.5 – 6.0 mmol/l 2.5 - 6.5 mmol/l 3.0 – 7.5 mmol/l


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PARACETAMOL INTERPRETATION

Please note that levels can’t be interpreted without knowing the time since the paracetamol was taken. Levels

cannot be interpreted until 4hr post dose until the drug is in the elimination phase.


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THERAPEUTIC DRUG MONITORING

* The conversion factors are included since it is a national requirement to move to using mass units in the

immediate future.

** There is little evidence to support the therapeutic monitoring of valproate or lamotrigine.

*** Therapeutic range relates to peak levels. Samples should be take 2hr post dose for fast release and 4hr for

slow release preparation

Samples for non-standard anti-epileptic drugs (e.g. gabapentin) will NOT be processed as monitoring is not

necessary.

Drug Therapeutic

Range

Units Conversion

factor*

Half life Sampling

time

Time to

steady

state

Carbamazepine 20 – 40 mol/l x 0.236

(mol→mg/l)

10 – 20 hr pre-dose 2 - 6 days

Cyclosporine A variable – see report

µg/l - 2 – 6 hr pre-dose 2 – 3 days

Digoxin 1.0 – 2.6 nmol/l x 0.781

(nmol→g/l)

36 – 48 hr minimum of 6hr post dose

5 – 7 days

Lamotrigine** 3.0 – 15.0 mg/l - 20 – 35 hr pre-dose 4 – 15 days

Lithium 0.4 – 1.0 mmol/l - 10 – 35 hr 12hr post dose

3 – 7 days

Phenobarbitone 10 - 30 mg/l - 80 – 120 hr pre-dose 10 – 25 days

Phenytoin 30 - 70 mol/l x 0.253

(mol→mg/l)

7 – 42hr pre-dose 7 – 35 days

Tacrolimus (FK506)

4 - 12 µg/l - 4 – 33 hr pre-dose 2 days

Theophylline 55 - 110 mol/l x 0.180

(mol→mg/l)

3 – 13 hr *** 2 – 3 days

Valproic Acid** 400 - 700 mol/l x 0.144

(mol→mg/l)

8 – 20 hr pre-dose 2 – 4 days


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ACUTE KIDNEY INJURY (AKI) ALERTS

In line with national guidance the Biochemistry department reports all creatinine results with AKI staging. The

interpretation is as follows:

AKI Alert Stage Comment

NA Insufficient data to calculate AKI stage alert

0 AKI alert not activated by previous creatinine results

1 Increase of creatinine by >26.0 mol/l or 1.6 to 1.9 times the baseline creatinine.

2 Increase of creatinine by 2.0 to 2.9 times the baseline creatinine.

3 Increase of creatinine by >3.0 times the baseline creatinine or a creatinine >354

mmol/l.

The above is part of the Trust’s response to NICE guidelines CG169. The algorithm used to calculate these alerts

can be found at http://www.england.nhs.uk/wp-content/uploads/2014/06/psa-aki-alg.pdf

Stage 2 and 3 alerts will be phoned to the wards and reported via Lorenzo/TQuest.

INTERPRETATION OF VITAMIN D RESULTS

Comments are appended to all vitamin D results. The Biochemistry Department reports total 25-OH vitamin D

(25-OH vitamin D2 and D3) and interprets according to the National Osteoporosis Society guidelines:

Total 25-OH vitamin D (nmol/l) Comment

<30 Consistent with vitamin D deficiency. Treatment with cholecalciferol

recommended.

30-50 May be inadequate in some patients. Treatment advised in high risk

groups

50-250 Adequate vitamin D status

>250 Associated with toxicity

http://www.england.nhs.uk/wp-content/uploads/2014/06/psa-aki-alg.pdf


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POCT (POINT OF CARE TESTING)

Point of Care Testing (POCT) is defined as any analytical test performed by a Healthcare Professional outside

the conventional laboratory setting.

The POCT Service is required to comply with:

1. Guidelines from the MHRA; Management and use of IVD POCT devices

2. ISO 22870:2006 POCT Requirements for Quality and Competence

3. ISO 15189:2006 Medical Laboratories Quality and Competence

4. The Royal College of Pathologists

5. The Institute of Biomedical Sciences (IBMS)

As the Pathology Directorate manages and leads on all POCT issues, direct liaison from the users of the POCT

service with the Pathology Directorate and primarily the POCT Co-ordinator is essential to ensure compliance is

achieved.

POCT POLICY The POCT Policy is available on the Trust intranet and outlines the roles and responsibilities of all individuals

associated with POCT.

POCT COMMITTEE The POCT Committee monitors and audits current POCT devices for compliance of policies and procedures and

report any issues and breaches of policy to the MDG and Clinical Risk Management.

No POCT device is to be introduced and implemented within the Trust without approval from the POCT

Committee.

If considering the implementation of a POCT device, the POCT Co-ordinator must be contacted, not company

representatives regarding procurement. The POCT Co-ordinator will then assist with business case and

planning, including cost-benefit analysis, clinical need, and equipment evaluation and selection.


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POCT DEVICES CURRENTLY WITHIN TAMESIDE HOSPITAL NHS FOUNDATION TRUST INCLUDE:-

BLOOD GAS ANALYSERS

A+E, CCU, NICU, W40, ITU,

Children’s Unit

Labour Ward

Chest Clinic

BLOOD GLUCOSE METERS

(all wards)

URINE DIPSTICK TESTING

(all wards)

BLOOD HBA1C ANALYSERS

(all wards)

URINE PREGNANCY TESTING

ED, WHU

HAEMOGLOBIN ANALYSIS

Theatres

FOETAL FIBRONECTIN ANALYSIS

Labour Ward

TRAINING Only personnel who have completed training and demonstrated competence shall be issued passwords to

carryout POCT. Passwords MUST NOT be shared; sharing of passwords is a disciplinary offence.

