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Pathology Users Handbook
Pathology Users Handbook
Pathology Users Handbook
CONTENTS
1.0 INTRODUCTION
2.0 QUALITY ASSURANCE
2.1 DATA PROTECTION AND CONFIDENTIALITY
3.0 GENERAL INFORMATION
3.1 LOCATION OF PATHOLOGY CUMBERLAND INFIRMARY, CARLISLE
3.2 LOCATION OF PATHOLOGY WEST CUMBERLAND HOSPITAL,
WHITEHAVEN
4.0 SPECIMENS/REQUEST FORMS
4.1 SPECIMENS
4.2 REQUEST FORMS
4.3 HIGH RISK SPECIMENS AND SAFETY
4.4 RECEIPT OF SPECIMENS
4.5 GP SURGERIES AND OTHER HOSPITALS
4.6 VISITORS
4.7 PATIENTS
4.8 PATHOLOGY SUPPLIES
4.9 REPORTS
5.0 BIOCHEMISTRY DEPARTMENT
5.1 DEPARTMENTAL INFORMATION
5.2 SPECIMEN RECEPTION AND RESULT ENQUIRIES
5.3 SENIOR STAFF CONTACT DETAILS
5.4 LABORATORY OPENING HOURS
5.5 REQUEST FORMS AND SPECIMEN CONTAINERS
5.6 TURNAROUND TIMES
5.7 TIME LIMITS FOR REQUESTING ADDITIONAL TESTS
5.8 URGENT REQUESTS & TELEPHONING OF CRITICAL VALUES
5.9 SPECIAL ARRANGEMENTS FOR SPECIFIC TESTS
5.10 REFERRAL OF TESTS TO OTHER LABORATORIES
5.11 MINIMUM REQUEST INTERVALS (MRI)
5.12 INDIVIDUAL ASSAY INFORMATION
5.13 SAMPLE TYPE, REFERENCE RANGES AND TURNAROUND TIMES
6.0 HAEMATOLOGY AND TRANSFUSION DEPARTMENT
6.1 DEPARTMENTAL INFORMATION
6.2 SPECIMEN RECEPTION AND RESULT ENQUIRIES
6.3 SENIOR STAFF CONTACT DETAILS
6.4 LABORATORY OPENING HOURS
6.5 SCOPE OF LABORATORY SERVICE
6.6 REQUEST FORMS AND SPECIMEN CONTAINERS
6.7 TELEPHONING OF CRITICAL VALUES
6.8 ROUTINE HAEMATOLOGY SECTION
1.0 INTRODUCTION
Our aim is to provide a wide range of high quality Pathology services for our users
and patients, in a timely manner and consistent with the needs of best clinical
practice. We are always pleased to hear any of your comments or suggestions
which may help us to improve the services that we offer. General comments should
be addressed to Francine Duncan, Pathology Services Manager. Should you have
any specific problems please contact the Head of the Department concerned.
If you wish to discuss any concerns you have you should speak to:
Information about other senior staff can be found under the individual departments.
or
Complaints Department
Cumberland Infirmary Tel: 01228 814018
All departments aim to give the highest quality of service with the minimum of delay.
To ensure this, all departments are UKAS accredited:
Blood Sciences - UKAS accredited medical laboratory No. 8555
Infection Sciences - UKAS accredited medical laboratory No. 8874
All work is subject to extensive internal quality control checks and laboratories
participate in external quality assurance (EQA) schemes.
The information on patients and other individuals held in the laboratory is subject to
the Data Protection Act 2002, which controls the use of personal data in whatever
form it is held. Laboratory data is also likely to be subject to a Common Law duty of
confidentiality, and Caldicott guidelines. The Trust’s Caldicott guardian is Graham
Putnam. The Human Rights Act is also likely to cover the misuse of personal
information.
Therefore, both the laboratory and individual employees can be prosecuted if they are
found to have disclosed personal data without authorization. An unauthorised
disclosure is where identifiable personal details are given either, verbally,
electronically or in writing to anyone not authorised to receive them. Such disclosure
would be considered gross professional misconduct and consequently viewed
extremely seriously.
All the Pathology laboratories and the Mortuary are located on the lower ground
floor of the Cumberland Infirmary, shown on the plan B below.
Access for visitors is from Newtown Road.
If you are travelling by car and using satellite navigation, the postcode for the
Cumberland Infirmary is CA2 7HY.
From M6:
Exit M6 at Junction 43 and continue past Tesco on right and Rosehill Industrial
Estate on left. Continue forward and at the traffic lights turn right onto Victoria
Place. Follow road passing Carlisle College on right. At traffic lights turn right onto
Georgian Way (keep left). At roundabout (Hardwicke Circus) take the first left onto
Castle Way (A595).
Continue along Castle Way, onto Bridge Street moving into the right hand lane.
Straight ahead at traffic signals, at the roundabout take the second exit onto
Caldcotes, (signposted B5307 - Kirkbride) and continue past Port Road Industrial
Estate. Entrance to the Cumberland Infirmary is second right at the traffic signals.
Public Transport
Buses run frequently to the Cumberland Infirmary from the centre of Carlisle and
the surrounding area:
Stagecoach Bus Services No. 60, 67 and 68 run every 5-10 minutes but it is
recommended that you contact the local service provider to check on timetables as
they are subject to change. Stagecoach Ltd can be contacted on 0871 200 22 33.
(Calls cost 10p per minute from a BT landline, calls from other service providers
and calls from mobiles may vary). You can also download timetables from their
website.
From M6:
Exit M6 Junction 40, taking the A66 towards Keswick/Workington. This is the most
direct route avoiding the Lakes tourist routes. This route also by-passes the towns
of Penrith, Keswick and Cockermouth.
Public Transport
Buses run frequently to the West Cumberland Hospital but it is recommended that
you contact the local service provider to check on timetables as they are subject to
change. The local service provider is Stagecoach Ltd and can be contacted on
0871 200 22 33 (Calls cost 10p per minute from a BT landline, calls from other
service providers and calls from mobiles may vary). You can also download
timetables from their website.
Staff
Disabled
Designated
Visitor
To ensure that requests are dealt with effectively, it is essential to comply with the
following guidelines.
This requirement is met by using the ICE requesting system. An ICE request is
much more than a printed form.
4.1 SPECIMENS
When collecting blood samples bleed only one patient at a time. Positively identify
patient and label samples immediately at the bedside
The BD Vacutainer Tube Guide and Order of draw is available on request from
Pathology.
Vacutainers are used to collect most blood samples which obviate the need for
syringes. Please note that Vacutainers are not designed to have their tops removed
during blood collection and great care must be taken to ensure that, if this occurs,
tops are replaced securely, particularly if the sample is to be sent through the
pneumatic tube system. Specimens must be identifiable. Unlabelled samples are
not usually processed.
Small (38x20mm) pre-printed labels may be attached to the specimen bottles.
(Please do not use larger labels as these often obstruct our automated equipment
and delay result turnaround.)
Note that there are special instructions regarding requests and specimen labelling
for Blood Transfusion purposes.
Supplying the time of collection on the form is desirable as this allows correct
sequencing of results within the ICE results browser.
The container should be sealed, placed in the relevant bag, blue for Infection
Sciences (Microbiology/Virology/Immunology) and clear for all other samples, then
attached to the Pathology request form. Specimens should be transported to the
laboratory as rapidly as possible after collection to ensure that no significant
deterioration occurs before processing.
Out-patient and A&E samples can still make requests using the manual forms
pending deployment of ICE to these areas.
If ICE is unavailable use a colour coded manual form or the reverse of the ICE
request form:
Biochemistry/Haematology (green-red )
ANC booking bloods use special FOQ form.
Microbiology (blue/white)
Immunology/Virology (blue/pale blue)
Histology/Non-Gynae Cytology (black/white)
Blood Transfusion (red)
For further information on ICE requesting contact Ian Pearson ext. 14643
ian.pearson@ncuh.nhs.uk
It is essential that the correct request form be completed to ensure an efficient flow
of work. Please ensure that request forms and specimen labelling are completed as
specified below and that the writing is legible.
A completed request form must accompany each specimen sent to the laboratory. It
must clearly state the following legible information.
Full patient name
Date of birth
NHS number
Sex
PAS number
Patient address including postcode
The requesting location and address for report
Relevant clinical information/drug therapy
The tests being requested
Type of specimen and date and time collected
Indication if HIGH RISK status (see below)
http://nww.staffweb.cumbria.nhs.uk/policies/categories/risk-
management/completion-of-laboratory-chain-of-evidence.pdf
Laboratory testing for haemoglobin variants in this low prevalence area is based on
an assessment of individual risk- determined by completing a Family Origin
Questionnaire (FOQ) which asks women about their or their baby’s father’s family
origin, or for those women who request screening, and also on the results of a full
blood count performed on the mother.
