Pathology Users Guide
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Version 5 - 2014
Controlled Document Code: PATH.CD.018.3
(Please note that only the electronic version of this document is controlled, once
printed it is not a controlled document)
The information contained within this guide is intended for users of
the Pathology Directorate at Tameside General Hospital. Please
contact the Pathology Directorate if you have any comments or
suggestions concerning this guide.
Version 5.0 (August 2014) - Review date: August 2016
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Contents
Content
Contact numbers
General information
Blood Sciences
Biochemistry:
• Biochemical Profiles
• Test information (inc. reference ranges)
• Paediatric reference ranges
• Point of care testing (POCT)
• Paracetamol interpretation
• Therapeutic Drug Monitoring
• Dynamic Function Tests and Special Tests
• Glucose Tolerance Test
• Synacthen Test
• Dexamethasone suppression test (low dose)
• Renin and aldosterone
• Water deprivation test
• Tumour markers
• Drugs of abuse
• Virology
• Porphyrin screen
Haematology
Blood Transfusion
Immunology Services
Microbiology Department
Cellular Pathology
Mortuary Department (at TGH)
List of laboratories for referred investigations (all departments)
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82
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97
100
Contact numbers
Tameside General Hospital
Pathology Fax:
0161 922 6000
0161 922 6496
Directorate internal hospital numbers (prefix with 0161 922 if dialing from outside). If in
doubt concerning who part of the directorate to contact then please use General Enquiries
on 6497 who will then be able to advise and re-direct your call.
Pathology Directorate
Clinical Director
Dr Vicki Howarth
6417
Diagnostics Manager
Mr Geoff Lavelle
6392
Secretary to Mr Lavelle
4003
IT/QMS Manager
Ms Nicola Bullough
6419
Pathology (Main Office/General Reception)
6393
Specimen Reception and General Enquiries
6497
Administration and Clerical Manager
Ms A Reece
6596
Blood Sciences Department
Results and Enquiries
6497
Laboratory Fax
6499
Blood Science Manager
Ms Gillian Lewis
6318
Deputy Blood Sciences Manager
Ms Raheela Bibi
4620
General Enquiries (Haematology)
6497
General Enquiries (Blood Transfusion)
6391
Consultant Clinical Scientist
Mr Tony Tetlow
6495
Consultant Haematologist
Dr Hussein Baden
6501
Dr Andrew
Heppleston
4634
Specialist Practitioner of Transfusion
Ms Caroline Holt
5484
Point of Care Coordinator
Ms Raheela Bibi
4620
Microbiology Department
General Enquiries
6492
Consultant Microbiologist
Microbiology Manager
Dr P Unsworth
6500
Dr H Sacho
4086
Ms C Hatch
6418
Mortuary Department (at TGH)
Mortuary Manager
Sharon McMinn
6520
Mortuary Office
6059
On call technician
Via hospital
switchboard
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Cellular Pathology Department
6059
General Enquiries (Mortuary)
The service has now transferred to University Hospital South Manchester as Part of the
South Sector Pathology Initiative. Please refer to relevant section of user guide.
Any of the above departments can be contacted by mail at:
Department of ---------Directorate of Laboratory Medicine
New Fountain House
Tameside Hospital
Ashton-under-Lyne
Lancashire OL6 9RW
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General Information
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Laboratory opening times
Sample Reception: 8:30am to 6:00pm (Monday to Friday)
The Haematology/Blood Transfusion and Biochemistry Departments
(Blood Sciences) operate a 24 hours service; one qualified staff
member is on duty in each of the 2 disciplines outside routine working
hours. These departments also operate a senior staff “on-call” rota in
collaboration with neighbouring hospitals (contactable via the
switchboard on duty).
The Microbiology Department operates a core service 08.35 hrs to
17.30 hrs, outside these hours an ‘on-call’ service for urgent work
only is available, contact should be made via the switchboard.
Consultant staff are also available outside normal laboratory hours for
clinical advice (contactable via the Biomedical Scientist on call).
SPECIMEN COLLECTION
The Trust phlebotomy is managed by the nursing directorate.
The service can be accessed by the following:
A. In-patients
Blood samples are normally taken by a phlebotomist, but if one is not
available, the doctor or a trained support worker may take the blood.
Request cards should be left on the wards before the phlebotomist
commences their duties (8.30 am). Specimens for requests made after
the phlebotomist has left the ward will not be taken before the
following normal working day. A limited phlebotomy service is
available on Saturdays, Sundays and Bank Holidays.
The department has standardised on the "Monovette" blood
collection system which acts as a combined syringe/blood container,
rather than the conventional syringe and needle. If you require tuition
in the collection of samples by this technique, please contact a
phlebotomist.
B. Out-patients
Blood can be collected from out-patients by referring them to the
phlebotomists at the Blue Suite Clinic (internal 6637) between 9:00am
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and 4:30pm Mon-Fri.
C. GP Patients
Patients can be referred to the hospital for the collection of blood. The
phlebotomists are present between 9.00 am and 4.30 pm at the Blue
Clinic (see above).
SPECIMEN SPILLAGE
When spillages occur during transport of specimens then:
• Ward and clinic areas – inform nursing staff and follow local policy.
• Pneumatic tube system – inform maintenance (ext 6999).
• Laboratory areas – inform senior staff, policy for
cleaning/decontamination to be found in Risk Management Policy
and Blood Sciences Health and Safety Policy. Consult Q-Pulse for
relevant policy (PATH.POL.004).
• All other areas – contact laboratory for advice.
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Blood collection bottles available:
Blood Transfusion
The Monovette blood collection system is used throughout the
hospital. Please read the instructions and types of specimens required
before collection. Paediatric sample tubes are also available (see over).
Please note that when the sample is taken then the tube should be
mixed by a minimum of 12 inversions as recommended by the
supplier. This is necessary to ensure the quality of analytical data
obtained.
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Paediatric/micro blood bottles available:
1.3ml EDTA for full blood
counts
1.1ml serum gel – all
tests requiring serum
1.3ml citrate for
coagulation tests
0.5ml lithium heparin
0.5ml lithium heparin
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Request Form and Specimen Labelling
Please note this is covered by the Trust’s Specimen Acceptance Policy (2008)
and Patient Identification Policy (2008) available from Trust’s intranet site or
by contacting the laboratory.
Pathology reserves the right to refuse any specimen which has not been
adequately labelled.
All specimens must be accompanied by a completed request form. Below
are the details required for satisfactory identification.
Request form:
• Full name (surname and forename)
• Date of birth
• District number (or NHS number or first line of address)
• Test(s) required.
• Location for report
• Name of Consultant or General Practioner.
Specimen:
• Full name (surname and forename)
• Date of birth.
• District number (or other identifier from request form).
• (Requests for Blood Transfusion mustbe hand written and have the
signature of the person taking the sample plus the date)
Note: it is the responsibility of the Health Care Professional to establish the
identity of the patient before the sample is taken (see Trust’s Patient
Identification Policy, http://tis/documents/PatientIdentificationPolicy.pdf)
The Clinical Director in conjunction with the Trust Board and Risk
Management operates a “zero-tolerance” approach in the interests of
patient safety. Only under very exceptional circumstances when the
specimen can not be repeated will accepting a sample is considered. The
full details and an explanation of what constitutes a “non-repeatable”
sample are on the Trust’s intranet site
(http://tis/documents/specimenacceptancepolicy.pdf ) or contact Mr Tony
Tetlow (ext. 6495)
Additional note regarding requests for Blood Products:
All request forms must be signed by the requesting clinician. Additionally the
sample tube must be hand written, signed and dated.
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Air tube Conveyor System
Air tube stations are situated around the site. Full operating details are
available at each station, and further details can be obtained via Pathology
or the Estates Department. Breakdowns and faults should be reported to
Estates Tel: 6999. Please note that the air tube system is NOT the
responsibility of Laboratory Medicine.
Ward Order Communications
The hospital has an electronic link between the Patient Administration
System (PAS) and the Pathology Computer System. Specialised software
(Lorenzo) allows pathology requests to be made electronically. The system
is available for Haematology (NOT Transfusion), Microbiology and
Biochemistry requests from all wards and clinics; all requests for these
departments must be made electronically. Please note that blood bank
request are available via Lorenzo but this function must not be used and is
not function on the labpratory information management system – please
see transfusion policy.
Medical staff training on this system is undertaken by the IT Department. All
Haematology Biochemistry and Microbiology results are available on
Lorenzo once they are released. Please look for the results on Lorenzo
before telephoning.
GP Electronic Reporting
The Pathology Department at present transfers results electronically to GP
Practices. Results are sent continuously in order that patients' results are
available for viewing next morning on the GP's' own computer systems for
those that can accept standard transfer protocols for Pathology results. The
two most common GP computer systems VAMP and EMIS are both capable
of receiving results.
New GP practices can easily be mail boxed with results if and when required
providing their computer systems are compatible.
For any query about pathology IT issues please contact Geoff Lavelle
(Pathology Manager)
High Risk Specimens
Specimens from a patient deemed to be high risk must be labelled and
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transported to the laboratory following the Trust’s Policy for high risk
specimens/patients.
This is to comply with the responsibilities under the Control of Substances
Hazardous to Health regulations (COSHH) and a recent national H&S alert.
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Transport of samples to laboratory
From Wards and Out-patient Departments
Apart from the air tube system samples are also picked up from the
following collection points.
Time
10:30am
Location
Ante Natal Clinic
Yellow Suite
Blue Suite
Ante natal Clinic
Yellow Suite
Blue Suite
Care of the Elderly
MI Unit
Ante Natal Clinic
Yellow Suite
Blue Suite
Care of the Elderly
Ante Natal Clinic
Yellow Suite
Blue Suite
11:45am
2:45pm
3:45pm
For urgent samples both during and after the working day, it is the
responsibility of the originator of the request to make arrangements for the
transport of the sample to the laboratory by e.g. air-tube or portering
services. During the working day, samples should be brought direct to the
laboratory or sent via the air-tube. Outside working hours specimens should
be sent via the air-tube or taken to the department (access is gained via a
buzzer/intercom system).
GP'S
The laboratory provides a transport service which collects samples from GP
surgeries in the Tameside and Glossop district in the morning and
afternoon, everyday from Monday to Friday. Please contact laboratory for
collection times for each practice.
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Microbiology – ‘On Call Emergency Service’
Urgent Joint Fluids
CSF Samples
Urgent Paediatric Urines
Other samples: via consultation with the Medical Microbiologist.
Distribution of printed reports
In-patients:
GP patients:
There are 2 report distributions per day, 12:30 and
17:30
Reports are sent by transport (daily).
Please note the directorate operates a no-faxing policy unless the fax
machine has been established as a “safe haven”. Please see Trust’s data
protection policy for further details
(http://tis/documents/SafeHavenPolicy.pdf) or contact laboratory for
advice.
Telephoned results
It would be appreciated if telephone enquiries to the laboratory asking for
results, could be kept to a minimum. All results from pathology are
electronically sent to the Lorenzo EPR, if the request is made electronically
or the district number is used on the request. So please check the Lorenzo
system before telephoning for results.
If contacting the department by phone then please ensure you have full
patient details, date of collection and tests required.
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Note: in line with the Royal College of Pathology’s guideline (2010):
“Out-of-hours reporting of markedly abnormal laboratory test results to
primary care: Advice to pathologists” and in consultation with service users the
following limits for telephoning seriously abnormal results have been agreed:
Therapeutic Drug
Enzymes
Profile Components
Biochemistry
Analyte
Units
Sodium
Action limits
Below
Above
mmol/l
<120
>160
Potassium
mmol/l
2.5
6.0*
Urea
mmol/l
-
30
Creatinine
µmol/l
Glucose
mmol/l
2.5
20**
Calcium (corrected)
mmol/l
1.80
3.00
Magnesium
mmol/l
0.4
-
Phosphate
mmol/l
0.3
-
AST
U/L
-
750
ALT
U/L
-
750
CK
U/L
-
5000
Amylase
U/L
-
500
Carbamazepine
µmol/l
-
60
Digoxin
nmol/l
-
3.5
Theophylline
µmol/l
-
150
Phenytoin
µmol/l
-
150
Phenobarbitone
µmol/l
-
>300
Lithium
mmol/l
-
1.5
250
*Check sample is not haemolysed (sample quality check), EDTA contaminated
(check magnesium, calcium and alkaline phosphatase) or if there has been a
delay in separation (check phosphate)
** >30 mmol/l if known diabetic
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Haematology
Action limits
Analyte
Units
below
Haemoglobin
Profile components
Total White Cell Count
Absolute Neutrophil Count
Platelet Count
g/L
80
9
10 /L
2
9
10 /L
1
9
30
10 /L
Above
INR
5.0
APTTR
3.0
Fibrinogen
g/L
1.0
Newly presenting leukaemia
Newly presented malaria
Positive Sickle Cell Haemoglobin in patients about to undergo anaesthesia
Additionally:
Troponins (GP only)
If >0.07 ug/l
Paracetamol
Always treat as urgent and potentially
life threatening
CSF (total protein and glucose)
If not requested by ward order coms
(WOC).
Blood gases
If not requested by WOC.
The directorate will make every endeavour to communicate any results
requiring immediate attention to the initiator of the request. If there are
insufficient details on the request form this may be impossible outside of core
laboratory hours and may cause delays in these results being transmitted.
High risk specimens
To comply with Health and Safety, and COSHH regulations the Collection,
Transport and Reception is covered in the Pathology Policy available on
request from Q-Pulse.
Referred investigations
All investigations requests are not performed in the Pathology Department at
Tameside General. Specialist investigations and the less requested investigation
may be referred to other more specialist laboratory in the region or throughout
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the country. These investigations may take longer to be reported. The
directorate does audit these tests and in the event of an excessive delay, please
contact the laboratory for help and/or advice. An indication is made for many
tests in this handbook but this can only act as a guide.
A list of laboratories used for referred tests is available later in the user guide.
Should you need to contact an external laboratory we strongly recommend
you discuss this with the laboratory first. This will save time and confusion.
Requests for further tests on samples already held by laboratory
It is occasionally possible for further testing to be done on samples held by the
laboratory. Samples are held for a minimum of 5 calendar days by Biochemistry
and a maximum of 2 calendar days (minimum 1 day) by Haematology (for
Microbiology and Histology please contact relevant department). Requests for
further tests are possible after considerations of:
• If there is sufficient sample remaining.
• If the requested analyte is stable under the storage conditions.
• The sample is the correct type.
Tests not present in User Guide
Please note that the User Guide does not mention all possible investigations for
reasons of brevity, only the most commonly requested tests are included. If an
assay is required but is not in this document then please contact the relevant
department.
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BIOCHEMISTRY
DEPARTMENT
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Biochemistry – telephone extension number.
Results
6497
General Enquiries
6498
Mr Tony Tetlow
([email protected] )
Consultant Clinical Scientist
6495
Gillian Lewis
(gillian.lewis@tgh,nhs.uk )
Blood Sciences Manager
6318
Raheela Bibi
([email protected] )
Deputy Blood Sciences
Manager/Point of Care
Coordinator
6420
When phoning from outside the hospital use 0161-922 then the extension
number.
Specimen collection – please note the following pre-laboratory errors
frequently occur but may be avoided by –
• Correct sample for relevant test (see later)
• Insufficient mixing of blood sample with contents of blood collection
tube (minimum of 12 full inversions).
• Prompt delivery to the department.
The most common reasons for pre-analytical factors affecting results are:Problem
Common causes
Consequences
Delay in separation
Overnight storage.
Delay in transit
Increased K , PO4, ALT, LDH.
+
Decreased HCO3 , (Na occasionally)
Storage
Storing at 4 C
Haemolysis
Expelling blood through needle into
tube
Over vigorous mixing of specimen
o
Storing specimen in freezer (-20 C)
Excessive delay in
transit
Leaving specimen in hot environment
o
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+
+
Increased K
Decreased HCO3
Problem
Common causes
Consequences
Inappropriate sampling
site
Specimen taken from drip arm
Increased drip analyte e.g. glucose,
+
2+
K , Mg
(dilutional effect)
Incorrect container or
anticoagulant
No enzyme inhibitor,
EDTA tube or transferring blood from
one tube to another
Low glucose
+
+
Increased K , Na
2+
2+
Decreased Ca , ALP, Mg
Problem
Common causes
Consequences
Lipaemia
Specimen taken after a fatty meal.
