Tests
Departments
Advice
About Us
Requesting
Version - September 2016
This version of the handbook will expire on 31st December 2016
- To obtain an up to date copy please visit www.dbh.nhs.uk
About Us
Overview
Contacts
Quality
Departments
Phlebotomy
Point of Care
Requesting
Making a request
Labelling
Transport
Tests
Test Information
Profiles
Advice
Clinical Information
Complaints
Results
Pathology CSU
Welcome to the Pathology Laboratory Handbook.
The Pathology CSU at Doncaster and Bassetlaw Hospitals encompass the Departments of Clinical
Biochemistry, Haematology, Histopathology, Non-Gynae Cytology, Morbid Anatomy, Microbiology,
Immunology and Virology. An open access (not 24 hours) Phlebotomy service is also provided.
We have produced this handbook to provide information which will allow you to make best use of our
services.
This new format handbook is designed to be used in an electronic format. Printed copies will not be
available, as it is impossible to ensure that paper copies are kept current.
The handbook updates will always be available at the Doncaster and Bassetlaw Hospitals website
www.dbh.nhs.uk and for trust users through the DBH Intranet
Using the handbook
Pre-requisites
The Handbook is distributed in Adobe Acrobat format. It is capable of being read on a variety of
devices which support this format. The reader is readily and freely available on the Adobe website. If
you have difficult installing the reader, contact your IT support.
The handbook makes use of the facilities that are built into the Acrobat Reader software. As there are
several versions of this software available, the look and feel of some of the functions may alter
slightly, however the features of this handbook will all be available to users of Acrobat 5 or above.
When the handbook starts up, it will always open on the first page, and be zoomed so that it is
possible to see the entire first page on screen at once.
Author
Title
Document No.
Peter J Taylor
Pathology Handbook Introduction
PD-UserHbk-007 ver1.0
Page 1 of 3
01/08/2009
Browsing
The page browser toolbar allows you to
one page to the next.
The single blue arrows are to go forward and back to the next or previous pages.
The arrow and bar symbols are to go to the first or last pages in the document.
The green buttons are to go forward and back in visited pages.
step from
Bookmarks
To the left of the handbook pages is a pane which shows the Bookmarks that have been created in
the Handbook to make finding information more straightforward.
These colour coded bookmarks give shortcuts to the various sections within the Handbook, and then
each section has subordinate markers which go to particular pages within the section. This includes
bookmarks for all tests that the directorate offers.
Clicking the X at the top of the Bookmark pane will hide the bookmarks and allow you to have a
larger view of the screen. Pressing the Bookmarks tab will open this pane back up again. The
handbook always opens with the Bookmarks pane showing.
Searching
It is possible to use the Search facilities to find particular words or phrases in the handbook.
•
•
•
•
Click on the Search Icon
on the toolbar
A second pane will pop up on the right of the screen.
In the first box type in the phrase or word you wish to look for.
Press Search. A list of matches then comes up in the pane.
The above example shows a search for FBC (Full Blood Count)
The software takes you to the first instance of the searched item. Clicking on each of the items in the
results will take you to the page they are on, and will highlight the search text.
If you wish to do another search, press the New Search button.
When you have finished searching, use the Hide button to close the pane.
Pages
Author
Title
Document No.
Peter J Taylor
Pathology Handbook Introduction
PD-UserHbk-007 ver1.0
Page 2 of 3
01/08/2009
If you click the Pages tab to the side of the Bookmarks pane, the view will change to a set of
thumbnails which show you what each page looks like. It is too small to see any text, but is useful for
finding pages with graphical content such as the Maps in the Appendices.
Other toolbar functions
Zooming
Use the Zoom buttons
to set the amount of each page that can
be viewed. By default, the screen always fits to a page width, the view can be modified to zoom to a
particular section (Use the magnifying glass tool), To page height, page width, or use the – and +
buttons to zoom to a particular size.
Highlighting and copying text
.
If you wish to copy a piece of information from the handbook text, use the Select button
Once this is pressed, mark around the text by highlighting, and then press Copy from the Edit Menu
on the menu bar. It is then possible to Paste this information into another document. Remember
however that this will no longer be kept up to date.
Printing
Because of document control, it is undesirable to have printed copies of the handbook available, as
they would soon be out of date. For this reason it is not possible to print from the handbook, and the
print icon has been disabled.
Problems
If you have any problems with this application, please contact Peter Taylor at DRI (01302 381449)
Author
Title
Document No.
Peter J Taylor
Pathology Handbook Introduction
PD-UserHbk-007 ver1.0
Page 3 of 3
01/08/2009
Pathology CSU
What’s New
The following items have been revised since the last version of the Laboratory Handbook.
The latest release is dated July 2015
•
Laboratory Tests
The laboratory test pages have been reviewed. Please check to ensure that you are meeting
the current requesting requirements.
•
Contacts
The laboratory contacts have been updated to reflect our current staffing arrangements.
•
Pathology Policies
Versions included align with those available through the intranet site
Author
Title
Document No.
Peter J Taylor
Laboratory Handbook - What's New
PD-UserHbk-01
July 2015
Tests
Advice
About Us
Requesting
Departments
Pathology CSU
About Us
The Pathology Clinical Service Unit (CSU) of The Doncaster & Bassetlaw Hospitals NHS Foundation
Trust
The Pathology CSU is part of Doncaster & Bassetlaw Hospitals NHS Foundation Trust (DBHFT) which was
formed on the 1st April 2001 and became a first wave Foundation Trust on 1st April 2004.
It is a twin sited pathology CSU serving a network of five hospitals plus two Primary Care Trusts serving a
population of 410,000.
All services and facilities provided by the Trust can be found on the Doncaster & Bassetlaw Hospitals NHS
Foundation Trust website. http://www.dbh.nhs.uk
The Pathology Service encompasses a main centralised laboratory located on the Doncaster Royal Infirmary
(DRI) site and a satellite laboratory at Bassetlaw District General (BDGH) Hospitals site with an additional
facility of a small specimen reception area at Mexborough Montagu hospital.
Postal Addresses
Doncaster Site:
Pathology CSU
Bassetlaw Site:
Pathology CSU
Doncaster Royal Infirmary
Armthorpe Road
Doncaster
DN2 5LT
Bassetlaw District General Hospital
Kilton
Worksop
S81 0BD
Tel: 01302 553131
Fax: 01302 553132
Tel: 01909 500990
Fax: 01909 502462
Mexborough Site:
Phlebotomy, blood bank,
storage fridge & specimen
reception
Montagu Hospital
Adwick Road
Mexborough
S64 0AZ
Tel: 01709 585171 x5235
Information on the services provided by the Pathology CSU, along with contact telephone numbers and location
of all the pathology departments are all available in the Pathology Laboratory Handbook (PD-UserHbk-01). This
is available from the Pathology CSU Offices and also via the hospital internet site. http://www.dbh.nhs.uk
Laboratory Opening Hours
Monday to Friday
- 09:00 – 17:15
Saturday, Sunday, Bank Holiday and after 17:15 Monday – Friday
Histopathology does not operate an out of hours service.
- on-call BMS service
The Pathology CSU is responsible for the provision of pathology laboratory services to Primary and Secondary
Care throughout the Doncaster and Bassetlaw districts. The CSU is committed to providing a service of the
highest quality and is aware of and takes into consideration the needs and requirements of its users.
In its pursuit of excellence and as part of its continuous quality improvement programme the Pathology CSU
participates in all relevant internal and external quality assurance schemes.
All laboratory work is carried out on up to date equipment in modern laboratories which meet with all statutory
requirements of a quality management system.
The repertoire of tests provided by Pathology support the Trust in its diagnostic and screening programmes.
Author
Title
Document No.
Peter J Taylor
About Us
PD-UserHbk-008 ver 3.0
Page 1 of 3
1/6/2012
The services provided by the Pathology CSU are delivered by three main departments:
Cellular Pathology
-
Non-Gynae Cytology
Histology
Mortuary
Clinical Laboratory Sciences
-
Blood Transfusion
Clinical Biochemistry
Haematology
Immunology
Phlebotomy
Microbiology
-
Infection Control
Bacteriology
Virology
An open access Phlebotomy service is provided for outpatients and GP patients at all sites with a mornings
only phlebotomy service available to the wards at Bassetlaw DGH and Doncaster Royal Infirmary site, seven
days per week and Mexborough Montagu Monday to Friday.
The departments of Clinical Laboratory Sciences and Microbiology share the same specimen reception area
and request forms. Histopathology and Non-Gynae Cytology departments are located only at Doncaster Royal
Infirmary site and have their own request forms and specimen reception arrangements.
The pathology services are fully computerised with all laboratories using ISS Omnilab Computer system with a
fully integrated database across all pathology disciplines.
Pathology results are available electronically via the Trust network at ward level or via the GP electronics links.
Hard copies (if required) are returned daily Monday-Friday.
Summary of Departmental services:
a) Clinical Laboratory Sciences
The Clinical Laboratory Sciences service is provided on a 24 hour basis at DRI and BDGH, with the main
laboratory site at DRI. The laboratory provides an out-of-hours service at DRI and BDGH between the hours of
17:15 to 09:00 Monday to Friday and all day Saturday, Sunday and bank holidays.
The range and volume of test requests reflects the usual demands of a large District General hospital service.
Clinically urgent requests during the normal working day are available via a Fast Track system.
Consultant advice (separately for Clinical Biochemistry and Haematology) is available on-site on an open
access basis during normal working hours and on an on-call basis at all other times.
Consultant input to the Immnunology service is via an SLA with Sheffield Teaching Hospitals.
The department participates in a variety of internal and external audit activities both within the Trust and region
and also subscribes to national external quality assessment schemes.
b) Cellular Pathology Department
All Histopathology and non-gynae cytology laboratory services are provided from a centralised laboratory on
the Doncaster Royal Infirmary site (basement corridor). Mortuary services are provided at Doncaster Royal
Infirmary, Bassetlaw District hospital and Mexborough Montagu.
Histopathology and non-gynae cytology is processed and reported Monday to Friday 08:30 to 17:00.
Consultant advice is available on-site on an open access basis during normal working hours.
Morbid Anatomy services are registered with the Human Tissue Authority for:
• The making of a post-mortem examination (DRI Site)
•
The removal from the body of a deceased person of relevant material of which the body consists or
Author
Title
Document No.
Peter J Taylor
About Us
PD-UserHbk-008 ver 3.0
Page 2 of 3
1/6/2012
which it contains, for use for a Scheduled Purpose other than transplantation (DRI Site)
•
The storage of the body of a deceased person, or relevant material which has come from a human
body, for use for a Scheduled Purpose (DRI, BDGH & Mex sites)
Licensing number – 12268
Designated Individual – Dr Jean Wardell (Pathology ClinicalDirector)
Licence Holder - Doncaster & Bassetlaw Hospitals NHS Foundation Trust
Body storage facilities are available at all 3 main hospital sites on a 24 hour basis. The facility to view bodies is
typically offered via appointment 8am to 4pm Monday to Friday. A Bereavement Service in liaison with the
Hotel Services Department is provided at DRI. At BDGH, appointments for viewings can be arranged by
telephoning the mortuary and at Montagu viewings are arranged by the Hotel Services Supervisors.
c) Microbiology & Virology
The Microbiology Department services are provided from a centralised laboratory on the DRI site providing a
formulary of tests reflecting the usual demands of a large District General hospital service.
Specialist and Reference test services are used where necessary.
Bacteriology services are provided on a 24 hour basis, with a routine service available between 09:00 and
22:00 Monday to Friday and 09:00 and 12:30 on Saturday.
The laboratory provides an on-call bacteriology service between the hours of 22:00 and 09:00 Monday to
Friday, 12:30 to 09:00 Saturday and all day Sunday and bank holidays.
Virology services are provided Monday to Friday 09:00 to 17:00.
Consultant advice is available on-site on an open access basis during normal working hours and on an on-call
basis at all other times. Consultant input to the Virology service is via an SLA with Sheffield Teaching Hospitals.
The Consultant Microbiologists contribute to the Infection Control services of the Trust.
d) Point of Care Testing
The Directorate of Pathology undertakes the oversight of all point of care testing (POCT) within the Trust via
the Pathology Point of Care Governance Committee and the services of a Pathology Point of Care Coordinator.
This includes advice on suitable tests and equipment for use at the point of care, co-ordination of training and
oversight of internal quality control and external quality assurance.
POCT currently covered under this remit include:
blood gas analysers based in the intensive care units at DRI and BDGH
pregnancy testing
urine dip stick testing
coagulometers
blood glucose meters
hemocue meters
All users of POCT equipment must adhere to the Trust policy CORP RISK 8 ‘Point of Care Governance Policy
and Guidelines for Point of Care Testing’
Users of POCT equipment are responsible for the associated operational and maintenance costs
Tests undertaken POCT are not included in the directorate workload statistics and costings
Author
Title
Document No.
Peter J Taylor
About Us
PD-UserHbk-008 ver 3.0
Page 3 of 3
1/6/2012
Pathology CSU
Contacts
RESULT ENQUIRIES
IN ALL CASES FIRSTLY CHECK I.T. SYSTEMS FOR RESULTS
Doncaster Royal Infirmary
Clinical Biochemistry/Microbiology/Virology/Haematology:
3131
Direct 01302 553131
Fax 01302 553132
Up to four calls will be queued.
Further callers receive a message asking them to ring back
Histopathology:
Cytology:
Morbid Anatomy:
Blood Transfusion (Direct)
Coagulation (Direct)
3130 / 3782 / 3532
3543
4003
3779
3677
Bassetlaw District General
Clinical Biochemistry/Microbiology/Virology/Haematology:
2344 / 2345
Direct 01909 502344 or 01909 502345
Blood Bank:
Morbid Anatomy:
Author
Title
Document No.
Peter J Taylor
Pathology Contacts
PD-UserHbk-010 ver 3.0
2452
2814
Page 1 of 3
1/8/2013
Pathology CSU
Contact Telephone Numbers:
DEPARTMENT OF CLINICAL LABORATORY SCIENCES
Clinical Biochemistry
DRI
Consultant Biochemist
Director of Pathology
Dr J. Wardell
Secretary to Dr. Wardell
Dr S. Spoors
Secretary to Dr. Spoors
Dr R. Stott
Miss K. Wright
Mr M. Slokan
BDGH
3106
3535
Consultant Biochemist
Head of Department
2486
Principal Biochemist
Principal Biochemist
Consultant Immunologist
2481
4293
3883
0114 2715700 ext 2837/2058
BMS 3
3786
Other Useful Numbers
Results and Specimen Enquiry (Direct Lines)
Pathology Specimen Reception
Day Ward Booking
Fax numbers (Internal)
3131 (01302 553131)
3860
3535
01302 553132 (3132)
2344 (01909 502344)
2450
2544
01909 502462 (2462)
Haematology / Blood Transfusion / Coagulation
DRI
BDGH
4098
2457
6483
4180
3001
2457
2457
Consultant Haematologist
Lead Clinician
Consultant Haematologist
Consultant Haematologist
Consultant Haematologist
Dr Y. Souror*
Dr S. Kaul
Dr J. Joseph*
Dr R. Cutting*
*Denotes Radiopage holder
Haematology Secretaries (Direct Line)
Mrs G. Bell
Mrs S. Bambrough
BMS 3
BMS 3
Other Useful Numbers
Results and Specimen Enquiry (Direct Lines)
Pathology Specimen Reception
Day Ward Booking
Fax numbers (Internal)
Blood Transfusion Laboratory (Direct Line)
Blood Transfusion Fax Number (Internal)
Author
Title
Document No.
Peter J Taylor
Pathology Contacts
PD-UserHbk-010 ver 3.0
4179 (01302 554179)
3002 (01302 553002)
3779
4023
2495 (01909 502495)
3131 (01302 553131)
3860
3535
01302 553209 (3209)
3779 (01302 553779)
2344 (01909 502344)
2450
2544
01909 502462 (2462)
2452
01909 530693
Page 2 of 3
1/8/2013
Pathology CSU
DEPARTMENT OF HISTOPATHOLOGY
Histopathology / Cytology / Morbid Anatomy
Dr S. Rogers
Dr G. Kurien
Dr M. Muzaffar
Dr R. Bhobe
Dr A. Verghese
Histology Secretaries
(Direct Line)
Mr P. Gravil
Mrs A. Hall
Ms C. Copley
Consultant Histopathologist
Lead Clinician
Consultant Histopathologist
Consultant Histopathologist
Consultant Histopathologist
Consultant Histopathologist
Head BMS
BMS 3
BMS3
Other Useful Numbers
Fax number
Morbid Anatomy
DRI
BDGH
3531
6353
6016
4210
6354
3130, 3782, 3532, 4048
01302 553130
6378
4344
4344
01302 553264
3526
2814
DRI
BDGH
MICROBIOLOGY DEPARTMENT
Microbiology / Virology
Dr K. Agwuh
Dr L.A. Jewes
Dr C.M. Hoy
Dr K. Gajee
Dr M. Milupi
Microbiology Secretaries
Mr P. Gravil
Bacteriology Laboratory
Virology Laboratory
Fax number
Consultant Microbiologist
(Lead Clinician)
Consultant Microbiologist
Consultant Microbiologist
6041 (pager 07659 521138)
Consultant Microbiologist
Consultant Microbiologist
4017
3717
6517
6007
3834
6519
01302 381338
Head BMS
GENERAL PATHOLOGY
Mrs F. Dunn
2480
2488
01909 502462
DRI
Pathology IT Systems
Manager
Pathology Quality Manager
Mr P. Taylor
(pager 07659 500329)
2490
3049 (pager 07659 528215)
01302 553269 (6169)
01302 381473 (6473)
External Links
Lab Tests On-line
http://www.labtestsonline.org.uk/
Labs are Vital
http://www.labsarevital.co.uk/
Specimencare
http://www.specimencare.com/
Health Protection Agency
http://www.hpa.org.uk/
Author
Title
Document No.
Peter J Taylor
Pathology Contacts
PD-UserHbk-010 ver 3.0
Page 3 of 3
1/8/2013
Pathology Services
Pathology Quality Policy
The Pathology Services is committed to providing an analytical, interpretative and advisory service of
the highest quality and shall be aware and take into consideration the needs and requirements of its
users.
In order to ensure that the needs and requirements of users are met, Pathology Services will:

provide a diagnostic service in the following disciplines; Haematology, Blood Bank, Clinical Biochemistry,
Immunology, Microbiology, Virology, and Cellular pathology and Mortuary Services

operate a quality management system to integrate Pathology procedures, processes and resources

set quality objectives and plans in order to implement this quality policy

ensure that all personnel are familiar with this quality policy to ensure user satisfaction

ensure that personnel are familiar with the contents of the quality manual and all procedures relevant to
their work

commit to the health, safety and welfare of all its staff. Visitors to the department will be treated with
respect and due consideration will be given to their safety while on site

uphold professional values and be committed to good professional practice and conduct
Pathology Services will comply with standards and guidelines set by Clinical Pathology Accreditation (UK) Ltd
(CPA), Medicines and Healthcare products Regulatory Agency (MHRA), and the Human Tissue Authority
(HTA) and with relevant environmental legislation. Pathology Services is committed to:

staff recruitment, training, development and retention at all levels to provide a full and effective service to its
users

the proper procurement and maintenance of such equipment and other resources as are needed for the
provision of the service

the collection, transport and handling of all specimens in such a way as to ensure the correct performance
of laboratory examinations

the use of examination procedures that will ensure the quality of all tests performed meets user
requirements

reporting results of examinations in ways which are timely, confidential, accurate and clinically useful

evaluation of all processes within Pathology to ensure continued quality improvement through internal
audit, external quality assurance and assessment of user satisfaction
Signed on behalf of the Pathology Services
Dr Jean Wardell
Assistant Care Group Director (Pathology Services)
Author
Title
Document No.
Fiona Dunn
Directorate Quality Policy
QM-COM-002 v7
Date……21/5/2015………..
Page 1 of 1
21/5/2015
Tests
Advice
About Us
Requesting
Departments
Pathology CSU
PHLEBOTOMY SERVICE - BASSETLAW
In Patient Service
A mornings only phlebotomy service is available to the wards at Bassetlaw DGH seven days per week. (Limited
weekend & public holiday service).
Monday to Friday
Each ward will be visited by a member of the phlebotomy team who will take the request forms & bleed patients
as required provided that they are wearing appropriate wristbands. On no account will the phlebotomist return
to a ward that day.
Saturday, Sunday and Public Holidays
A reduced number of staff cover this time and requests should be kept to a minimum i.e. those tests that are
necessary for immediate patient management only. The forms should be available from 07:00 & the
phlebotomist WILL NOT return to any area after the initial visit.
Please note that National Guidelines will be followed in that any patient not wearing the appropriate wristband
will not be bled.
Out Patient Service
A phlebotomy service is provided in the outpatient department at Bassetlaw DGH Monday to Friday. This
service is for the venepuncture of outpatient clinic and General Practitioner patients.
Additionally a service is provided in Newgate Medical Centre four mornings per week.
The opening times for the Bassetlaw site are 08:30 to 16:30 with Newgate Medical Centre open from 08:30
to 12:15 Monday to Thursday.
It is not generally necessary to make an appointment for blood tests, the exception being for Glucose Tolerance
Tests.