At the time of booking all expectant mothers will have booking bloods taken and
complete the FOQ request form for Sickle Cell and Thalassaemia screening along
with antenatal booking bloods for infectious disease screening.
For further advice on completion of the FOQ please contact the Pathology
department on the numbers listed in section 3.1.
Coccidioides immitis
IV drug-use
patients who have had recent foreign travel with unexplained high pyrexia
NB. Specimens and Request Forms MUST be labelled with “High Risk”. The form
must be folded to ensure confidentiality. The specimen must be sealed in the plastic
transport bag. The specimen must then be placed in a secondary biohazard plastic
bag and sealed.
To protect all health care workers requests for investigations on high risk samples
should be the minimum required for diagnosis and good management. Great care
must be taken in obtaining specimens, and equipment such as needles and blades
must be immediately disposed of safely, in approved sharps boxes. Should a
spillage of blood, fluids or tissue occur this should be made safe and disposed of,
no matter what the risk to the patient.
Blood Bikes
Blood Bikes Cumbria and South West Scotland is a “Not for Profit” charity staffed by
volunteers dedicated to provision of an out of hours courier service. They will
transport samples, reagents, medication and diagnostic material upon request
between NCUHT sites and referral laboratories. They will also transport blood and
blood products between CIC and WCH and NHSBT if required. Many of the
volunteers will utilise their own motorcycles and there will be access to emergency
liveried motorcycles for “blue light” transportation.
N.B. This service can only be utilised on authorisation by the laboratory staff.
4.4.3.3 Faults/problems
Report immediately to Interserve Help Desk on ext. 13434
c. Place the request form and samples in a Pathology (RED) sample carrier
DO NOT use a Pharmacy (GREEN) carrier.
DO NOT use a damaged carrier.
d. Enter the destination address code:
911 or 912 - Pathology reception
e. Check the display corresponds to the destination required.
f. Confirm by pressing the ‘E’ key
g. If the display shows ‘Destination Accepted’ the pod will leave
automatically when the system has capacity to deal with it
Do not remove pod after confirmation of the send at step e.
SAMPLE ISSUES
Ward staff are requested to ensure that request forms are completed before
the phlebotomist arrives.
Urgent specimens should be taken by ward staff. Use the pneumatic tube system
to send the sample, if suitable, to the laboratory. Otherwise arrange for a porter to
deliver the sample. Alert the laboratory about urgent requests by telephone.
4.6 VISITORS
To ensure safety, all visitors should introduce themselves at Pathology reception,
and wait there until they are met by the person they wish to see. It is best to make
appointments in advance, to ensure the right person is available.
4.7 PATIENTS
All patients should report to Pathology reception on arrival unless instructed
otherwise.
4.9 REPORTS
This excludes all Histopathology reports which will continue to be printed out for the
foreseeable future, and all pathology reports for outpatient departments that
currently do not have sufficient monitors to view reports electronically.
To ensure patient safety is not compromised we will continue to monitor the rate of
viewing of ICE reports to make sure this remains above 95% for ward areas.
Clinicians are reminded that they have a responsibility to act upon the results once
viewed, and reports should be electronically filed to demonstrate that this
responsibility has been accepted.
ICE
Results are available via the ICE web browser. The Laboratory computer system
(Telepath) sends an update of recently authorised results to ICE every 10 minutes
every day. It is important for ward based staff to realize when using ICE that there
might be occasions when there are several individual records for one individual
patient. This undesirable occurrence is due to poor data quality supplied with
various requests, which do not allow lab data entry staff to match new requests to
previously received patient work.
Contact the Information Services help desk on ext. 14085 for further information on
access to Pathology results via ICE, to arrange training or if you have forgotten your
password.
Out of hours i.e. between 20:00 and 08:00, Monday to Friday, 17.00 Saturday to
08:00 Monday and all day during Bank Holidays the Biochemistry laboratory is
staffed by a single BMS, primarily to provide a service for emergency and essential
work.
Outside these hours a multi-disciplinary service operates with one member of staff
covering Biochemistry, Haematology and Blood Transfusion.
If you are sending a blood gas sample to the lab outside of Monday-Friday 8am-
8pm please phone and inform the lab.
Urgent tests required out of hours must have contacted the duty BMS. Request
forms marked ‘Urgent’ or ‘Please Phone’ and not accompanied by a telephone call
will be dealt with on the next scheduled batch.
All routine samples from Primary Care are now processed at the Cumberland
Infirmary in Carlisle. In order to ensure delays are minimised for the small amount of
urgent Blood Sciences (Biochemistry, Haematology and Blood Transfusion) work
the following procedure should be followed:
Seal samples and request form in a plastic bag and place in a cardboard
transport box.
The investigations in the tables for which ward procedure sheets are available are
marked BIS.
The departments provide a wide range of drug analyses either on site or from
reference laboratories. For therapeutic drug monitoring (see alphabetical listing)
pre-dose blood samples are usually required.
In cases where there is suspected drug abuse, qualitative drug screens on urine
samples can be obtained through the laboratory. Results are usually available
within 48 hours of despatch to the reference laboratory. If there is greater urgency
please discuss the case with a senior member of the laboratory staff. The following
groups of drugs are encompassed by a ‘drugs of abuse’ screen:
amphetamines
benzodiazepines
cannabinoids
cocaine metabolite
methadone metabolite
opiates
For further information, particularly on drugs not listed here, please phone the
department.
Department Accreditation
Address Tests referred
Name Number
ACTH
Acylcarnitines
Aldosterone
Amino Acids
Androstenedione
Apolipoproteins
Apo E Phenotyping
Beta lipoprotein studies
Calcitonin
Cortisol (urine)
C-Peptide
7-Dehydrocholesterol
DHEAS
Royal Victoria Infirmary
Department of Growth Hormone
Queen Victoria Road Accredited
Clinical IGF-1
Newcastle upon Tyne 8543
Biochemistry Insulin
NE1 4LP
Lactate/Pyruvate(Inter.Metabolites)
Maternal Serum Screen
NEFA
NHDL-C/ApoB ratio
Organic acids
P3NP
Phenobarbitone
Renin
17-Hydroxyprogesterone
TRAb
Thyroglobulin
TSH (blood spot)
Urine Cysteine Screen
Alkaline Phosphatase Isoenzymes
Beta Crosslaps
Chromium
Ciclosporin
Cobalt
Freeman Hospital Copper
Department of
High Heaton Accredited Faecal Elastase
Clinical
Newcastle upon Tyne 925 5HIAA
Biochemistry
NE7 7DN Metadrenalines (urine and plasma)
Methotrexate
Selenium
Sirolimus
Tacrolimus
Zinc
Sunderland Royal Hospital
Department of Accredited
Kayll Road Calculus analysis
Clinical Chemistry 662
SR4 7TP
Department Accreditation
Address Tests referred
Name Number
Amiodarone
Ethosuximide
The Academic Centre Flecainide
Toxicology Accredited
Penarth Gabapentin
Laboratory 0841
CF64 2XX Lamotrigine
Levetiracetam
Vigabatrin
Department of Immunology
Alpha-1-acid glycoprotein
Protein Reference PO Box 894 Accredited
Alpha-1-antitrypsin phenotype
Unit Sheffield 113
Chromogranin A
S5 7YT
Wythenshawe Hospital
Southmoor Road
Dept of Clinical Accredited
Wythenshawe Everolimus
Biochemistry 0223
Manchester
M23 9LT
Royal Surrey County Hospital
Gastrin
Egerton Road Accredited
Clinical Laboratory IGF-BP3
Guildford, Surrey 1167
GU2 5XX
Dept of Newborn Birmingham Children’s Hospital
Screening & Steelhouse Lane Accredited Biotinidase
Biochemical Birmingham 1288 Very Long Chain Fatty Acids
Genetics B4 6NH
Department Accreditation
Address Tests referred
Name Number
Referred TSH, FT4 and FT3
Wansbeck General Hospital
Clinical Drugs of Abuse Screen
Woodhorn Lane Accredited
Biochemistry Ethylene Glycol
Ashington 1161
Department Methanol
NE63 9JJ
Toxicology
Department of Medical Citrate
Biochemistry Homocysteine
Special Chemistry Accredited
University Hospital of Wales Porphobilinogen
Section 841
Cardiff Porphyrins (blood, urine, faeces)
CF4 4XW Urine Oxalate
UCL
60 Whitfield Street Accredited
HSL Analytics Plasma Oxalate
London 1173
W1T 4EU
Royal Hospital for Sick Children
Biochemical Sciennes Road Accredited
Leucocyte lysosomal enzymes
Genetics Unit Edinburgh 0630
EH9 1LF
Bristol Royal Infirmary
Department of Marlborough Street Accredited
Mucopolysaccharides
Chemical Pathology Bristol UKAS 8227
BS2 8HW
Charing Cross Hospital
PLAP
Fulham Palace Road Accredited
SAS Reception SCC
London 1050
Gut Hormones
W6 8RF
Great Ormond Street Hospital
Chemical Pathology for Children Accredited
Amylase Isoenzymes
Department London 250
WC1N 3JH
Southmead Hospital Galactitol
Biochemical
Southmead Road Accredited Galatose –1-phosphate
Genetics
Bristol 34 Gal-1-PUT
Unit/Biochemistry
BS10 5NB Cholinesterase
Room 917
Clinical Institute of Neurology
Accredited Transferrin Glycoform Studies
Neuroimmunology Queen Square
1839 Asialotransferrin
Department London
WC1N 3BG
National Blood Newcastle-upon-Tyne Accredited
Tissue Typing / HLA analysis
Service NE2 4NQ 2823
Central Parkway
Institute of Human Accredited
Newcastle-Upon-Tyne Cytogenetics
Genetics 2212
NE1 3BZ
Cell markers / flow cytometry
CD61
Royal Victoria Infirmary EMA
Haematology
Queen Victoria Road Accredited Factor V Leiden
Specials
Newcastle-Upon-Tyne 8543 G6PD
Laboratory
NE1 4LP HIT screen
Prothrombin G20210A mutation
Von Willebrand factor
Liverpool School of Tropical
Diagnostic Medicine
Accredited Malaria Parasite
Parasitology Pembroke Place
4001 Identification/Confirmation
Laboratory Liverpool
L3 5QA
Haematology Lab Accredited BCR-ABL
NewGene Ltd st
1 floor Leech Building 0926 Calreticulin
Department Accreditation
Address Tests referred
Name Number
Medical School JAK 2 Gene
Royal Victoria Infirmary
Queen Victoria Road
Newcastle-Upon-Tyne
NE1 4LP
Test RRI
25-OH Vitamin D 365 days
Alpha -1 antitrypsin 999 days
Alpha -1 antitrypsin Phenotype 999 days
ACE 30 days
Anti-TPO Ab 999 days
B12/folate/ferritin 30/30/30 days
Caeruloplasmin 365 days
CDT 14 days
CRP 21 hours
Faecal elastase 6 months
HbA1c 60 days
HDL-Cholesterol 30 days
NT-proBNP 365 days
Procollagen Peptide 88 days
TRAb 365 days
Transferrin saturation 30 days
Thyroid function 24 days
Total cholesterol 30 days
TPMT 999 days
Tumour markers 13 days
If a test request is received within the MRI a report is generated indicating the short
interval, appending the most recent result to assist patient management. We retain
samples for up to six days. If there are special reasons for an early repeat assay,
please contact a senior member of Biochemistry staff.