Decreased Na
+
PLASMA OR SERUM SAMPLES (WHITE, BROWN OR ORANGE TUBES) MUST BE TAKEN
BEFORE EDTA SAMPLE (YELLOW OR RED).
Contamination of blood specimens with potassium EDTA is a major problem
for the Biochemistry department and the following will explain why.
Q. What are the effects of EDTA contamination?
• Increased potassium - leading to an incorrect interpretation of
potassium levels.
• Decreased calcium, magnesium and alkaline phosphatase.
Q. Why use EDTA if it is such a problem?
Potassium EDTA is the anticoagulant primarily used by the Haematology
department because the cellular components and morphology of the blood
cells are preserved and it is the recommended anticoagulant for
haematology.
Q. How does it work?
EDTA inhibits clotting by chelation of calcium and magnesium which inhibits
several calcium and magnesium dependent enzymes critical to the clotting
cascade.
Q. Can it be spotted by the lab?
Gross contamination can be spotted by the lab due to unbelievable levels of
calcium (and/or magnesium), potassium and alkaline phosphatase. It only
takes a trace of EDTA to alter the results and this may not be obvious. THE
LABORATORY CAN NOT RELIABLY IDENTIFY EDTA CONTAMINATION. The safe
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practice is to avoid contamination in the first place and that is the
responsibility of the person taking the blood sample.
Q. How can contamination be avoided?
When taking a series of blood specimens, it is essential that specimens for
biochemistry (e.g. urea and electrolytes) are taken first and EDTA samples
are taken last.
If you have any doubts about the accuracy of a potassium e.g. if it does not
agree with the patient’s condition or with previous results then obtain a
fresh sample (of which you are sure of the integrity) and have it analysed as
a emergency.
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Biochemical Profile
These are tests groups together to simplify requesting. All profiles require 5ml
sample (minimum) the only exception is the paediatric profile which requires a
full microtainer. All profiles will be analysed the same day and if indicated as
urgent, within 1 hour. The common profiles are:Profile
Tests
Reference Range
Routine profile
(GP only)
Sodium
Potassium
Chloride
Bicarbonate
Urea
Creatinine (ince eGFR)
Calcium (plus corrected calcium)
Albumin
133 – 136 mmol/l
3.5 – 5.0 mmol/l
95 – 108 mmol/l
22 – 29 mmol/l
2.5 – 7.8 mmol/l
40 – 110 µmol/l
2.12 – 2.63 mmol/l
31 – 45 g/l
U&E
Sodium
Potassium
Chloride
Urea
Creatinine
133 – 143 mmol/l
3.5 – 5.0 mmol/l
95 – 108 mmol/l
2.5 – 7.8 mmol/l
40 – 110 µmol/l
A&E
(must reach laboratory
within 30min or it will
be replaced by U&E
profile)
Sodium
Potassium
Chloride
Urea
Creatinine (inc eGFR)
Glucose
133 – 143 mmol/l
3.5 – 5.0 mmol/l
95 – 108 mmol/l
2.5 – 7.8 mmol/l
40 – 110 µmol/l
2.6 – 6.5 mmol/l
Liver profile
Total Protein
Albumin
Globulin (by calculation)
Bilirubin
Alkaline Phosphatase (ALP)
Alanine Transaminase
γGlutamyl Transpeptidase (GGT)
62 – 80 g/l
31 – 45 g/l
24 – 43 g/l
3 – 21 µmol/l
25 – 125 IU/l
0 - 60 IU/l
0 – 50 IU/l
Bone Profile
Calcium (plus corrected calcium)
Albumin
Phosphate
Alkaline Phosphatase (ALP)
Total Protein
2.12 – 2.63 mmol/l
31 – 45 g/l
0.83 – 1.35 mmol/l
25 – 125 IU/l
62 – 80 g/l
Nutritional Marker
Magnesium
Prealbumin
C-Reactive Protein (CRP)
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0.7 – 1.0 mmol/l
150 – 350 mg/l
<8.0 mg/l
Profile
Tests
Thyroid profile
Thyroid Stimulating Hormone
Free Thyroxine
0.4 – 4.5 mU/l
7 – 17 pmol/l
Drug Profile (urine)
Opiates
Benzodiazepines
Amphetamines
Cocaine metabolite
Methadone metabolite
Creatinine
Not detected
Not detected
Not detected
Not detected
Not detected
>1.8 mmol/l
Lipid Profile
Cholesterol (total)
HDL Cholesterol
LDL Cholesterol
Triglycerides (fasting)
<5.0 mmol/l
>1.0 mmol/l
<4.0 mmol/l
<2.1 mmol/l
Androgen Profile (Male)
Testosterone
10 – 28 nmol/l
Androgen Profile
(female)
Testosterone
Sex Hormone Binding Globulin
Androstenedione
Free Androgen Index (calculated)
Androstenedione
<1.6 nmol/l
18 – 114 nmol/l
<6.0 nmol/l
< 4.5
<6 nmol/l
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Reference Range
Sample requirements and reference ranges (adult) for commonly requested
tests.
Due to the large number of possible requests not all assays are listed. If you
require a non-listed test then please contacted the laboratory for an estimated
turnaround time. We will contact the referral laboratory on your hehalf.
The turn around times are when we expect at least 90% of assays to be
completed. If result has not been returned within the quoted time then please
contact the laboratory who will then investigate.
Test
Specimen
Type
Volume
Required
Turn Around
Reference Range
Adrenocorticotrophin (ACTH). Second
line test for adrenal dysfunction.
plasma
(send to
lab on ice)
10ml
Referred test – 12
days
0 – 46 ng/l
Alanine Aminotransferase (ALT).
Increased levels indicate liver cell
damage of any cause.
serum
5ml
<24hr
<60 IU/l
Albumin
Low levels due to renal/GI loss, low
synthesis, dietary, over hydration of
redistribution.
serum
5ml
<24hr
31 – 45 g/l
Alcohol (blood)
blood
(fluoride)
5ml
<24hr
Not Detected
Alcohol (urine)
random
urine
5ml
<24hr
Not Detected
Aldosterone
Measured with renin for diagnosis of
Conn’s Syndrome.
plasma
10ml
Referred test – 21
days
See report
Aldosterone: renin ratio
random sampling of these hormones
gives a ratio used as an initial screen
for primary hyperaldosteronism.
plasma
(send to
lab on ice)
10ml
Referred test – 21
days
<630 pmol/l
Alkaline Phosphatase
Elevated in bone and liver disease
(naturally elevated in children and
pregnancy).
serum
5ml
<24hr
25 – 125 IU/l
Alpha-1-antitrypsin
Evaluation of COAD, emphysema and
liver disease. Acute phase reactant.
serum
5ml
referred test – 14
days
1.1 – 2.1 g/l
Alpha-1-antitrypsin (phenotyping)
Evaluation of low alpha-1-antitrypsin
levels
serum
5ml
referred test – 14
days
see report
Alpha-fetoprotein
Tumour marker for hepatocellular
carcinoma
serum
5ml
<24hr
<5 KU/l
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Specimen
Type
Volume
Required
Turn Around
Reference Range
17-alpha-Hydroxyprogesterone
Diagnosis of CAH due to 21rd
hydroxylase deficiency. 3 line
investigation of hirsutism (late onset
CAH). Monitoring of CAH patients
serum
5ml
referred test - 14
days
<10 nmol/l
Amino acids (urine).
Disorders of amino acid metabolism
urine
10ml
referred test –
28 days
Normal pattern
Ammonia
Paediatric disorders e.g. urea cycle
disorders. Contact lab before sending.
plasma
1ml
<1hr
Sick/prem = <150 µmol/l
neonate = <100 µmol/l
<16 yr = <50 µmol/l
Amylase
Raises in acute pancreatitis
serum
5ml
<24hr
20 – 110 IU/l
<35 IU/mmol creat.
Amylase:creatinine
clearance ratio: 0.02 –
0.05
Test
Amylase (urine)
Investigation of macroamylasaemia.
Comparison with serum, paired
sample should be taken at same time
urine
10ml
<24hr
Amino Acids
Investigation of inherited defects of
amino acid metabolism
urine
10ml
referred test –
28 days
see report
Androstendione
Investigation of hirsutism
serum
5ml
referred test - 14
days
<6.0 nmol/l
Angiotensin converting enzyme (ACE)
Monitoring sarcoidosis
serum
5ml
referred test –
12 days
15 – 55 IU/l
Antiepileptic drugs
Monitoring therapy and toxicity
serum
5ml
<24hr
see individual drugs
Anti-Mullerian Hormone
Assessment of ovarian reserve.
Note: consultant request only.
serum
5ml
referred test - 14
days
Aspartate aminotransferase
Raised in liver and muscle damage
serum
5ml
<24hr
11 – 37 IU/l
Bence-Jones Protein
Monoclonal immunoglobulin free light
chains in urine
urine
20ml
14 days
not detectable
Beta-2-microglobulin
prognostic indicator in myelomatosis
serum
5ml
14 days
0.9 – 2.5 mg/l
Bicarbonate
acid-base status
serum
5ml
<24hr
22 – 29 mmol/l
Bile acid
cholestasis of pregnancy
serum
5ml
<24hr
<14 µmol/l
Bilirubin
Raised in haemolysis, hepatocellular
damage or biliary obstruction
serum
5ml
<24hr
3 – 21 µmol/l (adult)
Bilirubin (neonate)
Spectrophotometric analysis only
suitable if <3 months old.
serum
0.5ml
<24hr
heparinised
arterial
blood
or capillary
sample
(on ice)
2 ml
<0.5hr
Blood gases
Acid – base status – must be received
by lab within 30min of sampling. Blood
gas analysers available on ITU. CCU
and A&E. Please note that the sample
must NOT contain any air gaps and
must have been thoroughly mixed.
Page 26 of 106
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<6.0 pmol/l
low
6-24.pmol/l
reduced
24 – 70
pmol/l
optimu
m
>70 pmol/l
PCOS
see paediatric ranges
see report
Test
BNP
Use to identify patients with left sided
heart failure who may require echo
ECG
Specimen
Type
Volume
Required
Turn Around
Reference Range
Whole
blood
(EDTA)
5ml
<4hr
reported as NTproBNP,
normal <100 ng/l.
Ca125 – see special tests section
Please see section on “tumour markers”.
Ca19-9 – see special tests section
Ca15-3 – see special tests section
Caeruloplasmin
Copper binding serum protein,
decreased in Wilson’s Disease
serum
5ml
referred test – 18
days
0.20 – 0.45 g/l
Calcitonin
Useful in diagnosis and monitoring of
medullary carcinoma of the thyroid.
May require a pentagastrin
stimulation test for diagnosis.
serum
5ml
referred test – 14
days
<18.9ng/l
Calcium
Report value corrected for albumin
serum
5ml
<24hr
2.12 – 2.63 mmol/l
Calcium (urine)
urine
collected
in acid
<24hr
Female = <6.5
mmol/24hr
Male = <7.5
mmol/24hr
-
Complete
sample
sent
referred test – 14
days
see report
Calculi
Identify component of renal, biliary or
bronchial stones
Carbamazepine
Anticonvulsant drug monitoring
serum
(pre-dose)
5ml
<24hr
therapeutic range:
20-40 µmol/l
Carboxyhaemoglobin
Measure % of carbon monoxide bound
to haemoglobin
heparinise
d sample
(orange
top)
5ml
<24hr
up to 10% in smokers,
normally <2%
serum
5ml
<24hr
<3 U/l (up to 10 in
smokers)
serum
5ml
referred test – 23
days
0.21- 0.50 g/l
urine
(collected
into acid)
24hr
collection
referred test – 22
days
see report
CCP (anti-)
raised in rheumatic disease, more
sensitive than rheumatoid factor
serum
5ml
referred tests – 21
days
<10 U/ml
Chloride
serum
5ml
<24hr
95 – 108 mmol/l
Cholesterol
Coronary artery disease
serum
5ml
<24hr
<5 mmol/l or <4
mmol/l if in high risk
group
Carcinoembryonic antigen (CEA)
Monitoring of colonorectal cancer, of
no use for diagnosis.
C1-esterase inhibitor
hereditary angioneurotic oedema
(type 1). C4 should be requested at the
same time, C!-esterase will not be
measured if C4 normal.
Catecholamines
Investigation of hypertension,
suspected phaechromocytoma.
Page 27 of 106
Version 5 - 2014
Specimen
Type
Volume
Required
Turn Around
Reference Range
serum
5ml
<24hr
Female = >1.1 mmol/l
male = >0.9 mmol/l
-
-
<24hr
<3.0 mmol/l or <2.0
mmol/l if high risk
serum (plus
whole
blood
(EDTA))
5ml
referred test – 27 days
see report
Chromium
Required to assess MoM joint wear
according to MHRA alert.
whole
blood
5ml
referred test – 21 days
see report
Clozapine
Anti-pyschotic drug requiring monitoring
whole
blood
5ml
referred test – 21 days
see report
Cobalt
Required to assess MoM joint wear
according to MHRA alert. Measured with
chromium (see above)
whole
blood
5ml
referred test – 21 days
see report
Complement
C3 and C4 assay for monitoring
inflammatory and autoimmune conditions.
Single point determinations of limited value
serum
5ml
referred test – 17 days
see report
Copper
Reduced in Wilson’s Disease. Increased in
many inflammatory disorders, pregnancy
and OCP. Also request caeruloplamin.
serum
5ml
referred test – 17 days
13 – 26 µmol/l
24hr urine
collection
(acid
washed
container)
-
referred test – 34 days
<1.0 µmol/24hr
serum
5ml
<48hr
09:00h ref. range =
<180 nmol/l
24hr urine
collection
(plain
container)
-
referred test – 38 days
<180 nmol/l
serum
5ml
<24hr
40 – 110 µmol/l (age
and muscle mass
dependent)
Test
Cholesterol - HDL
Inverse association between HDL
cholesterol levels and coronary artery
disease.
Cholesterol - LDL
Calculated parameter from cholesterol and
HDL cholesterol. Can not be calculated if
triglyceride greater than 2.4mmol/l
Cholinesterase
Anaesthetic sensitivity and
organophosphate poisoning. If deficiency
detected then whole required for
genotyping.
Copper (urine)
Increased in Wilson’s Disease.
Cortisol
Investigation of adrenal function. Important
to note time of specimen as reference
ranges relate to 09:00. Hydrocortisone,
prednisone and prednisolone will interfere
with this test but not dexamethasone.
Cortisol (urinary free)
First line investigation for Cushing’s
Syndrome
Creatinine
Assessment of renal function. Affected by
muscle breakdown and diet as well as renal
function
Page 28 of 106
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Specimen
Type
Volume
Required
Turn Around
Reference Range
24hr urine
collection
-
<24hr
see report
C-reactive protein
Acute phase reactant.
serum
5ml
<24hr
<8 mg/l
Creatine Kinase (CK)
Muscle enzyme, cardiac and skeletal
serum
5ml
<24hr
F = <145 IU/l
M = <170 IU/l
Cryoglobulin
Essential to keep sample at body
temperature on way to lab.
serum
5ml
<24hr
see immunoglobulins
CSF (Xanthochromia)
Estimation of haemoglobin and
bilirubin in (xanthochromia) CSF for
investigation of SAH. Sample must be
taken >12hr post event and may
remain abnormal for up to 10 days
CSF
1ml (min)
– sample
less than
1ml can
not be
processed
<48hr (not available
outside normal
laboratory hours)
see report
Cyclosporine
Monitoring immunosuppressant
therapy. Trough level taken although
2hr level often used as better
indication of therapy.
Whole
blood
(EDTA)
5ml
referred test – 10
days
see report
Digoxin
To assess compliance and toxicity.
Levels can not be interpreted if sample
taken less than 6 hr post dose – predose levels recommended.
serum
5ml
<24hr
1.0 – 2.6 nmol/l
Down’s Screening
Pre-natal detection of Down’s
Syndrome.
serum
5ml
Drug Screen
Screening for detection and
monitoring of drug abuse – opiates,
benzodiazepines, cocaine,
amphetamines, methadone
metabolite. Cannabis, buprenorphine
and ethanol can be added on request
urine
15ml
<24hr
not detected
Dehydroepiandrosterone (DHAS)
Investigation of hirsutism.
serum
5ml
referred test – 14
days
<12 µmol/L (female)
Electrophoresis
Detection of paraproteins, immune
deficiency and non-specific acute and
chronic phase deficiency.
serum
5ml
<14 days
see report
Plasma
(fluoride
oxalate,
yellow
tube)
5ml
<24hr
not detected
faecal
sample
1g
referred test – 14
days
see report
Test
Creatinine (urine)
See above. Used for calculation of
creatinine clearance.
