HAE-MAN-1
Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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Manual
Haematology and Blood Transfusion Handbook
Author : Jennie Rogers
Page 1 of 44
HAE-MAN-1
Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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Haematology &
Blood Transfusion
Handbook
The Pennine Acute Hospitals NHS Trust
Author : Jennie Rogers
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HAE-MAN-1
Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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The Central Pathology Facility at the Royal Oldham Hospital
Author : Jennie Rogers
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HAE-MAN-1
Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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Contents
Page
Section
Content
5
1
General Information
7
2
Contact Information
9
3
Hospital Blood Transfusion Practitioner
11
4
Blood Transfusion Tests and
Procedures
15
5
Anticoagulant Service
16
6
Haematology and Blood Transfusion
Test Repertoire, Specimen
Requirements and Reference Ranges
22
7
Specimen Collection System
27
8
Results
28
9
Specialist Tests and Procedures
33
10
Quality Control, Assurance and
Measurement Uncertainty
34
11
Referred Tests
Author : Jennie Rogers
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HAE-MAN-1
Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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1. General Information
Haematology and Blood Transfusion Laboratory
The Haematology and Blood Transfusion Laboratories within The Pennine Acute Hospitals
NHS Trust are IBMS (Institute of Biomedical Sciences) and HCPC (Health & Care
Professions Council) approved for Training Biomedical scientists.
The Royal Oldham, North Manchester General and Fairfield General Hospitals operate a 24
hour shift system 365 days a year. HCPC registered members of Haematology / Blood
Transfusion staff are always available on site. Samples originating from Rochdale Infirmary
are transported and processed at the Central Facility at Oldham, apart from the Clinical
Assessment Unit that have on site ‘point of care’ (PoCT) full blood count (FBC), INR and DDimer testing facilities.
Details of the more common tests, their sample requirements and turnaround times can be
found in section 6 of this document.
Haematology test requests
Pennine Acute Hospitals NHS Trust laboratories provide a comprehensive Haematology and
Blood Transfusion service. The laboratories provide a full service between 09:00 hours and
17:00 hours, Monday to Friday excluding public holidays.
Haematology requests can be made either through HealthViews electronic ward ordering
application which is becoming the normal procedure within the hospital or by using one of the
red Haematology/Biochemistry/Immunology request cards. GP requesting is normally made
through
TQuest
electronic
GP
ordering
system
or
by
the
Haematology/Biochemistry/Immunology request cards. In the event of any of the electronic
systems being unavailable the request card should be used.
On the Haematology request card a mark should be made clearly in the box opposite the
required test. There is additional space for writing any additional test which is not listed.
Request forms must bear the printed name and bleep number of the Medical Officer making
the requests & the requesting source. To permit processing by the departmental computer
and facilitate enquiry for results on ward terminals, the patient's date of birth, hospital number
(including any prefix letter with a total of 8 numeric characters) and name must be printed
clearly. With Health Views or TQuest, labels printed in the presence of the patient containing
the barcode must be used; when using the request card independent of an electronic
ordering system, addressograph labels can be used for the card, but the sample bottle
should be filled in by hand.
A/E routine tests are processed in less than 60 minutes. This is in line with our Key
Performance Indicator (KPI’s). KPI 6.1 Critical results communication is set by the Royal
College of Pathology. KPIs have been developed to assist laboratories in demonstrating their
contribution to patient management pathways. The KPIs should provide evidence of
conformity with standards of accreditation and, through discussion with users of the service,
will facilitate demand management and support a clinically effective service.
Author : Jennie Rogers
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Haematology and Blood Transfusion
Haematology and Blood Transfusion Handbook
Version 11
April 2017
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Information / Results
For inpatients the test results should be accessed via HealthViews electronic patient
management system or via the Pathology Results Enquiry portal on the Interactive link on
the Pennine Intranet homepage. For tests not requested via HealthViews a computer
generated paper report will be dispatched in the post. The Introduction of the HealthViews
ward order requesting should eliminate the need to have a paper record. Further information
provided in section 8.
Results, which are markedly abnormal and / or require urgent attention, will be
communicated via telephone or rarely by facsimile to a safe haven fax machine.
All requests must conform to the Pathology Sample & Request Card Labeling Policy
CPDI061 which can be found on the Trust Intranet.
The laboratories may be contacted directly using the telephone numbers contained in the
section below;
Author : Jennie Rogers
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April 2017
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Haematology and Blood Transfusion
2. Contact Information
The Clinical Haematology Service
The department of Haematology and Blood Transfusion provides a complete clinical referral
service for all the hospitals within Pennine Acute Hospitals NHS Trust and an outpatient
referral service for General Practitioners.
The Clinical lead for Haematology is Dr. David Osborne (71914)
The Consultant Haematologists within Pennine Acute are:Dr. Martin Rowlands, (71650/NMGH 42483)
Dr. Allameddine Allameddine (75033)
Dr. Hayley Greenfield (71259)
Dr. Antonina Zhelyazkova, (75033)
Dr. Satarupa Choudhuri (78387)
Dr Mohammad Pervaiz (78374)
All requests for Clinical Haematology advice can be made via switchboard who will
contact an appropriate member of the Clinical Haematology team through the Trust
paging system. This applies to all times of the day and not just outside of normal
working hours.
Haematology Management Team - All Sites
Michael Heaton - Haematology & Blood Transfusion Services Manager
0161 656 1678 (Internal 71678)
Jane Uttley - Technical Manager Blood Transfusion
0161 656 1761 (Internal 71761)
Jennie Rogers - Technical Manager Haematology
0161 778 5439 (Internal 75439)
Jane Nelson - Technical Manager Haematology
0161 656 1762 (Internal 71762)
Hospital Site
Address
Telephone No Haematology
Royal Oldham
Hospital
Postal Address:
Rochdale Rd
Oldham
OL1 2JH
North Manchester
General Hospital
The ESL
Laboratory is
located on the
For Technical
Queries:
Haematology Lab:
0161 627 8370 or
8371 (Internal
78370/1)
For General
Enquiries:
0161 604 5386
Author : Jennie Rogers
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Telephone No Blood
Transfusion
Lab:
0161 627 8372
(Internal 78372)
Lab:
0161 720 2100
(Internal 42100)
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Haematology and Blood Transfusion
Fairfield General
Hospital
main hospital
corridor.
Postal Address:
Delaunays Rd
Crumpsall
Manchester
M8 5RB
The Laboratory is
located behind the
Broadoak Suite
adjacent to
Fairfield House.
Postal Address:
Rochdale Old Rd
Bury
BL9 7TD
(Internal 45386)
For Technical
Queries:
Haematology Lab
0161 604 5387
(Internal 45387)
For Technical
Queries:
Haematology Lab
0161 778 2597
(Internal 82597)
Author : Jennie Rogers
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Blood Transfusion
lab
0161 778 2598
(Internal 82598)
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Haematology and Blood Transfusion
3. Hospital Blood Transfusion Practitioner
The Blood Transfusion Practitioners Contact numbers:Royal Oldham Hospital:
Fairfield General and Rochdale Infirmary:
North Manchester General:
Assistant Transfusion Practitioner:
Cell Salvage
Blood Transfusion Secretary:
Sue Andrews- 78790/ 07870692823
Bev Sedman- 83825/ 07976313807
Christopher Porada- 42797/ 07870693110
Deborah Curley- 07854764557
Jo Ann Bayliss- Bleep #7755
Margaret Hardy- ext. 71260
The Trust Transfusion Committee (TTC) aims to achieve better co-operation, communication
and closer working relationships between the Blood Transfusion Department and the users
of the service to improve Transfusion practice and improve patient safety.