To arrange training contact POCT Co-ordinator on Ext 4620

SAMPLE INTEGRITY AND RESULTS

Instructions for sample collection and preparation given during training are crucial to obtain accurate results.


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PATHOLOGY SUPPORT The Pathology Directorate provides advice on and facilitates the mechanism and methodology of the tests,

limitations of the method, troubleshooting, training, support, quality control and quality assurance, risk

management, health and safety and infection control issues.

Maintenance and daily monitoring of blood gas analysers is performed by Pathology staff.

Provision of the following consumables is also available via Pathology:

Blood Gas: Reagents, Printer Paper, Capillary Tubes

Glucose: Glucometer, Batteries, Quality Control, QC Record Book

Urinalysis: Urinalysis Results Stickers

All other consumables are ordered locally or via Pharmacy.

INSTRUMENT FAILURE In the event of equipment failures refer to local instructions; the laboratory needs to be informed immediately

and is available as backup and will assist where possible.

To report any issues ring Ext 6498


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DYNAMIC FUNCTION TESTS AND SPECIAL TESTS

ORAL GLUCOSE TOLERANCE TEST

PATIENT PREPARATION:

This test is only necessary if fasting and/or random glucose measurements are equivocal i.e. 6.0 to 7.0

mmol/L.

This test should NOT be performed in patients who fulfil the criteria for diabetes mellitus. These are:

o A fasting plasma glucose >7.0 mmol/L on two or more occasions and

o Clinical symptoms of diabetes e.g. polydipsia, polyuria, ketonuria and rapid weight loss with a

random plasma glucose of >11.1 mmol/L).

This test should not be performed in patients who are under physical stress e.g. post-surgery, trauma,

infection or extreme psychological stress as these may give misleading results.

The patient should have a normal unrestricted diet with a minimum of 150g carbohydrate for at least 3 days

prior to test. Smoking prohibited on day of test. All drugs should be clearly indicated on the request form.

Patient should fast overnight (14 hrs) taking water only, and should sit quietly during the test.

INSTRUCTIONS:

Collect fasting blood sample for glucose. Ensure tube is appropriately labelled fasting. The glucose is

analysed immediately (glucose meter). If the glucose is >8.0 mmol/l the sample should be sent

immediately to the laboratory for confirmatory analysis. If confirmed as >8.0 mmol/l; then the test

should be discontinued.

Give patient 75g (anhydrous) oral glucose dissolved in 300 ml water.

o As an alternative the patient may be given 394ml of “Lucozade Energy” (73kcal/100 ml

formulation), which provides the equivalent of 75g anhydrous glucose. The glucose solution

should be drunk over a period no longer than 5 minutes. Please note that the some

formulations for “Lucozade Energy” are 70kcal/100 which will require 410ml to be given –

please check labelling on bottle.

Two hours after giving the glucose load, take a further blood sample for glucose. Ensure tube is

appropriately labelled “2 hr sample”.

Both samples must be collected into fluoride oxalate tube and both should be sent immediately to the

laboratory on completion of the test

INTERPRETATION:

Normal OGTT Fasting glucose ≤6.0 mmol/l and 2hr blood glucose

<7.8 mmol/l.

Impaired fasting Glycaemia Fasting Glucose 6.1 – 6.9 and 2hr glucose <7.8

mmol/l.

Impaired Glucose Tolerance Fasting glucose ≤7.0 mmol/l and 2hr glucose

between 7.8 and 11.0 mmol/l

Diabetes Fasting glucose ≥7.0 mmol/l and 2hr fasting glucose

≥11.1 mmol/l.


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(from: Methods and Criteria for Diagnosing Diabetes Mellitus – WHO criteria, June 1st 2000).

EXTENDED GTT

The GTT above can be extended for the investigation of reactive hypoglycaemia. Addition blood samples are

taken at 2.5hr, 3hr, 3.5hr and 4hr for glucose.

ADDITIONAL CRITERIA FOR DIABETES DIAGNOSIS

Recent guidelines from WHO for diabetes diagnoses (January 2011) have recommended the use of HbA1c for

diagnosis. The use of the following algorithm is now recommended.

HBA1C FOR MONITORING OF DM

The following has been recommended under advisement of the Diabetes Service and local practice the

following comments are added to reports:

“Patients with diabetes agree with their healthcare professional a documented personalised HbA1c target,

usually between 48 and 58 mmol/mol (6.5% and 7.5%), and receive ongoing review of treatment to minimise

hypoglycaemia. HbA1c levels <48 mmol/ml (6.5%) represent tight control but with increased risk of significant

hypoglycaemic attacks.”


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SHORT SYNACTHEN TEST This test evaluates the ability of the adrenal gland to produce cortisol after stimulation by synthetic ACTH

(Synacthen) and forms part of the differential diagnosis of Addison’s Disease.


The patient need not be fasted for this test but the test must be performed in the morning. The difference

between morning and late afternoon cortisol may be as great as 100 nmol/l for the 30min post Synacthen

sample.

INSTRUCTIONS:

Blood is taken for basal cortisol assay. Clearly marked sample as “baseline”.

250g of Synacthen (from Pharmacy) is injected (IV or IM)

30 minutes post injection blood is taken for cortisol assay. Clearly mark sample as “30 min”.

INTERPRETATION

In normal individuals the serum cortisol should increase by minimum of 200 nmol/l to a level of at least 550

nmol/l at 30 minutes.

DEXAMETHASONE SUPPRESSION TEST (LOW DOSE)

This is a simple screening procedure for Cushing’s syndrome and may be performed on an outpatient basis.


The patient should not be on rifampicin, anticonvulsants or any other enzyme inducing drugs. This will cause

rapid metabolism of dexamethasone leading to an unreliable result. The patient should not be on any steroid

therapy (please note hydrocortisone is another name for cortisol) as this leads to adrenal suppression and an

unreliable result.

INSTRUCTIONS:

Patient takes 1mg dexamethasone tablet at 23:00hr.

At 09:00 (next day) a blood sample is taken for cortisol. The sample should labelled “post

dexamethasone”.