Ethanol
To identify intoxication
Faecal Elastase
Measure of exocrine pancreatic
function.
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Reported directly from screening service at
Royal Bolton Hospital to ANC.
Test
Faecal Reducing Substances
Malabsorption/digestion of
carbohydrates (of paediatric
interest).
Please note that samples more than
1hr old will not be processed,
Specimen
Type
Volume
Required
Turn Around
Reference Range
faecal
sample
(must be
delivered to
lab
immediately
)
1g
referred test – 14
days
not detected
Ferritin
Assessment of iron stores
serum
5ml
<24hr
M = 24 – 337 µg/l
F = 11 – 307 µg/l
Free Androgen Index
Ratio of testosterone to SHBG
expressed as a percentage.
Investigation of Hirsutism.
serum
5ml
referred test – 14
days
F = <4.5
FSH
Assessment of ovarian failure,
infertility, pituitary dysfunction.
serum
5ml
<24hr
F = cyclical (see
report)
M = 1 -7 IU/l
Gamma Glutamyl Transpeptidase
(GGT)
Sensitive indicator of liver disease.
Increased after exposure to enzyme
inducing drugs (including ethanol)
serum
5ml
<24hr
M = <50 IU/l
F = <32 IU/l
plasma
(must be
delivered to
lab on ice).
5ml
referred test – 28
days
<40 pmol/l
Gastrin
Diagnosis of gastrinomas. Patient
must be fasted and have not
received omiprazole for at least 2
weeks
Gentamicin
Therapeutic drug monitoring is
essential to prevent complications of
therapy.
Serum
5ml
<24hr
See Trust guidelines
for antibiotic
prescribing and
sampling
Globulins
Elevated in myeloma, infections and
autoimmune disorders
calculated
result
-
<24hr
24 – 43 g/l
Glucose
Primarily measured in DM.
Plasma
(fluoride
oxalate,
yellow tube)
1ml
<24hr
2.6 – 6.0 mmol/l
(fasting)
Glucose Tolerance Test
Diagnosis of DM.
This test is no longer performed within the Pathology Directorate.
Phone Phlebotomists (6637) for appointment. For interpretation see relevant
section in user guide.
Glycosylated Haemoglobin (HbA1c)
Monitoring of diabetic control.
EDTA,
whole blood
1ml
<24hr
4.4 – 6.1 %
(24.6 – 43 mmol/mol)
Growth Hormone
Measured in acromegaly, pituitary
gigantism and dwarfism. Random
levels are of little value and secretion
is best assessed by stimulatory or
suppressive testing
serum
5ml
referred test – 21
days
see report
Gut Hormone Profile (gastrin, VIP,
PP, glucagon, neurotensin,
somatostatin, chromogranin A&B)
Diagnosis of neuroendocrine
tumours of the alimentary tract.
Contact lab before taking sample –
sample must be received within
10minutes of being taken
Plasma
10ml
referred test – 25
days
see report
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Test
Human Chorionicgonadotrophin
(HCG)
Increased in pregnancy, ectopic
pregnancy, hydatidiform mole,
seminoma, testicular and ovarian
teratomas
HCG (urine)
Pregnancy test, only performed if
POCT devices are not available
5-Hydroxyindole-acetic acid (HIAA)
Detection and monitoring of
carcinoid tumours./ Some foods
(bananas, pineapples) can cause
increased levels.
Immunoglobulins
Autoimmune disorders, liver disease,
infection and genetic deficiencies.
Immunoglobulin subclasses
Investigation of recurrent infection in
children
Immunoglobulin E
Allergic and atopic disease.
Specimen
Type
Volume
Required
Turn Around
Reference Range
serum
5ml
<24hr
<5 IU/l
urine
(random)
5ml
<24hr
see report
24hr urine
collection
into acid
-
referred test – 27
days
<50 µmol/24hr
serum
5ml
<48hr
IgG = 6.0 – 16.0 g/l
IgA = 0.8 – 4.0 g/l
IgM = 0.5 – 2.0 g/l
serum
5ml
referred test – 23
days
IgG1 = 2.4 – 12.6 g/l
IgG2 = 0.6 – 2.3 g/l
IgG3 = 0.2 – 1.4 g/l
IgG4 = 0.02 – 1.8 g/l
serum
5ml
referred test – 14
days
Age related – see
report
serum
5ml
<24hr
Iron Studies
Investigation of deficiency and
overload.
Iron
Iron binding capacity
7 – 29 mol/l
% saturation
20 – 55 %
Transferrin
Insulin
Detection of insulinoma, Sample
must be taken during a
hypoglycaemic attack. Glucose must
be assayed at same time.
45 – 70 mol/l
1.8 – 3.5 g/l (male)
1.9 – 3.8 (female)
serum
(sample
must be
sent to lab
on ice)
5ml
serum
5ml
Lactate Dehydrogenase (LDH)
Measured in megablastic and
pernicious anaemias, leukaemias,
lymphomas and liver disease.
serum
5ml
<24hr
350 – 600 IU/l
Lamotrigine
Anticonvulsant drug, TDM not
recommended.
serum
5ml
referred test – 21
days
3 – 15 mg/l
whole blood
EDTA
2ml
referred test – 14
days
see report
Insulin Growth Factor–1 (IGF-1)
Investigation of acromegaly and
growth disorders.
Lead
Monitoring environmental exposure.
Page 31 of 106
Version 5 - 2014
referred test – 13
days
referred test – 22
days
see report
see report
Specimen
Type
Volume
Required
Turn Around
Reference Range
LH
Assessment of ovarian failure,
infertility, pituitary dysfunction.
serum
5ml
<24hr
F = cyclical (see
report)
M = 3 – 12 IU/l
Lithium
Monitoring of lithium therapy. Sample
should be taken 12hr post dose.
serum
5ml
<24hr
0.4 – 1.0 mmol/l
(0.4 – 0.8 mmol/l if
>65yr)
Magnesium
Measured in case of hypocalcaemia
and hypoparathyroidism. Low levels
commonly seen due to intestinal
losses and diuretic therapy.
serum
5ml
<24hr
0.7 – 1.0 mmol/l
Mast Cell Tryptase
Suspected acute allergic reaction.
Sample should be taken at up to 3hr
post even and after 6 and 24hr.
serum
5ml
referred test – 14
days
<12.9 µg/l
Microalbumin (urine albumin)
Measured in diabetes as an indicator
of the development of renal disease.
Ratio to creatinine
urine
(random)
5ml
<24hr
<3.5 mg/mmol (male)
<2.5 mg/mmol
(female)
Myoglobin
Investigation of renal failure due to
rhabdomyolysis.
serum
5ml
Please contact
laboratory.
<76 µg/l
Oestradiol
Investigation of female infertility and
monitoring of oestrogen implants.
serum
5ml
<48hr
cyclical, see report
Organic Acids
Investigation of inherited defects in
organic acid metabolism.
urine
10ml
referred test – 47
days
see report
Osmolality
Estimation of “osmolar gap”.
Investigation of hyponatraemia.
serum
5ml
<24hr
285 – 295 mOsm/kg
Osmolality (urine)
Investigation of SIADH (with serum
osmolality)
urine
5ml
<24hr
40 – 1400 mOsm/kg
Oxalate (oxalic acid)
Investigation of renal stones
serum
5ml
referred test – 24
days
see report
Oxalate (urine)
Investigation of renal stones
urine
(acidified)
5ml
referred test – 24
days
see report
serum
5ml
referred test – 45
days
see report
Paracetamol
Paracetamol overdose, to assess need
for antidote. Sample must not be
taken less than 4hr since the overdose.
serum
5ml
<24hr
Normal <5mg/l. For
overdose please see
chart.
Parathyroid Hormone (PTH)
Investigation of hypo- and
hypercalcaemia. Sample must be
analysed within 2hr of being taken
serum
5ml
<48hr
15 – 88 pg/ml
Phenobarbitone
Check for toxicity and compliance.
serum
5ml
referred test – 21
days
15 – 50 mg/l
Test
P3NP (Procollagen Peptide)
Monitoring fibrogenic activity in the
liver of patients receiving long term
methotrexate
Page 32 of 106
Version 5 - 2014
Specimen
Type
Volume
Required
Turn Around
Reference Range
Phenytoin
Check for toxicity and compliance.
serum
5ml
<24hr
30 – 70 µmol/l
Phosphate
Investigation of calcium abnormalities.
serum
5ml
<24hr
0.83 – 1.35 mmol/l
plasma
red cells
urine
faeces
5ml
2ml
20ml
10-15g
referred test – 35
days
see report
serum
5ml
<24hr
3.5 – 5.5 mmol/l
urine
(random)
5ml
<24hr
see report
Progesterone
Detection of ovulation and evaluation
of corpus luteum function
serum
5ml
<48hr
Luteal Peak:
18 – 72 nmol/l
Prolactin
May cause infertility, amenorrhaoea
and galactorrhoea when increased.
serum
5ml
<48hr
F = 102-426 mU/l
M = 86 - 324 mU/l
Prostrate Specific Antigen (PSA)
Detection and treatment of prostatic
cancer,
serum
5ml
<48hr
< 4 ng/ml
Protein (Total)
Relates to liver function, state of
hydration and is part of myeloma
screening
serum
5ml
<24hr
62 – 80 g/l
urine
(24hr or
random)
5ml
<24hr
50 – 80 mg/24hr
<20 mg/mmol
(random)
CSF
1ml
<24hr
<0.45g/l
RAST
Allergen specific IgE. Must include
clinical details to ensure correct
allergen screened for.
serum
5ml
referred test – 17
days
see report
Renin
Diagnosis of primary
hyperaldosteronism (Conn’s).
Additional information from ratio of
aldosterone to renin
plasma
(on ice)
5ml
referred test – 35
days
0.3 – 2.2 nmol/l/hr
Rheumatoid Factor
Diagnosis of rheumatoid arthritis and
Sjorgen’s Syndrome
serum
5ml
<24hr
<15 IU/l
Salicyclate
Investigation of salicyclate poisoning.
serum
5ml
<24hr
not detected
Selenium
Nutritional monitoring..
serum
5ml
referred test – 14
days
0.9 – 1.7 mol/l
Test
Porphyrin Screen
Detection of porphyrias. Investigation
of such symptoms as abdominal pain
and skin photosensitivity. All samples
must be kept in the dark
Potassium
Seasonal and diurnal variation
observed. Old or haemolysed samples
are not suitable for analysis. Please
note that the reference range applies
to serum samples only.
Potassium (urine)
Investigation of hypokalaemia
Protein (urine)
Renal protein loss.
Protein (CSF)
Increased in meningitis or tumours of
the CNS
Page 33 of 106
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Test
Specimen
Type
Volume
Required
Turn Around
Reference Range
Sex Hormone Binding Globulin (SHBG)
Part of androgen profile. HRT and OCP
raise SHBG and obesity lower it. Not
indicated in males.
serum
5ml
referred test – 14
days
F: 18 – 114 nmol/l
Sodium
Main use is state of hydration.
serum
5ml
<24hr
133-146 mmol/l
urine
(random
or 24hr)
5ml
<24hr
40 – 220 mmol/24hr
Sodium (urine)
Measure of sodium excretion in
investigation of hyponatraemia.
Tacrolimus
Immunosuppressant therapy. Trough
level or 2hr post dose.
whole
blood
(EDTA)
5ml
referred test – <7
days
see report
T3 (free)
May be added to thyroid profile. Used
to monitor treatment of thyrotoxicosis
in first few months post diagnosis.
Occasionally for detection of T3
toxicosis (free T4 and TSH suppressed)
serum
5ml
<24hr
3.5 – 6.5 pmol/l
T4 (free)
Part of thyroid profile for the
investigation of thyroid disorders
serum
5ml
<24hr
7 – 17 pmol/l
Testosterone
Investigation of androgen disorders in
male and female
serum
5ml
referred test – 21
days
F: <1.5 nmol/l
M: 10 – 28 nmol/l
Theophylline
Assayed to check compliance and
therapeutic levels.
serum
5ml
<48hr
55 – 110 µmol/l
Thiopurine Methy Transferase (TPMT)
Deficiency is a cause of intolerance to
azothioprine or 6-mercaptopurine
Whole
blood
(EDTA)
5ml
referred test – 24
days
see report
Thyroid Peroxidase Antibodies (TPO)
Diagnosis of pre-clinical
hypothyroidism
serum
5ml
<48hr
0 – 9 IU/l
Thyroglobulin
This is used as a tumour marker, post
thyroidectomy only.
serum
5ml
Referred test – 21
days
See report
Thyroid Stimulation Hormone (TSH)
Raised in hypothyroidism.
serum
5ml
<48hr
0.4 – 4.5 IU/l
Transthyreitin (pre-albumin)
Nutritional assessment, always
measured with CRP to aid
interpretation.
serum
5ml
<48hr
150 – 350 mg/l
Triglycerides
Measured as part of lipid investigation
plasma
5ml
<24hr
<2.1 mmol/l
Troponin I
Currently best marker for cardiac
damage. Sample needs to be taken
>12 hours post suspected cardiac
event. Remains elevated for up to 10
days.
serum
5ml
<24hr
<0.07 µg/l
Page 34 of 106
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Test
Specimen
Type
Volume
Required
Turn Around
Reference Range
Urate
Raised in gout, renal failure,
malignancy and several other
conditions.
serum
5ml
<48hr
120 – 400 µmol/l
Urea
Indication of renal function and
hydration. Low levels seen in
starvation and advanced liver disease.
serum
5ml
<24hr
2.5 – 7.8 mmol/l
Valproate
Useful to check compl;iance or
overdose, little use for therapeutic
drug monitoring.
serum
5ml
<24hr
400 – 700 µmol/l
Vancomycin
Therapeutic drug monitoring is
essential to prevent complications of
therapy.
serum
5ml
<24hr
See Trust guidelines
for antibiotic
prescribing and
sampling or contact
Microbiology
Department
Vitamin D
Investigation of hypocalcaemia and
nutritional assessment
serum
5ml
referred test – 14
days
see report
White cell enzymes
Investigation of suspected inborn
errors.
whole
blood
(EDTA)
5ml
referred test – 36
days
see report
Xanthochromia (CSF)
Zinc
Nutritional assessment
See CSF scan
serum
5ml
referred test – 15
days
12 – 22 mmol/l
PLEASE NOTE:
Samples for routine profiles are stored at 4oC for a
maximum of 5 days. Please be aware of this when
requesting further tests as it may not be necessary
(depending on stability of analyte) to re-bleed the
patient. See notes in introduction to user guide
Page 35 of 106
Version 5 - 2014
Paediatric Reference Ranges
The following reference ranges are adapted from those in use at Royal
Manchester Childrens’ Hospital (with permission). They have been checked for
consistency with the methods used within this trust but have not been
rigorously evaluated. This is not a complete list, please contact laboratory if
further information required. Please interpret results with this in mind. All
reports for the following have age adjusted ranges.
Age
Reference Range
Alanine Aminotransferase
Analyte
plasma
up to 1 month
<90 IU/l
> 1month
<45 IU/l
Albumin
plasma
up to 1 month
25 – 35 g/l
1 to 6 months
28 – 44 g/l
Alkaline Phosphatase (ALP)
Ammonia
(Please ensure laboratory is aware
the sample is being taken and
transport to laboratory
immediately).
Sample type
plasma
Child
30 – 45 g/l
1 - 30 days
60 – 240 IU/l
1 – 12 months
52 – 444 IU/l
1 - 2 years
60 – 370 IU/l
2 – 8 years
60 – 320 IU/l
Pubertal
60 – 400 IU/l
Adult
20 – 125 IU/l
plasma
Bicarbonate
plasma
Bilirubin, total
plasma
Sick/prem = <150 mol/l
neonate = <100 mol/l
<16 yr = <50 mol/l
20 – 26 mmol/l
Full term infant
Levels will rise from birth to
approximately 150 µmol/l at 5-6
days and then fall to normal
childhood levels by day 10.