Each of the Trust Clinical Divisions are represented to ensure that relevant transfusion
related issues are raised, discussed and where appropriate policies amended or produced to
maintain and improve quality standards and patient safety.
The role of the Transfusion Practitioner is to educate and train Trust staff in Transfusion
Practice and promote a safe and effective service for all patients who require the transfusion
of blood and blood products.
Duties include:  Provision of education Competency Assessment and practical support to all staff involved
in the transfusion chain.
 Act as the key person relating to the Trusts Risk Management Strategy.
 Identifying areas suitable for research and audit and taking appropriate action in
accordance with the findings of the audit.
 Development and implementation of policies following national and local guidelines that
are designed to ensure the delivery of a safe and effective transfusion service.
The policies that have been produced are available on the Trust Intranet Documents in the
Blood Transfusion folder and are as follows - list not exhaustive;
Indications for red cell transfusion - the green policy: EDC007 Version: 7
Requesting, collecting and labeling of a blood sample for transfusion tests, which generate
a blood group. EDC012 V10
The Administration of Blood Components Policy: EDC006 V9
Management of Massive Blood Loss: EDC 009 v9.0
Guidelines for the Use of Platelet Transfusions in adults & children/neonates: CPDI011 V8
Policy for the use of Fresh Frozen Plasma Components CPDI 012 Version 9.0
Irradiated Blood Components Policy: CPDI035 Version 6
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Policy - Management of Transfusion Reactions: EDC 005 V10.2
Policy for the use of Blood and Blood Components on the Neonatal Unit CPDI026 V1.1
Protocol for the use of Human Albumin 4.5% & 20%. CPDI 137 Version 2
Policy – Transfer of Blood and blood components between hospitals within the Trust and
other hospitals: CPDI043, v6.0
Guideline – Management of bleeding in patients receiving antithrombotic agents or who
require emergency/elective anticoagulant reversal – CPDI 201, v1.0
Policy - The Management of all Patients Who Decline Blood Components, including
Jehovah’s Witnesses: CPDI064 v5.1
Policy for the collection of red cells from the blood bank fridge, EDC011, V10
Cell Salvage
Intra operative cell salvage services are now available within the Trust. For further
information please contact Jo-Ann Bayliss, Cell Salvage Coordinator via Trust switchboard
on bleep #7755.
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4. Blood Transfusion Tests and Procedures
Group and Save
Samples sent for Group and Save are processed for a blood group and antibody screen and
then retained for seven days for identification and record keeping purposes. However validity
of retained samples for blood product issue is dependent upon blood transfusion history and
obstetric status. Please see document Requesting, collecting and labeling of a blood
sample for transfusion tests, which generate a blood group EDC012 on Trust Intranet
Documents for further information.
Pre-operative samples needed for scheduled procedures must have the date of operation
clearly indicated on the request card. Samples are kept for 7 days, day one being the day
taken.
Specimens for Investigation of a Positive Antibody Screen.
Occasionally when a patient develops an antibody it may be necessary to send further
samples to the NHSBT for evaluation and confirmation.
The samples are requested by the laboratory staff, who then arrange the transportation to
the appropriate centre. The availability of results depends on the complexity of the testing.
NHSBT normally issues 95% of reports for all red cell investigation (RCI) tests within 5
working days of receipt of sample except in cases where more complex antibody
investigations are encountered or where extensive testing is required. In these cases the
Transfusion laboratory will be notified. RCI will prioritise investigations according to the
clinical requirements of the case.
In the case of an antenatal patient, paternal samples may be requested and a regime of
follow up testing for the mother may be implemented.
Red blood cells
Allocated blood is kept in the Blood bank issue fridges at various locations. The blood is
reserved until the morning of the second day post stated date required, then returned to the
laboratory and returned to stock. If the operation is cancelled or delayed, please inform the
Blood Transfusion department in order to facilitate any change.
Once a blood transfusion has commenced the total crossmatched blood MUST be used
within 48 hours. Timings of samples suitable for crossmatching must comply with BCSH
Guidelines 2012.
 Patients transfused within 90 days or pregnant -the sample must be taken no more
than 3 days before transfusion.
 Patient’s transfusion more than 90 days-the sample must be taken no more than 7
days before transfusion. This enables the laboratory to assess the antibody status of
the patient.
Blood is collected from the Blood bank issue fridges by trained nursing staff and porters who
must bring the appropriate patient identification documentation. Refer to document Policy
for the collection of red cells from the blood bank fridge, EDC011 on Trust Intranet
Documents for further information.
Author : Jennie Rogers
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Haematology and Blood Transfusion Handbook
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April 2017
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NB: For the issue on any group specific blood product two blood groups are required
from two separate samples. If a further sample is required the laboratory will contact
the ward to request another group and save sample.
Platelets
Two blood group results from two different group and save samples will be required to be on
record before platelets can be issued.
 Pooled platelet concentrate, leucocyte depleted (random donor)
ABO and Rh specific, supplied by NHSBT already pooled from 4 donors, approximate
volume 300ml, content of platelets >240 x 109 per donation.
 Platelet apheresis, leucocyte depleted (single donor)
ABO and Rh group specific, supplied as one pack collected by cytophoresis from a single
donor. Volume 200-300ml, content of platelets >240 x 10 9 approximately equivalent to 4
single donations. These are also available as HLA/HPA antigen matched donors, which
may be effective in patients who do not respond to platelets due to HLA or HPA
antibodies. Crossmatched platelets may be indicated in certain instances – donors are
selected by a test for reaction with recipients’ plasma. HLA/HPA matched and
crossmatched platelets will need at least 24 hours’ notice to order as they are ordered in
specifically from NHST.
Refer to document Guidelines for the Use of Platelet Transfusions in adults &
children/neonates: CPDI011 on Trust Intranet Documents for further information.
All platelet packs must be stored at room temperature 20-24oC with constant agitation and
must not be refrigerated. Platelet packs should be infused over a period of 30 minutes. A
fresh standard giving set should be used and will be issued with the platelet pack by the
laboratory.
Fresh Frozen Plasma
Two blood group results from two different group and save samples will be required to be on
record before FFP can be issued.

Fresh frozen plasma, leucocyte depleted (random donor)
ABO and Rh group specific, approximate volume 150-300ml plasma containing
CPDA, which contains normal plasma levels of stable clotting factors, albumin
and immunoglobulin. They do not contain platelets. Stored in the Blood bank at –
25oC and 40 minutes is required to defrost each request. Must then be used
within 4 hours if stored at room temperature or 24 hrs if stored at 4 oC in a
designated Blood bank refrigerator. Refer to document Policy for the use of
Fresh Frozen Plasma Components CPDI 012 on Trust Intranet Documents for
further information.

Methylene blue treated fresh frozen plasma, leucocyte depleted
Group AB plasma suitable for all groups treated with Methylene blue for virus
inactivation, for all neonates and children born after 01/01/96. Available in
volumes of approximately 250ml and paedipacks of 50m

Octaplas ( Solvent Detergent Treated Human Plasma )
In certain conditions such as Thrombotic Thrombocytopenia Purpura of for patients
requiring large plasma exchange then Octaplas should be given
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Haematology and Blood Transfusion
Cryoprecipitate, leucocytes depleted.