INTERPRETATION:

A normal response is shown by a suppression of 09:00hr cortisol to <50nmol/l.


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RENIN AND ALDOSTERONE

INDICATIONS

Investigation of hyperaldosteronism.


Avoid salt losing diuretics, purgatives and correct gastrointestinal losses.

Diet should contain 100-300 mmol/l Na+ per day and 50-100 mmol/l K

+ per day for 10 days before test.

Correct hypokalaemia with oral potassium supplements before testing.

A number of anti-hypertensive drugs may influence the interpretation of results.

EFFECT OF DRUGS ON RENIN AND ALDOSTERONE:

Diuretics and vasodilators elevate renin and aldosterone.

-blockers in large doses lowers renin and aldosterone.

Calcium channel blockers elevate renin and lower aldosterone.

ACE inhibitors elevate renin and lower aldosterone.

Indomethacin and other prostaglandin synthetase inhibitors lower renin and aldosterone.

Aldosterone antagonists (spironolactone) produce variable effects on aldosterone.

RECOMMENDED LENGTH OF TIME FOR WHICH DRUGS SHOULD BE DISCONTINUED:

Spironolactone 6 weeks Diuretics 2 weeks Prostaglandin synthetase inhibitors 2 weeks Cyproheptadine 2 weeks ACE inhibitors 2 weeks Vasodilators 1 week Calcium channel blockers 1 week Sympathomimetics 1 week

For patients in whom therapy cannot be withdrawn Prazosin, Doxazosin or Guanethidine would be the drug of

choice. NSAIDs should also be discontinued for two weeks prior to testing

PROCEDURE

The patient should be seated for 10 min.

Collect blood for renin and aldosterone (10 ml heparin tube, should be taken to laboratory urgently,

but not on ice and separated as soon as possible).

INTERPRETATION:

Aldosterone secreting tumours or bilateral adrenal hyperplasia result in hyperaldosteronism and

suppression of renin levels.

The upright posture normally stimulates renin and aldosterone release unless renin production is

suppressed by tumour induced hyperaldosteronism.

Adult Reference Range (Results are method dependent)

Aldosterone (pmol/l) Renin (pmol/ml/hr)

Random 100 – 800 0.5 – 3.1

Recumbent (overnight) 100 – 450 1.1 – 2.7

Ambulant (30 min) not applicable 2.8 – 4.5


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ALDOSTERONE / RENIN RATIO

The aldosterone / renin ratio provides additional useful information.

Aldosterone/renin ratio less than 800, Conn’s syndrome unlikely.

Aldosterone/renin ratio greater than 2000, Conn’s syndrome probable.

Diagnosis of the cause of primary hyperaldosteronism requires further investigation after the demonstration of

primary hyperaldosteronism and specialist endocrinological advice is recommended.

WATER DEPRIVATION TEST Performed for the investigation of suspected cranial or nephrogenic diabetes insipidus and primary polydipsia.

SCREEN

24hr urine volume. Three 24hr urine collections are performed; if volumes are less than 3 litres then DI is

unlikely.

WATER DEPRIVATION TEST.

ADH secretion is stimulated by hypovolaemia and hypertonicity. Failure to maintain normal urine and plasma

osmolarity when dehydrated suggests DI. Failure to correct the osmolality with exogenous DDAVP suggests a

nephrogenic problem, whereas correction following exogenous DDAVP suggests ADH deficiency (cranial DI).

The Laboratory must be informed that this test is planned to ensure all analyses are performed promptly.

Samples must NOT be batched but sent to the laboratory immediately.

Patient preparation – do NOT restrict food or fluid until the start of the test. Exclude adrenocortical or thyroid

deficiency. No tobacco or alcohol for at least 24hr.

Note – this test is potentially dangerous and must be undertaken with care and under clinical supervision.

Patients unable to conserve water may become critically dehydrated within a few hours of water restriction.

STOP TEST IF:

Weight loss >3% of baseline value (check plasma osmolality). Note test requires accurate weighing of

the patient.

Urine osmolality ever greater than 800 (i.e. normal response to fluid restriction).

Plasma osmolality >350 (give DDAVP 2mcg iv and fluids).

Urine output exceeds 5 litres in absence of weight loss (suggests surreptitious drinking).


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PROTOCOL

0800hr – insert cannula, weight patient, patient empties bladder. Measure urine volume and send for

osmolality. Measure blood pressure, weight, urine osmolality, plasma osmolality and urine volume hourly for 8

hours according to the schedule:-

INTERPRETATION:

Post-dehydration osmolality

(mmol/kg)

Post-DDAVP osmolality

(mmol/kg)

Diagnosis

Plasma Urine Urine

283-293 >750 >750 Normal

>293 <300 >300 Nephrogenic diabetes insipidus

>293 <300 >750 Cranial diabetes insipidus

<293 300-750 <750 Chronic polydipsia

<293 300-750 >750 Partial nephrogenic DI or primary

polydipsia

Weight BP U&E Plasma

Osmolality

Urine

Osmolality

Urine

Volume

08:00

08:30

09:30

10:30

11:30

12:30

13:30

14:30

15:30

16:30

If urine osmolality remains <750, give DDAVP (desmopressin) 2mcg im.

Give free fluids from now on.

17:30

18:30

19:30

20:30


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TUMOUR MARKERS

Due to the over requesting of tumour markers, in particular “tumour marker screens” it was felt that some

guidance should be offered. No serum marker incurrent use is specific for malignancy.

Many patients with early localized disease will have normal levels of serum tumour markers.

No cancer marker has absolute organ specificity. PSA however, appears to be relatively specific for

prostate tissue.

Requesting of multiple markers in an attempt to identify an unknown primary cancer is rarely of use

(see previous).

Reference ranges for tumour marker are not well defined and are used for only guidance. A level

below the reference range does not exclude malignancy whilst levels above do not necessarily mean

the presence of cancer. Changes in levels over time are of more use that absolute levels at a single

point in time.