For most test profiles (e.g. U&E) or individual tests a minimum of 1.0mL blood is
required.
In general, a filled SST tube is sufficient for up to 12 tests e.g. U&E, LFT, Calcium
/Albumin, TFT and haematinics.
A few tests, in particular more specialised tests, require larger volumes and a
separate tube is required. These are indicated as (V+) on the main table of
Biochemistry investigations below.
(Please note sample types marked with * are not currently accredited to ISO 15189)
Normal (mg/mmol)
Male <2.5
Female <3.5
Albumin/ Creatinine Ratio Urine in Vacuette Assayed daily Preferred test for proteinuria
Microalbuminuria
(ACR) preferably first void (PCR for use in pregnancy)
up to 30
Proteinuria
>30
‘Medicolegal’ eg. Drink-
Alcohol ‘limit for driving’
SST Assayed daily driving samples should be
(Ethanol) < 800 mg/L
referred to a public analyst.
Supine
103-859 pmol/L Turnaround time Contact Laboratory
Aldosterone EDTA
Ambulant 14-21 days BIS23 BIS29
103-1197 pmol/L
Calcium (Urine) 24hr collection 2.5 - 7.5mmol/24hr Assayed daily Part of Stone Screen
*Calprotectin Faeces in universal < 50 µg/L Turnaround 5 days Local guideline available
Target range
Carbamazepine SST Assayed daily Collect pre-dose sample
4 - 12 mg/L
Carbohydrate Deficient
SST < 1.6% Turnaround 7-14 days
Transferrin
Carbon Monoxide EDTA or blood gas Non-smokers < 2%
Assayed daily
(CarboxyHb) sample Smokers up to 10%
Carcino-embryonic antigen For monitoring colorectal
SST 0 - 5µg/L Assayed daily Mon-Fri
(CEA) carcinoma
Catecholamines (urine) See Metadrenalines Turnaround 7-14 days
Not part of standard U&E
Chloride (serum) SST 95 - 108mmol/L Assayed daily
profile.
Male: 13.2-7.6
mmol/24hr
Creatinine (Urine) 24hr collection Assayed daily
Female7.0-13.2
mmol/24hr
Contact laboratory
CSF Spectrophotometry Minimum 1 mL CSF Same day serum bilirubin
Qualitative report Assayed daily
(Xanthochromia) required in Universal required for interpretation.
BIS1
Cysteine Screen Urine Qualitative screen Turnaround 14-21 days Part of stone screen
Investigation of
Diabetes Insipidus Polyuria/Polydipsia.
BIS26
Haemochromatosis
EDTA Turnaround 21-28 days
Genotype
Non diabetic Cut off for diagnosis
HbA1c (Glycated Hb) EDTA Assayed daily Mon-Fri.
< 42 mmol/mol 48 mmol/mol
Male
HDLC / High Density 1.1 - 2.4mmol/L Part of full lipid profile and
SST Assayed daily
Lipoprotein Cholesterol Female cholesterol monitoring profile
1.1 - 2.6mmol/L
Contact laboratory
Homocystine EDTA 8.0 – 16.0 umol/L Turnaround 5-12 days
Deliver immediately
Female < 50 yrs
0 - 5 IU/L
Human Chorionic
SST Female >50 yrs Assayed daily
Gonadotrophin (HCG)
0 - 8 IU/L
Male 0 - 3 IU/L
5 Hydroxyindoleacetic Acid. 24hr urine ACID BIS13
0 – 40 µmol/24 hr Turnaround 7-14 days
(5HIAA) preservative Diet sheet available from lab.
Lactate/Pyruvate
Special collection tube Turnaround 7-14 days Contact laboratory first.
(Intermediary Metabolites)
Lactate Dehydrogenase Of value in monitoring some
SST 240 - 480 U/L Assayed daily
(LDH) malignancies e.g. Lymphoma
Investigation of diarrhoea
Laxative Screen Urine in Universal Qualitative report Turnaround 14-21 days
and/or hypokalaemia.
Lead EDTA < 0.5 µmol/L Turnaround 7-14 days
Luteal peak in an
ovulatory cycle Collect mid-luteal sample
Progesterone Clotted Assayed daily Mon-Fri
(e.g. day 21) and quote LMP
>20 nmol/L
Female
102 - 496 IU/L Stress may elevate - up to
Prolactin (PRL) SST Assayed daily Mon-Fri
Male 1000 mU/L
86 - 324 IU/L
µg/L
<60yrs 0 - 3.00 Take sample prior to rectal
Prostate Specific Antigen SST Assayed daily Mon-Fri
60-69yrs 0 - 4.00 examination.
>70yrs 0 - 5.00
Neonates (<28 days)
0.65-1.5g/L
Infants (29-56 days)
0.5-0.9g/L
Children (2 months -
18 years)
Protein (CSF) Universal Assayed daily
0.05-0.35g/L
Adults (18 years - 60
years)
0.15-0.45g/L
Adults (>60 years)
0.15-0.6g/L
Sodium (urine) 24hr collection 5 - 240 mmol/24hr Assayed daily Diet dependent
10 - 15 mg/L
Vancomycin SST Assayed daily See antibiotic guidelines
Pre-dose
Very Long Chain Fatty 0.5mL in Lithium -
Turnaround time 7- 21 days
Acids Heparin
Adult Male:
Vitamin A Clotted 0.77 - 3.95 µmol/L Turnaround 7-14 days Protect from light
Adult Female:
0.99 -3.35 µmol/L
25 -50 nmol/L
Vitamin D SST indicates insufficiency
25 -150 nmol/L Assayed daily Mon-Fri
- 25 Hydroxy < 25 nmol/L indicates
deficiency
Adult: Protect from light
Vitamin E Clotted Turnaround 7-14 days
9.5 - 41.5 µmol/L
For diagnosis and monitoring
VMA (Urine) See Metadrenalines Turnaround 14-21 days of children with
neuroblastoma.
Investigation of
Water Deprivation Test Polyuria/Polydipsia.