A cryoglobulin fraction of plasma containing concentrated FVIII: C and VW factor,
fibrinogen, FXIII and fibronectin. Stored in the Blood Bank at -25oC. Must be kept at
room temperature and transfused within 4 hours of thawing .
Investigation of Transfusion Reactions
In the event or suspicion of a transfusion reaction, please contact the department. A
transfusion investigation form must be completed and the relevant sample taken to
investigate further and the unit returned to the laboratory. Refer to document Management
of Transfusion Reactions: EDC 005 on Trust Intranet Documents for further informatio
Plasma Fractions
Human Prothrombin Complex, Factor VIII, Recombinant factor VIIa and other
coagulation factor concentrates
All requests for these products should be made via a Consultant Haematologist.
C1 Esterase Inhibitor
These products are not kept in stock but can be made available through the Transfusion
Laboratory at ROH. All requests for these products should be made via a Consultant
Haematologist.
Platelet and Granulocyte Immunology at NHSBT
Various platelet and granulocyte immunology investigations are available from Bristol
NHSBT. Details of sample type and request form are available from the laboratory; please
contact us if you need assistance. Turnaround time from reference laboratory - In 90% of
cases the NHSBT aim to issue reports within 14 working days from receipt of samples. If
further investigations are required the turnaround time may extend to 21 working days.
HLA at NHSBT
HLA typing is sent to Sheffield NHSBT. A request card can be obtained from the Blood
Transfusion department. Once completed, please return to the laboratory who will forward to
Sheffield. In 90% of cases reports are issued within 5 working days from receipt of the
samples in the lab, for example HLA and other immune polymorphism typing. A longer
turnaround time may apply to investigations of other immune polymorphisms. HLA specific
antibody test reports for patient’s refractory to platelet transfusion will normally be issued
within 7 days. Drug dependent antibody screens (other than HIT) will be issued within 20
working days. Urgent HIT test results can be faxed within approximately 3 hours of receipt of
samples.
Fetal Typing at NHSBT
Testing of fetal samples may be required when Hemolytic Disease of Fetus and Newborn or
Neonatal Alloimmune Thrombocytopenia is suspected. For this specific testing please
contact the laboratory in advance to discuss samples required and timing of samples.
In some cases of suspected HDFN maternal samples can be used to test to test for cell free
fetal DNA in order to predict the genotype of the fetus .
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Haematology and Blood Transfusion Handbook
Version 11
April 2017
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Antenatal Screening
The Antenatal protocol is as follows:
Booking Bloods at 12 weeks for blood grouping and antibody screening, follow up bloods at
28 weeks for all patients
If antibodies are detected at either screening a regimen of follow up testing may be
implemented. The samples will be referred to Liverpool NHSBT (NHS Blood and Transplant
Service) for confirmation and monitoring. Depending on the antibody specificity it may be
necessary for paternal samples to be requested. All Rhesus Negative women and Rhesus
Positive women with antibodies present require cord and maternal samples to be sent to the
laboratory at the time of delivery.
Routine Antenatal Anti D Prophylaxis (RAADP)
In accordance with NICE guidance issued in 2002, Pennine offers routine Anti D prophylaxis
to pregnant Rh Negative women.
The Obstetricians have taken the decision to use a single dose of 1500iu anti-D at 28 weeks.
All Rhesus Negative mothers are identified from the initial blood grouping and booked into a
dedicated weekly clinic at each site where the Anti D is administered after the 28 week follow
up bloods have been taken.
Potentially Sensitising Events
In addition to RAADP, Anti D immunoglobulin should be administered to pregnant Rh
Negative women following any potentially sensitising event.
500iu Anti D is required as a standard initial dose and a Kleihauer should be performed after
20 weeks gestation to assess the size of any bleeds. Anti-D must be given as soon as
possible and always within 72 hours.
For bleeds of >4mls red cells, extra Anti-D must be given (dose will be advised according to
the result) and a repeat kleihauer required 48 hours after the initial anti-D injection in order to
assess whether further anti-D is required .
Emergency Blood
Around the 4 hospital sites there are satellite Blood bank fridges that hold emergency O Rh
negative blood for emergency use only.
Author : Jennie Rogers
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Haematology and Blood Transfusion Handbook
Version 11
April 2017
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5. Anticoagulant Service
The Anticoagulant service offered varies across the hospital sites.
The Anticoagulant service varies across the hospital sites.
The anticoagulant services for Royal Oldham Hospital and Fairfield General Hospital are
provided by IntraHealth and are not provided on site. You can contact them on Tel 0191
5181656 Fax 0191 518 1656
North Manchester General Hospital and Rochdale Infirmary have nurse led Anticoagulant
services. The clinics, some of which are community based, using Roche Coagucheck Xs
handheld near patient testing devices (capillary samples).
The contact details are:North Manchester General Hospital Anticoagulant Service: Tel
720 2274
0161 720 4772 Fax 0161
Rochdale Anticoagulant Service Tel 01706 764324 Fax 01706 764321
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Haematology and Blood Transfusion
6. Repertoire of Tests and Reference Ranges
Blood Transfusion test repertoire
Specimen
Container
Required
volume
(mls)
EDTA
7.5
EDTA
7.5
EDTA
7.5
EDTA
7.5
EDTA
2.7
EDTA
7.5
Kleihauer
EDTA
2.7
Paternal Testing
EDTA
7.5
NAIT- Foetal Genotyping
EDTA/
Clotted
Maternal 6ml EDTA plus
6ml clotted sample
Paternal 6ml EDTA
Neonatal 1ml EDTA
Specimens For Investigation
Of Positive Antibody Screen
EDTA
7.5 x 2
HLA Typing
EDTA
7.5
Clotted
5.0
Cord and Maternal Investigation
EDTA
Maternal
EDTA Cord
7.5 x 2
4.9
Transfusion Reaction Investigation
EDTA
7.5
Request
Group & Save
Crossmatch
Fresh Frozen Plasma
If patients group unknown
Platelets
If patients group unknown
Direct Antiglobulin Test
Ante Natal Screen
HLA Antibody Investigation
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Haematology and Blood Transfusion
Haematology in house test repertoire
Request
FBC with Differential
Manual Differential
Reticulocyte Count
Malarial Parasite Screen
Haemoglobinopathy
Screen
Paul Bunnell
(Glandular Fever Screen)
G6PD Screen
Sickle Cell Screen
Plasma Viscosity
ESR
Serum B12 and Folate
Intrinsic Factor Antibodies
Serum Ferritin
2.7ml
2.7ml
2.7ml
2.7ml
Paediatric
Bottle
Available
Yes
Yes
Yes
Yes
Routine
Turnaround
Time
<24hours
5 days
<24hours
<24hours
Red Top EDTA
2.7ml
Yes
3 days
Red Top EDTA
2.7ml
Yes
<24hours
Red Top EDTA
Red Top EDTA
Red Top EDTA
Red Top EDTA
Brown Top Gel
tube
Brown Top Gel
tube
Brown Top Gel
tube
2.7ml
2.7ml
2.7ml
2.7ml
Yes
Yes
No
No
<24hours
<24hours
<24hours
<24hours
7.5ml
Yes
3 days
7.5ml
Yes
3 days
7.5ml
Yes