Child
<17mmol/l
Bilirubin, conjugated
plasma
neonate
up to 30µmol/l
Calcium
plasma
premature
1.50 – 2.5 mmol/l
up to 2 weeks
1.90 – 2.80 mmol/l
child
2.12 – 2.63 mmol/l
Chloride
plasma
Cholesterol, total
plasma
Creatinine Kinase
plasma
Page 36 of 106
Version 5 - 2014
98 – 110 mmol/l
up to 1 month
1.1 - 2.6 mmol/l
1m to 2 years
1.2 – 4.7 mmol/l
2 – 16 years
<5.0 mmol/l
up to 2 weeks
<600 IU/l
up to 1 month
<400 IU/l
up to 1 year
<300 IU/l
adult male
<170 IU/l
adult female
<145 IU/l
Analyte
Creatinine
Sample type
plasma
Age
Reference Range
<1 week
<100 µmol/l
1 – 2 weeks
<80 µmol/l
2 – 4 weeks
<55 µmol/l
1 month – 1 year
<40 µmol/l
1 - 3 years
<40 µmol/l
4 – 6 years
<46 µmol/l
7 - 9 years
10 - 56 µmol/l
10 - 12 years
30 - 60 µmol/l
13 - 15 years
40 - 96 µmol/l
16 years - adult
males
40 - 96 µmol/l
females
C-Reactive Protein
plasma
Gamma Glutamyl Transpeptidase
plasma
Glucose (fasting)
Urea
plasma
(fluoride)
plasma
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26 - 86 mol/l
<8 mg/l
0 – 1 month
10 – 270 IU/l
1 – 3 months
10 – 155 IU/l
3 – 6 months
10 – 93 IU/l
Adult
10 – 50 IU/l
up to 1 month
2.5 – 6.5 mmol/l
child
3.0 – 6.5 mmol/l
1 month
2.0 – 5.0 mmol/l
1 year
2.5 – 6.0 mmol/l
child
2.5 - 6.5 mmol/l
teens
3.0 – 7.5 mmol/l
POCT (Point of Care Testing)
Point of Care Testing (POCT) is defined as any analytical test performed by a Healthcare
Professional outside the conventional laboratory setting.
The POCT Service is required to comply with:
1. Guidelines from the MHRA; Management and use of IVD POCT devices
2. ISO 22870:2006 POCT Requirements for Quality and Competence
3. ISO 15189:2006 Medical Laboratories Quality and Competence
4. The Royal College of Pathologists
5. The Institute of Biomedical Scientist (IBMS)
As the Pathology Department manages and leads on all POCT issues, direct liaison from the
users of the POCT service with the Pathology Department and primarily the POCT Coordinator is essential to ensure compliance is achieved.
POCT POLICY
The POCT Policy is available on the Trust intranet and outlines the roles and responsibilities
of all individuals associated with POCT.
POCT COMMITTEE
The POCT Committee monitors and audits current POCT devices for compliance of policies
and procedures and report any issues and breaches of policy to the MDG and Clinical Risk
Management.
No POCT device is to be introduced and implemented within the Trust without approval
from the POCT Committee.
If considering the implementation of a POCT device, the POCT Co-ordinator must be
contacted, not company representatives regarding procurement. The POCT Co-ordinator will
then assist with business case and planning, including cost-benefit analysis, clinical need, and
equipment evaluation and selection.
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POCT Devices currently within Tameside Hospital NHS Foundation Trust include:Blood Gas Analysers
(A+E, CCU, NICU, W40,
ITU, Children’s Unit)
(Labour Ward)
(Chest Clinic)
Blood Glucose Meters
Urine dipstick testing
Blood HbA1c Analysers
(All Wards)
(All Wards)
(Children’s’ OPD)
Urine Pregnancy testing
Haemoglobin Analysis
Fetal Fibronectin analysis
(A+E, WHU)
(Theatres)
(Labour Ward)
TRAINING
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Only personnel who have completed training and demonstrated competence shall be issued
passwords to carryout POCT. Passwords MUST NOT be shared; sharing of passwords is a
disciplinary offence.
To arrange training contact POCT Co-ordinator on Ext 4620
SAMPLE INTEGRITY AND RESULTS
Instructions for sample collection and preparation given during training are crucial to obtain
accurate results.
PATHOLOGY SUPPORT
The Pathology Department provides advice on and facilitates the mechanism and
methodology of the tests, limitations of the method, troubleshooting, training, support,
quality control and quality assurance, risk management, health and safety and infection
control issues.
Maintenance and daily monitoring of blood gas analysers is performed by Pathology staff.
Provision of the following consumables is also available via Pathology:
Blood Gas:
Reagents, Printer Paper, Capillary Tubes
Glucose:
Glucometer, Batteries, Quality Control, QC Record Book
Urinalysis:
Urinalysis Results Stickers
All other consumables are ordered locally or via Pharmacy.
INSTRUMENT FAILURE
In the event of equipment failures refer to local instructions; the laboratory needs to be
informed immediately and is available as backup and will assist where possible.
To report any issues ring Ext 6498
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Paracetamol Interpretation
Please note that levels can’t be interpreted without knowing the time since the
paracetamol was taken. Levels can not be interpreted until 4hr post dose until
the drug is in the elimination phase.
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Therapeutic Drug Monitoring
Therapeutic
Range
Units
Conversion factor*
Half life
Sampling time
Time to steady state
Carbamazepine
20 – 40
µmol/l
x 0.236
(µmol→mg/l)
10 – 20 hr
pre-dose
2 - 6 days
Cyclosporine A
variable – see
report
ug/l
-
2 – 6 hr
pre-dose
2 – 3 days
Digoxin
1.0 – 2.6
nmol/l
x 0.781
(nmol→µg/l)
36 – 48 hr
minimum of 6hr
post dose
5 – 7 days
Lamotrigine**
3.0 – 15.0
mg/l
-
20 – 35 hr
pre-dose
4 – 15 days
Lithium
0.4 – 1.0
mmol/l
-
10 – 35 hr
12hr post dose
3 – 7 days
Phenobarbitone
10 - 30
mg/l
-
80 – 120 hr
pre-dose
10 – 25 days
Phenytoin
30 - 70
µmol/l
x 0.253
(µmol→mg/l)
7 – 42hr
pre-dose
7 – 35 days
Tacrolimus (FK506)
4 - 12
ug/l
-
4 – 33 hr
pre-dose
2 days
Theophylline
55 - 110
µmol/l
x 0.180
(µmol→mg/l)
3 – 13 hr
***
2 – 3 days
Valproic Acid**
400 - 700
µmol/l
x 0.144
(µmol→mg/l)
8 – 20 hr
pre-dose
2 – 4 days
Drug
* The conversion factors are included since it is a national requirement to move to using mass units in the immediate future.
** There is little evidence to support the therapeutic monitoring of valproate or lamotrigine.
*** Therapeutic range relates to peak levels. Samples should be take 2hr post dose for fast release and 4hr for slow release
preparation
Samples for non-standard anti-epileptic drugs (e.g. gabapentin) will NOT be processed as monitoring is not necessary.
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Dynamic Function Tests and Special Tests
1. Oral Glucose Tolerance test
Patient preparation:
•
•
•
This test is only necessary if fasting and/or random glucose measurements are
equivocal i.e. 6.0 to 7.0 mmol/L.
This test should NOT be performed in patients who fulfill the criteria for diabetes
mellitus. These are:
o A fasting plasma glucose >7.0 mmol/L on two or more occasions and
o Clinical symptoms of diabetes e.g. polydipsia, polyuria, ketonuria and rapid
weight loss with a random plasma glucose of >11.1 mmol/L).
This test should not be performed in patients who are under physical stress e.g. post
surgery, trauma, infection or extreme psychological stress as these may give
misleading results.
The patient should have a normal unrestricted diet with a minimum of 150g carbohydrate
for at least 3 days prior to test. Smoking prohibited on day of test. All drugs should be
clearly indicated on the request form. Patient should fast overnight (14 hrs) taking water
only, and should sit quietly during the test.
Instructions:
•
•
•
Collect fasting blood sample for glucose. Ensure tube is appropriately labelled
fasting. The glucose is analysed immediately (glucose meter). If the glucose is >8.0
mmol/l the sample should be sent immediately to the laboratory for confirmatory
analysis. If confirmed as >8.0 mmol/l; then the test should be discontinued.
Give patient 75g (anhydrous) oral glucose dissolved in 300 ml water.
As an
alternative the patient may be given 394ml of “Lucozade Energy” (73kcal/100 ml
formulation), which provides the equivalent of 75g anhydrous glucose. Please note
that the some formulations for “Lucozade Energy” are 70kcal/100 which will require
410ml to be given – please check labeling on bottle.
Two hours after giving the glucose load, take a further blood sample for glucose.
Ensure tube is appropriately labeled “2 hr sample”.
Both samples must be collected into fluoride oxalate tube and both should be sent
immediately to the laboratory on completion of the test
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Interpretation:
Normal OGTT
Fasting glucose ≤6.0 mmol/l and 2hr blood
glucose <7.8 mmol/l.
Impaired fasting Glycaemia
Fasting Glucose 6.1 – 6.9 and 2hr glucose
<7.8 mmol/l.
Impaired Glucose Tolerance
Fasting glucose ≤7.0 mmol/l and 2hr
glucose between 7.8 and 11.0 mmol/l
Diabetes
Fasting glucose ≥7.0 mmol/l and 2hr
fasting glucose ≥11.1 mmol/l.
(from: Methods and Criteria for Diagnosing Diabetes Mellitus – WHO criteria, June 1st 2000).
Extended GTT
The GTT above can be extended for the investigation of reactive hypoglycaemia. Addition
blood samples are taken at 2.5hr, 3hr, 3.5hr and 4hr for glucose.
Additional criteria for diabetes diagnosis
Recent guidelines from WHO for diabetes diagnoses (January 2011) have recommended the
use of HbA1c for diagnosis. The use of the following algorithm is now recommended:
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2. Short Synacthen Test
This test evaluates the ability of the adrenal gland to produce cortisol after stimulation by
synthetic ACTH (Synacthen) and forms part of the differential diagnosis of Addison’s Disease.
Patient preparation:
The patient need not be fasted for this test but the test must be performed in the morning.
The difference between morning and late afternoon cortisol may be as great as 100 nmol/l
for the 30min post Synacthen sample.
Instructions:
•
•
•
Blood is taken for basal cortisol assay. Clearly marked sample as “baseline”.
250µg of Synacthen (from Pharmacy) is injected (IV or IM)
30 minutes post injection blood is taken for cortisol assay. Clearly mark sample as “30
min”.
Interpretation
In normal individuals the serum cortisol should increase by minimum of 200 nmol/l to a level
of at least 550 nmol/l at 30 minutes.
3. Dexamethasone suppression test (low dose)
This is a simple screening procedure for Cushing’s syndrome and may be performed on an
outpatient basis.
Patient preparation:
The patient should not be on rifampicin, anticonvulsants or any other enzyme inducing
drugs. This will cause rapid metabolism of dexamethasone leading to an unreliable result.
The patient should not be on any steroid therapy (please note hydrocortisone is another
name for cortisol) as this leads to adrenal suppression and an unreliable result.
Instructions:
•
•
Patient takes 1mg dexamethasone tablet at 23:00hr.
At 09:00 (next day) a blood sample is taken for cortisol. The sample should labeled
“post dexamethasone”.
Interpretation:
A normal response is shown by a suppression of 09:00hr cortisol to <50nmol/l.
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4. Samples referred for renin and aldosterone
Indications
Investigation of hyperaldosteronism.
Patient preparation:
•
•
•
•
Avoid salt losing diuretics, purgatives and correct gastrointestinal losses.
Diet should contain 100-300 mmol/l Na+ per day and 50-100 mmol/l K+ per day for 10
days before test.
Correct hypokalaemia with oral potassium supplements before testing.
A number of anti-hypertensive drugs may influence the interpretation of results.
Effect of drugs on renin and aldosterone:
•
•
•
•
•
•
Diuretics and vasodilators elevate renin and aldosterone.
β-blockers in large doses lowers renin and aldosterone.
Calcium channel blockers elevate renin and lower aldosterone.
ACE inhibitors elevate renin and lower aldosterone.
Indomethacin and other prostaglandin synthetase inhibitors lower
renin and
aldosterone.
Aldosterone antagonists (spironlactone) produce variable effects on aldosterone.
Recommended length of time for which drugs should be discontinued:
Spironolactone
Diuretics
Prostaglandin synthetase inhibitors
Cyproheptadine
ACE inhibitors
Vasodilators
Calcium channel blockers
Sympathomimetics
6 weeks
2 weeks
2 weeks
2 weeks
2 weeks
1 week
1 week
1 week
For patients in whom therapy can not be withdrawn Prazozin, Doxazosin or Guanethidine
would be the drug of choice.
NSAIDs should also be discontinued for two weeks prior to testing
Procedure
•
•
The patient should be seated for 10 min.
Collect blood for renin and aldosterone (10 ml heparin tube, should be taken to
laboratory urgently, but not on ice and separated as soon as possible).
Interpretation:
• Aldosterone secreting tumours or bilateral adrenal hyperplasia result in
hyperaldosteronism and suppression of renin levels.
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•
The upright posture normally stimulates renin and aldosterone release unless renin
production is suppressed by tumour induced hyperaldosteronism.
Adult Reference Range (Results are method dependent)
Aldosterone (pmol/l)
Renin (pmol/ml/hr)
Random
100 – 800
0.5 – 3.1
Recumbent (overnight)
100 – 450
1.1 – 2.7
not applicable
2.8 – 4.5
Ambulant (30 min)
Aldosterone / renin ratio
The aldosterone / renin ratio provides additional useful information.
•
•
Aldosterone/renin ratio less than 800, Conn’s syndrome unlikely.
Aldosterone/renin ratio greater than 2000, Conn’s syndrome probable.
Diagnosis of the cause of primary hyperaldosteronism requires further investigation after
the demonstration of primary hyperaldosteronism and specialist endocrinological advice is
recommended.
5. Water Deprivation Test
Investigation of suspected cranial or nephrogenic diabetes insipidus and primary polydipsia.
Screen – 24hr urine volume. Three 24hr urine collections are performed; if volumes are less
than 3 litres then DI is unlikely.
Water deprivation test.
ADH secretion is stimulated by hypovolaemia and hypertonicity. Failure to maintain normal
urine and plasma osmolarity when dehydrated suggests DI. Failure to correct the osmolality
with exogenous DDAVP suggests a nephrogenic problem, whereas correction following
exogenous DDAVP suggests ADH deficiency (cranial DI).
The Laboratory must be informed that this test is planned to ensure all analyses are
performed promptly. Samples must NOT be batched but sent to the laboratory immediately.
Patient preparation – do NOT restrict food or fluid until the start of the test. Exclude
adrenocortical or thyroid deficiency. No tobacco or alcohol for at least 24hr.
Note – this test is potentially dangerous and must be undertaken with care and under
clinical supervision. Patients unable to conserve water may become critically dehydrated
within a few hours of water restriction.
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Stop test if:
•
•
•
•
Weight loss >3% of baseline value (check plasma osmolality). Note test requires
accurate weighing of the patient.
Urine osmolality ever greater than 800 (i.e. normal response to fluid restriction).
Plasma osmolality >350 (give DDAVP 2mcg iv and fluids).
Urine output exceeds 5 litres in absence of weight loss (suggests surreptitious
drinking).
Protocol:
0800hr – insert cannula, weight patient, patient empties bladder. Measure urine volume and
send for osmolality. Measure blood pressure, weight, urine osmolality, plasma osmolality
and urine volume hourly for 8 hours according to the schedule:-
Weight
BP
Plasma
Urine
Urine
Osmolality
Osmolality
Volume
U&E
08:00
08:30
09:30
10:30
11:30
12:30
13:30
14:30
15:30
16:30
If urine osmolality remains <750, give DDAVP (desmopressin) 2mcg im.
Give free fluids from now on.