BIS26
See CSF spectrophotometry
Xanthochromia
BIS1
10.7 – 19.5 µmol/L
Zinc (Serum) Clotted Turnaround 7-14 days
(Adult Only)
Outside routine hours the Department runs an emergency shift system so that the
service is provided 24 hours each day of the year. Both laboratory and clinical
advice are available at all times. The laboratories participate in all the national
quality assessment schemes which cover each area of Haematology and
Transfusion and the Consultant Haematologists regularly attend Regional clinical
meetings which include audit. Quality control is constantly monitored at both the
laboratory and clinical level to ensure that highest standards are maintained. Our
aim is to provide a friendly and accessible service both routine and emergency, with
minimal test turnaround times together with a full clinical service to which clinicians
and their patients have ready access.
TRANSFUSION RECEPTION
Tel: CIC Ext 14519
WCH Ext 23432
Dr Ian Neilly
Clinics held: Wednesday
Ext. 14511
Dr Simon Lyons
Clinics held: Thursday
Ext. 14511 Pager 157
Out of hours i.e. between 20:00 and 08:00, Monday to Friday, 17.00 Saturday to
08:00 Monday and all day during Bank Holidays the laboratory is staffed by a single
BMS, primarily to provide a service for emergency and essential work.
Outside these hours a multi-disciplinary service operates with one member of staff
covering Blood Sciences (Biochemistry, Haematology and Blood Transfusion).
Urgent Requests
For any urgent request the doctor concerned must telephone ext. 14514 at CIC or
ext. 23434 at WCH (which is also a pager). Outside normal working hours contact
the duty BMS via the pager.
Requests received without a telephone call but marked as “Urgent” or “please
phone” and not accompanied by a telephone call will be dealt with on the next
scheduled batch.
All routine samples from Primary Care are now processed at the Cumberland
Infirmary in Carlisle. In order to ensure delays are minimised for the small amount of
urgent Blood Sciences (Biochemistry, Haematology and Blood Transfusion) work
the following procedure should be followed:
Seal samples and request form in a plastic bag and place in a cardboard
transport box.
Arrange urgent transport to Pathology reception at your nearest laboratory
(West Cumberland Hospital or Cumberland Infirmary).
Label box ‘Urgent Blood Sample’ or something similar.
DO NOT PLACE THE BOX IN THE BAG WITH ROUTINE SAMPLES.
Telephone the laboratory to inform them an urgent sample is on its way and
to arrange for the results to be telephoned.
Requests for in-patient review on either site should be discussed with the
Consultant Haematologist or faxed to 01228 814831. Please note that Consultant
Haematologist presence at West Cumberland Hospital is very limited.
Out of hours (i.e. Mon-Fri 17.00-09.00 and all day at weekends) contact the
Consultant Haematologist on-call via the Northumbria Hospitals switchboard. A
combined rota covering North Cumbria and Northumbria operates.
The Haematology nursing team are available to offer advice and support to
patients/carers and staff in all aspects of Haematology care.
The Haematology Nursing Team are happy see patients who attend the
Anticoagulant Clinic and have been recently discharged from hospital. Patients will
be seen within 24-hours, if necessary, on telephone request (ext: 14604 or bleep
226) as long as they are able to attend the hospital. If they cannot attend the
hospital then they must be referred to their G.P.
Dedicated anticoagulant clinics, for the monitoring of Warfarin treatment, are held
between 08:30 and 11:00 on Tuesday and Thursday in the out-patients department
of the Cumberland Infirmary. Patients requiring testing outwith clinic days must
have an appointment arranged through the Haematology Nursing team. The team
can also provide advice on managing anti-coagulation for in-patients.
Note: Inadequately labelled specimens or those with illegible writing that makes
positive identification uncertain may be discarded and a repeat requested.
6.6.2 Requests
Requests for FBC, Retics, ESR, D-Dimer, INR, and Coagulation Screen may be
requested by using tick boxes provided on the form. All other tests MUST BE
written in the “others” area of the Haematology or Coagulation section of the
request card. A film and other tests may be carried out if the FBC result or clinical
details indicate this would be useful.
Most tests are carried out in-house; other more specialised tests are sent to CIC or
regional centres for analysis.
Specimens must be received before 3pm Thursday with full clinical reasons for
request.
The following is a guide to results which will be telephoned without delay (if the
patient has had a similar result within the previous seven days then the result will be
processed as normal).
TEST RANGE
This section provides the full automated blood count which includes haemoglobin,
MCV, white count (with automated differential) and platelet count; this section also
performs ESR, reticulocytes and blood film examination (including screening for
malarial parasites).
Our aim here is to provide:
A rapid screening service.
Diagnosis of the simple anaemias backed up by the Biochemistry laboratory; in
particular we aim to help the clinician in differentiating the causes of a microcytic
anaemia (iron deficiency or chronic disorder) with the help of ESR and ferritin,
and the macrocytic anaemias. In both areas we usually ask the Biochemistry
laboratory to perform the relevant assay if they have a suitable sample with
them for other purposes.
The diagnosis of primary haematological disorders.
Some help for the clinician in highlighting where significant non-haematological
disease is present and manifest in either an abnormal blood count or ESR.
Monitoring of treatment particularly in areas where the blood count may be
affected, such as chemotherapy.
The blood film is still an essential diagnostic tool in haematology; it is in this area
that a few clinical details are particularly helpful to the microscopist.
Leaked
> 24 hours old
The minimum sample requirements for a manual ESR is 1mL, as pediatric volume
manual ESR is no longer available. EDTA 3.5 mL tube with a minimum of 1.0 mL
will be processed for Alifax ESR or a manual ESR using the adult volume.
Generally further tests may be requested if the sample is < 24 hours old. However
please not the following:
APTR (Heparin Ratio) < 4 hours
D-Dimer < 24 hours
Samples for Thrombophilia / Lupus testing where the samples should be
received in the laboratory within 2 hours
ESR <36 hours
1. Cell surface marker studies on peripheral blood and bone marrow; this can be of
particular help in differentiating between a reactive polyclonal and a monoclonal
neoplastic lymphocytosis. These are performed at the RVI, Newcastle.
4. HLA typing / tissue typing service. These requests are forwarded to the tissue
typing laboratory of the regional transfusion service. Completed specific request
forms with samples will be forwarded by Haematology via the National Blood
Service delivery van or by 1st class post if a van is not available. Samples should
be stored at room temperature until their rapid delivery to Pathology.
Names and addresses of accredited referral laboratories used by the Haematology and
Transfusion departments are as follows:
ACCREDITATION
DEPARTMENT NAME ADDRESS TESTS REFERRED
NUMBER
Newcastle-upon-Tyne Accredited Tissue Typing / HLA
National Blood Service
NE2 4NQ 2823 analysis
Central Parkway
Institute of Human Accredited
Newcastle-Upon-Tyne Cytogenetics
Genetics 2212
NE1 3BZ
Cell markers / flow
cytometry
CD61
Royal Victoria Infirmary
EMA
Haematology Specials Queen Victoria Road Accredited
Factor V Leiden
Laboratory Newcastle-Upon-Tyne 8543
G6PD
NE1 4LP
Prothrombin G20210A
mutation
Von Willebrand factor
Liverpool School of
Tropical Medicine Conditional
Diagnostic Parasitology Malaria Parasite
Pembroke Place Approval
Laboratory Identification/Confirmation
Liverpool 4001
L3 5QA
Haematology Lab
1st floor Leech Building
Medical School BCR-ABL
NewGene Ltd Royal Victoria Infirmary Calreticulin
Queen Victoria Road JAK 2 Gene
Newcastle-Upon-Tyne
NE1 4LP
Molecular Diagnostics
Centre
CADET and MDC
Molecular Diagnostics Building
Centre (Provider of Central Manchester Accredited Haemoglobinopathy
Molecular Haematology University Hospitals 0862 referrals
Service) NHS Foundation Trust
Oxford Road,
Manchester
M13 9WL
6.12.1 HLA B27 and other specific HLA types associated with disease states.
The Histocompatibility & Immunogenetics department, at Newcastle Blood
Transfusion Service, carry out these tests.
All samples must be labelled, signed and dated by the sample taker.
Results from routine blood count and simple coagulation tests are available, usually
on the day of receipt of the sample and invariably within 24-hours. Most special
tests are available within 48-hours, other than those referred elsewhere.) See tables
below. Results are available via electronic reporting on the wards (Revive) or by GP
messaging. Some hard copy paper reports are still printed.