3 days
Specimen
Container
Required
Volume
Red Top EDTA
Red Top EDTA
Red Top EDTA
Red Top EDTA
Prothrombin Time and INR
Green top
Citrate
3ml
Yes
<24 hours
APTT/Thrombin Time
Green top
Citrate
3ml
Yes
<24 hours
D-Dimer
Green top
Citrate
3ml
Yes
< 4 hours
Thrombophilia Screen,
includes:Functional Antithrombin
activity, Functional Protein
C, Activated Protein C
resistance ratio,
Free protein S
Green top
Citrate
3 x 3ml
Yes
<7 days
2 x 3ml
Yes
<7 days
2 x 3ml
Yes
<7 days
2 x 3ml
Yes
<7 days
2 x 3ml
Yes
<7 days
Lupus anticoagulant test
Individual Factor Assays (
F2 to F13)
Extrinsic Coagulation
Pathway - F8,F9,F11,F1
Intrinsic Coagulation
Pathway - F2,F5,F7,F10
Green top
Citrate
Green top
Citrate
Green top
Citrate
Green top
Citrate
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Haematology and Blood Transfusion
Factor V (five) Leiden and
Prothrombin Gene Variant
Citrate or
EDTA
3ml or
2.7ml in
EDTA
Yes
<3 days
Heparin assay or Anti XA
assay
Von Willibrand Screen,
Includes:Von Willibrand Factor
Antigen, Ristocetin Cofactor
& Factor VIII
Green top
Citrate
3ml
Yes
<7 days
Green top
Citrate
3 x 3ml
Yes
< 4 weeks
Test (* see report for specific age/sex related reference
ranges)
FBC and Differential White cell Count
Reference Range
(Adults)
*RCC (Red Cell Count)
Male
4.5 – 5.5 x 1012 /l
Female
3.8 – 4.8 x 1012/l
Male
130 – 180 g/L
Female
115 – 165 g/L
Male
0.40 – 0.50
Female
0.37 – 0.47
*Hb (Haemoglobin)
HCT (Haematocrit)
*MCV (Mean Cell Volume)
80 – 100 fl
MCH (Mean Cell Haemoglobin)
27-32 pg
MCHC (Mean cell Haemoglobin Concentration)
315-350 g/L
*Platelets
150 – 450 x 109/l
Reticulocyte count
0.2 - 2.0%
40-100 X 109/l
*WBC (White Blood Cells)
4.0 – 11.0 x 109/l
*Neutrophils
2.0 – 7.5 x 109/l
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Haematology and Blood Transfusion
*Lymphocytes
1.0 – 4.0 x 109/l
*Monocytes
0.2 – 0.8 x 109/l
*Eosinophils
0.0 – 0.4 x 109/l
Basophils
0.0 – 0.2 x 109/l
PV (Plasma Viscosity)
1.50 – 1.72 mPas
ESR (Erythrocyte sedimentation rate)
Male
Female
HbA2 and HbF
2-10 mm in 1st hour
5-15 mm in 1st hour
<3.5 % and <1.5 % respectively
Coagulation Tests
INR Dependent upon reason for
Anticoagulation
2.5
Low level target
3.5
Higher level target
Prothrombin Time
9-14 secs
APTT
24 – 35 secs
Clauss Fibrinogen
1.7 – 4.0 g/l
Protein S
Female 58-120%
Male 53-93%
Protein C
Female 68-148%
Male – 69-133%
Anti-Thrombin III
75 – 125%
Factor Assays II, V, VII, VIII, IX, X, XII
(XI)
See individual report
APCR (Screening test for FVL mutation)
>2.0
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Haematinics
Serum B12
150 – 620 ng/l
Serum Folate
3.1 – 19.9 ug/l
*Serum Ferritin
10 – 300 ug/l (Minor differences depending on
age and sex)
Patient Consent
The laboratory staff have no involvement in direct collection of samples from patients. This is
carried out by the clinicians and HealthCare workers requesting tests. It is assumed that
arrival of a sample at the laboratory only occurs once the patient has consented to be tested
for the investigations requested.
Factors known to affect test performance
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It is essential, due to the dilution effect of the anticoagulant, that the citrate (green
top) tubes are filled to the mark.
All tubes containing an anticoagulant, EDTA (red top) and Citrate (green top) must be
mixed gently after filling to prevent the sample clotting. If these samples are laid to
one side without gentle inversion they will clot and be unsuitable for analysis.
Do not overfill tubes.
Avoid tipping blood from one container into another this can adversely affect results.
If blood ever has to be taken with a conventional needle and syringe do not force
blood into the sample containers through the needle, always remove the needle first.
Taking samples from a drip arm should be avoided as this can lead to a massive
dilution effect.
Difficulty with the venepuncture can cause problems. These may include haemolysis
or a partially clotted sample which may lead to a falsely low platelet count or altered
blood coagulation values.
Avoid storing the samples prior to dispatch to the laboratory at extremes of
temperature. (Avoid sample storage areas in direct sunlight or next to heat sources
such as radiators)
ESR samples can be processed from the same 2.7ml EDTA as the FBC as long as it
is completely filled to the 2.7ml mark, any less will be insufficient.
Samples for Plasma Viscosity should not be refrigerated overnight
FBC samples which cannot be sent to the laboratory and are kept overnight by the service
user, should be refrigerated. If in any doubt then contact the lab on ext 78370.
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Additional tests
Due to the limited viability of Haematology samples some additional tests may not be viable.
Please contact the laboratory for further to the general points below;

Due to the limitations of cold storage space FBC samples will be disposed of after 5
days

Coagulation tests may be added to samples already in the laboratory but users
must be aware that some coagulation tests may require a fresh sample.

Addition of a blood film to an FBC request should be done within 12 hours.

Addition of a Glandular fever screen may be done at any time providing the sample
is still held.

Addition of a Malaria antigen screen: as above.

Haemoglobinopathy screen may be added to samples any time prior to disposal
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Haematology and Blood Transfusion
7. Specimen Collection
The Sarstedt Blood Collection System
The Pathology Sample Labelling and Rejection Policy is available to all wards and
departments. Sample Collection and labelling.doc
Please note there is a separate policy for labelling blood transfusion samples
Requesting, Collecting and Labelling of Blood Sample for Transfusion Tests which
generate a Blood Group
The safety of the patient is the intended outcome of compliance with the policy. All these
occurrences create danger for the patient; any of these incidents could lead to incorrect
diagnosis, the wrong treatment and in extreme cases cause harm to the patient including
death.
The Monovette blood collecting system, comprising a combined syringe/container and a
needle with valve for multiple samples is used instead of the conventional syringe and
needle. The system has advantages both for the patient and for the person collecting the
specimens. Details of how to use the system are in every ward and department. If you take
blood using the Monovette system please collect tubes in the order shown below.
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Haematology and Blood Transfusion
Order of collection (draw)
White -
Serum
Brown -
Serum (Gel) -
Orange -
Plasma (Lithium Heparin)
Red -
EDTA
Yellow -
Sodium Fluoride
Green -
Coagulation
Completion of Pathology Request Card and Sample Bottles.
Labels generated whilst in the presence of the patient using a unique label printer are
acceptable; these must contain all of the required information for sample labeling and must
only cover the tube manufacturer’s primary label. If you are considering introducing a system
please inform the Pathology department.
** In certain circumstances Unique Coded identifiers might be used e.g. GUM patients, major
incidents and when a name is unobtainable.