With the exception of PSA, tumour markers are only of use in monitoring response to treatment if the tumour

has been demonstrated to be excreting that marker. They are of little use in diagnosis.

Recently NICE has issued the following guidance (CG104) for the use of tumour markers in the investigation of

CUP (carcinoma of unknown primary):-

NICE GUIDANCE ON TUMOUR MARKERS Identification of elevated serum tumour markers can sometimes facilitate diagnosis of certain treatable cancers

and their timely measurement in some circumstances can be associated with significant clinical gain.

In general however, tumour marker measurements are not recommended for diagnosis due to their low

sensitivity and specificity. Nevertheless, their use for this purpose had increased in recent years, due to their

routine availability on automated analysers in almost all clinical biochemistry laboratories. However,

inappropriately requested tumour marker results can lead to unnecessary and costly further investigations and

incorrect management as well as causing needless distress and worry to patients.

Clarifying which tumour markers should be measured and awareness of their significant limitations are critical

to their use in the diagnosis and management of patients with CUP.

Recommendation

Do not measure tumour markers during diagnosis except for:

o AFP and hCG in patients with presentations compatible with germ-cell tumours (particularly

those with mediastinal and/or retroperitoneal masses and in young men).

o AFP in patients with presentations compatible with hepatocellular cancer.

o PSA in men with presentations compatible with prostate cancer.

o CA125 in women with presentations compatible with ovarian cancer (including those with

inguinal node, chest, pleural, peritoneal or retroperitoneal presentations). Carefully interpret

the results because of limited test specificity

Qualifying statement

Evidence to support recommendations on measurement of serum tumour markers for patients with MUO is

sparse and of low quality. These recommendations therefore rely on additional evidence of the diagnostic

utility of these markers in patients who do not have MUO. The GDG reached a strong consensus that tumour

markers should be limited.


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Further information can be found in following article:

C M Sturgeon, L C Lai and M J Duffy: “Serum tumour markers: how to order and interpret them”. BMJ 2009;

339: 852-858.

Guidance on requesting can be seen in summary form at:

http://www.pathologyharmony.co.uk/harmony-bookmark-v7.pdf

http://www.pathologyharmony.co.uk/harmony-bookmark-v7.pdf


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DRUGS OF ABUSE

The approximate detection times for some of the commonly abused drugs are:

Drug Duration of detection in urine

Alcohol 4 - 12hrs

Amphetamines (including MDMA, MDA) 1 - 3 days

Benzodiazepines 1 – 3 days (can be significantly longer with chronic

use)

Cannabis 1 – 14 days (can be significantly longer with chronic

use)

Cocaine 1 – 3 days

Opiates 1 – 2 days

6-Monacetyl Morphine (6-MAM) up to 1 day (can be useful for confirming opiate

positive as heroin use)

Methadone 1 – 3 days (very dependent on dose)

Please note that detection times very approximate and are dependent on dose, its frequency, route of

administration, urine pH and urine dilution.

All samples have a creatinine measured. If level found to <1.8mmol/l then the sample is suspect. European

guidelines indicate that any sample with a creatinine less than 1.8 mmol/l should be considered too dilute and

not analysed.

Please contact laboratory for further information.

VIROLOGY

The biochemistry department does offer initial screening for the following:

Hepatitis A, B and C

Rubella

HIV

Treponemal Antibodies (performed by Microbiology)

Negative screen results are reported immediately (<24hr, Monday to Friday only) but positive results are

referred to a specialist laboratory for confirmation. The reports for positive results will be delayed for this

reason.

Please contact the laboratory for further information.


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PORPHYRIN SCREEN

The porphyrias are a group of eight inherited disorders classically presenting with either photosensitization or

neurological complaints such as abdominal pain. The sample requires are:

Sample type Volume/amount Test request

Urine 20ml Urinary porphyrins

Whole blood (EDTA), red top. 2.5ml RBC protoporphyrins and plasma

protoporphyrin screen.

Faeces A pea sized sample Faecal porphyrins

All samples must be protected from the light and delivered to the laboratory immediately after collection.

Porphyrins are photo-labile.

Please note that the pattern of porphyrin excretion is important in diagnosing the different types of porphyria.

In order to offer a full interpretation of the screen it is essential that full clinical details are written on the

request form.

Please note that some of the acute porphyria can show a normal excretion of porphyrins and their precursors.

It is important that any urine sample is obtained, if possible, during or as close as possible to any attack.

CRYOGLOBULINS

The laboratory must be contacted before the samples are taken. A Biomedical Scientist (BMS) will attend with a

Dewar flask containing sand at 37oC. The sample must not be taken until the BMS is in attendance , the sample

should then be taken and placed in the flask immediately. The BMS will return to the laboratory with the

sample. After separation at 37oC the sample is then referred to a specialist lab for analysis.


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HAEMATOLOGY DEPARTMENT Haematology Department General Enquiries 6491



Blood Science Manager Mrs G Lewis

([email protected])

6318

Secretary to Haematologist 6596

TURNAROUND TIMES

Routine working hours are 09:00 to 17:30 Monday to Friday.

All routine investigations which are required urgently - reports available within one hour.

Routine investigations (inpatients) are reported within four hours (i.e.: FBC, INR, coagulation screen,

D-Dimers, malaria screen).

GP samples processed within 24 hours

Blood film reports within 48 routine working hours

Haemoglobin Variant Screening for Antenatal Clinics within 72 routine working hours. Haemoglobin

Electrophoresis within 14 working days

Referred tests – please see Referred investigations (page68)

NOTE The haematinic and haemoglobinopathy tests are performed during normal working hours therefore out of

hours requests will be stored until the next batch is processed. Sickle screening however is available during all

working hours for urgent requests.

BLOOD COUNT REQUESTS

This includes WBC, RBC, HB, HCT, MCV, MCH, MCHC, platelet count, and five part differential (neutrophil,

lymphocyte, monocyte, eosinophil and basophil populations).