For certain investigations (ESR for example) the patient must attend before 16:00
PHLEBOTOMY SERVICE - DONCASTER
In Patient Service
A mornings only phlebotomy service is available to the wards at Doncaster seven days per week. (Limited
weekend and public holiday service)
Monday to Friday
Each ward will be visited by a member of the phlebotomy team who will take the request forms and bleed
patients as required provided that they are wearing appropriate wristbands. On no account will the
phlebotomist return to a ward that day
Saturday, Sunday and Public Holidays
A reduced number of staff covers this time and requests should be kept to a minimum i.e. those tests that are
necessary for immediate patient management only. The forms should be available from 07:00 and the
phlebotomist WILL NOT return to any area after the initial visit.
Author
Title
Document No.
Peter J Taylor
Phlebotomy
PD-UserHbk-011 ver 1.0
Page 1 of 2
1/4/2008
Please note that National Guidelines will be followed in that any patient not wearing the appropriate wristband
will not be bled.
Out Patient Service
A phlebotomy service is provided in the outpatient department at Doncaster Monday to Friday. This service is
for the venepuncture of outpatient clinic and General Practitioner patients.
The opening times for the Doncaster site are 08:00 to 17:00
It is not generally necessary to make an appointment for blood tests, the exception being for Glucose Tolerance
Tests.
For certain investigations (ESR for example) the patient must attend before 16:00
Author
Title
Document No.
Peter J Taylor
Phlebotomy
PD-UserHbk-011 ver 1.0
Page 2 of 2
15/05/2007
CORP/RISK 8 v.5 POINT OF CARE GOVERNANCE POLICY POINT OF CARE TESTING POLICY AND GUIDELINES This procedural document supersedes: CORP/RISK 8 v.4 – Policy and Guidelines for Point of Care Testing. Did you print this document yourself? The Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up‐to‐date version. If, for exceptional reasons, you need to print a policy off, it is only valid for 24 hours. Author/reviewer: (this Dawn Lee – Point of Care Testing Co‐ordinator version) Date written/revised: 02/01/2014 Approved by: Policy Approval and Compliance Group (on behalf of the Patient Safety Review Group) Date of approval: 19 March 2014 Date issued: 25 March 2014 Next review date: 01/03/2017 Target audience: All staff, Trust‐wide Page 1 of 23
CORP/RISK 8 v.5 Amendment Form Please record brief details of the changes made alongside the next version number. If the procedural document has been reviewed without change, this information will still need to be recorded although the version number will remain the same. Version Date Issued Brief Summary of Changes Author Version 5 25 March • Reviewed and formatted POCT Policy in line Dr J Wardell 2014 Mrs F Dunn with CORP/COMM 1 v.6 – APD Development and Management. Inclusion Ms D Lee of revised Section 6 – Monitoring Compliance with Procedural Document. Version 4 March 2012 • Reviewed and formatted POCT Policy in line Dr J Wardell Mrs F Dunn with CORP/COMM 1 v.5 – Development and Management of Procedural Documents Ms D Lee Within the Trust • Clarification of roles, section 7.5 Managers of Areas Using POCT • Slight amendment to Appendix 3 to include entry for the proposed area of application/implementation • Minor changes made throughout for clarity Version 3 February • Reviewed and formatted in line with ‘An Mrs H Chapman 2009 organization ‐wide policy for the development and management of procedural documents’ (NHSLA) • Introduction of an amendment form • More defined responsibilities • Introduction of a flowchart for implementation of POCT (appendix 2) • Introduction of a questionnaire (appendix 3) • Addition of a POCT organizational chart (appendix 4) Version 2 March 2007 • Inserted 3.7 – Role of POCT Co‐ordinator Dr J Wardell Dr R Stott Page 2 of 23
CORP/RISK 8 v.5 Contents Section Page No. 1 Introduction 4 2 Purpose 4 3 Duties and Responsibilities 5 4 Procedure 7 5 Training/Support 9 6 Monitoring Compliance with the Procedural Document 11 7 Definitions 13 8 Equality Impact Assessment 14 9 Associated Trust Procedural Documents 14 10 References 15 Appendices Appendix 1 The POCT Governance Committee Terms of Reference 16 Appendix 2 Flowchart for Implementation of POCT 18 Appendix 3 Proposal of New POCT Equipment 19 Appendix 4 Point of Care Testing Organisational Chart 23 Page 3 of 23
CORP/RISK 8 v.5 1. INTRODUCTION This policy is designed to ensure that all point of care testing (POCT) systems within the Trust are appropriately managed and quality assured in accordance with national guidelines and accreditation standards and that all risk and governance issues are addressed. It is also designed to ensure that the introduction of new point of care testing technology within the Trust is appropriate and consistent. 1.1 Accreditation of Services All POCT within Doncaster and Bassetlaw NHS Foundation Trust is subject to strict governance and must be performed to the same quality standards as all testing undertaken within the CPA (Clinical Pathology Accreditation) accredited laboratory. It is implicit that POCT fulfils international standard: ISO 22870 and is compliant for CPA with 15189:2007. 2. PURPOSE The aim of this document is to provide guidance for safe and effective management and use of POCT systems that are fit for their intended purpose, used by a competent individual on the correct patient, giving quality results which become part of the patient’s record. 2.1 Rationale for the Use of Point of Care Testing Devices Analysis of constituents in blood and other body fluids is a vital part of the decision making process associated with the diagnosis and management of disease. Typically specimens are sent to a laboratory for analysis with the results being returned by telephone, electronically or with a hard copy report. In some cases delays caused by sending the specimen to the laboratory are unacceptable to the clinical and/or operational situation; in these circumstances testing at the bedside, in the clinic or GP surgery is preferred. This type of testing is termed ‘point of care’ testing (POCT). Improvements in technology have permitted a number of analyses, which previously could only be performed in the laboratory, to be carried out at the bedside or in the clinic. Like all new technologies, however, the apparent simplicity of POCT often belies its complexity and masks the need for attention to detail in order to achieve optimum and accurate results. Situations in which point of care testing may be appropriate include: a) Where clinical management in an acute or life threatening situation may be aided by the result of a diagnostic test. b) Where availability of the result in the clinic may enable more effective counselling of the patient and/or change in therapeutic management. Page 4 of 23
CORP/RISK 8 v.5 c) Where the total attendance time for the patient can be reduced. d) Where the clinician can assess the patient and initiate or change subsequent management in a single visit. 3. DUTIES AND RESPONSIBILITIES The role and responsibilities of Departments and Individuals in the management of Point of Care Testing devices are described below. 3.1 The POCT Governance Committee will: Be accountable to the Trust Clinical Governance Standards Committee for ensuring the delivery of a high quality POCT service. 3.2 The POCT Co‐ordinator will: a) Be responsible for day‐to‐day operational matters of all the point of care testing sited within Doncaster and Bassetlaw NHS Foundation Trust. b) Ensure the co‐ordination and supervision of all point of care testing and the supervision, training and development of staff from various professions throughout the Trust in the use of POCT equipment. This ensures adherence to national standards in compliance with CPA accreditation of laboratory services. c) Be responsible for the co‐ordination, documentation and planning of the future POCT requirements of the Trust, on behalf of the Trust Point of Care Governance Committee. d) Maintain effective communication within the Pathology Clinical Service Unit and with clinicians, nurses, support staff, the Trust Medical Technical Services Manager and the Trust Supplies Manager. e) Ensure that systems are in place to enable quality standards to be maintained and to sign and date all standard operating procedures. He/she will also work with the Pathology Quality Manager to ensure that any problems identified by quality control and quality assurance procedures are rectified. f) Ensure that internal quality control and external quality assurance procedures are in place and followed by all those involved in point of care testing. 3.3 Clinical Users of POCT Devices will: a) Be individually accountable for their practice and ensure that they acquire, and maintain skills in the use of POCT devices. Page 5 of 23
CORP/RISK 8 v.5 b) Ensure all POCT results are correctly documented in the patient records. 3.4 Managers of Areas using POCT will ensure: a) All requests for new POCT systems are made in accordance with the selection and procurement criteria as described in this policy. b) That the General Manager of the Clinical Service Unit in which the device is to be used is responsible for the authorisation of any business cases for the use of the POCT devices before submission to the Trust POCT Governance Committee. c) That all users of POCT are competent and authorised to use the devices. d) That each Operator maintains competency and that training records are kept. e) Standard operating procedures are in place for point of care devices in their area. f) That quality assurance IQC and EQA are performed. g) Ensure designation of appropriate Healthcare Professionals who are required for the up keep of maintenance contracts and ordering consumables. They will be responsible for requesting significant assistance from the POCT coordinator (or the manufacturer of the device) should the need arise. h) Ensure a designated Link person or Nurse Educator will be responsible for training of new users of the device, update training and upkeep of associated training records. 3.5 The Pathology CSU will: a) Support the POCT Co‐ordinator. b) Provide advice concerning the limitations of POCT devices and interpretation of POCT derived results. 3.6 The Medical Equipment Department will: a)
b)
c)
d)
e)
Provide technical advice and support. Advise on the management of POCT equipment Trust wide. Distribute alerts from MHRA. Report technical performance problems to MHRA. Be involved in the purchase of new equipment. Page 6 of 23
CORP/RISK 8 v.5 3.7 The Supplies Department will: a) Liaise with the Trust POCT Governance Committee before any POCT equipment is purchased. b) Lead in the tender and procurement process of any new POCT equipment. c) Inform the POCT committee of any requests or purchasing wishes. 3.8 The IT Department will: a) Advise on POCT data management and connectivity to appropriate host systems. b) Liaise with suppliers and pathology to set up network connections to the hospital and laboratory computer systems. 4. PROCEDURE 4.1 Choosing the POCT equipment Advice regarding POCT should be sought before any equipment is considered. Approval of the Trust Point of Care Governance Committee must be obtained before any equipment is purchased thus ensuring: a) Results are comparable to results produced by the laboratory. b) Reliability of equipment and spares. c)
Good cover by service engineers/maintenance procedures. d) Reliability and regular supply of reagents. e) Avoidance of multiple suppliers of similar equipment. f) All clinical, economic and practical aspects are covered adequately in the business case. g) Connectivity requirements are met wherever possible. h) Adherence to protocols established by the Trust’s Supplies Department. i) Enrolment into external quality assurance schemes where available. j) Ensure business continuity measures are in place e.g. UPS for electrical equipment. k)
All health, safety and infection control aspects are considered. 4.2 Equipment and Consumables Procurement Initially, the need for POCT should be discussed with the Point of Care Co‐ordinator. All decisions relating to point of care testing must then be made via the Trust Point of Care Page 7 of 23
CORP/RISK 8 v.5 Testing Governance Committee thus ensuring equipment purchased, maintained and operated, will comply with Trust policy. The flow chart in Appendix 2 should be used to help the requestor before the process of implementing a new POCT device is considered. The questionnaire in Appendix 3 must be completed and returned to the Point of Care Co‐
ordinator prior to the initiation of the procurement process. 4.3 Process of Procurement A business case for the introduction of all point of care testing should identify the performance criteria required for the proposed service. The process of procurement should be in accordance with the protocol established by the Trust’s Supplies Department. Tenders for the business should be reviewed by the Point of Care Testing Governance Committee to ensure that the quality criteria are met. The economic aspects should be reviewed in consultation with the Trust’s Supplies Department. 4.4 Standard Operating Procedures (SOP) All techniques employed in the delivery of each point of care testing service are subject to adherence to a CPA accredited standard operating procedure or protocol. Each SOP should include or refer to the following: a) Clinical relevance/purpose of examination. b) Underlying principles of the test. c)
Correct preparation of the patient, specimen requirements and means of identification. d) Equipment and special supplies. e) Storage of reagents, standard or calibrant’s and internal control materials. f)
Calibration. g) Instructions for the performance of the procedure. h) Limitations of the procedure including interferences, cross reactions and reportable intervals. i)
Recording and documentation of results and appropriate action to be taken. j)
Internal quality control procedures need to be documented ensuring that the results lie within the manufacturers reference range/criteria. k)
Patient reporting reference ranges. l)
Alert limits and critical values must be incorporated where appropriate. Page 8 of 23
CORP/RISK 8 v.5 m) Included in the responsibilities of personnel authorising, reporting and monitoring results, is the duty to identify abnormal results that must be brought to the immediate attention of a clinician. n) Hazards and safety precautions to be highlighted, including disposal of consumables and cleaning of equipment. o) Performance criteria. A copy of the standard operating procedure must be available for all staff using POCT. The SOP(s) should be kept close to the equipment used or the place at which the test is performed. It is also available on the intranet in the Pathology Handbook. Photocopies must not be used; always use the official document. Each certificated operator must sign a statement to the effect that they have read and understand the procedure that they use. A library of current standard operating procedures must be kept in a central location known to all of the operators and their supervisor. 5. TRAINING/ SUPPORT 5.1 Personnel Only appropriate members of staff who have achieved satisfactory levels of competence are able to use the POCT devices. 5.2 Training The manufacturer of the device will instruct, and certify, the POCT coordinator and primary trainers in the correct use of the equipment. Succession training will occur thereafter to other users of the device. Evidence of training, either training register/record or certification (see Section 5.3 Certification) must be kept and produced for audit purposes, as requested by the POCT co‐ordinator. The training programme will be tailored to the technology and its complexity, but should include understanding of: a) Basic principles of the analytical method, its limitations and the clinical relevance of the results produced. The latter should include knowledge of results that must be made known to the clinician immediately, results which are indicative of an error, failure in the procedure or of a possible interfering substance. b) The correct procedure for the preparation of the patient. c) The correct procedure for preparation of the reagents, devices and/or equipment e.g. warming of reagents stored in the refrigerator to room temperature before use, to ensure correct performance of the test. Page 9 of 23
CORP/RISK 8 v.5 d) The correct procedure for performing a test and pitfalls associated with incorrect procedure. e) Agreed protocol for documentation/reporting of a result including the correct way to identify his/her unique ID as part of the patient’s record. Identification of results, which may have an adverse effect on the patient’s treatment, must be brought to the immediate attention of a clinician. f) The correct quality control procedures must be completed, validated and recorded before release of the patient result. g) The correct procedure for disposal of consumables, reagents and used analytical devices should be included in the programme. Awareness of any decontamination procedure required. h) The processing of IQC and EQA samples. 5.3 Certification When a member of staff has completed a training course the trainer must assess the individuals competence to perform the POCT procedure. A central record must be maintained of all those who have been shown to be competent at performing the POCT procedures. This record must be kept up to date and any individual whose competence fails, must be removed from the register until their competence has been re‐established. A copy of this record must be kept by the clinical area manager. The identification of each certified operator must be incorporated into test/log of point of care tests performed and also entered into the patient’s records. No operator should: a) Give their ID to another person in order for a test to be undertaken. b) Use another person’s ID. c)
5.4 Perform a point of care test without proper certification/ID. Re‐certification If any operator is shown to be performing below the required standard, a supportive course of action should be implemented. In the first instance of poor performance the operator in question needs to be assessed by their identified trainer. Closer monitoring of performance should be implemented and re‐assessment carried out. Should this fail then, certification must be withdrawn until competence can be demonstrated. If unresolved, escalation to the POCT coordinator may be necessary and corrective action will be implemented as appropriate. Page 10 of 23
CORP/RISK 8 v.5 6. MONITORING COMPLIANCE WITH THE PROCEDURAL DOCUMENT What is being Monitored Who will carry out the Monitoring MONITORING PERFORMANCE Participation in internal quality control (IQC) and external quality assessment (EQA) is mandatory for all POCT and resources for this must be met by the user. Quality assurance is the duty of operators of POCT equipment. The exact nature of the procedures will depend very much on the technology and details will be documented in the standard operating procedure for each method/device. ‐ Quality Assurance IQC will be performed by the users of POCT equipment on a regular basis as specified in the standard operating procedure for each particular POCT instrument. The recorded data should also identify the tolerance limits of acceptable performance. If IQC is within tolerance, and therefore acceptable, patient results may be released. EQA must be performed by the users of POCT equipment. The results submitted to the POCT co‐ordinator will be reviewed by the POCT Committee. If poor performance, persistent non‐
participation or gross performance problems are not rectified, then it may result in withdrawal of the POCT equipment. Clinical Area Manager. POCT co‐ordinator. How often Review of compliance should be carried out in keeping with the frequency of usage of the POCT equipment. That is, every week for regularly used items and periodically for seldom used equipment. Reviewed quarterly. Page 11 of 23
How Reviewed/ Where Reported to Non‐compliance with procedures will be assessed by the Clinical Area Manager, in the first instance. Root cause should be resolved through for e.g. training needs analysis or changes to the duty rota. Any areas of persistent non‐
compliance will be escalated to the POCT Committee via the POCT co‐ordinator. The POCT committee will review EQA performance at each biannual meeting and through POCT Summary reports. CORP/RISK 8 v.5 What is being Monitored Who will carry out the monitoring How often How Reviewed/Where reported to MONITORING COMPLIANCE ‐ Documentation and Record Keeping Patient results along with the time and date of analysis, operator ID and the POCT equipment used, must be recorded within the patient’s healthcare record. It is mandatory that procedures are in place to ensure the correct patient has been identified and correspond to patient notes or wrist band details. The requesting clinician must be made aware of the POCT result. Where possible, systems that allow the connectivity of POCT devices to the laboratory data system, including the electronic patient record must be used. Instrument maintenance. Records of instrument maintenance, faults and corrective action must be kept. It is essential that the routine maintenance and calibration of equipment is carried out according to the manufacturer’s instructions. Failure to properly maintain equipment may give misleading or dangerous results. Maintenance records must be kept for audit purposes. AUDITS All POCT procedures will be subject to regular audit. Clinical Area Manager. Clinical Area Manager, or identified link nurse, will be responsible for keeping local records. A copy should be supplied to the POCT coordinator. POCT co‐ordinator or Instrument Manufacturer/supplier. Periodic and local vertical audits by the Clinical Area Manager. As and when. Annually where practicably possible. Documentation on request by POCT coordinator. POCT co‐ordinator. Page 12 of 23
CORP/RISK 8 v.5 What is being monitored Who will carry out the Monitoring INCIDENT REPORTING Any adverse incidents All staff. associated with POCT should be CORP/RISK 13 Policy reported via the Trust Incident For the Reporting and Reporting System. A copy Management of should be made to the POCT Incidents and Near co‐ordinator. Misses. CLINICAL GOVERNANCE STANDARDS COMMITTEE (CGSC) REPORT An annual report is presented POCT co‐ordinator. to the CGSC. How often How Reviewed/Where Reported to Please refer to CORP/RISK 13 Policy For the Reporting and Management of Incidents and Near Misses. Annual. Please refer to CORP/RISK 13 Policy For the Reporting and Management of Incidents and Near Misses. CGSC Meeting. 7. DEFINITIONS 7.1 External Quality Assessment (EQA) EQA is the process whereby samples with unknown values are tested. Results are then subject to peer group assessment and statistical analysis to compare results across different sites. 7.2 Internal Quality Control (iQC) IQC can be one of two processes: a) The analysis of a sample of known concentration, ensuring that the result obtained falls within acceptable performance limits. b) Reproduce an analysis of a sample previously tested in the lab by POCT. This is to be carried out at regular intervals, e.g. once a week, to ensure that agreement with the laboratory method is being maintained. 7.3 Point of Care Testing For the purposes of this document point of care testing (POCT) refers to any form of diagnostic testing undertaken by a healthcare professional outside of an accredited laboratory environment. Page 13 of 23
CORP/RISK 8 v.5 7.4 POCT Equipment / Process This refers to all equipment and processes used outside the laboratory to perform analytical testing. For the purpose of this policy the word ‘device’ is used to include the whole range of items from simple urine dipstick tests to sophisticated desktop analysers. 7.5 The User The user is any person who handles a device whether it is used directly to produce results or for maintenance or quality control procedures. This includes clinicians, nursing staff, healthcare assistants and healthcare scientists. 8. EQUALITY IMPACT ASSESSMENT An Equality Impact Assessment (EIA) has been conducted on this procedural document in line with the principles of the Equality Analysis Policy (CORP/EMP 27) and the Fair Treatment For All Policy (CORP/EMP 4). The purpose of the EIA is to minimise and if possible remove any disproportionate impact on employees on the grounds of race, sex, disability, age, sexual orientation or religious belief. No detriment was identified. A copy of the EIA is available on request from the HR Department. 9. ASSOCIATED TRUST PROCEDURAL DOCUMENTS •
•
•
•
•
•
•
•
•
APD Development and Management Process ‐ CORP/COMM 1 Cleaning and disinfection of ward based equipment ‐ PAT/IC 24 Patient Identification Policy ‐ PAT/PS 7 Patient Safety Strategy ‐ PAT /PS 16 Policy for Reporting and Management of Incidents and Near Misses ‐ CORP/RISK 13 Record Keeping Standards ‐ CORP/REC 6 Risk Assessment Policy (Clinical and Non‐clinical) ‐ CORP/RISK 18 Sharps Policy – Safe Use and Disposal ‐ PAT/IC 8 Waste Policy and Procedures ‐ CORP/HSFS 17 9.1 Risk Management a) Health and Safety All POCT should be undertaken in a way that does not put the patient or any member of the Trust’s staff at additional risk. All Trust health and safety policies must be strictly adhered to. The standard operating procedure for each device should identify all specific health and safety precautions that must be taken to protect both patients and staff. Page 14 of 23
CORP/RISK 8 v.5 Any health and safety incidents must be reported to the Trust POCT Governance Committee via the Pathology POCT Coordinator. A risk assessment by the Infection Prevention Control Team must be carried out before the installation of a new piece of POCT equipment and similarly before an existing piece of POCT equipment is moved to another location. A copy of all associated documentation must be forwarded to the Pathology POCT Co‐ordinator. b) Infection Control Before purchasing any point of care equipment please ensure you have consulted with a member of the Infection Prevention & Control Team. The potential issues of storage and decontamination need to be considered before purchasing equipment. Once you have obtained the approval of the Infection Prevention & Control Team and purchased the equipment, please include decontamination in your daily maintenance programme referring to the Decontamination Policy PAT/IC 24. Please contact the Point of Care Co‐ordinator on extension (3544) or a member of the Infection Control Prevention & Team on extensions 3748 for further advice. c) Adverse Incident Reporting Any adverse incidents involving POCT devices e.g. instrument failure, health and safety issue or clinical incident must be reported in accordance with the Trust’s Incident Reporting System (CORP/RISK 13 ‐ Policy For the Reporting and Management of Incidents and Near Misses) and a copy forwarded to the Pathology POCT Coordinator. An adverse incident is an event that causes, or has potential to cause, unwanted effects. In a POCT environment this may involve the health and safety of patients, users or other persons. Examples are an incorrect result which could lead to a delay in treatment, exacerbation of a life‐threatening illness, cause serious deterioration in health or even death. The Medical Devices Agency (MDA) is responsible for investigating adverse incidents associated with all medical devices. Safety Notices and Product Alerts are issued by the MHRA, circulated and disseminated by the Trust’s Medical Devices Manager. 10. REFERENCES 1.