(Please note sample types marked with * are not currently accredited to ISO 15189)
'ADD-ON'
TESTS
TURNAROUND
ASSAY TUBE TYPE TEST REFERENCE RANGES (time limit
INTERVAL
from sample
collection)
Assayed daily ADULT Ranges
Male 130-180g/L
HB
Female 115-165g/L
Male 0.40-0.54
HCT
Female 0.37-0.47
Male 4.5-6.3 x 1012/L
RBC
Female 3.8-5.8 x 1012/L
MCV 80-99 fL
Full Blood count Within 24 hrs
3mL EDTA
MCH 27-32 pg unless clinically Within 24 hrs
urgent
RDW 11.0-14.8
Platelets 150-400 x 109/L
WBC 4.0-11.0 x 109/L
Neutrophils 1.8-7.5 x 109/L
Lymphocytes 1.0-4.0 x 109/L
Monocytes 0.1-0.8 x 109/L
Eosinophils 0.0-0.5 x 109/L
Basophils 0.0-0.1 x 109/L
'ADD-ON'
TESTS
TURNAROUND
ASSAY TUBE TYPE TEST REFERENCE RANGES (time limit
INTERVAL
from sample
collection)
Erythrocyte Male <15mm/hr Within 24 hrs
Sedimentation 3mL EDTA Assayed daily unless clinically Within 24 hrs
Rate (ESR) Female <20mm/hr urgent
Within 24 hrs
1 x Coagulation
Fibrinogen Assayed daily 2.0-3.9 g/L unless clinically Within 24 hrs
tube
urgent
http://nww.staffweb.cumbria.nhs.uk/clinical/clinical-
guidelines/repository/dvt---deep-vein-thrombosis---
(ambulatory-care-pathway).pdf
'ADD-ON'
TESTS
TURNAROUND
ASSAY TUBE TYPE TEST REFERENCE RANGES (time limit
INTERVAL
from sample
collection)
Within 1 week
Factor VIII, IX, XI 2 x Coagulation
Assayed daily 50-150 IU/dL unless clinically Within 24 hrs
levels tubes
urgent
Within 1 week
2 x Coagulation
Factor XII Assayed daily 30-150 IU/dL unless clinically Within 24 hrs
tubes
urgent
'ADD-ON'
TESTS
TURNAROUND
ASSAY TUBE TYPE TEST REFERENCE RANGES (time limit
INTERVAL
from sample
collection)
Assayed daily
*Malarial parasite
3mL EDTA Please telephone Within 4 hrs N/A
screen
lab
Glucose 6- 7-10 days unless
phosphate Contact lab first clinically urgent
3mL EDTA Glucose 6-phosphate dehydrogenase (G6PDH) Within 4 hrs
dehydrogenase (screening test) Referred to RVI
(G6PDH) Newcastle
Within 1 week
Haemoglobin
3mL EDTA Contact lab first Haemoglobin HPLC unless clinically Within 24 hrs
HPLC
urgent
Within 24 hrs
Sickle cell
3mL EDTA Contact lab first unless clinically N/A
screening test
urgent
HLA/Tissue Sent via NBS
Typing (referred to delivery van daily
the National Blood 2 x 3mL EDTA or by 1st class Within 5 weeks N/A
Service in post Monday –
Newcastle ) Friday.
Within 24 hrs
Reticulocyte count 3mL EDTA Assayed daily 20-100 x 109/L unless clinically N/A
urgent
1 day 9.4 -34.0 5.0 – 21.0 2.0 – 11.5 0.5 – 1.5 0.1 – 2.5 0.0 – 0.1
7 days 5.0 -21.0 1.5 – 10.0 2.0 – 17.0 0.3 – 1.1 0.2 – 2.0 0.0 – 0.1
14 days 5.0 – 20.0 1.0 – 9.5 2.0 – 17.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
1 month 5.0 – 19.5 1.0 – 9.0 2.5 – 16.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
2 months 5.0– 19.5 1.0 – 9.0 2.5 – 16.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
6 months 6.0– 17.5 1.0 – 8.5 4.0 – 13.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
1 year 6.0 – 17.5 1.5 – 8.5 4.0 – 10.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
2 years 6.0 – 17.0 1.5 – 8.5 3.0 – 9.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
4 years 5.5 – 15.5 1.5 – 8.5 2.0 – 8.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
6 years 5.0 – 14.5 1.5 – 8.0 1.5 – 7.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
8 years 4.5 – 13.5 1.5 - 8.0 1.5 - 6.8 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
10 years 4.5 -13.5 1.8 – 8.0 1.5 - 6.5 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
12 years 4.5 – 13.5 1.8 – 8.0 1.5 – 6.5 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
16 years 4.5 – 13.0 1.8 – 8.0 1.2 - 5.2 0.2 - 0.8 0.04 – 0.4 0.0 – 0.1
MCV fL 81 - 96 82 - 97 91 – 99
Any sample received without this form will be stored for a period of 28 days to allow
completion of the form. Samples will then be discarded if no form is received
Requesting Clinician:
Signature: Location:
Name: Title:
Other medication:
Details:
(eg age of onset, provoking factors)
Details:
Known heritable thrombophilic
Y/N
abnormalities?
How will the results of testing affect your management of this patient?
Note: This form is for requesting tests for heritable thrombophilic abnormalities, including currently
Antithrombin, Protein C and Protein S levels and the Factor V Leiden (F5G1691A) and Prothrombin Gene
mutations (F2G20210A). It is not required for antiphospholipid antibody (Lupus anticoagulant) testing, which
may be requested separately from the heritable thrombophilic abnormalities.
Practicalities of testing:
Please send four citrated blood samples (blue-top tubes) with this completed request form. If anti-
cardiolipin antibody is also required, please also send a serum sample (red-top tube). Samples
should reach the laboratory within two hours of venepuncture.
Samples received without a completed request form will be frozen and stored. The requesting
clinician will be notified. If a valid request form is not received within 28 days, the samples will be
discarded.
Warfarin (and other vitamin K antagonists) causes low levels of Protein C and S. Testing for these
should therefore be performed at least six weeks after cessation of warfarin.
Pregnancy is associated with a fall in Protein S levels to 40-50% of normal levels. Therefore, testing
for Protein S deficiency should be performed at least 3-6 months post-partum.
TRANSFUSION RECEPTION
Tel: CIC Ext 14519
WCH Ext 23432
A 6mL yellow top K2 EDTA sample (only available from the laboratory on an
individual basis) is required for urgent blood group and antibody screen samples
which have been telephoned to the laboratory where the patient has no historical
record (see section 6.18.1)
A pink top K2 EDTA sample containing at least 1mL of blood is acceptable for
neonatal sampling
For details on how to complete the Request Form please refer to Section 4.2 above.
In emergency situations where the patient cannot be immediately identified and the
core identifiers are unknown at least one unique identifier, usually a temporary (14
digit) A&E number must be present.
Additional Requirements:
Date and time of sampling and identification of the person taking the sample
(initials or signature) must be present on the sample or form to identify who
has taken the sample.
Samples must be handwritten, addressograph labels are not acceptable. A
handwritten plain label attached to a paediatric tube is acceptable.
The request form accompanying the sample must also contain four core
identifiers as a minimum requirement.
Zero Tolerance:
NCUH Trust has a zero tolerance policy in regard to sample errors:
Any errors in or alterations to a sample are not acceptable and the sample will be
rejected and a repeat sample requested
Blood can only be issued on a transfusion sample less than 72 hours old and must
be transfused within 72 hours of sampling.
The phrase “2nd sample required if need for blood anticipated” will be written
on the electronic or paper report
Send further one 6mL pink top K2 EDTA sample to the laboratory after a
minimum of 12 hours
The laboratory will inform you that the patient requires a blood group check
sample
The laboratory will arrange for a 6mL yellow top K2 EDTA sample tube to be
sent to you via pneumatic tube or porter (or this can be collected from the
laboratory by a member of staff)
Send the 6mL yellow top K2 EDTA sample back to the laboratory as soon as
possible
The yellow topped K2 EDTA sample tubes are held in the laboratory and will be
issued on a named patient basis following the receipt of a pink top K2 EDTA sample
accompanied by a telephone call of an urgent request from the requesting clinician
to the laboratory.
In a life threatening emergency, Group O red blood cells will be issued and can be
transfused under the clinical decision of the medical officer responsible for the
patient.
If possible, 48 hours’ notice should be given for patients with known atypical
antibodies who require a transfusion of red cells. Compatible blood may only be
available by special order from the NHS Blood and Transplant (Newcastle) and a
considerable time delay may be inevitable.
A Blood Group and Antibody Screen sample will be valid for 72 hours only, for
purposes of blood component issue.
Blood MUST NOT be taken to the clinical area until the patient is ready i.e.
cannula in-situ and the patient has been assessed for blood transfusion
In the event that blood components have been received in the clinical area but
the transfusion cannot be commenced, the blood must be returned to the
laboratory within thirty minutes
Blood components delivered to the clinical area must be used within four hours
of removal from controlled storage (i.e. refrigerator) with the exception of
platelets which must be transfused within one hour of removal from controlled
storage
Blood components and blood products MUST NEVER be stored in ANY clinical
area except the laboratory
Blood will be held for 24 hours after the time it was requested. It will then be
withdrawn and returned to stock unless the laboratory is informed of any extended
requirement. Occasionally blood may be required for longer periods of time, e.g. to
cover a placenta praevia. This should be arranged with the laboratory.