Specimens containing small clots and/or leaking, will be assessed for suitability for testing and repeat

requested if necessary.

The sample requirement for a full blood count is 2.7ml blood in a red (EDTA) tube.

Blood films and WBC manual differential, will be performed when the clinical information indicates a particular

leucocyte problem, or the blood count indicates abnormal findings. If you, or your senior medical staff wish to

have it performed for any specific reason, or would like the opinion of the consultant haematologist, please

state that clearly on the request.


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Reference ranges:

Test Range Units

White Blood Cell count (WBC)

4.0 – 11.0 10*9/L

Red Blood cell Count (RBC)

Male: 4.6 – 6.0 Female: 3.9 – 5.7

10*12/L

Haemoglobin (Hb)

Male: 130 - 180 Female: 115 – 165

g/L

Haemocrit (HCT)

Male: 0.40 – 0.54 Female: 0.36 – 0.48

-

Mean Cell Volume (MCV)

Male: 50.0 – 96.0 Female: 79.0 – 95.0

fL

Mean Cell Haemoglobin (MCH)

27.0 – 32.0 pg

Mean Cell Haemoglobin Concentration (MCHC)

315 - 355 g/L

Platelets (PLT)

130 – 400 10*9/L

Mean Platelet Volume (MPV)

6.0 – 12.0 fL

Red Cell Distribution (RDW)

12.0 – 15.0 -

Neutrophil Count

1.8 – 7.5 10*9/L

Lymphocyte Count

1.5 – 4.0 10*9/L

Monocyte Count

0.2 – 1.0 10*9/L

Eosinophil Count

<0.4 10*9/L

Basophil Count

<0.1 10*9/L

Nucleated Red Cells Differential

- 10*9/L

Please note the turnaround time for an emergency sample is <1hr and for all other samples this is <2hr (from

receipt at laboratory).


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ESR

The sample requirement for an ESR is 3.5 ml of blood in a citrate (purple) tube. Because of the amount of liquid

anticoagulant in an ESR tube, it is most important that the right amount of blood is used in the tube. A separate

specimen must be sent for an ESR request. Only proven or suspected cases of temporal arteritis indicate the

need for an urgent ESR request.

RETICULOCYTES

Reticulocyte count is a useful but under-utilised test. It reflects the ability of marrow to respond to stress

(bleeding, haemolysis, etc.) or its response to haematinic therapy. It will be performed if blood film indicates

the need for it (reflex testing) or on request.

ANTICOAGULANTS

It is beyond the scope of this booklet to give a fully comprehensive account of anticoagulation. You are advised

to refer to B.N.F. or discuss problems and queries with your seniors or the Haematologist. It is worth noting

that recommendations and practices can change rapidly in this field.

Parenteral and oral anticoagulants are used with increasing frequency. Oral anticoagulants may be used alone

or in combination with Heparin.

THERAPEUTIC RANGE The following are the ranges recommended by the British Society of Haematology.

INR Clinical State

2.0 – 3.0 Treatment of deep vein thrombosis.

Pulmonary embolism.

Transient ischemic attacks.

3.0-4.0 Recurrent deep vein thrombosis and pulmonary embolism.

Arterial disease including myocardial infarction.

Arterial grafts.

Cardiac prosthetic valves and arterial grafts.

For details refer to the British Society of Haematology guidelines.


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COAGULATION TESTS

INDICATION

SUSPECTED BLEEDING DIATHESIS

It is important to take a full history of present and past bleeding incidents and to enquire about family history

and drug ingestion. For screening purposes, the following tests are normally sufficient:-

P.T. and INR, APTT, Fibrinogen, Platelet count.

Requests for bleeding time and platelet function studies should be discussed with the Consultant

Haematologist.

SUSPECTED DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

PT, APTT, Fibrinogen and FDP (D-dimer), platelet count and blood film should be requested.

SCREENING FOR LIVER BIOPSY

PT, APTT and platelet count should be requested.

COAGULATION TEST – SAMPLE REQUIREMENTS

Analyte (Coagulation) Sample type Volume Turn

Around

Reference

Range

PT and INR Green Citrate plasma (green)

2.7 ml <2hr INR: 0.8 – 1.2

PT: 8.5 - 12.5s

APTT Green Citrate plasma (green)

2.7 ml <2hr 17 – 32 s

Fibrinogen Green Citrate plasma (green)

2.7 ml <2hr 1.5 – 4.0 g/l

FDP (d-dimer).

Note, the sample must be analysed within 4hr of collection.

Green Citrate plasma (green)

2.7 ml <2hr <500 ug/l

Factor assays Green Citrate plasma (green)

2.7 ml x 2 Referred

investigation,

expected TRT

of 28 days.

See report

Thrombophilia screen Green Citrate plasma

2.7ml x 5 Please note that some parts

of the screen have to be

referred to other

laboratories. The expected

turnaround time for this is

quoted as 4 weeks.

Serum (brown) 5 ml

EDTA 2.7ml x 2


PATH.QM.003.0


Analyte (Coagulation) –

Referred investigations

Sample type Volume(ml) Turn Around Reference

Range

Anti-Factor Xa Green citrate 1 x 2.7ml 11 days See report

Antithrombin III Green citrate 2 x 2.7ml 28 days See report

Protein C & Protein S Green citrate 2 x 2.7ml 28 days C: 77 – 148 IU/dl

S: 56 – 150 IU/dl

Anticardiolipin Antibodies Serum 5ml 13 days <16 units

Prothrombin Gene Variant EDTA 2.7ml 28 days See report

Factor V Leiden EDTA (2.7ml) 2.7 See report

Von Willebrands Factor Green citrate 2 x 2.7ml 28 days See report

Lupus anticoagulant Green Citrate plasma (green)

2.7 x 4 28 days See report

It is critical to fill the green citrate bottles to the line as they contain liquid anticoagulant –

this must be in the correct proportion to the blood to obtain the correct results, otherwise

incorrect diagnosis and/or treatment may occur.