International Standard, ISO 22870 – Point‐of‐care Testing (POCT) – Additional Standards for Point of Care Testing (POCT) Facilities. 2.
International Standard, ISO 15189 (2007) – Medical Laboratories – Particular Requirements for Quality and Competence. Page 15 of 23
CORP/RISK 8 v.5 APPENDIX 1 POCT GOVERNANCE COMMITTEE TERMS OF REFERENCE The POCT Governance Committee is responsible for overseeing all aspects of the delivery of point of care testing within the Trust. It may also be asked to take a similar responsibility for point of care testing in other environments where the Trust’s Pathology CSU is responsible for the delivery of the pathology services. Specifically it: •
has appointed core members: a) Chair ‐ Pathology Clinical Director. b) Deputy Chair – Head BMS Clinical Laboratory Sciences. c) Point of Care Testing Co‐ordinator. d) Pathology Quality Manager. •
comprises representatives from: a) All specialties within the Pathology CSU for which point of care testing is performed. b) The nursing and/or clinical support teams from each of the clinical directorates which undertake POCT – e.g. matrons. c) An individual involved in equipment maintenance. d) The Pathology CSU management team. e) The clinical staff ‐ preferably individuals involved in the use of POCT. f) PCT representative(s) ‐ preferably an individual able to represent all PCTs and either involved in, or with an interest in, POCT. g) The clinical governance lead for the Pathology CSU. h) Representation from supplies, finance and information technology. Page 16 of 23
CORP/RISK 8 v.5 • meets bi‐annually to: a) Agree the use of POCT. b) Work with the Trust’s supplies department to ensure consistency of procurement in relation to harmonisation of technology and value for money, whilst ensuring the needs of clinicians are always met. c) Ensure that all equipment is properly maintained. d) Oversee the maintenance of appropriate health and safety procedures in environments where POCT is performed. e) Undertake audits of point of care testing as appropriate to the needs of the Trust. f) Have the authority to withdraw a POCT device if the agreed standards of operation are not met despite adequate training. g) Report on a quarterly basis to the Pathology Directorate Management Team. h) Submit minutes of meetings and an annual report to the Trust Operational Board. i) Disseminate information regarding contraindications/interferences in POCT systems in use within the Trust and Community. j) Consider any other relevant business. The Committee also reviews the following: k) New business cases for POCT. l) Quality control and quality assurance performance data. m) Incident reports and action taken. n) Status of staff training, certification and recertification requirements. o) Standard operating procedures and modify as appropriate. p) Suitability of trainers for each POCT procedure. q) Review feedback from user or working groups. • Quorum at POCT meetings A minimum of 6 committee members is required comprising of at least 3 core members and 2 clinical representatives. Page 17 of 23
CORP/RISK 8 v.5 APPENDIX 2 IMPLEMENTING POCT: FLOWCHART Is this a NEW SERVICE? YES NO (replacing old equipment) Discuss with POCT Co‐ordinator Fill in Questionnaire in Appendix 3 Apply to Trust POCT Committee Seek advice from POCT Co‐ordinator on likely lifetime of existing equipment Can clinical needs be met by and need for replacement adapting existing lab service? Are different range/additional analytes required? Yes No Yes No POCT may not Liaise with POCT Co‐ordinator be the best option for options and costs Agree preferred option and any connectivity requirements Prepare business case and submit through Trust planning process [Service Level Agreement with Pathology ‐ if applicable] Purchase Equipment Commissioned, Users Trained; Local staff member responsible for supervision and keeping maintenance and training records Page 18 of 23
CORP/RISK 8 v.5 APPENDIX 3 PROPOSAL FOR NEW POCT EQUIPMENT Any proposed acquisition of new POCT equipment requires an application to the POCT committee AND the following completed form to be returned to: Point of Care Co‐ordinator, Pathology CSU, Doncaster site, Doncaster and Bassetlaw Hospitals Foundation NHS Trust. A proposal should also be submitted for replacement of existing POCT devices, extension of existing POCT activities including equipment on loan or for use in clinical trials. The Trust POCT Committee will consider the application and notify the applicant and the Medical Devices Management Committee of their decision. Question Answer Proposed Area of Application/Implementation Background Information 1 What new POCT process/device is proposed? 2 Does the proposal for equipment, to be acquired, fully comply with the requirements of the Trust Point of Care Policy? 3 Is the test available in the laboratory? 4 Why should the testing be done on the ward/unit rather than sending samples to the laboratory? 5 Has discussion with the POCT Coordinator and/or relevant Pathology Department taken place? 6 If so, with whom? 7 What resources have been identified to support this POCT? 8 Which group of patients need the test? 9 Is there a protocol or set of guidelines for selecting patients to test? Please enclose a copy. 10 11 How many samples will be analysed per annum? Are any confirmatory/additional tests required: (a) Using POCT devices? (b) Or, in the laboratory? (c) If Yes, how will this be funded? Page 19 of 23
CORP/RISK 8 v.5 12 What are the clinical benefits of POCT? Costs 13 What is the capital cost of the instrument (including VAT)? What is the annual consumable cost per annum? 14 (Include all consumables, collection devices, quality control, external quality assurance costs as well as devices lease if applicable.) 15 What are the maintenance/servicing costs after expiry of guarantee? 16 Is the cost of interfacing the device to the laboratory computer included in the cost? 17 If not what is the cost to interface? 18 Does an IT port need to be installed? 19 Is the cost of software/hardware to monitor and control the device from the laboratory included? 20 Have you considered what support you may require from Pathology? Devices 21 What device is most suitable for your purpose? 22 Is the device CE marked? 23 Has the equipment been evaluated by an external professional organization e.g. PASA or MDA? Will there be any health and safety problems? (A risk assessment by Infection Control is mandatory prior to the approval of POCT equipment.) 24 25 Are there adequate facilities for disposal of samples and consumables? 26 What is the distance to the nearest hand‐wash sink? 27 Is the room air‐conditioned? 28 Are the appropriate services available e.g. power, water, electricity, network point? 29 Does the device have a UPS (Uninterrupted Power Supply) unit? 30 Where will the devices be located? 31 Are there adequate facilities to perform POCT? Page 20 of 23
CORP/RISK 8 v.5 32 What space is available for the storage of stock items/consumables? 33 Can an engineer have easy access to the equipment? 34 Will POCT provide the required accuracy and precision? 35 Is the instrument able to be password protected? 36 What happens if devices/process breaks down? 37 Who will manage the ordering of consumables including quality assurance materials? 38 Who will maintain and take responsibility for the devices? 39 Who will arrange maintenance contracts and emergency call‐outs? Staff/Personnel Requirements 40 Who will be performing the tests? 41 What extra staff time will be required? Is the staff currently available? 42 Is extra staffing resourced? 43 Will the users be restricted to staff working in the location of the POCT process? 44 Who will have responsibility for the necessary training? 45 Will Pathology need to be involved? Reports/Results Has Pathology been consulted with regard to units, reference ranges, sample types and correlation with laboratory results? 46 47 Who will be responsible for interpretation of results and any clinical action based on the POCT result? 48 How will the results be recorded and stored? 49 Can the device be interfaced to the laboratory computer? 50 Do you need IT support? 51 Has the IT department agreed to your requirements? 52 Have you insured that the proposal for the equipment meets the requirements of the Trust POCT Policy fully? Page 21 of 23
CORP/RISK 8 v.5 Post POCT Committee Approval 53 Have you applied to the Medical Equipment Group for approval? Applicant signature Print name Position held CSU/ Ward Page 22 of 23
CORP/RISK 8 v.5 APPENDIX 4 – POINT OF CARE TESTING ORGANISATIONAL CHART
TRUST CLINICAL
GOVERNANCE
STANDARDS COMMITTEE
CLINICAL DIRECTOR OF
PATHOLOGY
PATHOLOGY
QUALITY
MANAGER
TRUST POCT
GOVERNANCE COMMITTEE
HEAD BMS
CLINICAL LABORATORY
SCIENCES
POCT CO-ORDINATOR
CSU CLINICAL
DIRECTORS & MANAGERS
CSU CLINICAL SUPPORT
SERVICES
MATRONS
LINK NURSES
Page 23 of 23
Tests
Advice
About Us
Requesting
Departments
REF: PAT/T 8
v.6
Directorate of Pathology
Specimen and Request
Form Labelling Policy
This procedural document supersedes: Policy for Specimen and Request Form
Labelling – PAT/T 8 v.5.
Did you print this document yourself?
The Trust discourages the retention of hard copies of policies and can only guarantee
that the policy on the Trust website is the most up-to-date version. If, for exceptional
reasons, you need to print a policy off, it is only valid for 24 hours.
Name and title of author/reviewer:
(this version)
Dr Richard Stott – Clinical Governance Lead,
Pathology
Date revised:
September 2013
Approved by (Committee/Group):
Policy Approval and Compliance Group on
behalf of the Patient Safety Review Group
Date of approval:
9 October 2013
Date issued:
17 October 2013
Next review date:
September 2016
Target audience:
Trust-wide
Page 1 of 10
REF: PAT/T 8
v.6
SPECIMEN AND REQUEST FORM LABELLING POLICY
Amendment Form
To be completed when reviewing an existing APD
Please record brief details of the changes made alongside the next version number. If
the APD has been reviewed without change, this information will still need to be
recorded although the version number will remain the same.
Version
Date
Issued
Version 6
17 October
2013
Brief Summary of Changes
•
•
•
•
•
Author
New style format included.
Dr Richard Stott
Removal of reference to general numbers
for neonates.
Addition of criteria for ICE order comms
labels.
Link to HSE notice
Revised trust document format.
•
Version 5
February
2011
Version 4
December
2009
Version 3
June 2009
Version 3
February
2007
Use of district number for all Trust requests in
place of other patient identification numbers.
• Added sample labels consistent with the order
communications software due to be introduced
from April 2011.
• Amendment form and contents page added
• Paragraphs numbered
• Introduction - addition of - “and patient wrist band
(if applicable).”
• P7, addition of – “or ‘Sharps’ included”
Reviewed, no change – Short review time given to
coincide with the introduction of new wristbands
• Alteration to minimum data sets for identification
of specimen details (no change to minimum data
sets for request form)
• Histopathology sample containers should be
handwritten
• Pre-printed addressograph labels are NOT
acceptable on sample containers
• Labels printed contemporaneously, will be
accepted on sample containers if they include the
minimum sample data set and are initialled by the
person taking the sample to confirm that they
have verified identification with the patient.
• Clarification that samples will not be analysed if
additional essential information is incomplete
Page 2 of 10
Dr Richard Stott
Dr Richard Stott
Dr Richard Stott
Dr Wardell
REF: PAT/T 8
v.6
SPECIMEN AND REQUEST FORM LABELLING POLICY
Contents
Paragraph
Page
1
Introduction
4
2
Purpose
4
3
Duties and responsibilities
4
4
Procedure
5
4.1 Request Forms
4.2 Specimen Details
4.3 Additional Department Specific Details
4.3.1 Blood Transfusion and Blood Grouping Requests
4.3.2 Clinical Biochemistry
4.3.3 Haematology
4.3.4 Microbiology
4.3.5 Histopathology
4.3.6 Cytology
4.4 Additional Information
4.4.1 Unidentified Patients
4.4.2 GUM Patients
4.4.3 Paediatric Samples/Gas syringes
4.4.4 Health and Safety
4.5 Inadequate and Incorrectly Labelled Requests and
Unsuitable Samples
5
6
7
7
7
7
7
7
8
8
8
8
8
8
8
5
Training / Support
9
6
Monitoring Compliance with the Procedural Document
9
7
Definitions
10
8
Equality Impact Assessment
10
9
Associated Trust Procedural Documents
10
Page 3 of 10
REF: PAT/T 8
v.6
SPECIMEN AND REQUEST FORM LABELLING POLICY
1.
INTRODUCTION
Inadequate or inaccurate labelling results in delays before pathology results are
available and hence affects patient care.
Inadequately or inaccurately labelled specimens or forms will not be accepted unless
they are considered to be ‘unrepeatable’. A classification of ‘unrepeatable’ will be on
an individual basis and in these cases the requestor may be required to come to the
laboratory to amend their request information and to document that they have done
so. Any labelling discrepancy will be included on the pathology report.
2.
PURPOSE
This policy outlines the required information to provide patient identification criteria for
Pathology specimens and request forms in order for them to be accepted by the
laboratory for analysis.
3.
DUTIES AND RESPONSIBILITIES
•
It is the responsibility of managers to ensure that –
o Staff in their area of responsibility are aware of the content of
this policy and follow the required elements for all pathology
requests.
o All patients have been formally identified according to the
appropriate sections of the trust patient identification policy. In
particular an ID band may be required.
•
It is the requestor’s responsibility to ensure that –
o All requestor, location and patient details on the request form
or computer screen are correct, clearly legible and that the
request form is signed if required for the requested tests (eg
blood transfusion related requests).
o The investigations required are clearly identified with relevant
supporting information.
o Any required timings are clearly indicated (eg sample time
relative to treatment).
o All appropriate Health & Safety requirements are complied
with.
•
The person responsible for taking the specimen (whether medical,
nursing or phlebotomy staff) MUST ensure that Page 4 of 10
REF: PAT/T 8
v.6
o All the necessary information is present on the request form.
Staff should NOT proceed with the venepuncture if this is not
the case.
o Containers are legibly labeled with the correct details of the
patient. In particular that the specimen details match those on
the form and patient wrist band (if applicable).
o Containers are securely packaged so they do not leak and are
unlikely to be broken on the way to the laboratory.
o Specimens to be transported by road are packaged in
compliance with the Transport of Dangerous goods legislation.
•
4.
All Pathology laboratory staff involved in the receipt and testing of
specimens are required to ensure that samples and forms are labelled
to the standards set out in this document before testing can proceed.
PROCEDURE
4.1 Request forms
Data Set for Identification on ICE pathology requesting labels:
•
•
•
•
•
•
District Number or NHS number (For primary care & other trusts patients)
Patient Surname and Forename (in full, not initials)
Date of birth (DOB)
Gender
Patient address
Request number barcode
All of this data will correspond to that on PAS at the time the label is printed and the
patient demographics should always be checked with the patient prior to taking
samples.
Printed labels for attaching to sample tubes contain the following data –
•
•
•
•
District Number or NHS number
Patient Surname and Forename
Date of birth (DOB)
Request number barcode
Written request Minimum Data Set for Identification:
•
•
District Number and/or NHS number (For primary care & other trusts
patients)
Patient Surname and Forename (in full, not initials)
Page 5 of 10
REF: PAT/T 8
•
•
v.6
Date of birth (DOB)
Patient address if District Number /NHS number not supplied
In addition to the minimum data set for patient identification please ensure all other
relevant fields of the request form are completed:
•
•
•
•
•
•
•
•
•
•
•
Ward/ Practice, Consultant/GP
Patient address
Patient gender
Date and time of collection
Specimen type
Investigation(s) required
Name of requesting clinician and bleep number
Relevant clinical details
Current drug therapy
Copy reports, if required
Patient category (PP/ CAT 2 / NHS)
No new request forms should be issued to patients without the district number.
Requests from outpatient locations will continue to use “general numbers” for some
time due to patients already having been given request forms without the district
number present.
4.2 Specimen Details
Minimum Data Set for Identification:
• Patient’s Surname
• Patient’s Forename (Initial is acceptable unless it is a blood transfusion
sample, but full name is preferable)
• Date of Birth and/or District Number / NHS number (both required for Blood
Bank samples)
Please Note:
• Pre-printed addressograph labels are NOT acceptable on sample containers
(except for samples labeled according to safe patient identification procedures
and pre-approved by Pathology). This includes histopathology samples.
• Labels printed contemporaneously, i.e. beside patient and at the time that the
sample is being taken, will be accepted on sample tubes if they include the
minimum data set and are initialled by the person taking the sample to
confirm that they have verified identification with the patient. (It is
important that the size and thickness of labels placed on samples does not
cause difficulties with sample testing. Therefore please seek guidance from the
relevant department before using labels).
• If the correct procedures are being followed, ICE sample labels are printed
using data obtained from the patient ID band or other patient associated
Page 6 of 10
REF: PAT/T 8
•
•
v.6
machine readable identification and are therefore more secure that the above
labels.
Addressograph labels are acceptable on request forms.
Request form and sample details must correspond.
In addition to the minimum data sets for identification, samples will not be
analysed if other essential information is incomplete. Please see additional
department specific details for information.
4.3
Additional Department Specific Details:-
4.3.1
•
•
•
Blood Transfusion and Blood Grouping Requests
Person taking blood must sign specimen and request form
Request form must be signed by requesting Doctor.
Latest Hb result and reason for transfusion, number of units required, time and
date required, special requirements e.g. CMV negative or irradiated products
required should be indicated on the form.
Please refer to the current version of the Hospital Blood Transfusion policy
PAT/T 2.
•
4.3.2 Clinical Biochemistry
• For glucose and lipids, state fasting or non-fasting.
• For drug analysis, time of last dose and time of sample collection are required.
• For antenatal screening for Down’s syndrome and NTD, gestational age and
patient weight must be provided.
• For pregnancy tests and female hormones, state LMP or day of cycle
• Patient gender must be included for reference ranges to be included on report.
4.3.3 Haematology
• Patient gender must be included for reference ranges to be included on report.
4.3.4 Microbiology
• Include specimen type and site
• For antibiotic assay levels e.g. Gentamicin, a ‘Gentamicin sticker’ must be
applied to the request form and the following information completed:
Mg of last dose given
Date and Time of last dose
Date and time that sample was taken (pre and post dose samples required for
multiple dosing).
Please refer to Gentamicin guidance document. Gentamicin labels are
available from Pathology reception.
4.3.5 Histopathology
• Include specimen type and site on both request form and specimen container
• Indicate patient consent / objection to use of surplus tissue for education /
Quality Control
Page 7 of 10
REF: PAT/T 8
v.6
4.3.6 Cytology
• Include LMP
4.4.
Additional Information
4.4.1 Unidentified Patients
The request form and samples must include a unique identifier number which is
available on PAS (i.e. District number), and patient gender.
All request forms must be signed.
4.4.2 GUM Patients
Where Patient name is not appropriate, then GUM number, patient gender and DOB
will be acceptable.
4.4.3 Paediatric Samples/Gas syringes
Use labels provided and attach to each sample tube.
4.4.4 Health and Safety
In 2011 the HSE issued a reminder regarding the legal requirement to notify certain
infection risks on pathology request forms
(http://www.hse.gov.uk/safetybulletins/clinicalinformation.htm).
Affix ‘Danger of Infection’ stickers on samples and request forms from patients with
the following conditions:
•
•
•
•
4.5.
Hepatitis B, Hepatitis C and HIV
Cases of infective or suspected infective diseases of the liver
Known or suspected cases of Mycobacteria (TB)
Salmonella typhi / paratyphi (Typhoid / Paratyphoid)
E.coli 0157
Dysentery with Shigella dysenteriae
Brucellosis
Patients in at-risk groups
Inadequate and Incorrectly Labelled Requests and Unsuitable Samples
The Directorate will make every effort to ensure requests are processed in a safe and
timely manner but it is essential that request forms and samples are labeled
appropriately and legibly in compliance with this policy.
It is also important to clearly identify the investigations required with relevant
supporting information.
If you have any doubts regarding this policy please ring the relevant department for
further information.
Page 8 of 10
REF: PAT/T 8
v.6
Specimens will not be accepted for analysis if: • There is no unique identification of the patient i.e. they do not meet the
minimum data set for identification.
• Blood transfusion requests without handwritten identification details
• There is an incorrect sample type or tube
• Incorrect transportation conditions
• Sample is received in a hazardous condition e.g. leaking or sharps attached.
• Sample or request form is unlabelled or incorrectly labeled with less than the
minimum data sets for patient identification
• Request form does not include all the essential additional information e.g. fully
completed gentamicin label
• Pre-printed addressograph label used on sample container (with the exception
of samples labeled according to safe patient identification procedures and preapproved by Pathology)
• Mismatch of details between the form and sample(s)
• The information provided is illegible
5.
TRAINING/ SUPPORT
This policy and the Patient identification policy are referenced during the Pathology
section of Trust induction.
The Trust provides training in phlebotomy techniques and the additional requirements
associated with transfusion samples. This training includes all relevant aspects of this
policy.
Training in the use of the ICE order communications system is available via the IT
trainers.
6.
MONITORING COMPLIANCE WITH THE PROCEDURAL
DOCUMENT
What is being Monitored
Who will carry out
the Monitoring
Accuracy of request form &
specimen container
labelling.