17:30
18:30
19:30
20:30
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Interpretation:
Post-dehydration
osmolality (mmol/kg)
Post-DDAVP osmolality
(mmol/kg)
Diagnosis
Plasma
Urine
Urine
283-293
>750
>750
Normal
>293
<300
>300
Nephrogenic diabetes insipidus
>293
<300
>750
Cranial diabetes insipidus
<293
300-750
<750
Chronic polydipsia
<293
300-750
>750
Partial nephrogenic DI or primary
polydipsia
6. Tumour Markers
Due to the over requesting of tumour markers, in particular “tumour marker screens” it was
felt that some guidance should be offered. No serum marker incurrent use is specific for
malignancy.
•
•
•
•
Many patients with early localized disease will have normal levels of serum tumour
markers.
No cancer marker has absolute organ specificity. PSA however, appears to be
relatively specific for prostrate tissue.
Requesting of multiple markers in an attempt to identify an unknown primary cancer
is rarely of use (see previous).
Reference ranges for tumour marker are not well defined and are used for only
guidance. A level below the reference range does not exclude malignancy whilst
levels above do not necessarily mean the presence of cancer. Changes in levels over
time are of more use that absolute levels at a single point in time.
With the exception of PSA, tumour markers are only of use in monitoring response to
treatment if the tumour has been demonstrated to be excreting that marker. They are of
little use in diagnosis.
Recently NICE has issued the following guidance (CG104) for the use of tumour markers in
the investigation of CUP (carcinoma of unknown primary):-
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Further information can be found in following article:
C M Sturgeon, L C Lai and M J Duffy: “Serum tumour markers: how to order and interpret
them”. BMJ 2009; 339: 852-858.
Guidance on requesting can be seen in summary form at:
http://www.pathologyharmony.co.uk/harmony-bookmark-v7.pdf
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7. Drugs of abuse
The approximate detection times for some of the commonly abused drugs are:
Drug
Duration of detection in urine
Alcohol
4 - 12hrs
Amphetamines (including MDMA, MDA)
1 - 3 days
Benzodiazepines
1 – 3 days (can be significantly longer with
chronic use)
Cannabis
1 – 14 days (can be significantly longer
with chronic use)
Cocaine
1 – 3 days
Opiates
1 – 2 days
6-Monacetyl Morphine (6-MAM)
up to 1 day (can be useful for confirming
opiate positive as heroin use)
Methadone
1 – 3 days (very dependent on dose)
Please note that detection times very approximate and are dependent on dose, its
frequency, route of administration, urine pH and urine dilution.
All samples have a creatinine measured. If level found to <1.8mmol/l then the sample is
suspect. European guidelines indicate that any sample with a creatinine less than 1.8 mmol/l
should be considered too dilute and not analysed.
Please contact laboratory for further information.
8. Virology
The biochemistry department does offer initial screening for the following:
•
•
•
•
Hepatitis A, B and C
Rubella
HIV
Treponemal Antibodies (performed by Microbiology)
For negative antigen results are reported immediately (<24hr, Monday to Friday only) but
positive results are referred to a specialist laboratory for confirmation and are considered to
be “presumptive positives” until confirmed (this is in line with national regulations). The
reports for positive results will be delayed for this reason.
Please contact the laboratory for further information.
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9. Porphyrin Screen
The porphyrias are a group of eight inherited disorders classically presenting with either
photosensitization or neurological complaints such as abdominal pain. The sample requires
are:
Sample type
Urine
Volume/amount
20ml
Whole blood (EDTA), red top. 2.5ml
Faeces
A pea sized sample
Test request
Urinary porphyrins
Rbc protoporphyrins and
plasma protoporphyrin
screen.
Faecal porphyrins
All samples must be protected from the light and delivered to the laboratory immediately
after collection. Porphyrins are photolabile.
Please note that the pattern of porphyrin excretion is important in diagnosing the different
types of porphyria. In order to offer a full interpretation of the screen it is essential that full
clinical details are written on the request form.
Please note that some of the acute porphyria can show a normal excretion of porphyrins and
their precursors. It is important that any urine sample is obtained, if possible, during or as
close as possible to any attack.
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HAEMATOLOGY
DEPARTMENT
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Haematology Department
General Enquiries
6491
Consultant Haematologist
Blood Science Manager
Dr Baden
6501
Dr Heppleston
4634
Ms G Lewis
([email protected])
6318
Secretary to Haematologist
6596
Additional notes request forms
Blood Count Requests
Addressograph labels should not be used on any specimens.
This includes WBC, RBC, HB, HCT, MCV, MCH, MCHC, platelet count, and five part
differential (neutrophil, lymphocyte, monocyte, eosinophil and basophil populations).
Specimens containing small clots and/or leaking, will be assessed for suitability for
testing and repeat requested if necessary.
The sample requirement for a full blood count is 2.7ml blood in a red (EDTA) tube.
Reference ranges are included on the Haematology report (printed and electronic and
are also available on the pathology website. Blood films and WBC manual differential,
will be performed when the clinical information indicates a particular leucocyte
problem, or the blood count indicates abnormal findings. If you, or your senior medical
staff wish to have it performed for any specific reason, or would like the opinion of the
consultant haematologist, please state that clearly on the request.
ESR
The sample requirement for an ESR is 3.5 ml of blood in a citrate (purple) tube. Because
of the amount of liquid anticoagulant in an ESR tube, it is most important that the right
amount of blood is used in the tube. A separate specimen must be sent for an ESR
request. Only proven or suspected cases of temporal arteritis indicate the need for an
urgent ESR request.
Reticulocytes
Reticulocyte count is a useful but under-utilised test. It reflects the ability of marrow to
respond to stress (bleeding, haemolysis, etc) or its response to haematinic therapy. It
will be performed if blood film indicates the need for it (reflex testing) or on request.
ANTICOAGULANTS
It is beyond the scope of this booklet to give you a fully comprehensive account of
anticoagulation. You are advised to refer to B.N.F. or discuss problems and queries with
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your seniors or the Haematologist. It is worth noting that recommendations and
practices can change rapidly in this field.
Parenteral and oral anticoagulants are used with increasing frequency. Oral
anticoagulants may be used alone or in combination with Heparin.
Therapeutic Range
The following are the ranges recommended by the British Society of Haematology
(1984)
INR
Clinical State
2.0 – 3.0
•
•
•
Treatment of deep vein thrombosis.
Pulmonary embolism.
Transient ischemic attacks.
3.0-4.0
•
Recurrent deep vein thrombosis and
pulmonary embolism.
Arterial disease including myocardial
infarction.
Arterial grafts.
Cardiac prosthetic valves and arterial grafts.
•
•
•
For details refer to the British Society of Haematology guidelines.
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COAGULATION TESTS
1. Suspected Bleeding Diathesis
It is important to take a full history of present and past bleeding incidents and to
enquire about family history and drug ingestion. For screening purposes, the following
tests are normally sufficient:•
•
•
•
P.T. and INR
APTT
Fibrinogen
Platelet count.
Requests for bleeding time and platelet function studies should be discussed with the
Consultant Haematologist.
2. Suspected Disseminated Intravascular Coagulation (DIC)
PT, APTT, Fibrinogen and FDP (D-dimer), platelet count and blood film should be
requested.
3. Screening for Liver Biopsy
PT, APTT and platelet count should be requested.
Coagulation test – sample requirements
Coagulation tests
Sample
PT and INR
Green citrate bottle (x 1)
APTT
Fibrinogen
FDP (d-dimer). Note, the sample must
be analysed within 4hr of collection.
Thrombophilia screen
Green citrate bottle (x 5)
Brown (x 1)
EDTA (x 1)
Factor assays
Green citrate bottle (x 2)
Lupus anticoagulant
Green citrate bottle (x 4)
Antithrombin III
Green citrate bottle (x 1)
Factor V Leiden
EDTA (2.7ml)
It is critical to fill the green citrate bottles to the line as they contain liquid anticoagulant
– this must be in the correct proportion to the blood to obtain the correct results,
otherwise incorrect diagnosis and/or treatment may occur.
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HAEMOGLOBINOPATHIES
For haemoglobinopathy screen please send an EDTA specimen in addition to one for
FBC.
Tests available:
• Haemoglobin electrophoresis
• Haemoglobin A2 level
• Haemoglobin F level
• Sickle cell
Also a serum ferritin may be performed to assess iron status.
ANTENATAL SCREENING
Antenatal patients are tested following the NHS Sickle Cell and Thalassaemia Screening
Programme.
HAEMOLYTIC DISORDERS
For screening purposes, a blood count, reticulocyte count, direct antiglobulin (Coombs)
test and haptoglobins should be requested together with bilirubin from the
Biochemistry department. Having established the presence of haemolysis, further tests
should be carried out to detect the underlying cause. Please discuss this with the
Consultant Haematologist.
HAEMATINIC ASSAYS
Tests for investigations of B12, folate and/or ferritin deficiency Test
Specimen requirement
Vitamin B12 (serum)
Folate (serum)
10 ml clotted (brown gel)
Ferritin (serum)
Red Cell Folate
EDTA (x 1)
Additional EDTA specimen required if RCF & FBC requested.
BONE MARROW ASPIRATE AND TREPHINE BONE BIOPSY
By arrangement after consultation with the Consultant Haematologist.
HAEMATOLOGY ADULT REFERENCE RANGES
Please see report form
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OTHER HAEMATOLOGICAL INVESTIGATIONS
Test
Specimen requirement
IM screen
RA screen
LE screen
10ml blood - plain bottle (brown gel)
Haptoglobins
IF antibodies
Malarial parasites
EDTA (2.7ml)
G-6-PD screen
EDTA (2.7ml)
SAMPLE STORAGE TIMES
FBC, ESR, Retics, malaria samples
- 24 hours
PT, APTT, Fibrinogen samples
- 24 hours.
Haematinics, RA LE and IM screens - 7 days.
Any further tests required must be requested within these storage times.
Referred investigations
Analyte
Specimen
Type
Bone Marrow for MDT
Stained
Slides
HBE - Abnormal Hb Variant
Confirmation
EDTA
Nitroblue Tetrazolium Slide
Test
Turn
Around
Ref range
14 days
See report
4 x 2.7ml
25 days
See report
EDTA
2 x 2.7ml
14 days
51 – 99s
Plasma Viscosity
EDTA
1 x 2.7ml
14 days
1.45 – 1.80 cp
WT1 Marker Blood
EDTA
4 x 2.7ml
14 days
See report
WT1 Marker Marrow
EDTA
1 x 2.7ml
14 days
See report
Anticardiolipin Antibodies
Serum
5ml
13 days
<16 units
BCR/ABL
EDTA
2 x 2.7ml
67 days
See report
HFE Hereditary
Haemochromatosis Gene
Typing
EDTA
2 x 2.7ml
19 days
See report
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Volume
Required
Analyte
Specimen
Type
Volume
Required
Turn
Around
Ref range
Janus Kinase 2
EDTA
3 x 2.7ml
43 days
See report
Lymphocyte Marker Studies Blood Must be received in
laboratory before 12 noon
on day of collection (Monday
to Thursday)
Orange
(LH)
10ml
13 days
See report
Lymphocyte Marker Studies Marrow
Special
bottle
2ml
13 days
See report
Spherocytosis Must be fresh
- by arrangement with
laboratory only
EDTA
1 x 2.7ml
Chromosome analysis blood. Must be received in
laboratory before 12 noon
on day of collection (Monday
to Thursday)
Orange
(LH)
10ml
29 days
See report
Chromosome analysis marrow
Special
bottle
2ml
29 days
See report
Pyruvate Kinase
EDTA
2 x 2.7ml
Erythropoeitin
Serum
10ml
12 days
3 – 18 mIU/ml
HAMS / Paroxysmal
Nocturnal Haemoglobinuria
EDTA
2 bottles
14 days
See report
Anti Factor Xa
Green
citrate
1 x 2.7ml
11 days
Antithrombin III
Green
citrate
2 x 2.7ml
24 days
Protein C & Protein S
Green
citrate
2 x 2.7ml
24 days
Von Willebrands Factor
Green
citrate
2 x 2.7ml
39 days
See report
See report
C: 77 – 148 IU/dl
S: 56 – 150 IU/dl
A list of referral laboratories is provided at the end of this user guide. Please note
that for brevity this is not a complete list of available tests, if in doubt please
contact laboratory.
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BLOOD TRANSFUSION
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Blood Transfusion Department
General Enquiries
6391
Consultant Haematologist
Dr Baden
6501
Dr Heppleston
4634
Secretary to Haematologist
6596
Blood Science Manager
Mrs G Lewis
([email protected])
6318
Advanced Biomedical Scientist
Andrew Blackburn
6391
Blood Transfusion Specialist
Caroline Holt
5484
Fatal transfusion accidents still occur. Nationally reported errors show that a high
percentage is due to failure of the bedside check or specimen labelling errors. They are
due to carelessness and are avoidable. At every stage of the procedure from taking
blood for the cross-match specimen to the actual transfusion of the blood, meticulous
attention to detail is essential.
REQUEST FORMS
The Request form must be filled in completely and correctly – see Specimen Acceptance
Policy available on Trust Intranet
Phlebotomists have been instructed not to take blood if the name, district number and
date of birth are not on the request form and patient's wristband.
Please note that in line with national guidelines pre-printed labels (from any source) are
not acceptable.
Please note (as previously stated):
All request forms must be signed by the requesting clinician.
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SPECIMEN REQUIREMENTS
Test
Specimen requirement
Group and save plasma/Cross match
EDTA (blue,4.5ml)
DAT
ANC investigations
EDTA (blue, 4.5ml)
Kleihauer
Cord and Maternal bloods
EDTA (blue, 4.5ml) from mother and
baby
HLA typing (use NBA form) –
PLEASE CONTACT LABORATORY
(ESSENTIAL)
EDTA (2 x 2.7ml)
HLA antibodies (use NBA form)
10ml clotted (white top)
Platelet antibodies (use NBA form)
Contact laboratory
Requests for:
Platelets/Cryoprecipitate/fresh frozen
plasma
Contact laboratory AND Consultant
Haematologist
Requests for:
Human albumin
Send signed request form
Request for:
Novoseven/Prothrombin complex
Strictly by discussion with the
Consultant Haematologist
NB. When FFP or platelets are required a FBC and coagulation screen must be requested
to assess the need and/or dosage of the FFP, Cryoprecipitate or platelets. In case of
major life threatening haemorrhage contact the laboratory immediately.
DEXTRAN
Dextran and other plasma expanders may seriously interfere with cross-matching.
Avoid giving them before taking the cross-match specimen. If this is unavoidable the
fact that they have been given should be indicated on the request card.
ROUTINE REQUESTS
When non-urgent transfusions are planned, requests should be made at least 24 hours
before the transfusion. This allows time for extra investigations to be made if the crossmatch is not straightforward.
Reservation of cross-matched blood
Blood ordered for theatre and not used is taken back into stock for other patients at
9.00 am on the day following operation. If blood is required after this, then please
inform the laboratory before 9.00 am, or leave a signed and dated note on the
appropriate fridge.
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Group and Save Plasma
The use of group and save plasma is encouraged. For many operations it is not
necessary to have cross-matched blood available. All patients for elective surgery must
have a group and save at pre-op assessment. On admission to the ward this must be
repeated.
With group and save requests plasma is tested for irregular antibodies. If these are
detected the M O. will be informed. Patients for surgery with irregular antibodies
should be discussed with the Blood Transfusion Department a minimum of 24hr before
surgery.
If blood is required, a signed request form should be sent to the laboratory stating the
number of units required. In the majority of cases (but not all cases) a sample is valid for
issue of blood for 72hr
Issue of Blood
N.B. BLOOD LEFT OUT OF A SPECIFIED BLOOD FRIDGE FOR MORE THAN 30 MINUTES
MUST NOT BE USED - PLEASE LABEL ANY SUCH UNIT INDELIBLY ON THE FRONT - NOT
SUITABLE FOR USE, AND INFORM THE BLOOD TRANSFUSION DEPARTMENT, TEL 6391
BLOOD MUST NOT BE STORED IN ANY WARD OR DRUG FRIDGE BUT ONLY IN
DESIGNATED CONTROLLED AND ALARMED BLOOD FRIDGES.
Emergency Group O Negative Blood
2 units of uncross-matched blood Group O Negative, are kept in the A&E fridge for
Accident and Emergency, and 2 units in the Maternity fridge for use in life threatening
emergency.
It is stressed that this blood is uncross-matched and its use should be governed by the
patient's clinical condition.
Contact Blood Transfusion (ext. 6391) before use. Note that the blood transfusion
sample must be taken before use.