Sample labelling policy
Specimen and request cards not meeting the minimum required criteria for
identification will not be processed, these samples will be retained for an appropriate
period. It is not always possible to inform the requestor by telephone of this outcome.
If the request is marked urgent the requestor will be informed.
Routine Hospital Specimens
A limited Phlebotomy Service to the wards is provided by the Outpatient's Department.
Contact Lesley Brimelow, Outpatient Manager.
Only staff that have undertaken a venepuncture-training programme or have been assessed
as competent should collect blood samples.
A porter collects specimens from the wards and departments. Specimens may be sent to
Pathology via the pneumatic tube system. (Except Rochdale Infirmary)
If a needle-stick injury is sustained, it is essential to follow the Trust Accidental
Inoculation Policy CPDI018 without delay. The Trust Accidental Inoculation Policy
CPDI018which can be found on the Trust intranet.
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Pneumatic Tube System (Not Rochdale Infirmary)
This system allows the rapid transport of specimens from wards and units to the Pathology
Department. Wherever possible urgent specimens should be sent via the pneumatic tube
system. Precious samples such as Bone Marrow should not be transported via the
pneumatic tube.
It is important when using this system for the rapid transport of specimens to ensure that all
specimen containers provided are used in the correct manner and that the lids are fastened
securely. Any leaking specimen leads to a delay in processing the sample and creates a
hazard to the laboratory staff that has to handle the specimen. Incorrectly closed canisters
jam the system, as does inserting two canisters at a time.
If you receive canisters from other stations, you must return them to their parent station
immediately.
Specimen Transport (General)
Pennine GP work is tested at the ROH Laboratory. The Trusts own internal transport system
is in place to transport samples regularly from Rochdale Infirmary, Fairfield and North
Manchester Hospital to the centralised lab at the Oldham site. In addition, the Trust provides
a GP collection system samples from GP surgeries within the North Manchester, Heywood
Middleton and Rochdale and Bury CCG. SRCL services provide GP sample collection for GP
surgeries within Oldham CCG.
High Risk Samples
To conform to the guidelines issued by the Advisory Committee on Dangerous Pathogens to
prevent infection in clinical laboratories and post mortem rooms the co-operation of all staff
involved in ordering requests and taking blood is essential.
Micro-organisms, viruses, materials etc., are classified into four groups according to the level
of hazard they present and the minimum safety conditions for handling them. The four
groups are described below:
Categorisation of Biological Agents according to Hazard and Categories of Containment - 4th
edition 1995)
Group 1 A biological agent unlikely to cause human disease.
Group 2 A biological agent that can cause human disease and may be a hazard to
employees; it is unlikely to spread in the community and there is usually effective prophylaxis
or effective treatment available.
Group 3 A biological agent that can cause severe human disease and presents a serious
hazard to employees. It may present a risk of spreading to the community but there is usually
effective treatment or prophylaxis available
Group 4 A biological agent that causes severe human disease and is a serious hazard to
employees. It is likely to spread to the community and there is usually no effective
prophylaxis or treatment;
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Group 4 Pathogens
Arena viruses:
Bunya viruses:
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Junin, Lassa, Machupo and
Mopeia viruses
Congo, Crimean
haemorrhagic fever, Hazara
Filo viruses:
Ebola, Marburg viruses
Tick-borne viruses:
Kyasanur Forest Disease,
Omsk haemorrhagic fever,
Absettarov, Hanzalova, Hypr,
Russian spring-summer
encephalitis.
Clinical advice regarding high risk specimens
Group 4 Pathogens
Dr Joel Paul Consultant Virologist and/or the Microbiology Dept. should be consulted
regarding such specimens, as should the Infectious Disease Physicians. There are no
facilities within the Pennine Acute Hospital Laboratories for the handling of specimens
suspected of containing Group 4 pathogens.
Patients suspected of having a Viral Haemorrhagic Fever (VHF), such as the 2015 Ebola
outbreak in West Africa, may present themselves at any of the hospitals within Pennine
Acute Trust and in particular at NMGH where the Infectious Diseases (ID) unit is based. The
Haematology dept. is responsible for baseline testing of samples for the presence of Malarial
Parasites and a Full Blood Count. They are also responsible for packaging samples for VHF
testing at the Rare and Imported Pathogens Laboratories (RIPL) at Porton Down or
Colindale. The laboratory has its own policy for the management of VHF samples. If VHF is
suspected contact the ID team and refer to the Trust Policy:Integrated Care Pathway for Patients Assessed as Being at Risk of Viral Haemorrhagic
Fever
MERS-CoV – All suspected cases are to be discussed with the Infectious disease registrar
and the laboratory must be informed. Link http://nwar.pat.nhs.uk/corporatedepartments/Emergency-Planning/mers.htm
Group 3 Pathogens
All specimens containing, or suspected of containing, organisms or viruses in Group 3, or
from patients in the categories listed, must be labeled using the yellow BIOHAZARD labels
both on the specimen container and request form by the person requesting the investigation.
The nature of the BIOHAZARD must be specified on the request form.
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Screening for Malaria and Other Blood Parasites.
The laboratory provides Rapid Diagnostic Test screening (RDT) and microscopy for the
presence of the following malarial parasites:
P. falciparum
P. vivax
P.ovale
P.malariae
P.knowlesi
The laboratory should be contacted prior to urgent screens being sent to the laboratory. The
laboratory is able to provide a RDT result within 1 hour of receiving a sample in the
laboratory. Full clinical details must be given including travel history and any prophylaxis
taken. Ideally the samples should be taken at the height of fever and should be repeated up
to 3 times if the screen is negative to fully exclude the presence of malarial parasites. This is
reflected as a disclaimer in the laboratory report. Rarely malarial antibodies can be requested
and sent to a reference laboratory.
If the malaria screen is positive samples are referred to the Malaria Reference Laboratory
(MRL) in London for confirmation of the species
All samples that are positive for malarial parasites are currently tested for G6PD deficiency
as certain treatments can give rise to a haemolytic crisis in patients that are found to be
G6PD deficient.
P. knowlesi: - a very rare malaria which should be considered if the patient has travelled to
South East Asia. The parasites are morphologically similar to P.malariae, however the
clinical course is similar to that of P. falciparum malaria and patients can deteriorate rapidly.
This is a medical emergency. Please contact the laboratory if you suspect P.knowlesi to
avoid possible misdiagnosis and delay.
Please contact the laboratory if screening for other blood parasites such as Trypanosomes
and Microfilaria are required.
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8. Results
Trust staff are able to review Pathology results on line through HealthViews or via the
Pathology Results Enquiry portal on the Interactive link on the Pennine Intranet homepage.
Due to the high volume of work received in the laboratory, service users are encouraged to
use on line services to check the status of diagnostic tests before the laboratory is contacted.
Warning: Results may be viewable before they have been technically validated. A
disclaimer will be viewable to inform the user when this is the case.
HealthViews allows wards to order laboratory tests, produce labels and send the request to
the lab. This is similar to the T-Quest GP ordering system, reducing transcription errors.
These systems then allow service users to view results once the tests have been processed.
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9. Specialist test information and procedures
Haemoglobinopathy Screening
Disorders of globin chain synthesis; both thalassemia and structurally abnormal haemoglobin
such as haemoglobin S, which gives rise to sickle cell anaemia, are common in the UK and
constitute a significant public health problem.