Pathology reception
staff.
How often
Every request
checked.
Suitability of samples for
analysis.
Page 9 of 10
How Reviewed/
Where Reported to
As detailed in section 4.5,
breaches which prevent
analysis will be recorded
on outgoing reports.
Clinical staff may have to
re-label unrepeatable
specimens before they can
be analysed.
REF: PAT/T 8
Significant breaches are
reported as incidents via
DATIX.
Reported by
Pathology reception
staff
Performance of individual
CSUs is monitored by
pathology.
Logged by Pathology
reception staff &
analysed by senior
staff.
7.
v.6
To Matrons & Risk office
All requests
monitored.
Outcome reported
annually.
Compliance reported and
targets set as part of the
SQLAs between individual
CSUs and Pathology.
DEFINITIONS
ABBREVIATIONS LIST:
• Hb
Haemoglobin
• CMV Cytomegalovirus
• NTD Neural Tube Defect
• LMP Last Menstrual Period
8.
EQUALITY IMPACT ASSESSMENT
An Equality Impact Assessment (EIA) has been conducted on this procedural
document in line with the principles of the Equality Analysis Policy (CORP/EMP 27)
and the Fair Treatment For All Policy (CORP/EMP 4).
The purpose of the EIA is to minimise and if possible remove any disproportionate
impact on employees on the grounds of race, sex, disability, age, sexual orientation or
religious belief. No detriment was identified.
A copy of the EIA is available on request from the HR Department.
9.
ASSOCIATED TRUST PROCEDURAL DOCUMENTS
ƒ
ƒ
Blood Transfusion policy
Patient Identification Policy
PAT/T 2
PAT/PS 7
NB - According to the Patient identification policy, any patients who are unable or
unwilling to identify themselves to the required level must be handled by the
requesting staff as an “unidentified patient”. Therefore the Trust’s Mental
Capacity Act 2005 Policy and Procedure - PAT/PA 19 and the Privacy and
Dignity Policy - PAT/PA 28 do not apply to this policy.
Page 10 of 10
SURNAME
FORENAME
SMITH
JOHN
Follow the trust policy (PAT/T8) and avoid
mistakes by labelling all types of samples
correctly with the
full name,date of birth and ID number
rather than the proven risk of the
wrong sticky label
Remember Transfusion samples must have all details and be signed
Refer to electronic Pathology Handbook
www.dbh.nhs.uk
Sample Labelling Poster - Trust Version - November 2005
Requesting
12/12/1864
TIME1.30PMDATE 5/4/05
WARD
X2
NO. 123 456 7890
SIG. Jo Bloggs
DOB
General Pathology Request Form
Use this form for Clinical Biochemistry, Haematology, Immunology, Microbiology and Virology
BIOHAZARD
Clinical Biochemistry, Haematology, Immunology
Microbiology, Virology
BIOHAZARD
Use this side for ICE Order Comms requests
If the ICE system is unavailable, use the reverse side of this form
Any tests manually added onto this form will not be performed
Blood Testing - opening times
1234567890
1234567890
Monday to Friday - 8.00am to 5.00pm at
Urgent / Fast Track
SURNAME
Forename
01/02/34
A sample will only be accepted as fast track if
Enquiries
1The Street
Any Town
AB1 2CD
Can be made via either site 09:00 to 17:15
Monday to Friday
123456
Dr Test
BG Intensive Therapy Unit
1xLilac 2xGold 1xGreen
1B123456X
1B123456X
Tests
High Risk Cases
All specimens and request forms from
patients known or suspected of having
Hepatitis B, Hepatitis C or HIV infection
BIOHAZARD
Attach ICE Demographic Label Here
In case of spillage
Isolate area and contact senior clinical / laboratory staff
Please ensure for all samples
The ICE sample label is placed DIRECTLY over tube label
Ensure gap remains between label so that sample is visible
Labels are placed on STRAIGHT
Labels placed diagonally will not be read by the laboratory
instruments and will delay analysis
Labels are attached as near to the cap as possible
FOLD TOP OVER TO SEAL
Details of Pathology services available in the laboratory handbook on the Trust intranet or via www.dbh.nhs.uk (includes sample tube guide)
Use this side for manual requests
Do not attach addressograph
labels to sample tubes.
NHS No.
CLINICAL BIOCHEMISTRY / HAEMATOLOGY / IMMUNOLOGY REQUESTS
FBC
ESR
APTT
Blue
U/E
Gold
PT/INR
Blue
BONE
Gold
LFT
Gold
Lavender
GLU
DISTRICT No.
Grey
SURNAME
D.O.B.
Fasting Random
FORENAMES
M/F
OTHER TESTS - Specify
PATIENT'S ADDRESS
CLINICAL DETAILS INC. DATE OF ONSET / DRUG THERAPY / TREATMENT
SEND COPY TO
CONSULTANT / GP
WARD / SURGERY
REMOVE COVERING STRIP
HAVE YOU LABELLED
PLACE SPECIMEN IN BAG
FORM & SAMPLE CORRECTLY ?
Pathology Requests
This form is being used as part of the ICE Order communications roll out. If access to ICE exists, please use ICE
as the method of requesting and collecting specimens. ICE will create the necessary labels which can be
applied to the front side of this form.
For non ICE orders, please use the reverse side of this form (which is the same as the previous form design).
If the front side of the form is used for non ICE orders, the request may be rejected.
SPECIMEN / SITE
TIME LAST MEAL / DOSE
DATE/ TIME SAMPLE TAKEN
MICROBIOLOGY / VIROLOGY REQUESTS
PLEASE USE INDIVIDUAL FORMS FOR THESE REQUESTS
AND A SEPARATE GOLD TOP TUBE FOR SEROLOGY SAMPLES
REQUESTING DOCTOR (BLOCK CAPITALS)
SIGNATURE
BLEEP No.
Has ID on form and all samples been verified with Patient ?
IF NOT NHS PATIENT PLEASE TICK
PRIVATE
YES / NO
CAT 2
M
SEX
BIOHAZARD
Blood Bank
Group & Save
D.O.B.
NHS No.
BLOOD PRODUCT REQUIREMENTS
M/F
Surname
BLOOD BANK
Red Cells
Forename
FFP*
Cryo*
Platelets*
Novo7*
Beriplex*
*Contact Consultant Haematologist
Patients
Address
Number of units / vials required
Date & Time required
Special Requirements
CMV Negative
Irradiated products
Previous Blood
Group
Known
Antibodies
Previous
Transfusion
Previous
Pregnancies
Consultant
Ward
Requesting Doctor
Bleep No.
Private
CAT 2
Sample may be delayed without details in this section
Recent Hb
Clinical Details
If Applicable give details indicated below:
NBS Number
Delivery or sensitising event
BIOHAZARD
NO.
Unit No.
Direct Coombs
Kleihauer
SMITH
JOHN
WARD
SURNAME
FORENAME
HAVE YOU LABELLED
FORM & SAMPLE CORRECTLY ?
DO NOT ATTACH ADDRESSOGRAPH
LABELS TO SAMPLE TUBES
DO NOT USE TRANSPORT TUBE SYSTEM
DOB 12/12/1864
TIME1.30PMDATE 5/4/05
X2
SIG. Jo Bloggs
123 456 7890
Blood Bank Request Form
Gestation
Date
Last Anti-D issue:
Date
Time
Dose
Date / Time
Sample taken by
Signature of Medical Officer
www.dbh.nhs.uk
BIOHAZARD
ENQUIRIES
Doncaster Extension 3779 Bassetlaw Extension 2452
IMPORTANT - Please read carefully before sample collection
Addressograph labels must NOT be used on the sample
All requests for blood products MUST be signed by a Medical Officer
To avoid the risks associated with transfusion please consider the use of alternatives.
(Iron, Folate, B12 Erythropoetin etc.)
Routine 'Top-Up' transfusions are processed during the normal working day and not 'Out of hours'.
Advice is available from Blood Bank, the Hospital Transfusion Practitioner or the Consultant Haematologist
as appropriate.
This section is for laboratory use only
Antibody Screen
Group of Baby
Kleihauer
DCT
Batch No.
Expiry
Issue of prophylactic Anti-D
Dose
February 2006 - Check the Pathology Handbook at www.dbh.nhs.uk for updates
BIOHAZARD
Group of Patient
FOLD TOP OVER TO SEAL
BLOOD BANK
All incorrect, illegible or incomplete requests (sample or form) will be discarded
(Please see the Trust's Blood Transfusion Policy and Sample labelling policy)
PLACE SPECIMEN IN BAG
REMOVE COVERING STRIP
Blood Bank
c
BD Vacutainer System
®
BD Diagnostics - Preanalytical Systems
Tube Guide including Order of Draw
Please display this in your clinical areas beside your venepuncture equipment
Doncaster and Bassetlaw Hospitals NHS Foundation Trust - Printed 0807
Blood samples should be taken in the following order:
Catalogue
Number
Colour Code
KFK186
Draw
Volume
4.5ml
5ml
4ml
Aerobic followed by anaerobic. If
insufficient blood for both culture
bottles, use aerobic bottle only.
Sodium
Citrate
Coagulation Screen, PT (INR),
APTT, Thrombophilia Screen, Lupus
Anticoagulant Screen
Sample MUST be filled to the mark
Black
3.5ml
4ml
4ml
SST II
All Biochemistry tests not mentioned
elsewhere (1 tube), Microbiology (1
tube), Immunology tests
Mixing guidelines: 5 - 6 times
Heparin
& PST II
Chromosome Studies, Amino Acids,
Troponin, Synovial fluids for crystals
Mixing guidelines: 8 - 10 times
Mixing guidelines: 5 - 6 times
TM
EDTA
Lavender
KFK277
Draw
Volume
6ml
Pink
KFK250
Draw
Volume
4ml
Grey
KFK235
Draw
Volume
7ml
Samples for anticonvulsants should
be taken before the dose is given
Green
KFK171
Draw
Volume
Mixing guidelines: 8 - 10 times
Procollagen, Lamotrigine
Gold
KFK281
Draw
Volume
Mixing guidelines: 3 - 4 times
Serum
TM
Draw
Volume
ESR at Bassetlaw Only. At Doncaster
Royal Infirmary use lavender Tube
(EDTA)
Red
KFK112
Special Instructions
Culture of micro organisms from
blood
ESR
KFK242
Draw
Volume
Determinations
Blood
Culture
Light Blue
KFK013
Draw
Volume
Tube
Type
Cross
Match
FBC, Sickle Screen,
Haemoglobinopathy Screen, G6PD,
Glandular Fever Screen, Malarial
Parasites, ZPP, RBC Folate, Cell Marker Mixing guidelines: 8 - 10 times
Studies, Lead, Complement, HbA1c,
PCR, Viral Loads, HLA B27, Kleihauer
Blood Group and antibodies,
Crossmatch, Cord Blood samples
Mixing guidelines: 8 - 10 times
Fluoride
Oxalate
Glucose, Ethanol (Alcohol), Lactate
Mixing guidelines: 8 - 10 times
Trace
Element
Copper, Selenium, Zinc
Mixing guidelines: 8 - 10 times
Royal Blue
*RECOMMENDED ORDER OF DRAW:
1. Blood culture bottles
2. COAGULATION Tubes
3. Tubes with no Additives
4. OTHER Tubes with ADDITIVES
For further copies of this guide and questions regarding specific tests,
please contact the main Pathology Laboratory.
BD, BD Logo, Vacutainer and Hemogard are all trademarks of Becton, Dickinson & Company.
*Clinical and Laboratory Standards Institute Guidelines H3-A5 Vol 23 No. 32, 5th Edition
BD Diagnostics - Preanalytical Systems, Tel: 01865 781603
BD Vacutainer System
®
BD Diagnostics, Preanalytical Systems
Mixing Guidelines
All BD Vacutainer tubes require immediate mixing following collection
®
Colour Code
Tube Type
Inversions
Serum
5-6 Times
Sodium Citrate
3-4 Times
Sodium Citrate ESR
8-10 Times
SST II
5-6 Times
Red
Light Blue
Black
TM
Gold
Heparin & PST II
8-10 Times
EDTA
8-10 Times
Cross Match
8-10 Times
Fluoride Oxalate
8-10 Times
Trace Element
8-10 Times
TM
Green
Lavender
Pink
Grey
Royal Blue
Insufficient mixing can result in inaccurate test results and the need to re-draw
*
Indicates a component of a group which may require little or no extra volume
for multiple tests.
TEST
17-αHydroxyprogesterone
3-Hydroxybutyrate
ACTH
Alpha-1-antitrypsin
TUBE
CK
Copper
600
Cortisol
400
600
Cows Milk Antibodies
600
Adult tube
1ml
500
C-Peptide
600
400
CRP
400
Phenotype
600
DHAS
400
Albumin*
Aldosterone
Alkaline Phosphatase*
Amino Acids
Ammonia
Amylase
Androstenedione
AST
B12/Folate
Bicarbonate
Bilirubin (D & I)*
Bilirubin (Total)*
Biotinidase
Blood Group & DCT (<6mo)
Bone Profile*
Caeruloplasmin
Caffeine
Carbamazepine
Chloride *
Cholesterol
Cholesterol HDL
Cholinesterase
Chromosomes
VOL
Quantitation
Genotype
Blood Group & X-match (>6 mo
All volumes relate to whole blood and
assume normal clotting and haematocrit.
Adult tube
Paediatric Tube Guide Dec 13
Phenylalanine
Phenobarbitone
Phenytoin
Phosphate*
Potassium*
Progesterone
Prolactin
Protein Electrophoresis
Protein (Total)*
4ml
Digoxin
400
400
Electrolytes & Urea*
400
600
Ethanol
400
400
Factor Assays
600
Ferritin
400
More Complex Coag Tests
400
Free Fatty Acids
600
400
Galactosaemia screen
400
400
Gliadin Antibodies
400
400
Glucose
400
600
Growth Hormone
400
HIV positive mother
400
IGF1
500
400
Immunoglobulins
400
600
IgE
600
500
Insulin (also send Glucose)
PTH
Renin
Salicylate
SHBG
Sodium*
Testosterone
Theophylline
Thyroid Function Tests
Triglyceride
TSH
TSH & Free T4
TSH, Free T4 & Free T3
U & E*
U & E, LFT*
U & E, LFT & Bone*
Urate
Urea*
Valproate
Zinc
Contact Lab
400
600
1ml
Iron
400
400
Ketones
400
600
Lactate
400
400
LDH
400
400
Liver Function Tests (LFT)*
600
400
LFT & Bone*
600
Fasting
400
LH & FSH
600
Fasting
400
Magnesium
400
Adult tube
2ml
Meningococcal PCR
600
Genetics
2 x 600
Microbial Serology
Karyotyping
2 x 600
Oestradiol
Osmolality
Paracetamol
400
600
400
400
400
400
400
400
400
PT/APTT/Coag Screen
2 x 600
On Ice
600
1.3ml
Contact Lab
400
600
400
400
400
600
400
600
400
600
600
1ml
400
600
600
400
400
400
Adult tube
1ml
1.2ml
600
TUBE COLOURS
Serum Gel
Li Heparin
400
Citrate Screw top
Fluoride Oxalate
EDTA
400
Trace metal tube
*
Indicates a component of a group which may require little or no extra volume
for multiple tests.
All volumes relate to whole blood and
assume normal clotting and haematocrit.
Paediatric Tube Guide Dec 13
Directorate of Pathology
Blood Cultures
Procedure for collection and inoculation of bottles
It is important that when taking blood cultures the following procedure is followed, this is to ensure the best recovery
of significant micro-organisms and to minimise contamination from skin flora. Blood cultures may be taken using
either a syringe and needle or a butterfly system. For an adult set use a blue and purple set of bottles and
inoculate each bottle with 10mls and for paediatric samples use a yellow bottle and add up to 4mls.
Blood culture should be taken from a venepuncture site specifically for this purpose. If a culture is being collected
from a central venous catheter, disinfect the access port with alcohol swab. When blood is being collected for other
tests, always inoculate blood culture bottles first.
•
Before starting, wash your hands with soap and water, dry and apply clean examination gloves. Ensure that all
necessary items are available:- tourniquet, syringe, needles/butterfly, vacutainer adapter caps/inserts, 3 alcohol
swabs, Sterile gauze swabs, Hypoallergenic tape, Request form and blood culture bottles (1 aerobic, blue and 1
anaerobic, purple for a normal set).
•
Stand bottles on a fixed, hard surface. Remove the protective coloured plastic covers from the caps of the blood
culture bottles and wipe the rubber seals with a fresh alcohol swab and allow to dry for 30 seconds.
•
Apply tourniquet, find target vein and wipe the area thoroughly for 30 seconds with alcohol swab, leave to dry
for 30 seconds. Do not palpate again after cleaning.
Butterfly system
• Attach butterfly to adapter cap (1,2)
•
Perform venepuncture. When the needle is in the vein, secure it with tape or hold it in place. (3,4)
•
With the bottles on a level surface place the cap over the bottle neck of the first blood culture bottle (blue) Allow
blood to flow until an increase in volume of approximately 10mls is achieved. Transfer the cap to the other bottle
(purple) and repeat. (4,5)
• Write patient details and if appropriate the site of sampling onto each bottle.
1
2
3
4
5
• If additional blood is required for other tests, place the Adapter Insert into the Adapter Cap and snap into place.
This makes the cap compatible with vacuum collection tubes. (6,7)
6
7
Syringe and needle
•
When using a syringe and needle draw 20mls and ensure 10mls of blood is added to each bottle,
inoculating the purple bottle first followed by the blue. Do not add more than 10mls to each bottle.
•
Do not reduce the volume of blood for cultures (unless difficulty in obtaining sample) as this will affect the
recovery of micro-organisms.
Author :Andrew Cross
Document Number: PD-UserHbk-05 ver 1.0, 26/7/2007
TRUST GUIDELINES AND ADVICE
Taking Blood Cultures – Standards for Best Practice
NOTE: This document should be used in conjunction with the Taking Blood Cultures – Competence
Assessment form
1. Blood cultures should be taken when there is reason to suspect a blood stream infection
e.g. Sepsis exists when there is evidence or suspicion of infection and two or more of the following
Chills with rigors
WBC>12000 l-1
Hyperthermia>38.30C
Hypothermia<360C
Tachycardia>90 min-1
WBC<4000 l-1
Acutely altered mental status Tachypnoea>20 min-1
Gluc>6.6mmol l-1
- Blood cultures should be taken as part of an investigation plan developed after systematic patient assessment.
- Blood cultures may not be indicated if sample taken within the previous 24 hours and no new indicators of further
systemic infection evident.
- If in doubt seek Microbiologist advice.
2. Ensure meticulous hygiene
- Clean and prepare a clinical trolley with the equipment you will need.
- Ensure you are bare below the elbows, wash your hands and use alcohol rub, always wear an apron and gloves.
- Clean the patient’s skin at the site where venepuncture will be performed for 30 seconds and allow to dry for 30 seconds
(use 2% Chlorhexidine Gluconate in 70% Isopropyl Alcohol).
- DO NOT touch the skin after cleaning. This is of utmost importance to prevent contamination of the sample.
- Clean the top of each blood culture bottle as for skin cleaning.
- If using a syringe and needle to take blood – ensure that a new needle is used to pierce each sample bottle.
- If other blood required for other samples, inoculate blood culture bottles first.
3. Take appropriate samples that will be of diagnostic value
- Samples should be taken before antibiotics are commenced or immediately before the next dose if already receiving
antibiotics.
- Collection of blood from peripheral venepuncture is the ‘Gold standard’. (DO NOT use indwelling peripheral cannulae).
- In extreme circumstances (e.g. a paediatric patient with one cannulatable vein), if a newly inserted cannula is used for
sampling, take all possible measures to avoid contaminating the line & state on request form ‘Blood from new cannula’.
- If suspected line-related infection in addition to peripheral venepuncture, collect blood from indwelling intravascular lines
in situ for >48 hours (e.g. Central line, Arterial Line, ‘Vas Cath’ , but not peripheral cannula). Ensure the hub is cleaned
prior to sample collection as described above for venepuncture.
- In multi-lumen lines - blood should be drawn from at least one lumen – preferably the most accessed/manipulated
lumen. If TPN is in progress, sample from this port at bag change to minimise the risk of contamination.
4. Communicate information about samples sent for culture
- Label the sample bottles clearly after verifying the patient’s identification details according to Trust policy.
- Ensure that the patient’s details are also clearly documented on the request form.
- State the reason why the sample has been taken (clinical indicators / evidence of infection/sepsis or other relevant
medical conditions).
- State current/recent antibiotic treatment or ‘Not receiving antibiotics’.
- State site of blood collection (‘Peripheral venepuncture’, ‘Blood from new cannula’, ‘Central line blood’, ‘Arterial line
blood’, ‘Vas cath blood’).
- Ensure that the name of the person who has obtained the blood sample is legibly written on the request form. (To allow
audit and maintenance of standards across all professions taking blood culture samples).
5. Maintain clinical competence and clinical standards
- All practitioners taking blood samples for culture should have documented evidence of their training and competence.
- This should be re-verified by annual assessment (by another competent registered professional) and documented
at annual appraisal by the appraiser/manager.
- The standards stated here should be audited at least annually within the Trust and results shared with all relevant
clinical areas.
- These standards are principles aimed at ensuring best practice and maximum diagnostic value. Technical and practical
Leefor
Cutler
Dr Christine
2008.
in Trust
training packages, in the Pathology
details about techniques and equipment
blood /sampling
can beHoy,
foundMay
Handbook and are taught in practical workshops. For further details contact the training department.
Lee Cutler / Dr Christine Hoy, May 2008.