If any O Negative blood is used in an emergency, then the appropriate red form MUST
be filled in and sent to the laboratory immediately. The Blood Transfusion staff MUST
also be informed by telephone in order that replacement O Negative can be issued
immediately on receipt of the completed red form.
PLEASE SEE AND READ THE HOSPITAL TRANSFUSION POLICY FOR COMPREHENSIVE
GUIDANCE
This guidance is also available on the Pathology website and also on the Trust
Documents section on the intranet.
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Any problems or queries please contact the Blood Transfusion Laboratory, the
Consultant Haematologist or the Specialist Practitioner of Transfusion as appropriate.
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IMMUNOLOGY SERVICES
The referral laboratory for immunological investigations is the Immunology
Department at Salford Royal Hospitals Foundation Trust (Hope Hospital).
A copy of their handbook can be obtained by emailing
[email protected].
The following brief notes have been reproduced (with permission) from
Hope Hospital’s Immunology Department User Guide.
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CONTACT DETAILS
To call in from outside the Trust please dial (0161) 20 followed by the extension number.
General Enquiries
Extension
Patient Enquiries
65572
Laboratory Enquiries
65575
Medical Staff
Name
Consultant & Clinical Lead
Dr Hana Alachkar
65572
Consultant
Dr Archana Herwadkar
61503
SPECIMEN REQUIREMENTS
With the exception of the cellular investigations, the majority of immunology tests can be
carried out on 7.5ml clotted blood. In most cases the samples are stable if kept at room
temperature or 4oC for no more than a couple of days before delivery to Immunology. The
exceptions are the tests listed below.
Cellular Investigations
(a) T and B lymphocyte markers - 5ml of heparinised or EDTA blood.
(b) Lymphocyte function - 10ml of heparinised blood (prior arrangement with the laboratory
is needed)
(c) Neutrophil Function Tests - 10ml of heparinised blood (prior arrangement with the
laboratory needed).
(d) Leukaemia and lymphoma immunophenotyping - 10 ml heparinised blood or bone
marrow sample required.
NOTE: These investigations require the blood to be fresh and it is up to the requestor to
ensure the sample is delivered to the Immunology department before 3pm, to allow
processing and analysis.
Determination of Intrathecal IgG Synthesis and CSF Oligoclonal Bands
To carry out these investigations we need paired CSF (1ml) and clotted blood samples. The
CSF should not be bloodstained as this would indicate contamination with serum IgG,
rendering the sample unusable.
Functional Complement Studies (CH50 & AP100)
Some Complement components are labile and so for functional Complement studies we
require fresh blood. This must be delivered to the laboratory immediately or separated and
stored at -70oC prior to dispatch.
Mast Cell Tryptase
Blood should be collected between 15 minutes and 3 hours after a suspected anaphylactic
reaction. Additional samples may be taken six hours and 24 hours after the reaction. The
blood can be kept at room temperature for up to two days, or at 4oC for up to five days, or
separated and the serum stored at -20oC prior to dispatch.
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Investigation of allergy and anaphylaxis.
The laboratory investigation of atopic allergy relies upon the measurement of serum total
IgE and allergen specific IgE (previously known as RAST). In cases of anaphylaxis, for example
those that occur at surgery due to anaesthetics or latex, measurement of mast cell tryptase
may be useful.
Total IgE
Total IgE levels are of limited clinical value and are rarely essential. Normal levels don’t
exclude allergy. Very high levels of lgE are seen both in atopic eczema and in parasitic
infestations and also in the rare hyper-IgE syndrome and extremely rare cases of IgE
myeloma.
Indications:
•
Differentiation of IgE - from non IgE-mediated disorders, where this is difficult by clinical
means.
•
Identification of patients at risk of allergic disease, whether or not they are symptomatic.
This particularly applies to early childhood.
•
IgE may be raised in non-atopic disease, especially parasitic conditions.
Allergen-Specific IgE
Specific IgE testing is performed for a range of allergens requested by the clinician and
should be based on a detailed history.
When requesting Specific IgE tests it is important that you specify the allergens to be tested.
If you are not sure whether we are able to test for IgE levels to a specific allergen, please
contact the laboratory and discuss your requirements. The laboratory will not screen sera
against a large panel of allergens in cases of questionable clinical hypersensitivity. Specific
IgE testing is not a substitute for clinical history.
Specific IgE can be requested when skin prick test can’t be done:
•
In the presence of dermographism or dermatitis which preclude skin-tests.
•
In situations in which treatment that would influence skin reactivity cannot be
stopped.
•
In cases where extreme levels of sensitization mean that skin tests are potentially
dangerous.
•
Or to help with interpretation of doubtful skin tests.
Specific IgE results are reported both as a value in kilo-units per litre (KU/l) and graded as a
class:
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Allergen specific IgE results - Interpretation of class
Allergen specific IgE results KU/L
Class
Interpretation
<0.35
0
Absent
0.35 - 0.69
1
Low
0.70 - 3.49
2
Moderate
3.50 - 17.49
3
High
17.50 - 49.99
4
Very High
50.00 -100
5
Extremely High
>100
6
Highest
Clinical correlation
Consider non-allergic
cause
Uncertain clinical
relevance
Possibly clinically
relevant
Probably clinically
relevant
Highly clinically
relevant
Results interpretation :
The relevance of allergen specific IgE must be carefully assessed in the context of the clinical
history.
Normal IgE level makes atopy unlikely, however, it does not exclude sensitisation to
individual allergens. As a general rule even weakly positive allergen specific IgE may be
clinically relevant in patients with a low normal IgE.
Mast Cell Tryptase (MCT)
•
MCT is a marker of mast cell activation and degranulation.
•
MCT can be useful in identifying an anaphylactic event as a cause of unexplained
circulatory collapse.
•
Blood must be taken within a window of 15 minutes to 3 hours following the event,
another sample should be taken after 6 hours and after 24 hrs.
•
Normal range is <13.5ug/L.
•
Elevated levels may be found in patients with mastocytosis.
Complement
Measurement of complement is useful in assessing disease states where complement may
be consumed (e.g. due to immune complex activation) or synthesized as an acute phase
response. Measurement of functional complement activity (classical and alternate
pathways) is useful in identifying complement component deficiencies. A deficiency can then
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be investigated further by testing for the presence or absence of individual pathway
components.
Special requirements: falsely-low functional complement levels occur if sera are improperly
treated, e.g. there is a transport delay or repeated freeze-thawing. Send samples directly to
the laboratory.
Complement components - C3 and C4
Complement components act as acute phase reactants, and thus inflammation causes a rise
in levels. Activation of the complement cascade causes depletion of C3 and C4 (classical and
lectin pathways) or C3 alone (alternative pathway).
Indications:
•
•
Assessment and monitoring of patients with renal disease, immune complex
disorders (SLE) and vasculitis. 'Routine' complement tests are of little value in most
other acute and chronic inflammatory or infectious diseases.
Consider requesting complement levels in the following situations: Unusual
meningococcal serotype disease, recurrent meningococcal disease, FH of
meningococcal disease or glomerulonephritis, recurrent pyogenic infections and
isolated angioedema (Measurement of C3 and C4 is not the investigation of choice
when complement deficiency is suspected), discuss with the consultant
immunologist.
Interpretation:
•
•
Raised levels are found where synthesis in increased, especially as part of an acute
phase response after inflammation and trauma. No diagnostic significance is
attached to the degree of elevation.
Low levels of C3 and/or C4 are particularly found after increased consumption. A low
C4 and C3 suggests complement consumption via the classical pathway while a low
C3 with a normal C4 suggests alternative pathway activation.
C1 inhibitor
•
In patients with suspected hereditary angio-oedema, C4 should be measured. During
an episode of angio-oedema, the C4 level is very low and thus a normal C4 virtually
excludes the condition.
•
The diagnosis is confirmed by measuring the C1 inhibitor level. Hereditary angiooedema is an autosomal dominant condition: heterozygotes are symptomatic and
half-normal levels of C1 inhibitor are significant.
•
If the C1 inhibitor is 'normal' in the face of a low C4, a functional assay of C1 inhibitor
activity is indicated because 15% of kindreds inherit an immunochemically detectable
but non-functioning molecule.
•
Acquired C1 inhibitor deficiency is found in patients with lymphoid malignancy and
autoimmune disorders.
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Autoantibodies
Autoantibodies should be measured where an autoimmune process or aetiology may be
suspected in the following disease categories:
- Connective tissue disorders
- Liver disease
- Renal disease
- Neurological disorders
- Endocrinopathies
- Skin disease
- Gastrointestinal disorders
A wide range of autoantibodies are measured using immunofluorescence and immunoassay
techniques - See the table below.
Accurate clinical details can help the laboratory staff to make an informed decision as to
which autoantibodies may be appropriate for a patient.
If you are unsure as to the correct choice of autoantibody test please contact the
immunology lab.
A result for some autoantibodies (i.e. ANCA, anti GBM) may be requested urgently. If this is
the case then please contact the laboratory.
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Tests for Autoantibodies
Test
Result reported
Anti-Nuclear
Antibody
(ANA or ANF)
Normal Range
Indication and interpretation
Semi-quantitative:
Negative
Negative/Positive
plus titre
(screening titre 1/100 for adults
and 1/40 for children).
The absence of an ANA virtually excludes SLE. ANA may also occur in a number of other conditions including juvenile chronic
arthritis, Sjogren’s syndrome, fibrosing alveolitis, chronic active hepatitis (CAH), viral infections particularly EBV and CMV and
in drug reactions. Low titre ANA are detected at increasing frequency in normal individuals with increasing age.
ANA has no value in laboratory monitoring of disease activity.
Staining pattern
Variants
- Homogeneous
- Speckled
Homogeneous ANA – Found in SLE, RA, JCA, Scleroderma.
Speckled ANA – Found in SLE, Sjogren’s syndrome, MCTD.
- Annular
Annular ANA – Found in SLE, autoimmune liver disease.
- Nucleolar
Nucleolar ANA – Found in Scleroderma & associated overlap syndromes.
- Centromere
Centromere ANA - Found in the limited cutaneous form of systemic sclerosis and in the CREST variant, up to 12% of patients with
primary biliary cirrhosis, over half of (50% have clinical signs of scleroderma).
Anti-ds DNA
Quantitative: IU/mL
Less than 10 IU/mL
10-15 IU/mL – Borderline, 16-30 IU/mL – Weak Positive, >30 IU/ml Significant Positive.
Positive in up to 70% of SLE. Level can be used to monitor disease activity.
Anti-dsDNA may be found in patients with autoimmune chronic active hepatitis
Weak positives are found in other connective tissue diseases and in chronic and acute infection.
Rheumatoid Factor
(RhF)
Quantitative: IU/ml
Less than 20 IU/mL
Although 70-80% of adults with rheumatoid arthritis are positive for rheumatoid factor, it is not disease specific and can also occur
in a number of other conditions including: SLE, scleroderma, HIV and other infections. Also rheumatoid factor is present in 5% of
normal healthy adults.
20-70 IU/mL Weak positive
71-250 IU/mL Significantly positive
>250 IU/mL Strongly positive
Very high RhF levels found in patients with extra-articular features, e.g. vasculitis, nodules, etc.
RF is not of value in laboratory monitoring of disease activity.
We suggest that you repeat the test in approximately 3-6 months time if clinical symptoms have persisted and RF was only weakly
positive.
Where there is a strong clinical suspicion of Rheumatoid Disease anti-CCP should be ordered.
Patients with Sjogren’s syndrome may have very high levels of RF despite only minor joint symptoms. Occasionally a similar level
may be seen in patients with cryoglobulinaemia.
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Test
Result reported
Cyclic Citrullinated
Peptide (CCP)
antibodies
Antibodies to
Extractable Nuclear
Antigens (ENA)
Variants
Normal Range
Indication and interpretation
Quantitative: U/ml
Less than 10 U/ml
0 -7 U/ml Negative, 7-10 U/ml Equivocal, > 10 U/ml Positive
More sensitive (77%) and specific (97%) for Rheumatoid Arthritis (RA) than rheumatoid factor (RF: Sens= 74%; Spec= 65%).
The presence of Anti-CCP antibodies correlates with erosive RA disease progression. Anti-CCP antibodies are present earlier in
disease than RF and therefore are useful in predicting the development of RA.
Qualitative:
Negative
Negative or Positive
Antibody specificity
- Anti Sm
Sm: Subset of SLE (20%), found alone or with anti-RNP.
- Anti-RNP
RNP: Mixed Connective Tissue Disease.
- Anti Ro
Ro: Sjogren's syndrome, Neonatal lupus & congenital heart block. Subacute cutaneous lupus.
- Anti La
La: Sjogren’s syndrome.
- Anti Scl-70
Scl-70: Scleroderma
- Anti-Jo-1
Jo-1: Myositis – often with pulmonary fibrosis.
- Anti PM1
PM1: Myositis.
Specialist further tests may be available on consultation with the Consultant Immunologist or Clinical Scientist.
Anti-Cardiolipin
Antibodies
Quantitative:
GPLU/ml or
MPLU/ml
Test
Result reported
Variants
Less than 17 GPLU/ml
Interpretation on the report:
<18 GPLU/ml - Anti-Cardiolipin IgG Antibodies – Negative
18-36 GPLU/ml - Anti-Cardiolipin IgG Antibodies – Low Positive
36-81 GPLU/ml - Anti-Cardiolipin IgG Antibodies – Moderate Positive
>81 GPLU/ml - Anti-Cardiolipin IgG Antibodies – Strong Positive
Found in Primary Phospholipid Antibody Syndrome and some cases of SLE. Associated with: venous and arterial thrombosis;
recurrent intrauterine death/ spontaneous abortion.
Low levels of autoantibodies to cardiolipin may also be found in normal people, infections and in various other conditions and
persistent presence of higher levels are required to confirm antiphospholipid syndrome.
Normal Range
Indication and interpretation
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Anti-Neutrophil
Cytoplasmic Antibody
(indirect
immunofluorescence,
IIF)
Mitochondrial antibody
(AMA)
Atypical ANCA are found in some cases of drug induced vasculitis but otherwise are of uncertain clinical significance
Negative or Positive
plus titre
Staining pattern
ANCA specifics
(MPO/PR3 abs)
Negative (screening titre 1/32)
Semi-quantitative:
- cANCA
C-ANCA with specificity for PR-3 has a high predictive value for active generalised Wegener’s granulomatosis (WG) and can also
be found in patients with microscopic polyangiitis (MPA).
- pANCA
P-ANCA with MPO specificity is predictive for patients with active MPA and Churg Strauss syndrome (CSS), some patients with
WG also have this antibody.
P-ANCA with specificities other than MPO occur in some patients with inflammatory bowel disease, sclerosing cholangitis,
rheumatoid arthritis, SLE, chronic active hepatitis and other autoimmune diseases.
Quantitative:
Tested :
Anti-MPO in U/ml
Anti-PR3 in IU/ml
MPO <7 U/ml
PR3 <2 IU/ml
New ANCA IIF positives; If ANCA pattern appears to have changed; If ANCA is masked by ANA staining (MPO/PR3 done twice
only)
Semi-quantitative:
Negative
A titre of greater than or equal to 1/160 Indicates Primary Biliary Cirrhosis, at low titers may be associated with other conditions
including drug induced hepatitis, SLE , myocarditis and infections
Negative
This antibody may indicate Autoimmune Hepatitis Type 2, drug- induced hepatitis or Hepatitis C infection
Positive or Negative
Plus titre
Staining pattern
Liver Kidney
Microsomal antibody
(LKM)
Qualitative:
- M2 pattern
Negative, Weak
Positive or Positive.
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Test
Result reported
Anti-Smooth Muscle
Antibody (SMA)
Semi-quantitative:
Negative or positive
plus titre
Staining pattern
Anti tissue
transglutaminase
antibodies
Quantitative: U/ml
Endomysial Antibody
Qualitative:
Variants
Normal Range
Indication and interpretation
Negative
- SMA(T)
SMA(T): Strong association with chronic active hepatitis.
- SMA(G)
SMA(G): Intermediate form.
- SMA(V)
SMA(V): Non-specific: occurs in viral infections. Often found in normal patients.