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HAEMOGLOBINOPATHIES

For haemoglobinopathy screen please send an EDTA specimen in addition to one for FBC.

HAEMOGLOBINOPATHY TESTS AVAILABLE:

Haemoglobin electrophoresis

Haemoglobin A2 level

Haemoglobin F level

Sickle cell

Also a serum ferritin may be performed to assess iron status.

ANTENATAL SCREENING

Antenatal patients are tested following the NHS Sickle Cell and Thalassaemia Screening Programme.

HAEMOLYTIC DISORDERS

For screening purposes, a blood count, reticulocyte count, direct antiglobulin (Coombs) test and haptoglobins

should be requested together with bilirubin from the Biochemistry department. Having established the

presence of haemolysis, further tests should be carried out to detect the underlying cause. Please discuss this

with the Consultant Haematologist.

HAEMATINIC ASSAYS

Tests for investigations of B12, folate and/or ferritin deficiency – now performed by Biochemistry, see relevant

section.

Additional EDTA specimen required if RCF & FBC requested.

BONE MARROW ASPIRATE AND TREPHINE BONE BIOPSY

By arrangement after consultation with the Consultant Haematologist.

HAEMATOLOGY ADULT REFERENCE RANGES

Please see report form


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OTHER HAEMATOLOGICAL INVESTIGATIONS

Test Specimen Type Volume

required

Turn Around Ref Range

IM screen Serum (brown) 5ml <5 days See report

RA screen Serum (brown) 5ml <1 day <20 IU/ml

LE screen Serum (brown) 5ml <1 day See report

Haptoglobins Serum (brown) 5ml <1 day See report

IF antibodies Serum (brown) 5 ml <2 days See report

Malarial parasites Whole blood (red, EDTA) 2.7 ml <1 day See report

G-6-PD screen EDTA (2.7ml) 2.7ml <1 day See report

SAMPLE STORAGE TIMES

FBC, ESR, Retics, malaria samples - 24 hours

PT, APTT, Fibrinogen samples - 24 hours.

Haematinics, RA LE and IM screens - 7 days.

Any further tests required must be requested within these storage times.

REFERRED INVESTIGATIONS

Analyte Specimen

Type

Volume

Required

Turn Around Ref range

Bone Marrow for MDT Stained Slides 14 days See report

Erythropoetin Serum 5 ml 15 days See report

HBE - Abnormal Hb. Variant

Confirmation

EDTA 4 x 2.7ml 25 days See report

Plasma Viscosity EDTA 1 x 2.7ml 14 days 1.45 – 1.80 cp

WT1 Marker Blood EDTA 4 x 2.7ml 14 days See report

WT1 Marker Marrow EDTA 1 x 2.7ml 14 days See report

BCR/ABL EDTA 2 x 2.7ml 28 days See report

HFE Hereditary Haemochromatosis

Gene Typing


CALR mutation EDTA 4 x 2.7ml 21 days See report


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Analyte Specimen

Type

Volume

Required

Turn Around Ref range

Janus Kinase 2 EDTA 3 x 2.7ml 28 days See report

Immunophenotyping - Blood Must

be received in laboratory before 12

noon on day of collection (Monday

to Thursday)

EDTA 2.7 ml x 2 14 days See report

Immunophenotyping - Marrow Special bottle 2ml 14 days See report

Spherocytosis must be fresh - by

arrangement with laboratory only

EDTA 1 x 2.7ml Contact

referral

laboratory

See report

Chromosome analysis - blood. Must

be received in laboratory before 12

noon on day of collection (Monday

to Thursday)


Chromosome analysis - marrow Special bottle 2ml 28 days See report

Pyruvate Kinase EDTA 2 x 2.7ml Contact

referral

laboratory

See report

HAMS / Paroxysmal Nocturnal

Haemoglobinuria

EDTA 2 bottles 14 days See report

A list of referral laboratories is provided at the end of this user guide. Please note that for brevity this is not a

complete list of available tests, if in doubt please contact laboratory.


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BLOOD TRANSFUSION

CONTACTS

General Enquiries 6391



Secretaries to Haematologists 6596

Hospital Blood Transfusion Manager Gillian Lewis 6318

Advanced Biomedical Scientist Andrew Blackburn 6391

Specialist Practitioner of Transfusion Caroline Holt 5484

Trust Intranet page: http://tis/Pages/bloodtransfusion.asp

CAUTION

Fatal transfusion accidents still occur. Nationally reported errors show that a high

percentage is due to failure of the bedside check or specimen labelling errors. They are due

to carelessness and are avoidable. At every stage of the procedure from taking blood for the

cross-match specimen to the actual transfusion of the blood, meticulous attention to detail is

essential.

REQUEST FORMS

The Request form must be filled in completely and correctly – see Specimen Acceptance Policy available on

Trust Intranet

Phlebotomists have been instructed not to take blood if the name, district number and date of birth are not on

the request form and patient's wristband.

Please note that in line with national guidelines pre-printed labels (from any source) on samples

are not acceptable.

Please note (as previously stated):

All request forms must be signed by the requesting clinician.

http://tis/Pages/bloodtransfusion.asp


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SPECIMEN REQUIREMENTS

Test Specimen requirement

Group and save plasma/Cross match EDTA (blue,4.5ml)

DAT EDTA (blue, 4.5ml)

ANC investigations

Kleihauer

Cord and Maternal bloods EDTA (blue, 4.5ml) from mother and baby

HLA typing (use NBA form) –

PLEASE CONTACT LABORATORY (ESSENTIAL)

EDTA (2 x 2.7ml)

HLA antibodies (use NBA form) 10ml clotted (white top)

Platelet antibodies (use NBA form) Contact laboratory

Requests for:

Platelets/Cryoprecipitate/fresh frozen plasma

Contact laboratory AND Consultant Haematologist

Requests for:

Human albumin

Send signed request form

Request for:

Novoseven/Prothrombin complex

Strictly by discussion with the Consultant

Haematologist

NB. When FFP or platelets are required a FBC and coagulation screen must be requested to assess the need

and/or dosage of the FFP, Cryoprecipitate or platelets. In case of major life threatening haemorrhage contact

the laboratory immediately. Full patient, clinical and requestor details must be provided.