Lee Cutler / Dr Christine Hoy, May 2008.
AFFIX LABEL HERE IF AVAILABLE
HMR111(g)
Unit Number: ..................................................................................................................
Surname: ............................................................................................................................
Forename(s): ...................................................................................................................
Address: ..............................................................................................................................
HIGH DOSE EXTENDED-INTERVAL GENTAMICIN
PRESCRIPTION AND MONITORING PATHWAY
Hospital:
Doncaster
Montagu
......................................................................................................................................................
D.o.B.: ....................................................................................................................................
Bassetlaw
Retford
Tickhill Road
PILOT DOCUMENT
Consultant: ...................................................................................................................... Ward: ............................................................................................................................................
Weight (kg): ................................................................. Height (cm): ................................................................ Ideal weight (kg): ................................................................
Prescriber's Responsibility - it is the prescriber's responsibility to:
a) Ensure that the gentamicin is not prescribed without full information regarding the patient's renal function and latest
gentamicin levels being known - see overleaf.
b) To take or ensure that gentamicin level samples are taken at the appropriate time.
c) Ensure the request form is legibly completed with the date and time of the last dose and the date and time of the
sample, and the request clearly indicates DAILY DOSING. Pre-printed stickers which are available on the wards should
be used to supply this information.
Dose 5-7 mg / kg (based on ideal body weight). Frequency depends on serum gentamicin levels - see over
Exclusion criteria - Endocarditis, pregnancy, children (<16 years), cystic fibrosis, amputees, patients with ascites,
major burns, impaired renal function (CrCl<20ml/min), or on other potentially ototoxic or nephrotoxic drugs.
FIRST DOSE - YOU MUST NOT PRESCRIBE the first dose of gentamicin before the renal function is established.
Date
Date
Serum Creatinine (micromols/l)
Creatinine Clearance (ml/min) - see over
Infusion
Time
of dose
Prescribed
by
Time
started
Given
by
Witnessed Time
stopped
by
GENTAMICIN ........................................... mg
in Sodium Chloride 0.9% 50ml by IV infusion over 30 mins
Serum gentamicin level MUST be taken 6-14 hours after start of infusion, with EXACT time recorded
Serum Gentamicin level after FIRST DOSE - See over
Date
Time sample taken
Interval between start
of infusion and sample
Serum Gentamicin level (mg/ml)
Interval to next dose
YOU MUST NOT PRESCRIBE the next dose before the first level has been established.
YOU MUST NOT ADMINISTER the next dose before the first level has been established.
Date
Time
of dose
Prescribed
by
Infusion
Time
started
Given
by
Witnessed Time
by
stopped
GENTAMICIN ........................................... mg
in Sodium Chloride 0.9% 50ml by IV infusion over 30 mins
GENTAMICIN ........................................... mg
in Sodium Chloride 0.9% 50ml by IV infusion over 30 mins
GENTAMICIN ........................................... mg
in Sodium Chloride 0.9% 50ml by IV infusion over 30 mins
Serum Creatinine Monitoring
At time of first dose and at least three times weekly
Serum creatinine
Creatinine clearance
Date
(micromols/l)
(ml/min) - see over
WPR?
Oct. 2004
Serum Gentamicin Level Monitoring - See over
Twice weekly 6-14 hours after the start of the infusion
Date Time sample Interval between start Serum Gentamicin Interval to
next dose
taken of infusion and sample level (mg/ml)
High Dose Extended-Interval Gentamicin
Dosage Calculation and Monitoring
Sampling Schedule
Gentamicin levels samples should be taken between 6 and 14 hours after thet start of the infusion.
Note - It is not usually necessary for gentamicin levels to be reported outside normal working hours, provided
levels are available before the next dose is due. Samples which require processing out-of-hours MUST be discussed with a microbiologist.
In all cases it is imperative that the date and time of last dose administered and the date and time when sample was
taken are recorded on the request form.
Calculation for ideal body weight if obese (obesity: > ideal body weight + 20%)
Male: Ideal body weight (kg) = Height (cm) - 100
Female: Ideal body weight (kg) = Height (cm) - 105
Calculation for creatinine clearance
Male: Creat Cl = 1.23 x (140 - age) x wt (kg)
serum creatinine (micromol/l)
Female: Creat Cl = 1.04 x (140 - age) x wt (kg)
serum creatinine (micromol/l)
Suggested dosing schedule and monitoring: The Hartford Nomogram
Check exclusion criteria (see over). If obese, calculate ideal body weight and use to determine dose.
Calculate creatinine clearance - if<20 ml/min DO NOT use high dose extended-interval gentamicin
Initial dose: 5-7 mg/kg in 50ml sodium chloride 0.9% by intravenous infusion over 30 minutes
•
Obtain a single serum level after the first dose, between 6-14 hours after the start of the infusion.
It is very important that the exact time is documented on both the request form and prescription chart.
•
Evaluate gentamicin level on the nomogram. If the level falls in the area designated Q24h, Q36h or Q48h,
continue the same dose at an interval of 24, 36 or 48 hours respectively. If the point is on the line choose the
longer interval.
•
If treatment continues for longer than four days repeat levels should be monitored twice weekly.
•
If the level is off the nomogram, stop the scheduled therapy and discuss with microbiologist.
•
Gentamicin should preferably not be given with other ototoxic or nephrotoxic drugs and whenever possible
treatment should not exceed 7 days.
Pathology CSU
CONSENT TO A POST MORTEM EXAMINATION
The Human Tissue Act 2004 sets out a new legal framework for the storage and use of tissue from the living
and for the removal, storage and use of tissue and organs from the dead. The Act also established the Human
Tissue Authority (HTA) as a regulatory body for all matters concerning the removal, storage, use and disposal
of human tissue for scheduled purposes. The Human Tissue Authority has issued codes of practice which are
available on the HTA website.
The statutory requirements for consent are as follows:
The Living:
Consent for treatment and examination including removal is a common-law matter dealt with in the Department
of Health’s reference guide to consent for examination and treatment.
Consent from the living is needed for storage and use of tissue for obtaining scientific or medical information
which maybe relevant to any other person now or in the future, research, public display and transplantation.
Consent from the living is not needed for storage and use of tissue for:
Clinical audit, educational training, performance assessment, public health monitoring.
The Deceased:
After a Coroner’s post mortem, for the continued storage or use of material no longer required to be kept for the
Coroner’s purposes.
For the removal, storage and use for the following scheduled purposes:
Anatomical examination, to determine the cause of death, and establishing after a person’s death the effects of
any drug or other treatments administered to them.
To obtain scientific or medical information, public display, research, transplantation, clinical audit, educational
training, performance assessment, public health monitoring and quality assurance.
Consent is not needed for:
Carrying out investigation into the cause of death under the authority of the Coroner.
Keeping material after post mortem under the authority of a Coroner for as long as the Coroner requires it.
Keeping material in connection with a criminal investigation or following a criminal conviction.
Post mortem examination is important for informing relatives, Clinicians and legal authorities about the cause of
death. It can also inform bereaved relatives about possible acquired or genetic diseases which may need
treatment and care. Post mortem examination may lead to improvements in clinical care, maintenance of
clinical standards, increase our understanding of disease and prevent the spread of infectious diseases and
may contribute to research and training.
Bereaved people should be treated with respect and sensitivity at all times, both to help them take important
decisions at a difficult time and to ensure continuing improvements in care.
A post mortem examination may take place either because the Coroner (medical/legal autopsy) considers it
necessary or because it has been agreed upon by the deceased person or their relatives (voluntary/consent
autopsy).
Consent is not required for the carrying out of a Coroner’s post mortem, consent is however required for the
removal, storage and use of human tissue or organs. Voluntary post mortems require informed consent.
Author
Title
Document No.
Suzanne Rogers
Consent to a Post Mortems
PD-UserHbk-012 ver1.0
Page 1 of 2
24/05/2007
Discussing the post mortem with the family: who may seek consent?
The way in which a post mortem examination is discussed with the deceased person’s relatives or close friends
is extremely important. They need to be given honest, clear, objective information; the opportunity to talk to
someone they can trust and whom they feel able to ask questions; reasonable time to reach decisions (about a
hospital post mortem and about any donation of organs or tissue); privacy for discussion between family
members if applicable and support if they need and want it. Only once relatives have had time to reach a
decision should they be invited to sign the consent form.
Obtaining consent for a hospital (voluntary) autopsy should involve a team approach. The team should
comprise a member of the bereavement staff, a member (preferably senior) of the clinical team involved in the
care of the deceased and the pathologist who will be carrying out the examination. Those seeking consent for
hospital post mortem examination should be sufficiently senior and well informed, with a firm knowledge of the
procedure. They should have been trained in the management of bereavement and know the purpose and
procedures of post mortem examinations.
Wherever possible, before the discussion with relatives, the responsible clinician should contact the Pathologist
who will perform the post mortem examination. They can give accurate guidance on which if any tissue or
organs are likely to be retained, for how long and for what purpose. There can then be an informed discussion
with the relatives and bereavement staff in attendance, as to what type of examination is envisaged and what
specimens may be required. They can then be guided through the consent process to make their decisions
having been fully informed of all the options.
The current Trust consent forms (WPR32770) should be used as a basis for obtaining informed consent. There
are accompanying explanatory leaflets (WPR32780 A simple guide to a hospital post mortem) which should be
made available to the relatives. The various options such as limiting the post mortem examination and the
consequence of this should be explained to the relatives.
The discussion with the relatives should include a basic explanation of what happens in a post mortem
examination; the benefits of a post mortem examination and the questions to be addressed in any particular
case. Possible alternatives to a full post mortem examination and any limitations of these alternatives should
be explained. Information about tests needed and whether these might cause delays in the process (eg
retention of the whole brain) should be explained. Options for what will happen to the body or remains and any
organs or tissue removed including tissue blocks and slides should be discussed. The timing of burial or
cremation should be established and discussions take place about the uniting of any material with the body for
burial or cremation if the relatives so wish. Religious factors, such as the need for quick funerals in the jewish,
muslim and hindu faiths should be taken into account. Relatives should be given a copy of the signed consent
form and there should be a cooling off period during which relatives may change their mind.
Dr Suzanne Rogers
Consultant Pathologist
January 2010
Author
Title
Document No.
Suzanne Rogers
Consent to a Post Mortems
PD-UserHbk-012 ver1.0
Page 2 of 2
24/05/2007
Pathology CSU
The following document is taken from the Association of Clinical Pathologists (ACP) News
Instructions for doctors certifying cause of death
The purposes of death certification
Death certification serves a number of functions. A medical certificate of cause of death (MCCD) enables the
deceased’s family to register the death. This provides a permanent legal record of the fact of death and enables
the family to arrange disposal of the body, as well as to settle the deceased’s estate.
Information from death certificates is used to measure the relative contributions of different diseases to
mortality. Statistical information on deaths by cause is important for monitoring the health of the population,
designing and evaluating public health interventions, recognising priorities for medical research and health
services, planning health services and assessing the effectiveness of those services. Death certificate data are
extensively used in research into the health effects of exposure to a wide range of risk factors through the
environment, work, medical and surgical care, and other sources.
After registering the death, the family gets a certified copy of the register entry, which includes an exact copy of
the cause of death information that you give. This provides them with an explanation as to how and why their
relative died. It also gives them a permanent record of information about their family medical history, which may
be important for their own health and that of future generations. For all of these reasons it is extremely
important that you provide clear, accurate and complete information about the diseases or conditions that
caused your patient’s death.
Planned changes to death certification
The government has announced plans to change the laws on death investigation, certification and the coroner
1
service. These changes will address the issues raised by the Shipman Inquiry and the Fundamental Review of
Death Certification. However, the law has not changed yet. When new legislation is passed, doctors will receive
instructions on the changes and the date from which they should be implemented. Changes are not likely to
take effect before 2007-8. This guidance is to remind you of the duties placed on medical practitioners under
current legislation, and to clarify best practice.
Who should certify the death?
When a patient dies it is the duty of the doctor who has attended in the last illness to issue the MCCD if they
are able to do so (although see below regarding referral to the coroner). Though there is no clear legal
definition of “attended”, this is generally accepted to mean a doctor who has cared for the patient during the
illness that led to death and so is familiar with the patient’s medical history, investigations and treatment. The
certifying doctor should also have access to relevant medical records and the results of investigations.
In hospital there may be several doctors in a team caring for the patient. It is ultimately the responsibility of the
consultant in charge of the patient's care to ensure that the death is properly certified. Any subsequent
enquiries, such as for the results of post-mortem or ante-mortem investigations, will be addressed to the
consultant.
In general practice more than one GP may have been involved in the patient’s care and so be able to certify the
death. If no doctor who cared for the patient can be found, the death must be referred to the coroner to
investigate and certify the cause.
If the attending doctor has not seen the patient within the 14 days preceding death, and has not seen the body
after death either, the registrar is obliged to refer the death to the coroner before it can be registered. In these
circumstances, the coroner may give permission for a doctor who was involved in the patient’s care at some
time to certify, despite the prolonged interval, and the registrar will then accept the MCCD. Here practices vary
between coroners; some will allow certification by a doctor who attended outside the 14 days and some will not.
Yet others disregard the provision for viewing after death, and insist that the doctor issuing the MCCD must
have seen the patient in the last 14 days of life. However, a doctor who has not been directly involved in the
patient’s care at any time during the illness from which they died cannot certify under current legislation. The
doctor should, in these circumstances, provide the coroner with any information that may help to determine the
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 1 of 9
24/05/2007
cause of death. The coroner may then provide this information to the registrar of deaths. It will be used for
mortality statistics, but the death will be legally “uncertified” if the coroner does not investigate through an
autopsy, an inquest, or both.
Referring deaths to the coroner
Registrars of births and deaths are under a legal duty to report certain categories of deaths to the coroner
before they can be registered; these include deaths associated with accident, suicide, violence, neglect (by self
or others) and industrial disease. Also deaths occurring during an operation, or before full recovery from an
anaesthetic, as well as deaths occurring in, or shortly after release from, police or prison custody should be
reported. In practice, doctors usually report such deaths themselves and seek the advice of the coroner. The
Office for National Statistics (ONS) encourages doctors to do this and to explain to the family why the death is
being referred, as well as how and when they will learn the outcome of the referral. The coroner should also be
informed if there is no doctor who attended the deceased available to certify, or the certifying doctor did attend
the deceased but has not seen them either within 14 days before death, or after death.
Strictly speaking, the doctor should complete an MCCD even when death has been referred to the coroner as,
if the coroner decides that the death does not require investigation, the registrar can be instructed to use the
doctor’s MCCD to register the death. In practice, most coroners ask that a doctor does not complete the MCCD
unless directed to do so after discussion.
When a death is referred, it is up to the coroner to decide whether or not it should be further investigated. It is
very important that the coroner is given all of the facts relevant to this decision. As above, the doctor should
discuss the case with the coroner before issuing an MCCD if at all uncertain as to the cause of death, or
whether he or she should certify. This allows the coroner to make enquiries and decide whether or not any
further investigation is needed, before the family tries to register the death. The coroner may decide that the
death can be registered and direct the doctor to complete the MCCD. For example, 75% of deaths with
fractured neck of femur mentioned on the certificate are registered from the MCCD completed after discussion
with the coroner, whereas only about 15% go to inquest, and 10% are registered after a coroner's autopsy.
Omitting to mention on the certificate conditions or events that contributed to the death, in order to avoid
referral to the coroner, is unacceptable. If these come to light when the family registers the death, the registrar
will be obliged to refer it to the coroner. If the fact emerges after the death is registered, an inquest may still be
held.
In Scotland, deaths that may have been related to adverse effects of medical or surgical treatment, or to
standards of care, or about which there has been any complaint, are reportable to the procurator fiscal. While
this is not a requirement in England and Wales, it is anyway advisable to refer deaths in these categories to the
coroner.
How to complete the cause of death section
Doctors are expected to state the cause of death to the best of their knowledge and belief; they are not
expected to be infallible. However, it is likely that there will be increased scrutiny of death certification and
patterns of mortality by local and national agencies as a result of the Shipman Inquiry, even before any
changes to the law. Suspicions may be raised if death certificates appear to give inadequate or vague causes
of death. For example, deaths under the care of an orthopaedic surgeon that do not mention any orthopaedic
condition or treatment, or deaths in an acute hospital from old age, with no disease, injury or operation
mentioned, may prompt further investigation. Doctors who consistently use only vague or uninformative causes
of death, or terminal conditions such as bronchopneumonia, may find that these are queried and checked
against hospital and/or primary care records. The level of certainty as to the cause of death varies. What to do,
depending on the degree of certainty or uncertainty about the exact cause of death, is discussed below.
Sequence leading to death, underlying cause and contributory causes
The MCCD is set out in two parts, in accordance with WHO recommendations in the International Statistical
Classification of Diseases and Related Health Problems (ICD). You are asked to start with the immediate,
direct cause of death on line 1a, then to go back through the sequence of events or conditions that led to death
on subsequent lines, until you reach the one that initiated the fatal sequence. The condition on the lowest line
of part one that is used will usually be selected as the underlying cause of death for statistical purposes.
Remember that this underlying cause may be a longstanding, chronic disease or disorder that predisposed the
patient to later fatal complications. You should also enter any other diseases, injuries, conditions, or events that
contributed to the death, but were not part of the direct sequence, in part two of the certificate.
Example:
1a.
Intraperitoneal haemorrhage
1b.
Ruptured secondary deposit in liver
1c.
Adenocarcinoma of ascending colon
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 2 of 9
24/05/2007
2.
Non-insulin dependant diabetes mellitus
1a.
1b.
1c.
Cerebral infarction
Thrombosis of basilar artery
Cerebrovascular atherosclerosis
In some cases, a single disease may be wholly responsible for the death. In this case, it should be entered on
line 1a.
Example:
1a.
Meningococcal septicaemia
More than three conditions in the sequence
The MCCD in use in England and Wales currently has three lines in part one for the sequence leading directly
to death. If you want to include more than three steps in the sequence, you can do so by writing more than one
condition on a line, indicating clearly that one is due to the next.
Example:
1a.
Post-transplant lymphoma
1b.
Immunosuppression following renal transplant
1c.
Glomerulonephrosis due to insulin dependent diabetes mellitus
2.
Recurrent urinary tract infections
More than one disease may have led to death
If you know that your patient had more than one disease or condition that was compatible with the way in which
he or she died, but you cannot say which the most likely cause of death was, you should include them all on the
certificate. They should be written on the same line and you can indicate that you think they contributed equally
by writing “joint causes of death” in brackets.
Example:
1a.
Cardiorespiratory failure
1b.
Ischaemic heart disease and chronic obstructive pulmonary disease
(joint causes of death)
2.
Osteoarthritis
1a.
1b.
1c.
Heart failure
Ischaemic heart disease
Hypercholesterolaemia, widespread atherosclerosis and non-insulin dependent diabetes mellitus
Where more than one condition is given on the lowest used line of part one, ONS will use the internationally
agreed mortality coding rules in ICD-10 to select the underlying cause for routine mortality statistics. However,
since 1993 ONS also codes all of the other conditions mentioned on the certificate. These multiple cause of
death data are used by ONS in a variety of routine and ad hoc analyses, and are made available for research.
This provides useful additional information on the mortality burden associated with diseases that are not often
selected as the main cause of death. For example, diabetes mellitus is mentioned on death certificates four
times as often as it is selected as the underlying cause of death.
In contrast to the above, if you do not know that your patient actually had any specific disease compatible with
the mode and circumstances of death, you must refer the death to the coroner. For example, if your patient
died after the sudden onset of chest pain that lasted several hours and you have no way of knowing whether he
or she may have had a myocardial infarct, a pulmonary embolus, a thoracic aortic dissection, or another
pathology, it is up to the coroner to decide what investigations to pursue.
Results of investigations awaited
If in broad terms you know the disease that caused your patient’s death, but you are awaiting the results of
laboratory investigation for further detail, you need not delay completing the MCCD. For example, a death can
be certified as bacterial meningitis once the diagnosis is firmly established, even though the organism may not
yet have been identified. Similarly, a death from cancer can be certified as such while still awaiting detailed
histology. This allows the family to register the death and arrange the funeral; however, you should indicate
clearly on the MCCD that information from investigations might be available later. You can do this by circling “2”
on the front of the MCCD for autopsy information, or by ticking box “B” on the back of the certificate for results
of investigations initiated ante-mortem. It is important for public health surveillance to have this information on
a national basis; for example, to know how many meningitis and septicaemia deaths are due to
meningococcus, or to other bacterial infections. The registrar will write to the certifying doctor if a GP, or to the
patient’s consultant if in hospital, with a form requesting further details to be returned to ONS.
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 3 of 9
24/05/2007
Old age
Old age should only be given as the sole cause of death in very limited circumstances. These are that:
• You have personally cared for the deceased over a long period (many months or years)
• You have observed a gradual decline in your patient's general health and functioning
• You are not aware of any identifiable disease or injury that contributed to the death
•
You are certain that there is no reason that the death should be reported to the coroner (but see below)
You should bear in mind that coroners, crematorium referees, registrars and organisations that regulate
standards in health and social care, may ask you to support your statement with information from the patient's
medical records and any investigations that might have a bearing on the cause of death. You should also be
aware that the patient’s family may not regard old age as an adequate explanation for their relative’s death and
may request further investigation.
It would be considered unlikely that patients would die of old age, with no apparent disease or injury, in an
acute hospital. Similarly, patients dying under the care of surgeons with no surgical condition, or orthopaedic
surgeons with no injury or musculoskeletal condition mentioned, would not be expected to die of old age alone
and such certificates may be queried. You can specify old age as the underlying cause of such deaths, but you
should mention in part one or part two, as appropriate, any other conditions that may have contributed to the
death. If fractures are to be mentioned, the case should first be discussed with the coroner.