One EDTA (2.7 ml) and a brown Gel tube (5ml) are required for each Haemoglobinopathy
request. The initial screen for common abnormal variants and beta thalassemia includes full
blood count, differential, haemoglobin electrophoresis and serum ferritin. If an abnormality is
detected, further samples may be required for identification by DNA analysis.
In an emergency, e.g. pre-anesthetic, a sickle solubility test (Sickle Check)) can be
performed for the presence of haemoglobin S. All requests will be followed by a full
haemoglobinopathy screen.
Counseling should be offered to the patient before the test request is made and if a clinically
significant abnormality is detected the patient should be referred for genetic counseling and
family studies should be considered. It is assumed by the laboratory that the patient has
given informed verbal consent for haemoglobinopathy screening to be performed. If the
screen shows an abnormality that requires further investigation and DNA screening then
informed written consent may be required. A consent form will be faxed to the requestor in
such cases or it can be obtained from the laboratory on 0161 627 8371 (internal ext. 78371).
If an abnormality is detected a card, letter and a booklet will be issued, outlining the
significance of the card and location of an appropriate counseling centre.
Haemoglobinopathy screening of pregnant women is one of our Key Performance
Indicators. The target, which we meet, is Target 100% The 72 hour turnaround is quoted as
Standard AO2a in the NHS Sickle Cell and Thalassemia Screening Programme Standards
for the linked Antenatal and Newborn Screening Programme. This is also cross referenced in
the Minimum criteria (standards) for laboratories undertaking antenatal screening outlined in
the Sickle Cell and Thalassemia Handbook for Laboratories. At Risk couples where both
partners are found to have an abnormal Haemoglobinopathy screen and Women with an
abnormal Haemoglobinopathy screen whose partner is unavailable for screening, are
referred by Ante Natal to the Manchester Sickle Cell and Thalassemia Centre for further
counselling and the offer of Pre Natal Diagnosis testing.
Bone Marrow Testing
Bone Marrow examination may be needed for diagnosis of primary bone marrow diseases
such as leukaemia’s and myelodysplasia or as an addition to a staging procedure in solid
tumours such as lymphomas or in some cases to investigate the cause of anaemia.
A bone marrow aspirate provides films on which the cytological details of developing cells
can be examined and the proportion of different cells counted. Special stains can be made
to differentiate between types of acute leukaemia or in suspected cases of metabolic storage
diseases. Iron stores may also be assessed by performing a Perl’s stain.
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Bone marrow trephine biopsies produce cores of bone and marrow that are decalcified and
are processed for histological assessment. The trephine provides an excellent sample for
examination of marrow architecture and cellularity and is the most reliable method for
detecting marrow infiltration with non-haemopoietic malignancies.
Immunophenotyping is a test by which antigens are detected on the cell surface and is
usually used to differentiate types of acute leukaemia or subtypes of lymphoproliferative
disorders. The test is usually performed on bone marrow aspirate sample but some stains
can be carried out on a bone marrow trephine as well.
Blood and Bone marrow, immunophenotyping and associated haematological malignancy
investigations should only be requested by a Consultant Haematologist who would assess
the patient and arrange further specialist diagnostic investigation as required.
Blood Coagulation
All the laboratories carry out blood coagulation testing using Instrumentation Laboratory
automated coagulometers.
Routine testing is performed on a single citrated sample which must be less than six hours
old (for APTT) and filled to the 3ml level. Results for Prothrombin Time (PT), International
Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT)
and Fibrinogen are available the same day.
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
usually sufficient:
Prothrombin Ratio (INR)
Activated Partial Thromboplastin Time (APTT)
Platelet Count
Suspected Disseminated Intravascular Coagulation (DIC)
Fibrinogen, D-Dimer, platelet count and blood film should be requested.
Screen for Liver Biopsy
Prothrombin ratio, APTT, and platelet count should be requested (FBC)
Heparin Therapy
Intravenous unfractionated Heparin should be given by continuous infusion and monitored by
the APTT.
Monitoring is not usually necessary if subcutaneous Heparin prophylaxis is used for surgery.
Therapeutic as opposed to low dose subcutaneous Heparin should be monitored by the
APTT taken 4 hours after the last injection.
Low molecular weight Heparin (LMWH) is now the parenteral anticoagulant of choice and
does not cause prolongation of the APTT. LMWH given prophylactically or therapeutically
does not usually need to be monitored. If monitoring is necessary e.g. renal failure or
pregnancy then the anti-factor Xa assay should be used.
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Haematology and Blood Transfusion
Oral Anticoagulants
These should be monitored by the INR (International Normalized Ratio). The therapeutic
level lies between 2.0 and 4.5 and depends upon the condition being treated.
The following targets are those recommended by the British Society for Haematology (1998)
Target INR
2.5
Atrial Fibrillation
Treatment of deep vein thrombosis
Pulmonary embolus
3.5
Transient ischaemic attacks
Recurrent deep vein thrombosis and pulmonary embolism
Mechanical Prosthetic Heart Valve
Antiphospholipid Syndrome
Thrombophilia screen
The laboratory is able to offer Thrombophilia Screening, in order to investigate the possibility
of hypercoagulable states that can lead to an increased tendency for thrombosis. Screening
tests include measurement of Protein C, Protein S, and Antithrombin and activated Protein C
Resistance to Factor V.
The addition of a Homocysteine level may be appropriate
depending on the clinical findings.
Three citrated sample) are required for Thrombophilia screening to be carried out & an EDTA
if Homocysteine is required (see page 35).
Genetic screening tests for Factor V Leiden Mutation and Prothrombin Gene Variant are
processed at Royal Oldham Hospital. A single citrated or EDTA (2.7ml) sample is required.
Not all patients with thrombosis need a thrombophilia screen. In the majority of patients with
an inherited thrombotic tendency the thrombosis is venous and not arterial. Requests for
screens may be appropriate where there is evidence of:
 Venous thromboembolism under the age of 45 years
 A family history of early venous thrombosis
 Recurrent thromboembolism
 Venous thrombosis at unusual sites
 Recurrent superficial thrombophlebitis
A single venous thrombosis in an elderly patient is not an indication for a thrombophilia
screen.
Warfarin reduces levels of Protein C and S and can interfere with other thrombophilia tests.
Thrombophilia screens should be done only when patients have been off Warfarin for at least
6 weeks. Protein C and S levels can also be affected by pregnancy
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Lupus Anticoagulant Screen
Lupus Anticoagulant screening requires the collection of 2 citrated samples. Positive
screening tests will be confirmed using a reagent high in phospholipid. Anti Phospholipid
syndrome is an autoimmune disease associated with a high risk of thrombosis, recurrent
spontaneous miscarriages and thrombocytopenia.
D Dimer
D Dimer is used specifically to aid in the diagnosis of Deep Vein Thrombosis (DVT) and
Pulmonary Embolism (PE). Raised levels of D Dimer are indicative of a thrombotic event and
the lysis of the thrombi, they may however be raised in infection, trauma, pregnancy and
inflammation.
D Dimer cannot therefore be used to diagnose DVT but forms part of an analysis based
strategy using clinical information to form part of a negative predictive value.
A normal D Dimer makes clinically significant DVT or PE less likely. It is advisable to perform
a Wells score prior to sending a D-Dimer test
Factor Assays
Clotting factor assays require three (where possible) citrated samples and are used to
diagnose factor deficiencies, Haemophilia A, Haemophilia B and Von Willebrands disease.