Blood Components
Definition:
Types:
Blood Products
Definition:
Any therapeutic product derived from human blood or plasma (BSQR 2005)
Types:
Anti-D Immunoglobulin
Prothrombin complex concentrates (i.e. Beriplex®)
Haemophilia factor concentrates (i.e. Haemate-P®)
Activated FactorVIIa (i.e. NovoSeven®)
Requests for blood components or blood products (with the exception of red blood
cells) should be made by telephone request to the laboratory. Some of these may
warrant discussion with the consultant haematologist.
It is recommended that patients born on or after 1st January 1996 should only
receive Methylene Blue treated fresh frozen plasma (MBFFP).
It is essential that the requirement for irradiated blood components be assessed for
each patient and documented on the Blood Transfusion Chart and blood
component request form.
Up to date guidelines for the use of irradiated blood products can be found at:
http://www.bcshguidelines.com/documents/Irradiation_BJH_2011.pdf
The laboratory will use irradiated blood according to these guidelines unless
informed otherwise. The irradiation of blood reduces the shelf life to 14 days. The
irradiation of platelet concentrates does not affect the shelf life. Fatal Transfusion
Associated Graft-versus-Host Disease can occur if non-irradiated components are
transfused into immunocompromised patients.
Porters will not pick up any blood component from Pathology without a completed
blood product request sheet which must have the full patient details present. Only
Porters who have been trained and competency assessed may remove blood
components or blood products from the pathology department.
All blood components and some blood products will have a traceability label
attached. This is a legal document and 100% traceability must be maintained.
Date & Time taken from Fridge and Initials (portering staff)
Date & Time receive on Ward and Initials (registered professional in clinical
area)
Date & Time transfused and Signature(s) (registered professionals
administering and checking blood component in clinical area)
Administered by (registered professionals administering and checking blood
component in clinical area)
Ward (patient location)
Date (date patient transfused)
Time (time patient transfused)
The detachable sticky label on the traceability label must be applied to the relevant
section on the Blood Transfusion Chart.
The detachable section of the traceability label must be returned to the laboratory
as soon as is reasonably possible, preferably via the pneumatic tube system.
Non-returns will be followed up until each unit has been recorded as used or
returned/discarded.
TURNAROUND
TEST TUBE TYPE COMMENTS
TIME
The Cell Sciences Department is a UKAS accredited medical laboratory No. 8874
and are also accredited for training Biomedical Scientists by the Institute of
Biomedical Science
Internal 14535
External (01228) 814535
Dr Joanne Wilkinson
01228 814361 CIC Ext 14361
Joanne.Wilkinson@ncuh.nhs.uk
Dr Zouheir Maarouf
01228 814106 CIC Ext 14106
Zouheir.Maarouf@ncuh.nhs.uk
Dr Susan Davies
01228 814532 Ext 14532
Susan.davies@ncuh.nhs.uk
Dr David Rosero
01228 814044 Ext 14044
David.rosero@ncuh.nhs.uk
Dr Seema Rana
01228 814877 Ext 14677
Seema.dana@ncuh.nhs.uk
Dr Soumit Dey
01228 816894 Ext 16894
Soumit.dey@ncuh.nhs.uk
Specimens are accepted between 08:30 and 17:00 at CIC Monday to Friday and
8:45 and 17:00 at WCH (except Bank Holidays)
Specimens, which will not fit into the largest histology containers, should be placed
into leak proof, opaque plastic bags, labelled, sealed and delivered to Pathology
reception without delay. Outside of normal working hours, a member of the
portering staff should take these specimens to the Mortuary refrigerated body store
with their accompanying request form and a note left at Pathology Reception,
stating specimen in body store refrigerator.
Histology reports are issued as soon as possible after receipt of the specimen. The
department aims to issue all reports within 99% of all reports within 6 weeks of
receipt.
The Histology department should be contacted with the details. Please telephone
01228 814535, or a Consultant Histopathologist to discuss the degree of urgency. It
may be necessary to arrange transport from WCH to CIC. Please discuss with the
laboratory staff.
Frozen sections ideally should be arranged with the department at least 24hours in
advance to confirm Consultant availability.
Cumberland Infirmary
Specimens for frozen section should be delivered directly to the Histology
Department.
Renal biopsies must be arranged with the department at least 24 hours in advance.
The sample should be placed onto a piece of cotton wool moistened with normal
saline, and sealed into the lid of a small specimen container.
Renal biopsies must not be delivered by the pneumatic air tube system.
The sample should be placed into Michel’s media which can be requested from the
laboratory; alternatively the sample should be transported to the laboratory
immediately after the biopsy has been taken.
Infection risk cases for histology will be allowed to fix in formalin for an extra 24
hours before processing. High-risk cases should therefore be clearly labelled as
such, and should be immersed in an ample volume of fixative.
There may be a requirement to send histology cases away for reporting. Urgent
histology cases remain reported in-house, unless there are extenuating
circumstances, with routine histology cases being sent away.
The department is responsible for all the work that is outsourced for reporting.
Accreditation status of the referral laboratories is checked and where a non-
accredited laboratory is used for a referred test, this will be recorded in the report
issued by the department.
Use the Histology and Non- Gynae Cytology request forms (WQG531).
To fix slides; a spray fixative is preferred, and is available from the Histology
department at CIC.
1. Place the nozzle of the spray about 6 inches from the slide and apply a
liberal amount of fixative to the surface.
2. Ensure all the material on the slide is well covered
3. Allow to dry before transferring to a slide transport box.
Air-dried slides should be allowed to dry thoroughly before placing in the slide
transport box.
If there is likely to be a delay in getting fresh samples to the laboratory, they should
be placed into a refrigerator.
Outside of these hours the on call mortuary technician is contactable for urgent
enquiries via hospital switchboard.
These are:
1. Death from unknown causes.
2. All cases seen only after death
3. Deaths that occur within 24 hours of an anaesthetic or operative/investigative
procedure.
4. The Coroner wishes to be informed about such deaths although he may
authorise the reporting doctor to issue a Death Certificate.
5. All deaths that occur within 24hours of admission to hospital.
6. Similarly, it may be that, after discussion, the Coroner will authorise the
reporting doctor to issue a Death Certificate.
7. All violent and unnatural deaths related to:
a. Poisoning or drug mishap
b. Criminal abortions
c. Assault or accident – irrespective of the timeline interval between the
event and death
d. Want, exposure or neglect
e. Industrial diseases e.g. Pneumoconiosis
f. Inmates of prisons
g. If there is any suggestion or allegations of neglect or malpractice
against hospital or medical staff.
At the time of completing the Death Certificate the Clinician seeks permission
for an autopsy from the bereaved relatives.
A consent form must be signed and any restrictions in the autopsy procedure
(e.g. no examination of the head) must be clearly indicated.
The requesting Clinician must complete the request for Hospital post mortem
and supply full clinical information.
This should be submitted immediately with the case notes and x-rays to the
Pathology Secretaries.
The Clinician who signs a post mortem request form should be present
during the post mortem examination.
A written report of the post mortem findings is sent directly to the Consultant
in charge of the case and to the deceased’s General Practitioner.
A written report will be sent to HM Coroner, and the General Practitioner and where
applicable the hospital Consultant.
An identity card MUST be put inside the plastic patient sleeve on the outside of the
cadaver bag. A BIOHAZARD label need only be attached to the outside of the
plastic sleeve if the patient has died from one of the listed communicable diseases.
All information must be dealt with the strictest confidence.
There is no risk to staff transferring the patient to the mortuary, but non-sterile
gloves MUST be available for the porters to wear when they transfer the body to the
mortuary.
If any doubt arises about the correct action to be taken, then contact the mortuary
staff before removal of the body.
People under the age of 18 will not normally be permitted to attend a post mortem
Persons with no medical training, such as police officers and trainee hospital
personnel will only be permitted to attend a post mortem by prior arrangement with
the duty Consultant Pathologist.
7.8.9 Viewings
The hospital Mortuary is not officially a Viewing Chapel and relatives should make
arrangements with their Funeral Director in order to view a body at their premises.
However there are occasions when viewing of the deceased in the mortuary is
unavoidable. In such cases prior arrangements must be made with the mortuary
staff.
Official police identifications will be carried out by similar prior arrangement.
Specimens maybe delivered to the department within the opening hours above.
Delivery times outside of these hours should be confirmed with the department and
within 1 hour of production.
Patients who have difficulty delivering their sample within an hour of production can,
by appointment only, arrange to produce their sample onsite.
Date and time of collection must be added to the request form following production
of the sample.
The sample must be delivered within 1 hour of collection, if not produced onsite
pH ≥7.2
Volume 1.5mL
7.10 GOVERNANCE
The Cell Sciences Department is a UKAS accredited medical laboratory No. 8874
It holds a licence to practice as accredited by the Human Tissue Authority - Licence
number 12091
The department and its staff adhere to the Trust’s Information Governance,
Confidentiality and Freedom of Information polices. All staff are required to
undertake training annually.