Example:
1a.
Pathological fractures of femoral neck and thoracic vertebrae
1b.
Severe osteoporosis
1c.
Old age
2.
Fibrosing alveolitis
1a.
2.
Old age
Non-insulin dependent diabetes mellitus, essential hypertension and diverticular disease
1a.
1b.
1c.
Hypostatic pneumonia
Dementia
Old age
When the chief medical statistician first advised in 1985 that old age or senility would be accepted as the sole
cause of death in some circumstances, he recommended a lower age limit of 70 years. There is no statutory
basis for this limit and some crematorium referees have set higher limits for accepting applications for
cremation when the only cause of death is old age. The average life expectancy at birth for men is now about
76 years, and for women it is 80 years. After much discussion, the ONS Death Certification Advisory Group has
recommended that deaths certified as due to old age or senility alone should be referred to the coroner, unless
the deceased was over 80, the conditions listed above are all fulfilled and there is no other reason that the
death should be referred. However, some coroners require that they be informed of all deaths where the doctor
wishes to give this as the sole cause of death, so they can decide whether or not to allow certification.
Natural causes
The term “natural causes” alone, with no specification of any disease on a doctor's MCCD, is not sufficient to
allow the death to be registered without referral to the coroner. If you do not have any idea as to what disease
caused your patient's death, it is up to the coroner to decide what investigations are needed.
Organ failure
Do not certify deaths as due to the failure of any organ, without specifying the disease or condition that led to
the organ failure. Failure of most organs can be due to unnatural causes, such as poisoning, injury or industrial
disease. This means that the death will have to be referred to the coroner if no natural disease responsible for
organ failure is specified.
Example:
1a.
Renal failure
1b.
Necrotising-proliferative nephropathy
1c.
Systemic lupus erythematosus
2.
Raynaud's phenomenon and vasculitis
1a.
1b.
1c.
Liver failure
Hepatocellular carcinoma and liver cirrhosis
Chronic Hepatitis B infection
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 4 of 9
24/05/2007
1a.
1b.
Congestive cardiac failure
Essential hypertension
Conditions such as renal failure may come to medical attention for the first time in frail, elderly patients in whom
vigorous investigation and treatment may be contraindicated, even though the cause is not known. When such
a patient dies, you are advised to discuss the case with the coroner before certifying. If the coroner is satisfied
that no further investigation is warranted, the registrar can be instructed to register the death based on the
information available on the MCCD. The registrar cannot accept an MCCD that gives only organ failure as the
cause of death, without instruction from the coroner.
Abbreviations
Do not use abbreviations on death certificates. The meaning may seem obvious to you in the context of your
patient and the medical history, but it may not be clear to others. For example, does a death from “MI” refer to
myocardial infarction or mitral incompetence? Is “RTI” a respiratory or reproductive tract infection, or a road
traffic incident? The registrar should not accept a certificate that includes any abbreviations. You, or the
patient's consultant, may be required to complete a new certificate with the conditions written out in full, before
the death can be registered. This is inconvenient for you and for the family of the deceased. The same applies
to medical symbols.
Specific causes of death
Stroke and cerebrovascular disorders
Try to avoid the term “cerebrovascular accident” if at all possible and consider using terms such as “stroke” or
“cerebral infarction” instead. If you cannot avoid the term, be sure to explain to the deceased's family that the
death was from a disease, not an accident. Give as much detail about the nature and site of the lesion as is
available to you. For example, specify whether the cause was haemorrhage, thrombosis or embolism, and the
specific artery involved, if known. Remember to include any antecedent conditions or treatments, such as atrial
fibrillation, artificial heart valves, or anticoagulants that may have led to cerebral emboli or haemorrhage. Death
related to treatment should be discussed with the coroner before issuing the MCCD and some coroners will
require investigation by autopsy, and possibly hold an inquest.
Example:
1a.
Subarachnoid haemorrhage
1b.
Ruptured aneurysm of anterior communicating artery
1a.
1b.
1c.
Intraventricular haemorrhage
Warfarin anticoagulation
Pulmonary embolism following hysterectomy for uterine fibroids with menorrhagia
Deaths from neoplasms
Malignant neoplasms (cancers) remain a major cause of death. Accurate statistics are important for planning
care and assessing the effects of changes in policy or practice. Where applicable, you should indicate whether
a neoplasm was benign, malignant, or of uncertain behaviour. Please remember to specify the histological type
and anatomical site of the cancer.
Example:
1a.
Carcinomatosis
1b.
Small cell carcinoma of left main bronchus
1c.
Heavy smoker for 40 years
2.
Hypertension, cerebral arteriosclerosis, ischaemic heart disease.
You should make sure that there is no ambiguity about the primary site if primary and secondary tumour sites
are mentioned. Do not use the terms “metastatic” or “metastases” unless it is clear whether you mean
metastasis to, or metastasis from, the named site.
Example:
1a.
Intraperitoneal haemorrhage
1b.
Widespread metastases to liver
1c.
Primary adenocarcinoma of ascending colon
2.
Non-insulin dependent diabetes mellitus
1a.
1b.
1c.
Pathological fractures of left shoulder, spine and shaft of right femur
Widespread skeletal metastases
Adenocarcinoma of breast
(But see above comments regarding discussion of fractures with the coroner.)
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 5 of 9
24/05/2007
1a.
1b.
Lung metastases
Testicular teratoma
If you mention two sites that are independent primary malignant neoplasms, make that clear.
Example:
1a.
Massive haemoptysis
1b.
Primary small cell carcinoma of left main bronchus
2.
Primary adenocarcinoma of prostate
If a patient has widespread metastases, but the primary site could not be determined, you should state this
clearly.
Example:
1a.
Poorly differentiated metastases throughout abdominal cavity
1b.
Adenocarcinoma from unknown primary site
If you do not yet know the tumour type and are expecting the result of histopathology, indicate that this
information may be available later by initialing box “B” on the back of the certificate. You, or the consultant
responsible for the patient's care, will be sent a letter requesting this information at a later date. In the case of
leukaemia, specify whether it is acute, sub-acute or chronic, and the cell type involved.
Example:
1a.
Neutropenic sepsis
1b.
Acute myeloid leukaemia
1a.
1b.
2.
Haemorrhagic gastritis
Chronic lymphocytic leukaemia
Myocardial ischaemia, valvular heart disease
Diabetes mellitus
Always remember to specify whether your patient’s diabetes was insulin dependent/type one, or non-insulin
dependent/insulin resistant/type two. If diabetes is the underlying cause of death, specify the complication or
consequence that led to death, such as ketoacidosis.
Example:
1a.
End-stage renal failure
1b.
Diabetic nephropathy
1c.
Insulin dependent diabetes mellitus
1a.
1b.
1c.
2.
Septicaemia - fully sensitive Staphylococcus aureus
Gangrene of both feet due to peripheral vascular disease
Non-insulin dependent diabetes mellitus
Ischaemic heart disease
Deaths involving infections and communicable diseases
Mortality data are important in the surveillance of infectious diseases, as well as monitoring the effectiveness of
immunisation and other prevention programmes. If the patient's death involved a notifiable disease, you should
inform your local Health Protection Unit (HPU) about the case, unless you have already done so. If you are not
sure whether a case is notifiable, or what investigations are needed, you can get advice from your local HPU or
consultant in communicable disease control (CCDC).
In deaths from infectious disease, you should state the manifestation or body site, eg, pneumonia, hepatitis,
meningitis, septicaemia, or wound infection. You should also specify:
• The infecting organism, eg, pneumococcus, influenza A virus, meningococcus
• Antibiotic resistance, if relevant, eg, methicillin resistant Staphylococcus aureus (MRSA), or multiple drug
resistant mycobacterium tuberculosis
• The source and/or route of infection, if known, eg, food poisoning, needle sharing, contaminated blood
products, post-operative, community or hospital acquired, or health care associated infection.
You need not delay completing the certificate until laboratory results are available, provided you are satisfied
that the death need not be referred to the coroner. However, you should indicate by ticking box “B” on the back
of the certificate that further information may be available later. A letter will then be sent to you, or to the
patient's consultant, requesting this information. The coded cause of death will then be amended for statistical
purposes.
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 6 of 9
24/05/2007
Example:
1a.
Bilateral pneumothoraces
1b.
Multiple bronchopulmonary fistulae
1c.
Extensive, cavitating pulmonary tuberculosis (smear and culture positive)
2.
Iron deficiency anaemia
Failure to specify the infecting organism can lead to unnecessary investigation. For example, every year deaths
are certified as being due to spinal or paraspinal abscess, without stating the organism(s) involved. These are
then coded as tuberculosis following the ICD index. Unless ONS can establish that the abscess was due to
another organism, the local CCDC will then have to investigate whether or not it was TB. Remember to specify
any underlying disease or treatment, such as chemotherapy, radiotherapy, autoimmune disease or organ
transplant, which may have suppressed the patient's immunity and so led to death from infection. Deaths
related to treatment should be discussed with the coroner first.
Health care associated infections
It is a matter for your clinical judgment as to whether a condition the patient had at death, or in the preceding
period, contributed to their death, and so whether it should be included in part one or part two of the MCCD.
However, families may be surprised if you do not mention on the death certificate something that they believe
contributed to their relative's death. ONS receives frequent queries from a wide range of sources about
mortality related to health care associated infections, and complaints about the quality of information given
about them on death certificates.
Example:
1a.
Methicillin resistant Staphylococcus aureus septicaemia
1b.
Immunosuppression
1c.
Non-Hodgkin’s lymphoma
1a.
1b.
2.
Carcinomatosis
Adenocarcinoma of the prostate
Chronic obstructive pulmonary disease and catheter-associated Escherichia coli urinary tract infection
Deaths from pneumonia
Pneumonia may present in previously fit adults, but often it occurs as a complication of another disease
affecting the lungs, mobility, immunity, or swallowing. Pneumonia may also follow other infections and may be
associated with treatment for disease, injury or poisoning, especially when ventilatory assistance is required.
Remember to specify, where possible, whether it was lobar or bronchopneumonia and whether primarily
hypostatic, or related to aspiration. You should include the whole sequence of conditions and events leading up
to it. If known, specify whether the pneumonia was hospital or community acquired. If it was associated with
mechanical ventilation, or invasive treatment, this should be clearly stated.
Example:
1a.
Pneumococcal lobar pneumonia
1b.
Influenza A
2.
Ischaemic heart disease
For many years, bronchopneumonia was given as the immediate cause of death on a large proportion of
certificates in England and Wales. This may have reflected common terminal chest signs and symptoms,
rather than significant infection in many cases. The proportion of certificates that mention bronchopneumonia
has been steadily falling for 20 years. If you do report bronchopneumonia, remember to include any
predisposing conditions, especially those that may have led to paralysis, immobility, or wasting, as well as
chronic respiratory conditions such as chronic bronchitis.
Example:
1a.
Aspiration pneumonia
1b.
Motor neurone disease
2.
Pressure ulcers on sacrum and heels
Deaths from injuries
All deaths involving any form of injury or poisoning must be referred to the coroner. However, if the death is not
one for which an inquest is mandatory and the coroner instructs you to certify, remember to include details as
to how the injury occurred and where it happened, such as at home, in the street, or at work.
Example:
1a.
Pulmonary embolism
1b.
Fractured neck of femur
1c.
Tripped on loose floor rug at home
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 7 of 9
24/05/2007
2.
Moderate left sided weakness and difficulty with balance since haemorrhagic stroke five years ago.
Hemiarthroplasty two days after fracture
Remember to state clearly if a fracture was pathological, that is due to an underlying disease process such as a
metastasis from a malignant neoplasm, or other conditions such as osteoporosis.
Deaths due to substance misuse
Deaths from diseases related to chronic alcohol or tobacco use need not be referred to the coroner, provided
the disease is clearly stated on the MCCD.
Example:
1a.
Carcinomatosis
1b.
Bronchogenic carcinoma upper lobe left lung
1c.
Smoked 30 cigarettes a day
2.
Chronic bronchitis and ischaemic heart disease.
However, deaths due to acute or chronic poisoning, and deaths involving drug dependence, or misuse of
substances other than alcohol and tobacco, must be referred.
Finally, remember that there are instructions for certifiers in the front of every book of MCCDs. These remain
current, except for the change in lower age limit at which “old age” is thought to be acceptable as the sole
cause of death (now 80 instead of 70, as covered in detail above). Doctors should familiarise themselves with
the instructions, and consult them if they are in any doubt about whether, or how, to certify a death.
1
Reforming the Coroner and Death Certification Service: A position paper. March 2004, Home Office.
Cm 6159.
Dr Cleo Rooney is Medical Epidemiologist at the Office for National Statistics in London
E-mail: [email protected]
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 8 of 9
24/05/2007
Deaths which must be referred to the coroner:
The cause of death is unknown
The death was violent or unnatural, or there are suspicious circumstances
The death may be due to:
• accident
• suicide
• self-neglect
• neglect by others
• an industrial disease, or the deceased’s employment
The death occurred during
• an operation, or before full recovery from an anaesthetic
• detention in police or prison custody, or shortly after release
There is no doctor who attended the deceased available to complete the MCCD
The deceased was not seen by the certifying doctor either after death or within 14 days before death
Author
Title
Document No.
Cleo Rooney (Dr S Rogers)
ACP Guidance for MCCD
PD-UserHbk-013 ver1.0
Page 9 of 9
24/05/2007
Tests
Advice
About Us
Requesting
Departments
Pathology CSU
Pathology Tests
This section covers the tests that the Pathology CSU offers according to the service repertoire agreed with our
users.
The laboratory performs many tests which are grouped into sets which are performed together. Examples
include the Full Blood Count (FBC) or a Liver Function Test (LFT). This is the usual method for requesting
these tests. Within this section all tests are referred to via their common requesting set name, and within each
set description, the individual test components are detailed – These are the elements of the requesting set that
are reported.
Certain tests are also requested individually. If you cannot find the test from the index list, then the test can be
retrieved using a free text search on the handbook using the functionality built into Acrobat (Click the Find
button on this page).
Time limits for requesting additional tests on already received samples do exist depending on sample type and
analyte requested. Please contact the laboratory direct for any “add-on” requests required and advice will be
given as to whether this can be done.
Information Available
For each test the following items of information are supplied within these pages.
• Department performing the test
• Contact Telephone numbers for enquiry and advice
• Which sample containers are required
• Which request form should be used
• What specimen is required for the test
• When the test is available
• Comments on the use of this test
• If there are any special storage requirements
• How long the sample is stable for prior to laboratory testing
• Special Requirements for the performing of this test
Requesting Urgent/Fast Track Samples
The urgent/fast track service is available from the departments during 09.00 - 17.00 Monday to Friday, outside
this time on-call requesting arrangements operate.
A sample will only be accepted as fast track if the department receives a telephone call BEFORE the sample is
received. Work will be analysed as routine if there is no phone call or if the sample is already in the laboratory
when the phone call is received.
Processing time is subject to equipment availability, and is timed from when the sample arrives at the
laboratory.
Protocol for Fast Track Samples
• Take the sample and complete the appropriate request form.
• Write "FAST TRACK" on the request form.
• Telephone Pathology Reception (DRI 3860 BDGH 2344) with the following information:
• Your name and location, Patients name, Test(s) required and the reason for the urgent
request
• Details of route for result (Phone No./Bleep No.)
• Send the sample to Pathology Reception either via the Air Tube delivery system or via
Service Assistant
Reference Intervals
Reference intervals for any test are specific to that test and laboratory methodology. They are also often age
and sex specific. Reference intervals will be displayed with the patient results taking these factors into account.
These will be available, whether the result is sent via paper, through ward/web enquiries or via the electronic
links to General Practice.
Author
Title
Document No.
Peter J Taylor
Notes on Test Sets Section
PD-UserHbk-023 ver4.0
Page 1 of 2
6/8/2013
Pathology CSU
Laboratory Results
Pathology results are available electronically immediately after authorisation via the Trust network at ward level
or via the GP electronics links. Hard copies of reports are produced and returned daily Monday-Friday, unless
this service is specifically not required by the requesting clinician.
All laboratory results are returned to the requesting clinician who has ultimate responsibility for ensuring that all
results are actioned and communicated to the patient as appropriate.
The laboratory has agreed procedures for results which require urgent telephone communication. (QR-BIO005, QR-BIO-006, QR-HAEM-009, PAT/T 61). An escalation process is also followed in the event that a
particular doctor or location cannot be contacted see Trust policy PAT/T61 .
Turnaround times
The laboratory continually monitors its turnaround times to ensure that it complies with its responsibilities within
the patient pathway. The laboratory measures its turnaround times as the time from which the sample is
booked into the laboratory computer system (which is largely equivalent to the time of receipt), until the point at
which the result is authorised (at this point the result is available through direct enquiry and is available for
transmission via GP links).
The expected turnaround times for each test are indicated on the individual test sheets. For detailed turnaround
times for each test and actual performance, please contact the laboratory.
Interrogation of the electronic systems allows for full audit of the reception, testing and reporting process,
including time of report viewing and report printing.
Referred Tests
The laboratory provides a range of specialist testing which is undertaken at reference centres. These tests are
indicated within this section. Please contact the laboratory for details of the tests offered, name and location of
the testing laboratory and information regarding any special sample requirements.
Author
Title
Document No.
Peter J Taylor
Notes on Test Sets Section
PD-UserHbk-023 ver4.0
Page 2 of 2
6/8/2013
Directorate of Pathology
Estimated Glomerular Filtration Rate (eGFR)
Press <TAB> to update values
Calculator corrected for DBH Creatinine Values
160
DBH Creatinine
Patient Age (years)
25
eGFR (Male)
46
eGFR (Female)
34
Multiply eGFR by 1.21 for African-Caribbean patients
Interpretative comments for eGFR values less than 90 mL/min/1.73m2 in accordance with the Department of
Health and the UK CKD guidelines.
eGFR
(mL/min/1.73m2)
60 – 89
Stages of Chronic Kidney Disease (CKD)
45 – 59
eGFR result does not indicate CKD unless there is existing
laboratory/clinical evidence of disease
Since the calculation tends to underestimate normal or near
normal renal function all values over 60 should be reported as
>60.
NOTE: A significant (e.g. 20%) rise in Creatinine while the
eGFR is >60 may still be important as it usually reflects a real
change in GFR
Stage 3A CKD – Moderate renal impairment
30 – 44
Stage 3B CKD – Moderate renal impairment
15 – 29
Stage 4 CKD – Severe renal impairment
< 15
Stage 5 CKD – Very severe or end stage renal failure
These comments are only applicable in patients with stable renal function.
Please refer to the Renal Association web site www.Renal.org/eGFR/eguide.html for further information.
IMPORTANT CAUTIONS ABOUT eGFR:
1) eGFR is only an estimate and is not validated for use in:
Children
Acute Renal Failure
Pregnancy
Oedematous states
Malnourished patients
Amputees
Muscle wasting disease states
2) Creatinine levels must be stable. eGFR calculations assume that the level of creatinine in the blood is
stable over days or longer. They are not valid if creatinine levels are changing.
3) Some ethnic minorities may not fit the MDRD equation well. The eGFR result from the laboratory is not
corrected for race.
For African-Caribbean patients multiply the laboratory eGFR result by 1.21
Author
Title
Document No.
Peter J Taylor
eGFR Calculator
PD-UserHbk-06
Page 1 of 1
26/03/2012
Pathology CSU
Interpreting Results of Thyroid Function Tests
High FT4
Normal FT4
Low FT4
High TSH
• Sporadic compliance
with thyroxine therapy
• TSH-secreting tumour
• Thyroid hormone
resistance
• Subclinical
hypothyroidism
Normal TSH
• Euthyroid with high
binding globulin, e.g.
pregnancy, OCP
Low TSH
• Thyrotoxicosis
• Thyroiditis
• Euthyroid
• Primary
hypothyroidism
• Sick euthyroid
• Low binding globulin
• Secondary
hypothyroidism
Elevated FT3
• Thyrotoxicosis
• Thyroidtis
Normal FT3
• Recovering Graves’
• Ophthalmic Graves’
• Thyroid nodules
• Secondary
hypothyroidism
•
In overt primary hyperthyroidism TSH is nearly always below 0.10 mU/L and in overt primary hypothyroidism
plasma TSH is always increased above 10 mU/L.
•
In mild (subclinical) disorders, TSH will be the most sensitive indicator of failing thyroid function since plasma
FT4 and FT3 are often normal. Before the diagnosis of subclinical thyroid disorders can be made, causes of
an abnormal TSH other than thyroid disorders must be excluded
"Non-thyroidal illnesses" and the "sick-euthyroid syndrome”
Patients suffering from chronic or acute non-thyroidal illnesses, may show abnormalities in thyroid function tests
even though they are clinically euthyroid.
•
•
•
In hospitalised patients a TSH <0.10 mU/L is at least twice as likely to be due to nonthyroidal illness as hyperthyroidism.
In hospitalised patients an increased TSH is as likely to be associated with recovery
from illness as hypothyroidism.
Because of the poor predictive value of thyroid function tests in hospitalised
patients, these tests should only be requested if there is a clinical reason for
suspecting a thyroid problem.
Pregnancy
In the first trimester a TSH of <0.10 mU/L may be found. FT3 and FT4 values fall thoughout pregnancy.
Author
Title
Document No.