DEXTRAN

Dextran and other plasma expanders may seriously interfere with cross-matching. Avoid giving them before

taking the cross-match specimen. If this is unavoidable the fact that they have been given should be indicated

on the request card.

ROUTINE REQUESTS

When non-urgent transfusions are planned, requests should be made at least 24 hours before the transfusion.

This allows time for extra investigations to be made if the cross-match is not straightforward.

RESERVATION OF CROSS-MATCHED BLOOD Blood ordered for theatre and not used is taken back into stock for other patients at 9.00 am on the day

following operation. If blood is required after this, then please inform the laboratory before 9.00 am, or leave a

signed and dated note on the appropriate fridge.


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GROUP AND SAVE PLASMA The use of group and save plasma is encouraged. For many operations it is not necessary to have cross-

matched blood available. All patients for elective surgery must have a group and save at pre-op assessment. On

admission to the ward this must be repeated.

For expected blood usage please refer to Maximum Surgical Blood Order Schedule:

http://tis/documents/BloodTransfusionPolicy.pdf

With group and save requests plasma is tested for irregular antibodies. If these are detected the M O. will be

informed. Patients for surgery with irregular antibodies should be discussed with the Blood Transfusion

Department a minimum of 24hr before surgery.

If blood is required, a signed request form should be sent to the laboratory stating the number of units

required. In the majority of cases (but not all cases) a sample is valid for issue of blood for 72hr – please contact

laboratory for information.

ISSUE OF BLOOD

N.B. blood left out of a specified blood fridge for more than 30 minutes must not be used -

please label any such unit indelibly on the front - not suitable for use, and inform the blood

transfusion department, tel. 6391

Blood must not be stored in any ward or drug fridge but only in designated controlled and

alarmed blood fridges.

EMERGENCY GROUP O NEGATIVE BLOOD

Contact Blood Transfusion (ext. 6391) before use. Note that the blood transfusion sample must be

taken before use.

2 units of uncross-matched blood Group O Negative, are kept in the A&E fridge for Accident and Emergency,

and 2 units in the Maternity fridge for use in life threatening emergency. These may not be suitable for patients

exhibiting adverse antibodies.

It is stressed that this blood is uncross-matched and its use should be governed by the patient's clinical

condition.

If any O Negative blood is used in an emergency, then the appropriate red form MUST be filled in and sent to

the laboratory immediately. The Blood Transfusion staff MUST also be informed by telephone in order that

replacement O Negative can be issued immediately on receipt of the completed red form.

Please see and read the hospital transfusion policy for comprehensive guidance

This guidance is also available on the Pathology website and also on the Trust Documents section on the

intranet.

Any problems or queries please contact the Blood Transfusion Laboratory, the Consultant Haematologist or the

Specialist Practitioner of Transfusion as appropriate.

http://tis/documents/BloodTransfusionPolicy.pdf


PATH.QM.003.0


IMMUNOLOGY SERVICES The referral laboratory for immunological investigations is the Immunology Department at Manchester

University Hospital NHS Foundation Trust (previously CMFT)

CONTACTS

For test results call the results hotline on 0161 276 8766.

For other enquiries:

Information concerning laboratory services can be found at:

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/immunology

(If this link does not function then please copy/paste into your web browser)

Name Title Tel Email

Dr Tomaz Garcez Head of Service and Consultant

Immunologist

0161 276 6468 [email protected]

Dr Sara

Drinkwater

Consultant Immunologist 0161 276 6468 [email protected]

Dr Hana Alachkar Consultant Immunologist 0161 206 5572 [email protected]

DrArchana

Herwadkar

Consultant Immunologist 0161 206 5572 [email protected]

Philippa Coles Laboratory Manager 0161 276 6442 [email protected]

John Hewitt Chief Biomedical Scientist

(Infomatics Lead)


Andrew Moran Chief Biomedical Scientist

(Training Lead)


Angela Bedford Administration Manager 0161 276 6468 [email protected]

Jill Edmonds Immunology Specialist Nurse 0161 276 6186 [email protected]

Colette McAlister Client Services Manager 0161 276 6042 [email protected]

- Clinic secretaries 0161 276

6686/5653

-

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/immunology












PATH.QM.003.0


MICROBIOLOGY/VIROLOGY DEPARTMENT

Please note that the service has now moved to Manchester University Hospital

NHS Foundation Trust (previously CMFT)

CONTACTS

For test results call the results hotline on 0161 276 8766.

MICROBIOLOGY DEPARTMENT


http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-

partnership/opening-hours-clinical-advice-and-results-line/microbiology-department-cmft


Name External number

Dr Andrew Dodgson Clinical Lead, Consultant Microbiologist, Infection Control Doctor

(0161) 276 6010

Dr Ed Kaczmarski Lead Consultant Microbiologist for Christie Hospital

(0161) 276 5746

Dr Debasis Sanyal Consultant Microbiologist (paediatrics)

(0161) 276 5089

Dr Ahmed Qamruddin Consultant Microbiologist

(0161) 276 4282

Dr Kirsty Dodgson Consultant Clinical Scientist Deputy Infection Control Doctor

(0161) 276 5746

Dr Barzo Faris Consultant Microbiologist

(0161) 746 2470

Mrs Geraldine Featherstone Microbiology Secretary

(0161) 276 5686

Specialist Registrars Office (0161) 276 6333

Mr Bernard Wood PHE Regional Head of Laboratory Operations/Head BMS MMMP

(0161) 276 4420

Mrs Rachel Jones Laboratory Manager

(0161) 276 5747

Mr Malcolm Armstrong Deputy Laboratory Manager

(0161) 276 8822

Mrs Katherine Mather Deputy Laboratory Manager

(0161) 276 4909

Fax (0161) 276 5744

Hospital Switchboard (0161) 276 1234

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership/opening-hours-clinical-advice-and-results-line/microbiology-department-cmft