Regular quality checks and audit procedures are carried out to ensure that the
quality and safety of the results provided as follows:-
The department also provides epidemiological surveillance data for Public Health
England, and investigate outbreaks of infectious disease in the community in
support of local Public Health England.
Microbiology
Ext: 14642
Direct dial: (01228) 814642
Virology/Immunology
Ext: 14649
Direct dial: (01228) 814649
Consultant Microbiologist
Dr Edward Barton
E-mail: Edward.Barton@ncuh.nhs.uk
Ext: 14640
Direct dial: (01228) 814640
Consultant Immunologist
Dr Adrian Heaps PhD FRCPath
Email: Adrian.Heaps@ncuh.nhs.uk
Ext: 14367 / 14649
Direct dial: (01228) 814367
CIC Hospital bleep 704
Laboratory Secretary
Miss Pat Finnemore
E-mail: Pat.Finnemore@ncuh.nhs.uk
Ext. 14641
Direct dial: (01228) 814641
8.4.1 Microbiology
8.4.1.1Routine specimens
All Microbiology samples are processed on the CIC site. Routine samples are
accepted between:
Monday to Friday 08.30 - 19.00
Saturday 08.30 - 17.00
Sundays 09.00 - 17.00 (for emergency samples only)
To ensure routine processing on day of receipt, samples should arrive before 18.00
weekdays and 16.00 Saturdays.
for emergency specimens only where the results will affect the patient’s immediate
management.
The on call BMS should be contacted through the Consultant Microbiologist. The
Blood Sciences Laboratory at the Cumberland Infirmary has a copy of the weekly on
call rota and will contact the on call BMS directly should an urgent sample be received
from West Cumberland Hospital. For on call samples originating from WCH, staff in
the Blood sciences department will package the sample in the containers provided
and make arrangements for transporting the sample to Blood sciences at CIC.
Laboratory users are given advance warning of reduced laboratory opening hours
over public holidays.
Please support the laboratory staff by considering the following before contacting
the Consultant Microbiologist:
During normal working hours please telephone urgent requests to the laboratory to
ensure priority processing and arrange for the specimen to be taken rapidly to
laboratory reception.
8.4.2 Immunology/Virology
The opening hours for the Immunology/Virology section are:
Mon-Fri 08.30 - 17.00
Saturday 08.30 - 12.30
8.6 CLINICS
Adult Immunology and allergy out patients’ clinics are provided by Consultant
Clinical Immunologists at the Royal Victoria Infirmary in Newcastle as part of the
North East Regional Immunology and Allergy Unit. Available clinics include
Immunoglobulin Infusion, Primary Immunodeficiency, Autoimmune Disease, Allergy
Assessment, Immunotherapy, Drug Allergy, Chronic Fatigue Syndrome and
Hereditary Angioedema clinics.
For safety and to ensure reliable reporting, it is essential that patient identification
details are included on both the request and specimen. Unlabelled specimens or
specimens with inadequately completed forms will be discarded.
The clinical details included in requests make a significant difference to the way in
which specimens are investigated. We use the information to ensure that
appropriate tests are performed and that the required results are obtained in a
timely manner. Important details may include:
If in doubt, the department are happy to advise about the most appropriate
investigation, and prefer to be involved early. Please indicate if the specimens are
HIGH RISK, see “General Information”
Please contact the laboratory if there is any doubt about the best specimen to take
or concerning the availability of a test.
Specific IgM can also give information early, which may influence management. An
IgM response is present early in the clinical course of some infections, when
symptoms and signs first appear, for example in hepatitis A. Serology also gives a
retrospective diagnosis, by detecting a rise in antibodies to the infecting agent. This
may be particularly helpful when post infectious complications occur, e.g. arthritis.
The date of onset is critical to interpreting serological tests. Serum should be taken
as early as possible in the illness and during convalescence, 10 to 14 days later, in
order to detect rising antibody levels.
Failure to use the correct container may result in the specimen being rejected.
Microbiology Containers
Tissue
Pus 30 mL Universal 48hrs*
N/A
Bile (White Cap) *3hrs for culture of anaerobic
Fluids from sterile sites organisms
Drain Fluids
Please can we remind you that a separate blood sample and request form is
required for Virology and Immunology requests.
In addition, please can you send a second SST sample if serum free light
chain analysis is required.
8.9.1 Microbiology
Please note, due to the instability of bacteria over time and the processing
undertaken for some samples, requesting additional tests on submitted samples is
not advised. Wherever possible a repeat sample should be collected.
8.9.2 Immunology/Virology
Requests to add on additional tests to the original sample should be made by
phoning the laboratory. The decision to perform additional tests will depend on the
delay in receiving the request and whether there is sufficient sample stored. In
general samples less than two weeks old or requests passed by Consultant staff
will be accepted.
8.10 REPORTS
With the exception of negative urines, which can be reported after one working day,
most bacteriology culture results are reported after 2-5 working days, depending on
the investigation. Intermediate reports may be issued for complex investigations.
We appreciate it if telephone enquiries are limited to those results that are urgent or
delayed. Please check that there is no written report before enquiring over the
telephone.
8.12.1 Immunology
Frequently requested tests are run daily/weekly, but others may be performed less
often, depending on demand. For urgent investigations please telephone Dr Heaps.
(Please note sample types marked with ^ are not currently UKAS accredited)
These tests require 6mLs of SERUM SST tubes unless stated otherwise (Yellow Haemogard Tubes).
AUTO-ANTIBODIES
For paediatric cases less sample may be acceptable (clear capped tubes).
Rheumatoid factor Negative <20 IU/mL Please note that ~20% of RA patient will
Neg. <7 U/mL; equiv. 7–10 U/mL; tested daily not have RhF/CCP antibodies
Anti-Cyclic Citrullinated Peptide (CCP) (seronegative RA).
pos. >10 U/mL
Anti-pyruvate dehydrogenase E2
Negative <10 IU/mL tested weekly
(AMA-M2 markers)
Soluble Liver Antibodies (SLA)
Not applicable tested weekly
Liver Cytosol 1 (LC1)
Extended anti-liver antibody immunoblot Please contact the Consultant
(AMA-M2, M2-3E (BPO), Sp100, PML, Gp210, Not applicable tested weekly Immunologist to discuss requests.
LKM1, LC1, SLA/LP, Ro52) Additional liver autoantibodies available.
Anti-complement C1q antibodies Negative <10 IU/mL Referred Include complement C3C4 testing.
Miscellaneous autoantibodies
Anti-ovarian antibodies Please contact the Consultant
Anti-sperm / testicular antibodies Immunologist if specialist autoantibody
Anti-skeletal/striated muscle antibodies testing required.
Anti-cardiac muscle antibodies
Anti-epidermal/skin antibodies Epidermal antibodies performed by
Anti-parathyroid antibodies indirect immunofluorescence. Specific
referred
Anti-Insulin antibodies antibody testing for Basement Proteins
(approx. 2-3 weeks)
Anti-IA2 & ZnT8 antibodies and Desmogleins available on request.
Anti-C1-esterase inhibitor (C1-INH) antibodies Please contact the Consultant
Anti-salivary gland antibodies Immunologist.
Anti-endothelial antibodies
Anti-Phospholipase A2 Receptor antibodies If direct immunofluorescence staining of
Anti-Type II Collagen antibodies skin, muscle or renal biopsy is required
Anti-Hsp70 (inner ear) antibodies please contact the Department of Cell
Anti-HMG-CoA reductase antibodies Sciences / Histopathology.
Anti-Mutated Citrullinated Vimentin (MCV)
For autoantibodies associated with autoimmune haemolytic anaemia / cytopenias and transfusion
Autoimmune cytopenias / AIHA reactions including cold-agglutinins, anti-platelet, anti-neutrophil, anti-coagulation factors, lymphocytotoxic
and anti-erythrocyte antibodies please contact the Blood Sciences department.
Lupus anti-coagulant antibodies Please contact the Blood Sciences department to arrange Lupus Anti-coagulant testing.
Other complement investigations available on request: please contact the Consultant Immunologist.
IF PRIMARY IMMUNODEFICIENCY IS SUSPECTED PLEASE CONTACT THE CONSULTANT IMMUNOLOGIST TO DISCUSS APPROPRIATE INVESTIGATIONS
^ Urine protein electrophoresis(Bence Jones Early morning urine sample in white top
Not applicable Tested twice weekly
protein) plain universal container.
^ Immunofixation (IgG, IgA, IgM and kappa
lambda) for paraprotein typing in serum or Not applicable as required IgD and IgE analysis also available.
urine.
Oligoclonal bands
CSF Oligoclonal bands (must have paired Referred
3mLs of CSF and 6mLs SERUM SST
CSF & serum sample for comparison) (approx. 3-4 weeks)
tubes
2 x 6mLs of clotted blood must
** Cryoglobulins must be arranged
Cryoglobulins be kept at 37oC – contact lab for
vacuum flask for sample transport
with the laboratory in advance **
8.12.2 Microbiology
Many of these investigations involve culturing organisms. This may take anything from a few hours to weeks in case of
mycobacteria. Antibiotic substances in the specimen or fixative in containers will interfere with culture. The following list is not
exhaustive. For tests not listed above, please contact the laboratory.