Alison Jones
Interpreting Results of Thyroid Function Tests
PD-UserHBk-025 ver1.0
Page 1 of 2
26/01/2011
Pathology CSU
Effect of Drugs on Thyroid Function Tests
Drugs may interfere with TSH secretion or the production, secretion, transport and metabolism of thyroid
hormones. The tables below list some drugs that may produce abnormal thyroid function tests.
Drugs which cause hyper- / hypo-thyroidism
Drug
Cholestyramine
Cholestapol
Aluminium hydroxide
Ferrous sulphate
Interleukin 1
Interferon α
Sucralfate
Calcium carbonate
Soy protein
Proton pump inhibitors
Interferon β
TNF α
Mechanism
Impaired absorption of
thyroxine from GI tract
Alter autoimmunity
Drugs which produce abnormal TFTs but patients remain clinically euthyroid
Amiodarone
Anabolic steroids
Androgens
Barbiturates
Beta antagonists
Carbamazapine
Clofibrate
Cytokines
Dopamine
Dopaminergic agents
Fenclofenac
Frusemide
Glucocorticoids
Heparin
Heroin
Iodide
Iopanoic acid
Lithium
Mefenamic acid
Methadone
Non-steroidal AIDs
Octreotide
Oestrogens
Phenytoin
Propranolol
Radiocontrast dyes
Raloxifene
Rifampacin
Salicylates
Tamoxifen
Lithium
Lithium can cause hypothyroidism and hyperthyroidism in up to 10% of patients. Patients with positive TPOAb
are particularly at risk. Patients taking lithium should have their TFTs measured at 6-12 month intervals or earlier
if goitre develops.
Amiodarone
Amiodarone has complex effects on thyroid metabolism and may also induce a destructive thyroiditis. Patients
may have an altered thyroid hormone profile without thyroid dysfunction but up to 20% of patients taking
amiodarone develop clinically significant hypothyroidism or thyrotoxicosis. Because of the long half-life of
amiodarone, clinical problems may occur up to a year after stopping the drug.
It is important to evaluate patients before they commence therapy with amiodarone. This should include clinical
examination and a basal measurement of TSH and TPOAb, together with FT4 and FT3. After starting treatment
these tests should be repeated every 6 months, including up to a year after the drug is stopped
Further reading: UK Guidelines for the Use of Thyroid Function Tests, developed by The Association for Clinical
Biochemistry, the British Thyroid Association and the British Thyroid Foundation, published 2006.
Author
Title
Document No.
Alison Jones
Interpreting Results of Thyroid Function Tests
PD-UserHBk-025 ver1.0
Page 2 of 2
26/01/2011
Pathology Services
INTERPRETATION & ACTION FOR LOW SERUM B12 LEVEL
Serum Level
Action
(ng/L)
Normal level - No action needed
No need to repeat B12 assay for 2 years
> 187
Start oral Cyanocobalamin - 100 g daily for 3 months
Repeat B12 level after 3 months:
 If the level comes up to normal then the deficiency is dietary. The patient
will need dietary advice. Then repeat 3 months later and if low again
treat as below.
 If the level fails to rise to normal range, treat as below
150 – 187
The patient should be treated lifelong with intramuscular Hydroxocobalamin
Hydroxocobalamin 1 mg intramuscular 3 times per week for 2 weeks then 1mg
then every three months for life.
< 150
Laboratory will carry out Intrinsic Factor Antibody Assay - A positive test
confirms the diagnosis of Pernicious Anaemia though a negative test does not
rule it out.
There is no need to repeat the B12 assay while the patient is on parenteral B12 supplement. The
effects should be assessed by FBC only.
B12 IN PREGNANCY
During pregnancy B12 level is usually lower than normal and testing should be discouraged unless
there a clinical suspicion.
Serum Level
Action
(ng/L)
> 100
<100
Author
Title
Document No.
No action needed
Repeat 6 weeks post-partum - If low follow as above
Start oral Cyanocobalamin - 100 g daily
Repeat B12 level after 1 month
 if >100 - continue oral Cyanocobalamin 100 g daily for the duration of
pregnancy and 6 weeks post-partum.
 If still <100 then treat with intramuscular Hydroxocobalamin for life.
Dr Youssef Sorour
Interpretation & action for low Serum B12 level
PD-UserHbk-026 v2.0
Page 1 of 1
12/11/2014
PRODUCTION AND DELIVERY OF A POST VASECTOMY
SEMEN SAMPLE
In order to be able to cease using contraception after a vasectomy, you
will usually be asked to provide two consecutive, clear (sperm free) semen
samples. The first sample should be provided approximately four months
after your vasectomy operation; during this time, you should preferably
have had at least 24 ejaculations.
You should:
• Label the container with the details of the man who has produced the
sample. A minimum of 3 identifying details are needed:
• His name
• His date of birth
• His address or NHS/hospital number
• Provide a complete/whole sample:
• We cannot examine incomplete or leaking samples as they may
lead to inaccurate results and/or inappropriate treatment.
• Only a single ejaculate should be provided for examination.
• Use the specimen pot provided by your doctor. Please don’t clean it or
wash it.
• Produce the sample by hand masturbation. Samples produced by
interrupted intercourse or by using a condom will not be suitable.
• Not have sex or masturbate for at least 2 days before producing your
sample, but not wait more than 7 days after sex/masturbation before
producing your sample.
• Deliver the sample to Doncaster Royal Infirmary’s Histopathology
Specimen Reception (see directions below) within 4 hours of
production; we cannot guarantee we will be able to examine
specimens outside of this timeframe.
We accept Post vasectomy semen samples for analysis between 9am and
12 noon, Monday to Friday (excluding bank / public holidays).
Additional Information
• Please note that there are no facilities available on-site for the
POST VASECTOMY ANALYSIS
WPR12684
Oct 2013
production of semen samples.
• We recommend keeping the sample as close to body temperature as
possible by placing it close to your skin or in a pocket.
• Patients will be asked to provide additional information about their
sample on arrival at Histopathology specimen reception (e.g. date
and time of production, length of abstinence, whether the sample was
complete). Samples received via GP surgeries or without this additional
information will not be accepted.
• Results will take between 7 and 14 days to become available. Your
clinician will advise you how and when to obtain your results.
If you have any queries, please phone Histopathology on 01302 366666
ext 3533.
Directions to Histopathology specimen reception, Doncaster Royal
Infirmary
Enter the hospital via A&E, turn right and take the first turning on your left,
then continue to the end of the corridor. Turn right and go through the
double doors and down the flight of stairs onto the basement corridor.
The Histopathology reception is immediately on the left-hand side; please
ring the bell for access.
Travelling to Doncaster Royal Infirmary?
Why not use the free Park & Ride service from Doncaster racecourse - free
parking with free shuttle buses to and from the hospital every 15-20
minutes (6.30am-10pm, Mon-Fri).
Travelling between our hospitals?
Why not use the free shuttle buses between:
Bassetlaw Hospital and Doncaster Royal Infirmary
Montagu Hospital and Doncaster Royal Infirmary
Patient Advice & Liaison Service (PALS)
PALS staff are available to offer advice or information on healthcare
matters. The office is in the Main Foyer (Gate 4) of Doncaster Royal
Infirmary. Contact can be made either in person, by telephone or email.
PALS staff can also visit inpatients on all Trust sites.
The contact details are:
Telephone: 01302 553140 or 0800 028 8059
Minicom (Text talk): 01302 553140 Email: [email protected].
POST VASECTOMY ANALYSIS
SEMEN SPECIMEN FOR INFERTILITY INVESTIGATIONS
You should:
• Label the container with the details of the man who has produced the
sample. A minimum of 3 identifying details are needed:
• His name
• His date of birth
• His address or NHS/hospital number
• Provide a complete/whole sample:
• We cannot examine incomplete or leaking samples as they may
lead to inaccurate results and/or inappropriate treatment.
• Only a single ejaculate should be provided for examination.
• Use the specimen pot provided by your doctor. Please don’t clean it or
wash it.
• Produce the sample by hand masturbation. Samples produced by
interrupted intercourse or by using a condom will not be suitable.
• Not have sex or masturbate for at least 2 days before producing your
sample, but not wait more than 7 days after sex/masturbation before
producing your sample.
• Deliver the sample to Doncaster Royal Infirmary’s Histopathology
Specimen Reception (see directions below) within 1 hour of production;
we cannot guarantee we will be able to examine specimens outside of
this timeframe.
We accept infertility semen samples for analysis between 9am and 12
noon, Monday to Friday (excluding bank / public holidays).
Additional Information
• Please note that there are no facilities available on-site for the
production of semen samples.
• We recommend keeping the sample as close to body temperature as
possible by placing it close to your skin or in a pocket.
INFERTILITY ANALYSIS
WPR12683
Sept 2012
• Patients will be asked to provide additional information about their
sample on arrival at Histopathology specimen reception (e.g. date
and time of production, length of abstinence, whether the sample was
complete). Samples received via GP surgeries or without this additional
information will not be accepted.
• Results will take between 7 and 14 days to become available. Your
clinician will advise you how and when to obtain your results.
If you have any queries, please phone Histopathology on 01302 366666
ext 3533.
Directions to Histopathology specimen reception, Doncaster Royal
Infirmary
Enter the hospital via A&E, turn right and take the first turning on your left,
then continue to the end of the corridor. Turn right and go through the
double doors and down the flight of stairs onto the basement corridor.
The Histopathology reception is immediately on the left-hand side; please
ring the bell for access.
Travelling to Doncaster Royal Infirmary?
Why not use the free Park & Ride service from Doncaster racecourse - free
parking with free shuttle buses to and from the hospital every 15-20
minutes (6.30am-10pm, Mon-Fri).
Travelling between our hospitals?
Why not use the free shuttle buses between:
Bassetlaw Hospital and Doncaster Royal Infirmary
Montagu Hospital and Doncaster Royal Infirmary
INFERTILITY ANALYSIS
11 - Deoxycortisol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
11-Deoxycortisol :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
nmol/L
For patient specific reference intervals please refer to printed report or IT systems
11 - Deoxycortisol
17-Alpha-Hydroxyprogesterone
17OHP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
To screen for, detect, and monitor treatment for congenital adrenal hyperplasia (CAH).
In the newborn, the test should be performed on infants more than 48 hours old. In older
patients suspected of mild CAH, contact laboratory for advice.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Blood sample should be collected between 8.00 and 9.30 am
Tests
Units
nmol/L
Upper Limit
15
8.5
4.7
3.1
2.6
4.9
15
8.5
4.7
3.1
2.6
4.9
10.4
Date Result Returned:
Lower Limit
0
0.6
0
0
0
0
0
0.6
0
0
0
0
1.8
Units
Enquiry Line:
Units
Testing Laboratory:
Units
17 OH Progesterone :
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
92 Days
1 Years
3 Years
11 Years
0 Days
15 Days
92 Days
1 Years
3 Years
11 Years
15 Years
End Age
14 Days
91 Days
364 Days
3 Years
11 Years
15 Years
14 Days
91 Days
364 Days
3 Years
11 Years
15 Years
110 Years
Applicable from
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
20/08/2011
For patient specific reference intervals please refer to printed report or IT systems
17-Alpha-Hydroxyprogesterone
5-Alpha-Dihydrotestosterone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Dihydrotestosterone :
Units
Enquiry Line:
Units
Testing Laboratory:
Units
nmol/L
For patient specific reference intervals please refer to printed report or IT systems
5-Alpha-Dihydrotestosterone
6-Acetyl Morphine
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Drugs of abuse screening
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Abbott Architect
Tests
6-acetylmorphine
Units
For patient specific reference intervals please refer to printed report or IT systems
6-Acetyl Morphine
7 Dehydrocholesterol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Heparin
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
For diagnosis of Smith Lemli Opitz Syndrome
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
7-DEHYDROCHOLESTEROL
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Units
CHOLESTEROL
Reference Ranges
Lower Limit
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
0 Days
3 Months
3 Years
16 Years
0 Days
3 Months
3 Years
16 Years
End Age
90 Days
36 Months
16 Years
19 Years
90 Days
36 Months
16 Years
19 Years
Date Result Returned:
Lower Limit
1.5
1.2
2.8
2.8
1.5
1.2
2.8
2.8
Units
Enquiry Line:
Units
Testing Laboratory:
Units
umol/L
Upper Limit
<2
<2
mmol/L
Applicable from
01/01/2011
01/01/2011
Upper Limit
4.0
4.7
6.0
5.7
4.0
4.7
6.0
5.7
Applicable from
01/01/2011
01/01/2011
01/01/2011
01/01/2011
01/01/2011
01/01/2011
01/01/2011
01/01/2011
For patient specific reference intervals please refer to printed report or IT systems
7 Dehydrocholesterol
Acanthamoeba culture
Department:
Microbiology
Contact:
Clinical Contact:
01302 553131 (3131)
Turnaround Time Band
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Contact Lens or Contact Lens Solution
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Acanthamoeba DNA
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Acanthamoeba culture
Acetylcholine Receptor Antibodies
ACR
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Myasthenia (80%) Gravis and Thymic Tumours
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
nmol/L
Upper Limit
0.2
0.2
0.2
Date Result Returned:
Lower Limit
0
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Acetylchol. Receptor Ab:
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Applicable from
18/03/1996
18/03/1996
18/03/1996
For patient specific reference intervals please refer to printed report or IT systems
Acetylcholine Receptor Antibodies
Activated Partial Thromboplastin Time
APTT
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood - Plasma
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Not Possible
Special Requirements:
Tests
APTT
Reference Ranges
Ratio
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Units
secs
Lower Limit
25.0
25.0
Units
Upper Limit
36.5
36.5
Applicable from
09/12/2011
09/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Activated Partial Thromboplastin Time
Adamts-13 Activity
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Citrate
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Must have approval from Consultant Haemotologist
Tests
Units
ADAMTS-13 Activity
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
52
52
%
Upper Limit
130
130
Applicable from
01/01/2012
01/01/2012
For patient specific reference intervals please refer to printed report or IT systems
Adamts-13 Activity
Adenovirus PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Or can be Stool sample
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Adenovirus PCR
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Who sent?
Units
For patient specific reference intervals please refer to printed report or IT systems
Adenovirus PCR
Adrenocorticotrophin
ACTH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (assayed every two weeks)
Investigation Comments:
Test useful in determining the aetiology of proven Cushings syndrome or Addison's
disease.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Pre-Chilled Tube on Ice - 10 to 15 minutes
Long Term Stability
Not possible
Special Requirements:
Prearrange with laboratory. Cool sample tube to 4°C before drawing blood. Immediately
send to laboratory on ice
On Ice
Immulite 2000
Tests
Units
ACTH
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
Adreno Corticotrophin
Reference Ranges
Sex
Female
Male
Lower Limit
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
ng/L
Upper Limit
<49.0
<49.0
ng/L
Applicable from
01/05/2013
01/05/2013
Upper Limit
<47
<47
Applicable from
05/02/1996
05/02/1996
For patient specific reference intervals please refer to printed report or IT systems
Adrenocorticotrophin
Alkaline Phosphatase Isoenzymes
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used to establish the likely source of isolated elevations in alkaline phosphatase
results.Test can identify liver, bone, intestinal and placental isoenzymes. Total ALP
should be significantly raised for this test.
Test can identify liver, bone, intestinal and placental isoenzymes. Total ALP should be
significantly raised for this test.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Serum samples are recommended and should be refrigerated at 2-8°C as soon as possible
after collection
Sebia Hydrasys
Tests
Units
IU/L
Upper Limit
380
425
130
380
425
130
ALP Isoenzymes
Lower Limit
70
60
30
70
60
30
Units
ALP Isoenzymes Ratio
Units
Alk.Phos :
Reference Ranges
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Days
29 Days
16 Years
0 Days
29 Days
16 Years
End Age
28 Days
5844 Days
110 Years
28 Days
5844 Days
110 Years
Applicable from
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
For patient specific reference intervals please refer to printed report or IT systems
Alkaline Phosphatase Isoenzymes
Alpha Feto Protein (Tumour Marker)
AFP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (assayed twice a week)
Investigation Comments:
For use as a marker in monitoring clinically proven cases of liver, ovarian or testicular
tumours. Tumour markers are not sufficiently sensitive or specific to use for screening.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Immulite 2000
Tests
Units
AFP ( Abbott Tumour Marker)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
0
0
KIU/L
Upper Limit
6.7
6.7
Applicable from
31/01/2012
31/01/2012
For patient specific reference intervals please refer to printed report or IT systems
Alpha Feto Protein (Tumour Marker)
Alpha galactosidase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Units
pmol/punch/hour
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
6.3
6.3
Units
Upper Limit
47
47
umol/l/h
Applicable from
01/03/2014
01/03/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
3
3
Units
Upper Limit
20
20
umol/l/h
Applicable from
01/10/2014
01/10/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
3500
3500
Applicable from
01/10/2014
01/10/2014
Date Result Returned:
Lower Limit
600
600
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Alpha-galactosidase activity
Reference Ranges
Sex
Female
Male
Alpha-galactosidase:
Reference Ranges
Sex
Female
Male
Beta-hexosaminidase A+B
Reference Ranges
Sex
Female
Male
For patient specific reference intervals please refer to printed report or IT systems
Alpha galactosidase
Alpha-1-Antitrypsin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Results lower than 1.2 g/L are sent away for Phenotyping.CRP also measured to
assess possible acute phase response.
CRP also measured to assess possible acute phase response.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Alpha-1-Antitrypsin
Reference Ranges
g/L
Sex
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Months
6 Months
1 Years
5 Years
10 Years
15 Years
18 Years
0 Months
6 Months
1 Years
5 Years
10 Years
15 Years
18 Years
End Age
6 Months
12 Months
5 Years
10 Years
15 Years
18 Years
115 Years
6 Months
12 Months
5 Years
10 Years
15 Years
18 Years
115 Years
Lower Limit
0.9
0.8
1.1
1.1
1.4
1.2
1.1
0.9
0.8
1.1
1.1
1.4
1.2
1.1
Units
Upper Limit
2.2
1.8
2.0
2.2
2.3
2.0
2.1
2.2
1.8
2.0
2.2
2.3
2.0
2.1
mg/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Upper Limit
5
5
Applicable from
12/12/2011
12/12/2011
C Reactive Protein
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Alpha-1-Antitrypsin
Alpha-1-Antitrypsin Genotype
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Full clinical details and history required to investigate Alpha-1-Antotrypsin deficiency
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Not to be used as first line screen for alpha1-AT deficiency - for this send serum
for quantitation and phenotyping.
Genotyping is used for confirmation of phenotype identification, admission to the
national AAT deficiency register, and family studies.
Tests
AAT Genotype
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Alpha-1-Antitrypsin Genotype
Alpha-1-Antitrypsin Phenotype
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Full clinical details and history required to investigate Alpha-1-Antotrypsin deficiency
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
A1AT phenotype
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Alpha-1-Antitrypsin Phenotype
Aluminium
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Z10
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
ug/L
Upper Limit
20
20
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Aluminium :
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Applicable from
01/01/2011
01/01/2011
For patient specific reference intervals please refer to printed report or IT systems
Aluminium
Amino Acids (CSF)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
CSF
Availabilty:
Routine hours only
Investigation Comments:
Sample contamination a severe problem. Handle with care. No gel separator or
clotting aids. Send empty tubes from same batches to check for contamination.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
A paired plasma sample must also be sent. Usually require CSF: Plasma Glycine
ratio.
Tests
Units
umol/L
Sex
Female
Male
Start Age
0 Days
0 Days
End Age
180 Days
180 Days
Lower Limit
15
15
Units
Upper Limit
60
60
umol/L
Applicable from
01/06/2011
01/06/2011
Sex
Female
Male
Start Age
0 Days
0 Days
End Age
180 Days
180 Days
Lower Limit
0
0
Units
Upper Limit
10
10
umol/L
Applicable from
01/06/2011
01/06/2011
Sex
Female
Male
Start Age
0 Days
0 Days
End Age
180 Days
180 Days
Lower Limit
35
35
Units
Upper Limit
80
80
umolL
Applicable from
01/06/2011
01/06/2011
Sex
Female
Male
Start Age
0 Days
0 Days
End Age
180 Days
180 Days
Upper Limit
178
178
Applicable from
01/06/2011
01/06/2011
CSF/Plasma Glycine
Lower Limit
12
12
Units
Date Result Returned:
Units
Enquiry Line:
Units
Plasma Glycine
Units
CSF Alanine
Reference Ranges
CSF Glycine
Reference Ranges
CSF Serine
Reference Ranges
CSF Threonine
Reference Ranges
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Start Age
0 Days
8 Days
6 Months
2 Years
10 Years
17 Years
0 Days
8 Days
End Age
7 Days
180 Days
24 Months
10 Years
17 Years
110 Years
7 Days
180 Days
Lower Limit
200
140
100
120
110
100
200
140
umol/L
Upper Limit
600
420
425
480
465
450
600
420
Applicable from
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
Amino Acids (CSF)
Amino Acids (CSF)
Male
Male
Male
Male
Testing Laboratory:
6 Months
2 Years
10 Years
17 Years
24 Months
10 Years
17 Years
110 Years
100
120
110
100
Units
425
480
465
450
01/06/2011
01/06/2011
01/06/2011
01/06/2011
For patient specific reference intervals please refer to printed report or IT systems
Amino Acids (CSF)
Amino Acids (Plasma)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Quantitative amino acids, assayed at SCH.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Amino Acids (Plasma)
Amino Acids (Serum)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (assayed weekly)
Investigation Comments:
Screening test for the investigation of disorders of amino acid metabolism. Abnormal
results are sent to referral lab for quantitative analysis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Patient should be fasting if possible. For investigation of hypoglycaemia or seizures, take
sample during acute episode.Patient should be fasting, if possible. Centrifuge and separate
as soon as possible.