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership/opening-hours-clinical-advice-and-results-line/microbiology-department-cmft


PATH.QM.003.0



PATH.QM.003.0


VIROLOGY DEPARTMENT


http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-

partnership/opening-hours-clinical-advice-and-results-line/virology


Name External number

Dr Andrew Turner Clinical Lead Consultant Medical Virologist

(0161) 276 8853

Dr Nick Machin Consultant Virologist

(0161) 276 8838

Dr Louise Hesketh Consultant Clinical Scientist

(0161) 901 0188

Dr Malcolm Guiver Consultant Clinical Scientist, Head of Molecular Diagnostics

(0161) 276 8853

Miss Christel Matthews Secretary

(0161) 276 8787

Mr Peter Tilston Clinical Scientist - Resistance testing

(0161) 276 8849

Dr Alex Sargent Clinical Scientist (HPV lead)

(0161) 276 8680

Mr Benjamin Brown Clinical Scientist

(0161) 276 8680

Mr John Marsh Laboratory Manager

(0161) 276 8838

Mr Alan Lord Deputy Laboratory Manager

(0161) 276 8843

Fax (0161) 276 8787/5744

Hospital Switchboard (0161) 276 1234

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership/opening-hours-clinical-advice-and-results-line/virology

http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership/opening-hours-clinical-advice-and-results-line/virology


PATH.QM.003.0


CELLULAR PATHOLOGY

Please note that the service has now moved to Manchester University Hospital

NHS Foundation Trust (previously UHSM)

CONTACT DETAILS

All telephone extensions should be prefixed with 0161 291 when calling from outside the hospital unless

otherwise stated

Generic contact details Location Extension Information

Report enquiries Office 4813 At times, this number may have an answering machine: please leave a clear request and a number

for us to call you back

Report Fax Number Office 4809

Consultant Name and Speciality Office Secretary Email address

Dr M Scott Head of Histopathology Gynaecology, Gastrointestinal, Urology

2144 4812 [email protected]

Dr N Ali Breast, Skin, Gynaecology, Gastrointestinal cytology


Dr P Bishop Cardiothoracic, Skin, Head & Neck, Haematolymphoid Andrology


Dr A Chaturvedi Cardiothoracic, Skin, Head & Neck, Haematolymphoid


Dr A Davenport (part-time) Gastrointestinal


Dr H M Doran (part-time) Cardiothoracic


Dr V Howarth Skin, Gastrointestinal, Urology


Dr M Howe Breast, Urology


Dr R. Hunt Breast, Gastrointestinal, Gynaecology, Urology, Gastrointestinal cytology



PATH.QM.003.0


Consultant Name and Speciality Office Secretary Email address

Dr P Hyder Skin, Urology, Gynaecology, Head & Neck


Dr L Joseph Skin, Breast, Cardiothoracic


Dr C Lelonek Skin, Gynaecology, Urology


Dr S Pritchard Breast, Gastrointestinal, Head & Neck, Gastrointestinal cytology


Dr A-M Quinn Cardiothoracic, Skin, Head & Neck, Haematolymphoid


Dr A Yates Skin, Gastro-intestinal, Gastrointestinal cytology


Laboratory Fax Tel No. Email address

Mrs Dawn Clarke

Head Biomedical Scientist

4804 [email protected]

Specimen reception 4800

Histology laboratory 4800

Histology laboratory fax 4801

Cytology laboratory 2156


https://www.uhsm.nhs.uk/content/uploads/2016/10/Path-Handbook-rev-37-final-v2.pdf


https://www.uhsm.nhs.uk/content/uploads/2016/10/Path-Handbook-rev-37-final-v2.pdf


PATH.QM.003.0


MORTUARY DEPARTMENT – TAMESIDE AND GLOSSOP INTEGRATED CARE

NHS FOUNDATION TRUST HOSPITAL The services that we provide to the Trust and the Community includes storing of the deceased, post mortem

examinations, tissue donations, identifications and viewings for the bereaved relatives.

We follow strict guidelines under the HTA (Human Tissue Authority) license ensuring safety and security at all

times, also demonstrating respect and sensitivity for bereaved families.

Our dedicated and caring team deals with approximately >2,000 deaths a year from the hospital and the local

community, around >600 post mortem examinations are performed most of which from the direction of Her

Majesty’s Coroner for South Manchester.

The mortuary team consists of one Mortuary Manager and three Anatomical Pathology Technologists all who

show a caring dedicated approach in their roles.

The mortuary works very closely with the following services:

Bereavement services

HM Coroner’s office

Greater Manchester police

Doctors and Nursing staff

Transplant teams

Patient Advice and Liaison service (PALS)

Chaplaincy

Funeral Directors

MORTUARY OPENING HOURS

The mortuary is open Monday to Friday 8am-4.00pm.

Viewings and identifications can be made by appointment during these hours via the mortuary office.

An out of hours service is provided seven days a week until 8:00pm.

This is by appointment and arrangements can be made by contacting the on call technician via the hospital

switchboard.

CONTACTS

Telephone number (prefix 0161 922 from outside

hospital)

Sharon McMinn (Mortuary Manager ) 0161 922 6520

Mortuary Office 0161 922 6059

On call technician (via the hospital switchboard) 0161 922 6000

The Mortuary department also includes Bereavement services and is located behind the Pathology Building


PATH.QM.003.0



PATH.QM.003.0


LABORATORIES FOR REFERRED INVESTIGATION If you wish to contact the referral laboratory then the directorate maintains a list of contact numbers. We

would strongly recommend that you request the laboratory to follow up non-returned results (which is audited

by each department) to enable us to establish why the delay has occur.

If you require this the laboratory can supply a list of referral laboratories.