(Please note sample types marked with ^ are not currently UKAS accredited)
SPECIMEN/
SAMPLE TYPE COMMENTS TURNAROUND TIMES
INVESTIGATION
Written report / Electronic report: 2 -
Adenovirus Sterile universal container 72h stating, if appropriate, that a further
report will be issued
Clinically significant bacterial isolates
are tested for susceptibility to
antimicrobials. The range tested and
reported depends on many factors Written report / Electronic report: 16 -
^ Antibiotic
All including the specimen, organisms 72h stating, if appropriate, that a further
Sensitivity tests
isolated, current antibiotic policies, and report will be issued
the patients age, allergies etc. Please
give details of current antibiotic therapy
and any allergies the patient may have.
Written report / Electronic report: 16 -
Antral washings Sterile universal container 72h stating, if appropriate, that a further
report will be issued
20 mLs of fluid (minimum 10mL) in a
sterile universal container (not blood
culture bottles) for gram stain and Spontaneous Bacterial Peritonitis (SBP)
Written report / Electronic report: 16 -
culture. is diagnosed by the presence of >250
Ascitic fluid 72h stating, if appropriate, that a further
State whether investigation for TB polymorphs/mm3 in a sample of ascitic
report will be issued
required. fluid.
Send separate samples for protein and
cytology to the relevant laboratories.
Gentamicin These tests are performed in Biochemistry. Please use a Biochemistry/Haematology form
Vancomycin NB. These tests are performed in Biochemistry. Please use a Biochemistry/Haematology form
8.12.3 Virology
Most tests are run weekly. Some tests are batched and run less frequently. Urgent cases are managed as necessary, and urgent
testing can usually be arranged during normal working hours.
(Please note sample types marked with * are not validated and must be interpreted in conjunction with clinical findings)
(Please note sample types marked with ^ are not currently UKAS accredited)
TURNAROUND TIME
INVESTIGATION SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
any urgency, as early testing may be possible.
ANTIGEN DETECTION
Swabs/Urines
Endocervix, vaginal, vulvo-vaginal*, urethral*,
rectal*, throat swabs*. Cells are required so
swabs must be taken firmly.
a) Swabs: Appropriate plastic, stemmed swabs
Chlamydia trachomatis PCR
from collection packs. After swabbing, place
Neisseria gonorrhoea PCR 2 working days for a negative result – positive
swab in the Chlamydia transport media.
samples will require longer for confirmation.
(Yellow topped tube).
b) First-Void Urines: Pipette urine using pipette
from urine collection pack into Chlamydia
transport media (Yellow topped tube) as per
instructions. Urine in a plain sterile universal
can be used.
CSF samples & vesicle fluid/scab, genital, skin
3 working days, except CSF samples which are
Herpes simplex PCR (as requested) & eye swabs in Transport Media – red topped
processed on arrival
tube (viral transport)
CSF samples & swabs from lesions, vesicle
3 working days, except CSF samples which are
Varicella PCR (as requested) fluid/scab in Transport Media – red topped tube
processed on arrival
(viral transport)
TURNAROUND TIME
INVESTIGATION SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
any urgency, as early testing may be possible.
^Influenza A/Swine Flu PCR (as requested) Nose and Throat swabs As requested
Early morning urine. (Blood samples are NOT
Pneumococcal antigen appropriate for this test)
As requested
Legionella antigen Urine antigen testing is the appropriate
investigation for ACUTE Legionella diagnosis
^Respiratory Syncytial Virus (RSV) antigen
NPA sample As requested
detection
TURNAROUND TIME
SEROLOGY SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
any urgency, as early testing may be possible.
^Cytomegalovirus (CMV) IgM & IgG 6mL Serum SST 3 working days
TURNAROUND TIME
INVESTIGATION SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
any urgency, as early testing may be possible.
8.13.1 Microbiology
Parasites, intestinal protozoa and helminths, blood and tissue protozoa and helminths Dept of Clinical Parasitology, Hospital of Tropical Diseases
Respiratory and Systemic Bacteria Section - Streptococcus, Legionella, Mycoplasma, Ureaplasma &
PHE Colindale - RVPBRU
Bartonella
Staphylococcus - PVL PHE Colindale - AMRHAI
TB Newcastle Microbiology Services - TB Reference Lab
Vaccine Preventable Bacteria Section - Haemophilus influenzae, Streptococcus pneumoniae,
PHE Colindale - RVPBRU
Bordetella, Diphtheria & Tetanus
8.13.2 Immunology/Virology
Turnaround
Test Referral Facility
Time
16S PCR Great Ormond Street 7
Acetyl choline receptor autoantibodies (ACHR) Immunology Department, Churchill Hospital, Oxford 14
Acyclovir/Gancyclovir Bristol Southmead 14
Adalimumab levels and neutralizing antibodies Clinical Chemistry, City Hospital, Birmingham 7
Adenovirus PCR Newcastle PHE Molecular 5
Adrenal autoantibodies Blood Sciences, RVI, Newcastle 21
Amoebic London School of Tropical Medicine 2
Anti-Streptococcal DNAase B antibodies No longer available – test withdrawn
Anthrax EDTA Porton Down, Salisbury 7
Alternative Complement Pathway function (AP100) (contact Immunology in advance) Blood Sciences, RVI, Newcastle 14
Aquaporin 4 (NMO) autoantibodies (contact Immunology in advance) Immunology Department, Churchill Hospital, Oxford 14
ASO Hyaluronidase No longer available – test withdrawn
Aspergillus galactomannan antigen Freeman Hospital, Newcastle (Microbiology)
Aspergillus PCR Mycology Reference Centre Manchester 7
Basal Ganglia autoantibodies Institute of Neurology, Queens Square, London 10
Basement Membrane Protein autoantibodies (Epidermal, BP180 and 230) Immunodermatology Department, St. Johns Hospital, London 8
Beta Glucan Bristol PHE Mycology Reference Lab 3
BK PCR - (EDTA/Urine) Micropathology Coventry 1
Brucella Liverpool Virology Lab
C1 Esterase Inhibitor Function (contact Immunology in advance) Blood Sciences, RVI, Newcastle 21
C1 Esterase Inhibitor autoantibodies (contact Immunology in advance) Immunology, City Hospital, Birmingham 21
C1q autoantibodies PRU, Northern General, Sheffield 10
C1q quantification PRU, Northern General, Sheffield 20
C3 nephritic factor (C3NeF) (contact Immunology in advance) Blood Sciences, RVI, Newcastle 14
C3d (C3 breakdown products) (contact Immunology in advance) Blood Sciences, RVI, Newcastle
Campylobacter Serology Preston 14
Internal quality control solutions are available through the Blood Sciences
Department and are delivered to all Roche users in the Trust on a three monthly
basis.
Pathology Users Handbook – V20
PATH-SOP-15 Page 133 of 138 Issued: 19.2.18
Pathology Directorate
The meter will only give a result for glucose in the range of 0.6 - 33.3 mmol/L
Outside of this range the meter will either state “Hi” or “Lo”. In these cases the test
should be repeated. If the same result is given then a blood sample must be sent to
the laboratory urgently for confirmatory reporting.
The test strip has 7 test patches on it and is used for the semi quantitative
determination of pH, glucose, ketones, leukocytes, nitrate, protein, and blood in
urine by visual reading.
Internal quality control solutions are distributed on a quarterly basis by the PoCT
Manager to all ketone meter users.
In the cases where the blood ketone level is >3mmol/L the Trust DKA Policies
(Adults and Paediatrics) must be followed.
All consumables are the responsibility of each ward/clinical area. Service Level
Agreements (between the clinical area and the Blood Sciences Department) are in
place for general maintenance and troubleshooting for some clinical areas. For
assistance out of hours please contact Radiometer directly on 01293 517599.
Meters are only placed in agreed areas with strict levels of use.
Meters are not normally replaced. However, if the meter is broken or the error
message cannot be fixed, the meter must be sent to the PoCT manager who will
arrange for this to be sent to Roche for examination.
Located in the Children’s Out Patients Department at CIC and with the Paediatric
Diabetes Specialist Nurse at WCH
98% chance delivery will NOT 99% chance delivery will NOT
<10ng/mL
occur <14 days occur <34 weeks
98% chance delivery will NOT 92% chance delivery will NOT
10-49ng/mL
occur <14 days occur <34 weeks
29% chance delivery WILL occur 33% chance delivery WILL occur
200-499ng/mL
<14 days <34 weeks
46% chance delivery WILL occur 75% chance delivery WILL occur
≥500ng/mL
<14 days <34 weeks