Less than 3 U/ml
Tissue transglutaminase is the antigenic target for anti endomysial antibody. The test is used as a screening test for Coeliac
disease. Treatment with a gluten free diet leads to gradual disappearance of these antibodies. They can also be used to monitor
dietary compliance. In IgA deficient patients with Coeliac disease, IgG class tissue transglutaminase antibodies may be detected
with 70% sensitivity.
Negative
These IgA class antibodies are very specific (90-100%) for Coeliac disease and dermatitis herpetiformis. Treatment with a gluten
free diet leads to gradual disappearance of these antibodies. They can also be used to monitor dietary compliance. IgG class antiendomysial antibodies may be detected in IgA deficient patients with Coeliac disease.
Negative
Associated with atrophic gastritis - found in 90% of cases of PA and 40% of cases of gastric atrophy. Also found in 30% of
patients with autoimmune thyroid disease.
Negative
Useful in differential diagnosis of bullous eruptions.
Antibody Class (IgA
or IgG)
Negative, Weak
Positive or Positive.
Antibody Class (IgA
or IgG)
Gastric Parietal Cell
Antibody
Qualitative:
Negative, Weak
Positive or Positive
Skin Antibodies
Qualitative/Semiquantitative:
Epidermal basement
membrane
Negative, Doubtful or
Positive
Bullous pemphigoid
Inter-cellular cement
Negative or Positive
Plus titre
Pemphigus vulgaris, titre can be used to monitor disease activity.
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Test
Result reported
Antibodies to Adrenal
Cortex
Qualitative:
Variants
Normal Range
Indication and interpretation
Negative
Positive in 65% of cases of idiopathic adrenal insufficiency
Negative
Found early in some cases of insulin - dependent diabetes mellitus, gradually disappear with time.
Negative
Positive in 80% of cases of Sjogren's syndrome, 30% of sicca syndrome and 10% of RA
Negative, Weak or
Positive
Pancreatic Islet Cell
Antibody
Qualitative:
Negative, Weak
Positive or Positive
Salivary Duct Antibody
Qualitative:
Negative, Weak or
Positive
Glomerular Basement
Membrane (GBM)
Antibodies
Quantitative: U/ml
Less than 7 U/ml
Found in Goodpasture's syndrome which is a rapidly progressive glomerulonephritis. The antibody levels can also be of value in
monitoring response to therapy of this disease, and anti GBM disease, and occasionally in other renal disorders.
Skeletal Muscle
Antibody
Qualitative:
Negative
Found in 40% of cases of myasthenia gravis, and almost all (80 – 100%) patients with thymomatous myasthenia gravis. They can
also occur in patients with hepatitis, acute viral infections and polymyositis.
Negative, Weak or
Positive
Antibody to Acetyl
Choline Receptor
Quantitative: nM
Less than 0.50 nM
<0.5 nM Not detected, 0.51 – 2 nM Weak Positive, >2 Positive
Specific test for myasthenia gravis (85 – 90% of patients). 10-15% of MG patients are seronegative.
Voltage gated calcium
channel antibody
Quantitative: pM (if
positive)
Less than 45 pM
Found in Lambert-Eaton myasthenic syndrome
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Test
Result reported
Voltage gated potassium
channel antibody
Variants
Normal Range
Indication and interpretation
Quantitative: pM (if
positive)
Less than 100 pM
Associated with acquired neuromyotonia.
Anti Purkinje cell
antibody
(Anti Yo)
Qualitative:
Negative
Paraneoplastic cerebellar degeneration (associated with gynaecological or breast cancer)
Anti-neuronal nuclear
antibody (Anti Hu)
Qualitative:
Negative
Paraneoplastic encephalopathy or subacute sensory neuropathy (associated with small cell lung cancer)
Negative, Weak
Positive or Positive
Negative, Weak
Positive or Positive
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Cell marker studies.
Cell markers are carried out on freshly-drawn heparinised or K/EDTA blood (orange or red
top). Clotted blood samples are unsuitable.
Samples must be received in the Immunology Department before 3:00pm to allow
processing while fresh.
The choice of markers is determined by the working diagnosis. Prior discussion with the
laboratory is most important.
'Essential' indications:
•
•
Assessment and monitoring of primary immunodeficiency.
Classification of lymphoid and myeloid malignancy (bone marrow aspirates and
peripheral blood).
'Useful' indications:
Assessment of secondary immunodeficiency including HIV infection/AIDS.
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Immunological tests required for certain clinical conditions
Autoimmune Disease
SLE - Diagnosis
ANA, ENA, dsDNA antibodies, Complement (C3, C4 levels), Immunoglobulin levels (IgG, IgA,
IgM).
•
•
•
•
•
ANA testing should usually be ordered only once.
Positive ANA tests do not need to be repeated.
Changes in the ANA titre do not correlate with disease activity.
Negative ANA tests rarely need to be repeated (exceptions being if there is a strong
suspicion of an evolving CTD or a change in the patient’s illness suggesting the
diagnosis should be revised).
Once a specific ENA is positive there is no need for repeat testing.
SLE – Monitoring
dsDNA antibodies, Complement (C3, C4 levels).
SLE and Pregnancy
As ‘SLE – Monitoring’ + anti Cardiolipin antibodies.
Anti Phospholipid Syndrome, Recurrent Miscarriage, Unexplained Thrombotic Event/Stroke
Anti Cardiolipin Antibodies.
•
Repeat testing after at least 6 weeks interval is recommended to confirm the
diagnosis in appropriate clinical settings.
RA – Diagnosis
ANA, RF, Anti CCP antibodies and Immunoglobulins (IgG, IgA, IgM).
High titre RF is indicative of a likely poor prognosis.
RA – Monitoring
Complement (C3, C4 levels).
•
•
•
Repeat testing of RF has no role in patient monitoring.
Levels of complement components C3 and C4 are usually raised in RA, as is CRP,
indicative of an acute phase response.
Falling levels of C3 and C4 may indicate rheumatoid vasculitis
Suspected Connective Tissue Disorder
(Includes: Sjogren’s syndrome/congenital heart block, CREST/Raynaud’s phenomenon,
Mixed Connective Tissue Disease, Scleroderma/Systemic Sclerosis and
Polymyositis/Dermatomyositis).
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ANA, ENA, dsDNA antibodies, Complement (C3, C4 levels), Immunoglobulin levels (IgG, IgA,
IgM).
In Sjogren’s syndrome Anti Salivary Duct antibodies may be positive.
•
ENA antibodies are normally present at the time of diagnosis and generally do not
become positive later on
Autoimmune Liver Disease (CAH, PBC, PSC)
Autoantibodies to Smooth Muscle, Mitochondrial, Liver Kidney Microsomal (LKM) antibodies
and ANA (ANA and Gastric Parietal Cell antibodies are also included as part of this test),
Immunoglobulin levels (IgG, IgA, IgM)
Pernicious Anaemia
Gastric Parietal Cell antibodies (a tissue section of liver, kidney and stomach is used in the
identification of anti GPC antibodies therefore ANA, Smooth Muscle, Mitochondrial, Liver
Kidney Microsomal (LKM) antibodies are also included as part of this test).
Coeliac Disease – Diagnosis
TTG Antibody (positives are confirmed with anti endomysial antibody testing)
Coeliac Disease – Monitoring
TTG antibody
Vasculitis
RF, ANA, ANCA, Complement (C3, C4 levels), Immunoglobulin levels (IgG, IgA, IgM).
(Cryoglobulins may be requested as a second line investigation – please contact laboratory
for sample collection details).
Renal Failure
Anti Nuclear Antibodies (ANA), Anti Neutrophil Cytoplasmic Antibodies (ANCA), Anti-GBM,
Complement (C3, C4 levels), Immunoglobulin levels (IgG, IgA, IgM) and electrophoresis.
C3 nephritic factor: C3 is very low and C4 is normal (Mesangiocapillary Glomerulonephritis).
Lupus nephritis: C1q antibodies.
Wegener’s granulomatosis, Microscopic Polyarteritis, Churg Strauss Syndrome, Crescentic
glomerulonephritis: ANCA
Suspected Inflammatory Bowel Disorder
No specific immunology test is indicated for this condition however requesting ANCA,
Coeliac disease and Anti GPC antibodies may help with a differential diagnosis.
Autoimmune Diabetes – Diagnosis
Anti Islet Cell antibodies (ICA) may be positive in the early stages of disease.
Autoimmune Diabetes – Monitoring
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These patients should also have their anti thyroid peroxidase (TPO) and Coeliac disease
antibodies assessed on an annual basis.
Blistering Skin Disorders
Anti Skin (Basement Membrane Zone and Desmosome) antibodies.
Addison’s Disease
Anti Adrenal Antibodies (may also be positive in hypothyroidism).
Dressler’s syndrome, Cardiomyopathy, Myocarditis
Anti Cardiac antibodies.
Multiple Sclerosis
Immunoglobulin levels (IgG, IgA, IgM), CSF Oligoclonal Bands and Blood Brain Barrier Ratio
studies.
Myasthenia gravis, Unexplained Muscle Weakness +/- Thymona
Anti Striated Muscle and Acetylcholine Receptor (ACHR) antibodies. If ACHR antibodies are
negative consider following up with Muscle Specific Kinase antibodies (MuSK).
Lambert Eaton Myasthenic Syndrome (LEMS)
Voltage Gated Calcium Channel Antibodies.
Neuromyotonia
Voltage Gated Potassium Channel Antibodies.
Paraneoplastic Neurological Syndromes
Anti Paraneoplastic Antibodies (ANA will also be done to rule out its presence).
Sensory/Motor Neuropathy, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP),
Guillan Barré and Miller Fisher Syndrome
Anti Glycolipid Antibodies.
Sensory Neuropathy associated with IgM Paraprotein
IgM Myelin Associated Glycoprotein (MAG) Antibodies.
Stiff Person Syndrome
Anti Glutamic Acid Decarboxylase (GAD) Antibodies.
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MICROBIOLOGY
DEPARTMENT
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Contact details:
Microbiology Department
General Enquiries
6492
Consultant Microbiologist
Dr P Unsworth
6500
Dr H Sacho
4086
Microbiology Manager
Ms C Hatch
6418
INVESTIGATIONS
All sample should be sent directly to the laboratory.
Refrigerate if overnight storage required
Time limits for further investigations
Routine bacteriology specimens are stored for one week before disposal, except
respiratory specimen (48 hours).
Specimen type
Container/Sample
Notes
Antibiotic assays
(except gentamicin and
vancomycin – see
Biochemistry section)
5mls clotted (brown
gel)
Referred for analysis to
outside laboratory –
contact department for
further information.
Blood Cultures
Bottles/Monovette
supplied
Take before antibiotics
started and send
immediately to laboratory
Paediatric set
(paediatric plus bottle
set)
1-3mls blood
For neonates/infants –
older children use routine.
Routine set
(Aerobic/Anaerobic, 2
bottle set)
8-10 ml each bottle
? Infective endocarditis,
take 3 sets. Otherwise two
set minimum
Body cavity fluid e.g.
pleural, joint and
peritoneal
Sterile 60ml
container
Please indicate if TB
investigation required.
Please indicate if
examinations for crystals is
required as this will involde
a referral to another lab.
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Specimen type
Container/Sample
Notes
Cerebrospinal fluid
Sterile screw cap
bottles
2ml into each of four
containers labelled 1 to 4.
Please see section on CSF
investigations.
State if viral/herpes tests
required.
NOTE: if ?TB Meningitis then
5ml CSF required
Faeces
Sterile 30ml
universal with
spoon.
Clostridium Difficile
Toxin (CDT)
Faeces as above
Threadworm (send
sellotape slide
(“AnalTape”)
Glass slide in holder
Alternatively swab in saline
– moisten swab in sterile
saline. Swab perianal area;
break off swab into saline
pot. Sample to be taken in
the morning before washing
and defecation/
Genital swabs (HVS,
urethral, endocervical
Transwab
For reliable recovery of N.
Gonorrhoea – send cervical
and/or urethral swab.
Chlamydia samples:
Female cervical swab,
Male urethral swabs,
First stream urine
Abbott Multi Collect
Kit.
Chlamydia collection kit
supplied by Lab. Follow kit
instruction precisely.
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State if full examination for
parasites required – patient
history must be stated.
In cases of suspected
amoebic dysentery or
tapeworm please contact
laboratory.
For “? Enterobius” send
sellotape slide (“AnalTape”).
Specimen type
Container/Sample
Helicobacter (HPSA) stool antigen test.
Faecal sample.
Sterile 30ml
universal with
spoon.
Ear/Nose/Throat
Eye swabs
Transwab
Pernasal Swab
(Whooping Cough)
Flexible wire ENT
swab.
Line tips
Sterile sample
container (60ml)
or Transwab
Endotracheal tips
Sterile sample
container (60ml)
or Transwab
Wound swabs
(skin abscesses, burns,
sinuses)
Transwab
Indicate site/”deep
wound”/prosthesis
Pus
Sterile container
(60ml)/”capped
syringe”/transwab
If possible send actual pus. If
anaerobes queried then fill
container to exclude air or send
syringe with air and capped.
NOTE: syringes with needles still
attached will not be accepted by
the laboratory.
Tissue/biopsy samples
Sterile container
(60ml)
If storing overnight then cover
with sterile saline to prevent
desiccation.
Please indicate if TB
investigations required.
MRSA swabs
Routine screen nose
perineum. ITU
patients/dentures
throat swab also.
Transwab
Please refer to screening
protocol (infection control).
Policies on intranet.
Mycology:
skin scrapings
nail/hair clippings
Mycology
Dermapak
kit/sterile
container (60ml)
Sample collection kit and
instructions available from the
laboratory.
Sputum (routine)
Sterile container
(60ml)
Note: saliva samples are NOT
suitable for processing.
Sputum (TB)
Sterile container
(60ml)
Three early morning samples
required. Contact laboratory if
required urgently.
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Notes
State type/site tip sample
from.
Specimen type
Container/Sample
Notes
TB samples
(e.g. pleural fluid,
bronchial lavage, pus,
tissue, etc.)
Sterile container (60ml)
Contact laboratory if
required urgently.
Urines (routine)
MSU
CSU (catheter)
bag
Sterile container (boric
acid, 30ml)
Fill sample to line
ensure correct boric
acid concentration
achieved.
Urine (plain: non-boric
acid)
Sterile container (60ml)
Syringe or plain
container (non-boric
acid) – straight to lab
(“out of hours” –
refrigerate)
Urine (schistosomes)
Sterile container (60ml)
Full or end part of
sample taken between
10:00 and 14:00.
Urine (TB)
Sterile container (60ml)
Send 3 x EMU (first
urine passed) from 3
consecutive days.
Urine (Legionella,
pneumococcal antigen)
Sterile container (60ml)
Genital swabs ( Herpes
Simplex Virus)
Cotton tipped swan cut
1cm from end and
placed into vial of
virology transport media
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Do not put swab into
charcoal (Transwab)
SEROLOGY AND VIROLOGY SAMPLES
These samples are referred to the appropriate virus/reference laboratory - transport
leaves the laboratory each day (mon-fri) at 13.00 hrs. Please ensure the correct virology
request form accompanies the sample.
Specimen type
Container/Sample
Notes
Blood samples for
relevant serological
testing, e.g.
• Viral
antibody
titres
• Atypical
pneumonia
serology
10mls clotted blood
(brown gel)
Sample should be refrigerated
Needlestick bloods
10 clotted blood
(brown gel) from
source and recipient.
Pleas follow “Inocculation
Injury Protocol” – available in
all clinical areas and on Trust
intranet. Send sample directly
to laboratory/reference
laboratory.
CSF/Vesicle Fluid
Sterile screw cap
bottle
Suspected viral meningitis.
Please state if herpes
suspected
Faeces
Sterile universal
container (30ml with
spoon)
Rectal swab can be sent in
viral TX media if delay in
production of faeces –
followed by faecal sample
when available.
Swab – any site
Cotton tipped swab
cut 1cm from end and
place into vial of viral
TX medium
Do NOT put swab into
charcoal (Transwab). Viral TX
media available from
laboratory.
Urine
Sterile container
(60ml)
Plain urine only – NOT boric
acid container
R U Clear Chlamydia
samples (female
cervical swabs, male
urethral swab, first
stream urine)
Aptima Gen- probe
Collection Kit
Do NOT send R U Clear
samples in Abbott Multi
Collection Kits (orange lids)
Serology
if delay in sending to lab. –
refrigerated on arrival.