Factor assays for both the intrinsic and extrinsic pathways can be performed.
The screening test for Von Willebrand disease - a Von Willebrand Factor Assay, Ristocetin
Cofactor and Factor VIII assay is also performed in house.
Haemolytic Disorders
For screening purposes a blood count, film, reticulocyte count, direct antiglobulin (Coombs)
test should be requested from the Haematology/Blood Transfusion Department and plasma
bilirubin and serum Haptoglobin from the Chemical Pathology Department. The results of the
screening tests may lead to the need for further tests which the laboratory will undertake as
appropriate.
Haematinics assays
Serum B12, Folate & Ferritin levels are performed in Haematology. All tests can be done on
one Brown Gel sample but this must be a separate sample to any Biochemistry test
requested. Haematology is unable to use/access the brown Gel tube that Biochemistry may
have.
Manual Differential
If the presence of abnormal WBCs, RBCs or platelets is suspected, a blood film,
examined by a trained eye, is performed for identifying immature and abnormal cells.
There are many diseases, disorders and deficiencies that can have an effect on the
number and type of blood cells produced their function and their lifespan.
Blood films are examined systematically, starting with macroscopic observation of the
obtained film and then progressing from low-power to high-power microscopic
examination, as the diagnosis of the type of anaemia or other abnormality present
usually depends upon a comprehension of the whole picture which the film presents,
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the leucocytes, red cells, and platelets are all systematically examined. The film
examination also serves to validate the automated blood count indices.
Findings from the blood film test do not always give a diagnosis but can provide
information indicating the presence of an underlying condition and its severity and the
need for further diagnostic testing.
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10 Quality Control, Assurance and Measurement Uncertainty
Quality Control
The department participates in all relevant National External Quality Assurance Schemes.
Within batch accuracy and precision is monitored using commercially available quality control
preparations and statistical methods incorporated into instrumentation.
Quality Assurance
This is relevant to all aspects of patient care and is increasingly subject to scrutiny by the
processes of medical audit and accreditation. All laboratories will now be assessed by UKAS
against the ISO 15189 Standard – “Medical Laboratories – Requirements for quality and
competence”. The Haematology and Blood Transfusion laboratories within The Pennine
Acute Hospitals NHS Trust are ISO 15189 accredited.
Measurement Uncertainty (MU)
It is now widely recognised that, when all of the known or suspected components of error
have been evaluated and the appropriate corrections have been applied, there still remains
an uncertainty about the correctness of the value of the quantity being measured for any test
result. No measurement or test is perfect and imperfections give rise to “measurement
uncertainty” (MU) which in essence means that if the same test is performed on the same
sample several times, the results will differ slightly each time.
The Haematology and Blood Transfusion Laboratory has undertaken a Statistical analysis to
assess the degree of uncertainty for the results we produce. This is not routinely reported,
however, we will provide this information to our service users upon request
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11 Referred Tests
The tests listed below are not currently carried out within the Haematology laboratories at
Pennine Acute Hospitals NHS Trust.
Criteria used to assess the suitability of referral laboratories include: CPA status www.cpa-uk.co.uk
 UKAS ISO 15189 accreditation status www.ukas.com
 Satisfactory EQA participation
 Ability to meet expected turnaround times
The above are reviewed regularly annually.
ADAM TS13
SPECIMEN
2 x 3ml citrated samples.
ADDRESS
FAO Rebekah Fretwell
Sheffield Haemophilia and Thrombosis Centre
Coagulation Laboratory, Floor H
Royal Hallamshire Hospital
Glossop Rd
SHEFFIELD S10 2JF
ENQUIRES
Tel. No. 0114 2712955
FOR HMDS LEEDS
BCR-ABL, JAK2, Calreticulin, JAK2 Exon 12,
Rare BCR-ABL variants, APML, & NPM1, Other rare mutations
SPECIMEN
ADDRESS
10mls EDTA required, 5ml minimum for each test (2-3ml EDTA
sample for Bone Marrow). Blood may be refrigerated overnight;
Bone Marrow samples must go the same day. HMDS request
form
www.hmds.info/Content/GenInfo/Downloads/Downloads.aspx
HMDS
Level 3
Bexley Wing
St James’s University Hospital
Beckett Street.
Leeds
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Haematology and Blood Transfusion
LS9 7TF
ENQUIRES
0113 206 7851
BCR-ABL, JAK2, JAK2 EXON 12 & APML For MRI
SPECIMEN
10mls EDTA required, 5ml minimum for each test (2-3ml EDTA
sample for Bone Marrow). Blood may be refrigerated overnight;
Bone Marrow samples must go the same day.
ADDRESS
Molecular Diagnostics Centre
MRI
Oxford Road
Manchester M13 9WL
ENQUIRES
0161 276 4137
0161 276 4809
Direct line
Laboratory
B-RAF Mutation Analysisfor Hairy Cell Leukaemia
SPECIMEN
2 x 2.7ml EDTA
ADDRESS
HMDS
Level 3
Bexley Wing
St James’s University Hospital
Beckett Street.
Leeds
LS9 7TF
ENQUIRES
0113 206 7851
Cell Markers for MRI (Non Haematology Patients)
All cell markers for known Haematology patients &? Haematological Disorders (from
GPs or Ward) should be sent to HMDS, Leeds. The non-malignant cell markers for
non-Haematology patients’ needs to go to Immunology at MRI.
SPECIMEN
Any of the following specimens:
EDTA 5mls,
20mls blood and 400iµ heparin
5mls marrow and 100iµ heparin and transport medium
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(Preferably in special Transport medium bottles supplied by Immunology at MRI)
ADDRESS
Department of Immunology
Clinical Sciences Building
Directorate of Laboratory Medicine
Manchester Royal Infirmary
Oxford Road
Manchester M13 9WL
ENQUIRES
Tel: 0113 206 7851
Cell Markers on CSF - HMDS, Leeds (Haematology Patients)
SPECIMEN
CSF min 0.5ml. Samples must be sent immediately as they
deteriorate rapidly
ADDRESS
HMDS
Level 3, Bexley Wing
St James’s University Hospital
Beckett Street.
Leeds LS9 7TF
ENQUIRES
Tel: 0113 206 7851
Cytogenetics
SPECIMEN
Bone Marrow - 1ml in pink medium bottle, accompanied by a
completed oncology card. Be aware of expiry date on bottles.
ADDRESS
Oncology Cytogenetics
Pathology Department
Christie Hospital
Wilmslow Road
Manchester M20 4BX
ENQUIRIES
Telephone: 0161 446 3165
CD 4/CD8/CD20
SPECIMEN
EDTA 5mls
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Haematology and Blood Transfusion
ADDRESS
Department of Immunology
Clinical Sciences Building
Directorate of Laboratory Medicine
Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
ENQUIRIES
0161-276-6440
CHROMOSOME ANALYSIS (ST MARY'S) KARYOTYPING
SPECIMEN
1 x Lithium Heparin sample
ADDRESS
GENETIC MEDICINE
6TH FLOOR
St Mary's Hospital
Oxford Road
Manchester
M13 9WL
ENQUIRIES
0161 276 6118
DHR Test – Neutrophil Stimulation Test
SPECIMEN
1 x Lithium Heparin sample
ADDRESS
Department of Immunology
Clinical Sciences Building
Directorate of Laboratory Medicine
Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
ENQUIRIES
Telephone: 0161 276 6007
EMA screen for red cell membrane abnormalities (Spherocytosis screen)
SPECIMEN
2.7ml EDTA sample
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Haematology and Blood Transfusion
ADDRESS
Department of Immunology,
Clinical Sciences Building,
M.R.I.
Oxford Road
Manchester
M13 9WL
ENQUIRIES
0161 276 6440
Factor VIII inhibitor & Factor XIII (Factor 13)
SPECIMEN
3ml Tri - Sodium Citrate sample required
ADDRESS
Coagulation Laboratory
Manchester Royal Infirmary
Oxford Road
Manchester M13 9WL
TELEPHONE
0161 701 2123 Coagulation dept.
FIP1L1 - PDGFRA
SPECIMENS
1 x 10-20 ml peripheral blood in EDTA
ADDRESS
Professor Nick Cross
Wessex Regional Genetics Laboratory
Salisbury District Hospital
Salisbury
Wiltshire, UK
SP2 8BJ
ENQUIRIES
Tel: 01722 429080
G6PD Assay
SPECIMEN
ADDRESS
2.7ml EDTA
Red cell Dept.
Manchester Royal Infirmary
Author : Jennie Rogers
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Haematology and Blood Transfusion
Oxford Road
Manchester
M13 9WL
ENQUIRIES
0161 276 4689
G6PD GENETIC TESTING
Must seek approval from Haematology medics or laboratory managers before
sending this test.
SPECIMENS
EDTA sample
ADDRESS
Genomic Diagnostics Laboratory
Genetic Medicine
St Mary's Hospital
Oxford Road
Manchester
M13 9WL
ENQUIRIES
Tel: 0161 276 6122
HAEMOCHROMATOSIS GENE TESTING
SPECIMENS
1 x EDTA min 1ml
ADDRESS
FAO Dr Steve Keeney
Molecular Diagnostics Centre
Central Manchester Haematology Service
CADET and MDC Building
Central Manchester University Hospitals NHS
Foundation Trust
Oxford Road, Manchester M13 9WL
ENQUIRIES
01612764809
HAEMOGLOBINOPATHIES (Non Ante Natal)
SPECIMEN
1 x EDTA
ADDRESS
The National Haemoglobinopathy Reference Laboratory
Molecular Haematology
Level 4
John Radcliffe Hospital
Oxford OX3 9DU
Author : Jennie Rogers
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Haematology and Blood Transfusion
ENQUIRES
Telephone:
01865 572769
HEPARIN INDUCED THROMBOCYTOPENIA (HIT) TESTING
SPECIMEN
1 x Brown gel tube (centrifuged) or 1 x Citrate tube. Min 400µl
ADDRESS
FAO Kevin Horner
Coagulation Laboratory
Floor H
Royal Hallamshire Hospital
Glossop Rd
SHEFFIELD
S10 2JF
ENQUIRES
0114 2712955
HOLO TRANSCOBALAMIN/ACTIVE B12
SPECIMEN
7.5ml Serum Brown Gel.
ADDRESS
Nutristasis Unit
Haemostasis and Thrombosis
Viapath Pathology
5th Floor, North Wing
St. Thomas’ Hospital
London
SE1 7EH
ENQUIRES
Telephone:
02071886815
HOMOCYSTEINE
SPECIMEN
ADDRESS
An EDTA is required, within 30 minutes of venepuncture.
Medical Biochemistry Department
University Hospital of Wales
Cardiff
CF14 4XW
Author : Jennie Rogers
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Haematology and Blood Transfusion
ENQUIRIES:
029 2074 7747
029 2074 2805-Reception
029 2074 2637-Biochemistry
029 2074 3560-Special Biochemistry
MALARIA PCR
SPECIMEN
EDTA from Positive Malaria.
ADDRESS
Malaria Reference Laboratory
London School of Tropical Medicine
Keppel Street (Gower Street)
London
WC1E 7HT
ENQUIRIES
020 7927 2427
MALARIA ANTIBODIES
SPECIMEN
A minimum of 0.5ml of serum from Brown Gel Tube
or 0.5ml EDTA plasma is required.
ADDRESS
The Department of Clinical Parasitology
The Hospital for Tropical Diseases
3rd Floor Mortimer Market Centre
Mortimer Market
London WC1E 6JB
ENQUIRIES:
Tel Lab: 020 3447 5413 General enquiries: 020 3447 5418
MICROFILARIA MICROFILTRATION AND CONFIRMATION
SPECIMEN
3 x citrate (10-20ml blood)
For Loa Loa take samples 12noon – 2pm
For W. bancrofti & B.malayi take around midnight
ADDRESS
HPA - Diagnostic Parasitology Laboratory
London School of Hygiene & Tropical Medicine
Keppel St / Gower St
London WC1E 7HT
ENQUIRIES
020 79272427
Author : Jennie Rogers
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Haematology and Blood Transfusion
PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA (PNH)
SPECIMEN
4mls EDTA
ADDRESS
HMDS
Level 3
Bexley Wing
St James’s University Hospital
Beckett Street.
Leeds
LS9 7TF
ENQUIRIES
0113 206 7851
Platelet Function Assay - PFA 100
SPECIMEN
Sample 5mls Citrate. Needs to be <4hrs old from time sample
taken to time of processing at MRI.
ADDRESS
Coagulation Laboratory
Manchester Royal Infirmary
Oxford Road
Manchester M13 9W
ENQUIRIES
TEL: 0161 701 2123 Coagulation
0161 276 4695/4428 Specimen Reception
Platelet Flow Cytometry
SPECIMEN
4 x 3ml Citrate samples from the patient and 4 x 3ml citrate
Samples from a normal control patient.
GpIIb can be done on 1 x EDTA
ADDRESS
Immunology Dept
Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
ENQUIRIES
TEL: 0161 276 6440
Author : Jennie Rogers
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Haematology and Blood Transfusion
PYRUVATE KINASE DEFICIENCY
RED BLOOD CELL ENZYME DEFICIENCIES
SPECIMEN
1ml in Heparin or EDTA
ADDRESS
FAO Chris Lambert
Red Cell Laboratory
Department of Haematological Medicine
King's College Hospital
Demark Hill
London
SE5 9RS
ENQUIRIES
020-3299-9000
T CELL RECEPTOR GENE REARRANGEMENT STUDIES (TCR)
SPECIMEN
4 EDTA samples or Bone Marrow
ADDRESS
HMDS
Level 3
Bexley Wing
St James’s University Hospital
Beckett Street.
Leeds
LS9 7TF
ENQUIRIES:
Tel: 0113 206 7851
TRANSPLANTATION LABORATORY Tests
(Including cytotoxic antibodies)
SPECIMEN
EDTA's, heparin, heparin/saline.
Depending whether testing is on donor or recipient.
Clotted sample for cytotoxic antibodies.
ADDRESS
The Transplantation Laboratory
2nd Floor, Purple Zone
Manchester Royal Infirmary
Oxford Road
Manchester
M13 9WL
ENQUIRIES
Telephone: 0161 276 6397
Author : Jennie Rogers
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Haematology and Blood Transfusion
Zinc Protoporphyrin (Z.P.P)
SPECIMEN
0.5 – 1.0ml EDTA
ADDRESS
Block 46
St James’s University Hospital
Beckett Street
Leeds
LS9 7TF
ENQUIRIES
0113 206 4760 or 0113 206 6063
Author : Jennie Rogers
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