Referred to reference laboratory
(please contact laboratory for
further details). Antibody tests
require full clinical details
including date of onset for
interpretation of results.
Please send multiple samples if
multiple requests made.
Virology
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Turn around times for microbiological investigations
Analyte
Turn around time
CSF microscopy
culture
1 hour
24-48 hours
MRSA screen
24-72 hours
Swabs/pus culture
24-72 hours
5 days for anaerobic culture
Per nasal swabs
5 days
Blood cultures
7 days if negative
Positives on isolation-18
hours-7 days
Urines microscopy
Urine culture
1 hour if urgent
Non urgent 1-24 hours
24- 72 hours
Respiratory specimens
24-72 hours
Mycology microscopy
Mycology culture
24 -48 hours
Up to 3 weeks
TB microscopy
TB culture
24- 72 hours
Up to 6 weeks
Joint fluids microscopy
1 hour for inpatient samples
Same day for outpatient
samples
24-72 hours
Joint fluid culture
Ascitic /peritoneal fluid
microscopy
Ascitic/peritoneal fluid
culture
1 hour
24-72 hours
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Notes
Depending on
sample/isolates
Urgent Gram stain on
request
1 hour.
Interim report issued at 48
hours if negative
If urgent 1-2 hours
Analyte
Turn around time
Notes
Faeces microscopy
Faeces culture
24-72 hours
24-72 hours
Hot stools for ova/cysts and
parasites 1 hour. Inform
department prior to sending
Faeces Helicobacter Ag
1 week
C difficile toxin testing
24-48 hours
Norovirus
24-48 hours
Chlamydia and Gonococcal
PCR
2-7 days
Herpes simplex virus
1 week
Syphilis
1 week
Legionella and
Pneumococcal antigen
24 hours
ASO titres
24 hours
Referred samples
Urgent requests same day
to 24 hours depending on
request.
Non urgent 2 weeks.
Please note: The turn around time stated above apply to samples received
Monday to Friday.
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Referred investigations – referral laboratories.
Referral
laboratory
Analyte
Referred by
Sample
Reception
CMFT
Manchester
Medical
Microbiology
Partnership
Aspergillus PCR EDTA
Aspergillus PCR bronchial lavage/sputum
Atypical pneumonia serology
Candida PCR (EDTA)
Candida PCR ( bronchial lavage/sputum)
CMV
Coxsackie virus
Coxsackie B (swabs, faeces, CSF)
Enteroviruses serology
Enteroviruses – faeces culture/PCR
Epstein Barr (EBV)
Herpes simplex Antibodies
HPV swabs
Measles virus antibodies
Measles swabs/urines
Mumps Antibodies
Mycoplasma pneumonia antibodies
Parvovirus antibodies
Parechovirus
Q fever (Coxiella burnetti)
Rubella Antibodies
Respiratory viruses culture/PCR
Varicella zoster (VZV) antibodies
Varicella zoster antigen
TORCH screen
(maternal blood for CMV,Rubella and
Toxoplasma. Baby urine for CMV)
Toxoplasma
Meningococcal/Pneumococcal PCR
(CSF/EDTA)
Pneumocystis PCR
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Referred by
Microbiology
Referral
laboratory
Analyte
Referred by
Sample
Reception
CMFT
(Immunology)
TB quantiferon
Salford Royal
Hospital
(Immunology)
Aspergillus antibodies
Aspergillus precipitins
Avian precipitins
Diphtheria Antibodies
Farmers lung
Functional Antibodies (post vaccine –
pneumococcal. Haemophilus and
Tetanus)
Meningococcal C Antibodies
Referred by
Microbiology
Mycology
Reference
Centre
Wythenshawe
Hospital
Aspergillus galactomannan ELISA
(antigen)
Cryptococcal Antigens
Antifungal assays
PHE Colindale
Anti Staphylysin
Bartonella/cat scratch fever
Bordetella pertussis antibodies
Delta Ag
E.coli VTEC Antibodies
Listeriosis
Polio Antibodies/Antigen
Severe acute respiratory syndrome
Yersinia Antibodies
Buccal swabs
Lymphogranuloma venereum
PCR (rectal swabs)
Mumps virus PCR swabs
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Referral
laboratory
Analyte
Referred by
Sample
Reception
RIPL
Porton down
Causative agents/viral haemorrhagic
fever
Referred by
Microbiology
Arbo virus
Bacillus anthracis
C botulinum Antibodies
Dengue fever
Ehrlichia
Hantavirus
Rickettsia/Tuleraemia
West Nile fever
Yellow Fever
Borrelia/Lyme disease
Brucella
Reference unit
Liverpool
Brucella antibodies
Royal Preston
Hospital PHE
Campylobacter antibodies
Birmingham
PHE
Hepatitis E
Leeds General
Infirmary
Histoplasmosis antibodies
Molecular
Pathology, St
James Hospital
Leeds.
Whipples disease
Leptospira
reference unit.
Hereford
Leptospira antibodies
Liverpool
School of
Tropical
Medicine
Leishmania
Tropical serology
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Referral
laboratory
Analyte
Referred by
Sample
Reception
Referred by
Microbiology
Central
Veterinary
Laboratory.
Weybridge
Rabies
Immunotec,
Abingdon
T spot test (for TB immunity)
National CJD
Surveillance
Unit, Edinburgh
CJD (CSF)
PHE, Bristol
Cryptococcal antibodies
Please note:
Requests for Leptospira and Lyme Disease Borrelia require completion of a
reference laboratory form. Please contact the laboratory to request this form.
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CELLULAR PATHOLOGY
Please note that this service has transferred to University Hospital
South Manchester as part of the South Sector Pathology initiative.
Contact details and sample arrangement are contained on the
following pages.
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Contact Details
Report enquiries (answer phone). Please leave clear message and 4813
number if activated. (please note that if phoning externally then
prefix the number with (0161-) 291)
Report Fax Number
4809
Medical Staff
Office
Secretary
Dr L Joseph, Head of
Histopathology
[email protected]
4808
4812
Dr S Pritchard
[email protected]
4818
2143
Dr M Howe
[email protected]
4806
2121
Dr P Bishop
[email protected]
2159
2123
Dr H M Doran
[email protected]
2138
2123
Dr A Davenport
[email protected]
5311
2143
Dr M Scott
[email protected]
2144
4812
Dr P Hyder
[email protected]
4793
2121
Prof N Haboubi
[email protected]
5663
2121
Dr A. Chaturvedi
[email protected]
4793
2123
Dr R. Hunt
[email protected]
4930
2121
Dr V. Howarth
[email protected]
4793
2121
Dr P Dickens
[email protected]
2819
2121
Dr A Yates
[email protected]
5642
2121
Dr C Lelonek
[email protected]
5902
2121
Pathologist's room at Tameside
922 4943
Specialist Registrars
4814/4815/4816
Ms Dawn Clarke,
Cellular Pathology
Manager
[email protected]
4804
Specimen/Histology reception
4800
Cytopathology
[email protected]
2156
UHSM Mortuary
[email protected]
2541
Tameside Mortuary
[email protected]
6059
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Further information about the service at UHSM
available to Tameside users can be accessed via:
http://portal.uhsm.nhs.uk:20002/SouthSector/handbook_2004.htm
This can be accessed via GP practices and from
within Tameside Hospital NHS Foundation Trust.
If you have any problems with this then please contact
Mr Tony Tetlow on 0161 922 6495.
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Mortuary Department
(at TGH)
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Mortuary department
The services that we provide to the Trust and the Community includes storing
of the deceased, post mortem examinations, tissue donations, identifications
and viewings for the bereaved relatives.
We follow strict guidelines under the HTA (Human Tissue Authority) license
ensuring safety and security at all times, also demonstrating respect and
sensitivity for bereaved families.
Our dedicated and caring team deals with approximately 2,000 deaths a year
from the hospital and the local community, around 600 post mortem
examinations are performed most of which from the direction of Her Majesty’s
Coroner for South Manchester.
The mortuary team consists of one Mortuary Manager and three Anatomical
Pathology Technologists all who show a caring dedicated approach in their
roles.
The mortuary works very closely with the following services:
• Bereavement services
• HM Coroner’s office
• Greater Manchester police
• Doctors and Nursing staff
• Transplant teams
• Patient Advice and Liaison service (PALS)
• Chaplaincy
• Funeral Directors
Mortuary Opening Hours
The mortuary is open Monday to Friday 8am-4.30pm.
Viewings and identifications can be made by appointment during these hours
via the mortuary office.
An out of hours service is also provided for viewings and identifications 24
hours a day 7 days a week allowing families to spend time with their deceased
relative.
This again is by appointment and arrangements can be made by contacting the
on call technician via the hospital switchboard.
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Contacting the mortuary team
Sharon McMinn (Mortuary Manager )
Telephone number
(prefix 0161 922 from outside hospital)
0161 922 6520
Mortuary Office
0161 922 6059
On call technician
(via the hospital switchboard)
0161 922 6000
The Mortuary department also includes Bereavement services and can located
behind the Pathology Building
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Laboratories for referred investigation
If you wish to contact the referral laboratory then the directorate maintains a list of
contact numbers. We would strongly recommend that you request the laboratory to
follow up non-returned results (which is audited by each department) to enable us to
establish why the delay has occur.
BLOOD SCIENCES
Biochemistry Investigations
Referred Lab
City Hospital (Birmingham)
Analyte
ThioPurine Methyl Transferase (and 6-TG/MMMP)
Stone analysis
Laxative Screen
Elementals – Selenium, Lead, Chromium, Cobalt
Clozapine
Calprotectin
Infliximab assay
Hammersmith Hospital,
London
Gastrin
Salford Royal Hospitals NHS
Trust (Biochemistry)
ACTH
GI Polypertide Hormone (Gut Hormone Profile)
Catecholamines
Cortisol in urine (urinary free cortisol)
5-HIAA
Porphyrins
Central Manchester
Foundation Trust (Specialist
Assay Laboratory)
Procollagen Peptide (PIIINP)
Central Manchester
Foundation Trust
(Biochemistry)
Cholinesterase(pseudo- or acetylcholinesterase)
Salford Royal Hospitals
Foundation Trust
(Immunology)
Referral laboratory for all immunological investigations.
Newcastle Royal Infirmary
ADH
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Central
Manchester
Foundation
Trust
(Paediatric
Biochemistry)
Human Growth Hormone (and IGF-1) - paediatric
17-Hydroxy Progesterone (17OHP)
Insulin Like Growth Gactor (IGF-1) - paediatric
Insulin (and C-peptide)
Orosomucoid
Lamotrigine
Phenobarbitone
Royal Bolton
Hospital
Downs Syndrome Screening
Sheffield
(Royal
Hallamshire)
Ca 15-3
Stepping Hill
Hospital
CSF xanthochromia
University
Hospital of
South Wales
(Cardiff)
Thyroglobulin
Central
Manchester
Foundation
Trust(Willink
Laboratory)
Amino Acids
Carbohydrate Deficient Transferrin
Homocysteine
Carnitine/Acyl Carnitine
Lysomsomal Enzyme Screen
MCAD
Mucopolysaccharides
Organic Acid Screen
Transferrin Isoelectric Focusing
Very Long Chain Fatty Acids
White Cell Enzymes
University
Hospital South
Manchester
(Biochemistry)
Angiotensin Converting Enzyme (ACE)
Beta-2-microglobulin
Alpha-1-antitrypsin
Elastase (faecal)
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Sirolimus
Tacrolimus (FK506)
Vitamin D
Androgen Profile
Testosterone
Haematology Investigations
Christie
Hospital
(Cytogenetics)
Chromosome Analysis
Hammersmith
Hospital
Pyruvate Kinase
Leeds Royal
Infirmary
(Haematology)
Erythropoetin
Central
Manchester
Foundation
Trust
(Haematology
- Dr S Daly)
WT1 Marker
Central
Manchester
Foundation
Trust
(Haematology)
Bone Marrow for MDTs
Central
Manchester
Foundation
Trust
(Haematology)
Blood Volume Measurement
HBEMRI - Abnormal Hb variant Confirmation (Paed).
Anti Factor Xa
Plasma Viscosity
Platelet Aggregation Test
Central
Manchester
Foundation
Trust
(Paediatric
Haematology)
Spherocytosis
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Central
Manchester
Foundation
Trust
(Immunology)
Lymphocyte Marker Studies
Central
Manchester
Foundation
Trust
(Molecular
Diagnostics
Centre)
BCR/ABL
St, James
Hospital
(Haematology)
HAMS/Paroxysmal Nocturnal Haemoglobinuria
University
Hospital South
Manchester
(Haematology)
Activated Protein C resistance
Factor V Leiden
Hereditary Haemochromatosis Gene Typing
Janus Kinase 2
Prothrombin Gene Variant
Anti Thrombin III
Protein C and S
Von Willebrands Factor
Microbiology Investigations
Referred Lab
Analyte
Referred by:
Blood Sciences
Central
Manchester
Foundation
Trust
(Manchester
Medical
Microbiology
Partnership,
MMMP)
Virology including:
Cytomegalovirus
Varicella zoster
CMV
Coxsackie
EB
Parvo
Atypical pneumonia
(Legionella/mycoplasma/
Psittacosis)
Legionella blood Ab’s
Q fever (Coxiella) Ab’s
Tetanus antibodies
TORCH screens
Toxoplasma Ab’s
Haem/pnuemo Ab’s
Influenza swabs
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Microbiology
Pneumocystis PCR
Central
Manchester
Foundation
Trust
(Immunology)
TB quantiferon
Liverpool
School of
Tropical
Medicine
Tropical serology:
Hydatid serology
Amaeobic serology
Bilharzia serology
Filariasis
Malaria antibodies
Colindale
Anti-staphylysin
Legionella Urine
Meningococcal PCR
Measles swabs/ urines
Mumps swabs
Bartonella
Bordetella pertussis Ab’s
Buccal swabs
Diphtheria Ab
Yersinia Ab’s
Leeds
Aspergillus pptn/ Avian
pptn
Liverpool
Brucella Ab’s
Preston
Campylobacter Ab’s
Bristol
Cryptococcal Ab’s/ Ag’s
Hereford
Leptospira antibodies
Porton Down
Ricketsia/Arbo/Dengue/
Tuleraemia
London
Toxocara
No longer
available
Widal (Typhoid serology)
Various –
contact
laboratory
Antibiotic/ Antifungal
levels
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Immunology Investigations (non-SRFT)
Referred Lab
Analyte
Oxford via SRFT
Paraneoplastic Antibodies
Anti Neuronal Antibodies
Anti RNA
SRFT (Immunology)
Antibodies to Islet Cells
Antibodies to Salivary Duct
Antibodies to Striated Muscle
Antibodies to Thyroid Peroxidase
Antibodies to Skin (Pemphigoid/Pemphigus)
Anti Neutrophil Cytoplasmic Antibodies
(ANCA)
Antibodies to Glomerular Basement
Membrane (GBM)
Anti Adrenal Antibodies
Antinuclear, Antimitochondrial, smooth muscle or
gastric parietal antibodies deemed positive in house
Anti Islet Cell
Anti GAD
Anti/Double Stranded DNA
Antibodies to Extractable Nuclear Antigens
(ENA, including anti Ro/La and anti
SSA/SSB)
Tissue transglutamase antibodies (TTG) – confirmatory
assay. Primary screening is performed at SHH with
secondary confirmation (including anti-endomyseal
antibodies) at SRFT
Jejunal biopsy
MRI (Histology)
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Manchester DNA laboratory: St Marys
Manchester Cytogenetics laboratory: St
Marys
CF Gene probe (EDTA)
Fragile X DNA Studies (EDTA)
Dystrophin Gene (EDTA x2)
Molecular Testing (EDTA)
Phenotype (EDTA)
FISH Cytogenetics
Chromosomes (Orange Lithium)
Karyotype (Orange Lithium)
Anti Histone Antibodies
Sheffield (Immunology)
Antibodies to Acetylcholineserase
Antibodies to Acetylcholine Receptor
Antibodies to Voltage Gated Calcium
Channel
Antibodies to Voltage Gated Potassium
Channel
Royal Free Hospital - Hampstead
Hepatic iron index
Christies
HER-2
The laboratory has contact details for all the above departments should you
wish to contact them personally however it is strongly recommended that
you contact the laboratory at TGH first to enable staff to follow up none
returned results as this will save time.
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