Drug History required. TLC performed on site for routine screening, sample referred
for quantitation. A random urine sample should also be sent.
Tests
TLC Plasma AA Screen
Units
For patient specific reference intervals please refer to printed report or IT systems
Amino Acids (Serum)
Amino Acids (Urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Requires 25 ml urine. If this is not available from a single voiding collect and
freeze urine collections until the required volume is available.
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only (assayed weekly)
Investigation Comments:
Screening test for the investigation of disorders of amino acid metabolism. Abnormal
results are sent to referral lab for quantitative analysis. Single voidings can be mixed
and stored FROZEN until 25ml is collected.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Patient should be fasting if possible. For investigation of hypoglycaemia or seizures, take
sample during acute episode.
Do not use air transport tube
Tests
TLC AA Screen
Units
For patient specific reference intervals please refer to printed report or IT systems
Amino Acids (Urine)
Amino Acids (Urine, quantitative)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Quantitative amino acids, assayed at SCH.
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Amino Acids (Urine, quantitative)
Amiodarone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
2ml
Sample to be collected in a plain (Non SST) glass container. Use glass pipette to
aliquot serum
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
mg/L
Upper Limit
2.0
2.0
Date Result Returned:
Lower Limit
0.5
0.5
Units
Desethyl Amiodarone
Units
mg/L
Amiodarone
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
End Age
115 Years
115 Years
Lower Limit
Enquiry Line:
Units
Testing Laboratory:
Units
Upper Limit
<2.0
<2.0
Applicable from
01/06/2012
01/06/2012
Applicable from
01/06/2012
01/06/2012
For patient specific reference intervals please refer to printed report or IT systems
Amiodarone
Ammonia
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Heparin
Volume Required:
0.6ml
Container must be fully filled
Request Form:
Pathology Combined
Specimen:
Plasma
Availabilty:
Routune hours & On Call
Investigation Comments:
Used in the investigation of acutely sick children for inherited metabolic disorder.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Send to laboratory immediately
Long Term Stability
Not possible
Special Requirements:
Take sample on ice. Fill tube completely. Send to lab ASAP. Contact lab if outside core
working hours.
Abbott Architect
Tests
Units
umol/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Days
29 Days
1 Years
0 Days
29 Days
1 Years
End Age
28 Days
365 Days
115 Years
28 Days
365 Days
115 Years
Lower Limit
0
0
0
0
0
0
Units
Upper Limit
100
50
50
100
50
50
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Upper Limit
1
1
Applicable from
28/09/2000
28/09/2000
Blood Ammonia
Reference Ranges
Haemolysis index
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Ammonia
Amoebic Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Include relevant clinical details including reason for investigation and travel history.
Send stool sample
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Amoebic CAP (Serum)
Units
Amoebic IFAT(Serum)
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Amoebic Serology
Amylase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routune hours & On Call
Investigation Comments:
This method is sensitive to Salivary amylase as well as Pancreatic. Elevated results can
also occurr due to the presence of Macro Amylase (See urinary Amylase).
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Haemolysed and Icteric samples should be avoided
Tests
Units
Amylase
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
25
25
U/L
Upper Limit
125
125
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Amylase
Amylase (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Typically used to investigate a mildly elevated amylase result in the absence of clinical
signs of pancreatitis or salivary gland pathology. Normal urinary amylase confirms the
serum level is due to 'macro-amylase', a non-biologically active protein bound
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Do not use air transport tube
Special Requirements:
Tests
Amy /Cr Ratio
Reference Ranges
Start Age
0 Years
0 Years
0 Years
End Age
115 Years
115 Years
115 Years
Lower Limit
5
5
5
Units
Upper Limit
7
7
7
U/L
Applicable from
21/10/1998
21/10/1998
21/10/1998
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
25
25
Units
Upper Limit
95
95
umol/L
Applicable from
04/03/1996
04/03/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
44
44
Units
Upper Limit
110
110
mmol/L
Applicable from
10/01/1996
10/01/1996
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
Units
Upper Limit
9.4
14.2
U/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
115 Years
115 Years
100 Years
Lower Limit
0
0
0
Upper Limit
480
480
480
Applicable from
04/06/1996
04/06/1996
04/06/1996
P.Creatinine
Reference Ranges
U.Creat.Conc.
Reference Ranges
Urine Amylase
Reference Ranges
%
Sex
Female
Female (Pregnant)
Male
P.Amylase
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Amylase (urine)
Androstenedione
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Used in the investigation of precocious or delayed puberty in children/teenagers, and
hirsuitism or virilisation in adult females.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Lipaemic samples are unsuitable
Sample transported at -20°C
Tests
Units
nmol/L
Upper Limit
10.1
2.4
1.7
8.4
10.4
6.3
10.1
2.4
1.7
8.4
9.2
Date Result Returned:
Lower Limit
0.7
0.2
0.3
0.3
0.3
0.0
0.7
0.2
0.3
0.3
1.0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Androstenedione
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Start Age
1 Days
1 Months
1 Years
10 Years
17 Years
60 Years
1 Days
1 Months
1 Years
10 Years
17 Years
End Age
7 Days
12 Months
9 Years
16 Years
59 Years
115 Years
7 Days
12 Months
9 Years
16 Years
115 Years
Applicable from
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
01/03/2014
For patient specific reference intervals please refer to printed report or IT systems
Androstenedione
Angiotensin Converting Enzyme
ACE
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Measurement of serum activity is a useful confirmatory test of sarcoid granulomas if
values are elevated, and can be used to monitor the effectiveness of corticosteroid
treatments. ACE activity can also be raised in some patients with TB, Gaucher's
disease and hyperthyroidism.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
Angiotensin Conv. Enz.
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
IU/L
Upper Limit
52
52
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Angiotensin Converting Enzyme
Anti Cardiac Muscle Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Dressler's syndrome, post-MI
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Limited clinical significance
Tests
Cardiac Muscle Ab:
Units
Sent:
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti Cardiac Muscle Antibodies
Anti Cardiolipin Antibodies
ACA
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Can be transiently elevated so repeat after 3 months with concurrent lupus
anticoagulant. Not diagnostic in themselves and can be found without clinical antiphospholipid syndrome.
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
GPLU/ml
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Lower Limit
0
0
0
Units
Upper Limit
10
10
10
MPLU/ml
Applicable from
26/03/1998
26/03/1998
26/03/1998
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Lower Limit
0
0
0
Upper Limit
7
7
7
Applicable from
26/03/1998
26/03/1998
26/03/1998
IGG-Anticardiolipin
Reference Ranges
Sex
Female
Female (Pregnant)
Male
IGM-Anticardiolipin
Reference Ranges
Sex
Female
Female (Pregnant)
Male
For patient specific reference intervals please refer to printed report or IT systems
Anti Cardiolipin Antibodies
Anti CCP Antibodies
CCP
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine Hours only
Investigation Comments:
Rheumatoid Antibodies
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Initial investigation should be Rheumatoid factor if RF is negative and RA is still suspected a
referral to a specialist should be made who may utilise CCP as part of the clinical
assessment.
Tests
Units
Anti-CCP Antibodies:
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
110 Years
110 Years
110 Years
Lower Limit
0
0
0
U/mL
Upper Limit
10
10
10
Applicable from
09/05/2006
09/05/2006
09/05/2006
For patient specific reference intervals please refer to printed report or IT systems
Anti CCP Antibodies
Anti CCP Antibodies
CCP
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine Hours only
Investigation Comments:
Rheumatoid Antibodies
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Initial investigation should be Rheumatoid factor if RF is negative and RA is still suspected a
referral to a specialist should be made who may utilise CCP as part of the clinical
assessment.
Tests
Units
U/mL
Upper Limit
10
10
10
Date Result Returned:
Lower Limit
0
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Anti-CCP Antibodies:
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
110 Years
110 Years
110 Years
Applicable from
09/05/2006
09/05/2006
09/05/2006
For patient specific reference intervals please refer to printed report or IT systems
Anti CCP Antibodies
Anti Ganglioside Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Master Neuropathies
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Normal result = negative
Tests
Date Result Returned:
Units
Enquiry Line:
Units
GM-1 Ganglioside Ab IgG :
Units
GM-1 Ganglioside Ab IgM :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti Ganglioside Antibodies
Anti Gliadin Antibodies
Gliadins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Found in Coeliac disease, other bowels disorders and children without Coeliac disease.
Anti gliadin antibodies also present in dermatitis herpetiformis. IgG antigliadin antibodies
also found in many 'leaky' bowel disorders.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Anti-endomysial antibodies used for coeliac screening as it is more specific and more
sensitive. IGA & IgG TTG also used for Endomysial negative in children <5years old
Tests
Date Result Returned:
Units
Enquiry Line:
Units
IGA-GLIIADIN Ab
Units
IGG GLIADIN Ab
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti Gliadin Antibodies
Anti Histone Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Systemic lupus erythematosus (SLE), drug induced SLE (DIL)
Storage Requirements:
Short Term Stability
2-8°C
Long Term Stability
4 - 10°C
Special Requirements:
Assay does not mean antibody concentration but antibody activity. This can be affected by a
number of parameters such as antibody avidity
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Histone Antibodies :
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Units
U/mL
Lower Limit
0
0
Units
Upper Limit
40
40
Applicable from
01/12/2010
01/12/2010
For patient specific reference intervals please refer to printed report or IT systems
Anti Histone Antibodies
Anti Mullerian Hormone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Anti-Mullerian Hormone :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
pmol/L
For patient specific reference intervals please refer to printed report or IT systems
Anti Mullerian Hormone
Anti Musk Antibodies
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Myasthenia gravis in ACR negative patients
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Anti-Musk Ab
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti Musk Antibodies
Anti Nuclear Antibodies
ANA
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
SLE, Sjogrens syndrome, Raynauds,PBC, Scleroderma, Polymyositis, CREST,
Dermamyositis, insensitive for Jo-1 myositis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Not diagnostic in isolation. Only request if high suspicion dsDNA antibodies only due on
positive results. Low values common in elderly and the unwell
Tests
Anti-dsDNA
Units
Anti-Nuclear Factor
Units
Staining pattern:
Units
Anti-dsDNA
Units
Anti-Nuclear Factor
Units
Staining pattern:
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti Nuclear Antibodies
Anti Phospholipid Antibodies
APA
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Citrate
Citrate
Volume Required:
4.5ml
Citrate x 2 and Gold SST
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Units
Lupus Screen
Reference Ranges
Sex
Female
Male
Start Age
1 Years
1 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
1.20
1.20
Applicable from
21/05/1996
21/05/1996
Start Age
1 Years
1 Years
End Age
115 Years
115 Years
Lower Limit
0.0
0
Units
Upper Limit
1.10
1.10
Applicable from
29/05/1996
29/05/1996
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Upper Limit
1.2
1.2
Applicable from
18/05/1999
18/05/1999
Lupus Screen(50/50 NP)
Reference Ranges
Sex
Female
Male
Lupus Screen/Confirm Ratio
Reference Ranges
Sex
Female
Male
Units
Lupus Screen
Reference Ranges
Sex
Female
Male
Start Age
1 Years
1 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
1.20
1.20
Applicable from
21/05/1996
21/05/1996
Start Age
1 Years
1 Years
End Age
115 Years
115 Years
Lower Limit
0.0
0
Units
Upper Limit
1.10
1.10
Applicable from
29/05/1996
29/05/1996
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Upper Limit
1.2
1.2
Applicable from
18/05/1999
18/05/1999
Lupus Screen(50/50 NP)
Reference Ranges
Sex
Female
Male
Lupus Screen/Confirm Ratio
Reference Ranges
Sex
Female
Male
For patient specific reference intervals please refer to printed report or IT systems
Anti Phospholipid Antibodies
Antibiotic Assay
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Antibiotic
Units
Date result received:
Units
Date sent:
Units
Dosage type:
Units
Post dose (1 hr):
Units
mg/L
Post dose (2 hr):
Units
mg/L
Post dose (4 hr):
Units
mg/L
Post dose:
Units
mg/L
Pre dose:
Units
mg/L
Random sample:
Units
mg/L
Reference lab no:
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Antibiotic Assay
Anti-D Issue (Routine - RADI)
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
2ml
Minimum volume 2ml
Request Form:
Blood Bank
Specimen:
Venous Blood - Plasma
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Refrigeration at 4°C - Samples stored for 6 days
Long Term Stability
Not Possible
Special Requirements:
Tests
Batch Number :
Units
DOSE:
Units
Expiry Date :
Units
Patient Group
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti-D Issue (Routine - RADI)
Anti-D Issue (Sensitising - SADI)
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
2ml
Minimum volume 2ml / Antenatal Booking Bloods
Request Form:
Blood Bank
Specimen:
Venous Blood - Plasma
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Refrigeration at 4°C - Samples stored for 6 days
Long Term Stability
Not Possible
Special Requirements:
Tests
DOSE:
Units
Patient Group
Units
For patient specific reference intervals please refer to printed report or IT systems
Anti-D Issue (Sensitising - SADI)
Anti-streptolysin O
ASOT
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Significant titres: adult >400 IU/ml child >200 IU/ml.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Anti-Streptolysin O Antibody :
Units
BATCH LOT NO:
Units
iu/mL
For patient specific reference intervals please refer to printed report or IT systems
Anti-streptolysin O
Appendicectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Appendicectomy
Aquaporin 4 Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Neuromyelitis optica (NMO) or Devic's syndrome
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Aquaporin 4 Abs
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Aquaporin 4 Antibodies
Aspartate aminotransferase
AST
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
ALT is the more liver specific transaminase and is part of the LFT test set.
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Units
AST
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
5
5
U/L
Upper Limit
34
34
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Aspartate aminotransferase
Aspergillus Precipitins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Allergic Bronchopulmonary Aspergillosis (ABPA) and Extrinsic allergic alveolitis (EAA)
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
A.Fumigatus pptns
Units
For patient specific reference intervals please refer to printed report or IT systems
Aspergillus Precipitins
Aspergillus Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Aspergillus genus DNA
Units
Aspergillus antigen ELISA:
Units
Aspergillus IgG (ImmunoCAP)
Units
Aspergillus Index Value:
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
mgA/L
For patient specific reference intervals please refer to printed report or IT systems
Aspergillus Serology
Aspiration cytology NOS
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal Cytospin
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Aspiration cytology NOS
Auto Antenatal Antibody Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
EDTA X-Match
2ml
2x 2ml required
Request Form:
Antenatal
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Short Term Stability
4°C for 6 days
Long Term Stability
Not Possible
Special Requirements:
Tests
SCREENING CELL 1
Units
SCREENING CELL 2
Units
SCREENING CELL 3
Units
For patient specific reference intervals please refer to printed report or IT systems
Auto Antenatal Antibody Screen
Automated Antenatal Group
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
EDTA X-Match
2ml
2x 2ml required
Request Form:
Antenatal
Specimen:
Venous Blood - Plasma
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Short Term Stability
4°C for 6 days
Long Term Stability
Not Possible
Special Requirements:
Tests
A1 CELLS
Units
ABO + RH(D) GROUP
Units
ANTI-A
Units
ANTI-B
Units
ANTI-D
Units
B CELLS
Units
CTL-NEG
Units
For patient specific reference intervals please refer to printed report or IT systems
Automated Antenatal Group
Avian Precipitins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Useful in the investigation of Bird / Pigeon Fanciers Lung, Extrinsic Allergic Alveolitis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Budgie Faecal Extract
Units
Budgie Serum pptns
Units
Pigeon Faecal Extract
Units
Pigeon Serum pptns
Units
Poultry Serum pptns
Units
For patient specific reference intervals please refer to printed report or IT systems
Avian Precipitins
Avian Precipitins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Useful in the investigation of Bird / Pigeon Fanciers Lung, Extrinsic Allergic Alveolitis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Budgerigar Dropping (IgG)
Reference Ranges
Sex
Female
Male
Units
mg/L
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
40
40
mg/L
Applicable from
01/11/2014
01/11/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
40
40
Applicable from
01/11/2014
01/11/2014
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Pigeon Droppings (IgG)
Units
mg/L
Budgerigar Feather (IgG)
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
40
40
mg/L
Applicable from
01/11/2014
01/11/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
40
40
mg/L
Applicable from
01/11/2014
01/11/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
40
40
Applicable from
01/11/2014
01/11/2014
Pigeon Feathers (IgG)
Reference Ranges
Sex
Female
Male
Pigeon Serum (IgG)
Reference Ranges
Sex
Female
Male
Testing Laboratory:
For patient specific reference intervals please refer to printed report or IT systems
Avian Precipitins
B2 Glycoprotein Antibody
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Antiphospholipid syndrome
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Should be used in conjunction with clinical symptoms evaluation. Can be found without
clinical APS, check lupus anticoagulant also. Positive lupus should be checked after 6
weeks to confirm persistant autoantibody present. No Haemolysed or Lipaemic samples.
Tests
Beta 2 Glycoprotein IgG Ab :
Reference Ranges
Sex
Female
Male
Units
U/mL
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
10
10
U/mL
Applicable from
03/03/2011
03/03/2011
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
10
10
Applicable from
03/03/2011
03/03/2011
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Beta 2 Glycoprotein IgM Ab :
Reference Ranges
Sex
Female
Male
For patient specific reference intervals please refer to printed report or IT systems
B2 Glycoprotein Antibody
B-2-Microglobulin
B2M
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Prognostic indicator in multiple myeloma at time of diagnosis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
g/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
mg/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
1.2
1.2
Upper Limit
2.4
2.4
Applicable from
12/12/2011
12/12/2011
Albumin
Reference Ranges
B2 Microglobulin
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
B-2-Microglobulin
BCR-ABL
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
9ml
Request Form:
Specimen:
EDTA
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Ratio BCR-ABL/ABL %
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
BCR-ABL
Beta Natriuretic Peptide
BNP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
A rule out test for heart failure. Levels below the reference range make heart failure an
unlikely cause of symptoms.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Samples sent Mon,Tues, Wed only
Tests
Abbott BNP
Units
ng/L
For patient specific reference intervals please refer to printed report or IT systems
Beta Natriuretic Peptide
Beta Natriuretic Peptide
BNP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
A rule out test for heart failure. Levels below the reference range make heart failure an
unlikely cause of symptoms.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Samples sent Mon,Tues, Wed only
Tests
BNP:
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
pG/mL
For patient specific reference intervals please refer to printed report or IT systems
Beta Natriuretic Peptide
Bicarbonate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Bicarbonate is not stable once the sample tube is opened. This test cannot be added to
a sample which has already been analysed.
Specific request only as part of U&E profile
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Bicarbonate
Reference Ranges
mmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
22
22
Units
Upper Limit
29
29
mmol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
12
12
Upper Limit
20
20
Applicable from
10/01/1996
10/01/1996
Ions Difference
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Bicarbonate
Bile Acids
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Fasting sample preferred
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Only useful for investigation of icterus and itching in pregnancy
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
Bile Acids :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
umol/L
Upper Limit
6
6
Applicable from
09/12/2011
09/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Bile Acids
Bile cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Bile cytology
Bilirubin, conjugated
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.15ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Conjugated bilirubin performed on all total bilirubin results greater than 50µmol/L. Not
available to request separately from total bilirubin.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Minus 20°C
Special Requirements:
Abbott Architect
Tests
Units
C.Bilirubin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
umol/L
Upper Limit
9
9
Applicable from
12/11/2012
12/11/2012
For patient specific reference intervals please refer to printed report or IT systems
Bilirubin, conjugated
Biotinidase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Heparin
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Plasma
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
U/L
Upper Limit
10.5
10.5
Date Result Returned:
Lower Limit
2.5
2.5
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Biotinidinase :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
01/11/2011
01/11/2011
For patient specific reference intervals please refer to printed report or IT systems
Biotinidase
BK Virus PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Urine
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
BK virus
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
BK Virus PCR
Blood Culture ID
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Blood Culture Bottles
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Aerobic Bottle
Units
AEROBIC END TIME
Units
AEROBIC START TIME
Units
Anaerobic Bottle
Units
ANAEROBIC ENDTIME
Units
ANAEROBIC START TIME
Units
Gram stain
Units
Paediatric Bottle
Units
PAEDIATRIC END TIME
Units
PAEDIATRIC START
Units
Patient located on:
Units
Result:
Units
Site:
Units
Specimen Type:
Units
TIME TO REMOVAL
Units
For patient specific reference intervals please refer to printed report or IT systems
Blood Culture ID
Blood Film
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
1ml
Only done in conjunction with FBC
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Out of Hours depending on urgency at discretion of lab.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
For patient specific reference intervals please refer to printed report or IT systems
Blood Film
Blood Gases
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Anaerobic Heparin
Volume Required:
Blood Gas Syringe / Capillary
Request Form:
Pathology Combined
Specimen:
Arterial Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Please ensure handwritten label is used
Contact laboratory staff before taking.
Send sample packed on ice. If Glass capillary tube or other glass tubing. Analyse within
1 hour of taking.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes
Long Term Stability
Not Possible
Special Requirements:
Please ensure handwritten label is usedOut of hours, contact laboratory staff before
taking.Send sample to lab packed on ice immediately after collection. Do not use
pneumatic tube.
Do not use air transport tube
IL GEM 3000
Tests
Units
Base Deficit
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Upper Limit
<2
<2
mmol/L
Applicable from
01/02/1996
01/02/1996
Upper Limit
<2
<2
nmol/L
Applicable from
01/02/1996
01/02/1996
Upper Limit
44
44
Applicable from
01/02/1996
01/02/1996
Inspired Oxygen
Lower Limit
36
36
Units
O2 Saturation
Units
%
pCO2
Units
kpa
Units
Base Excess
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
4.6
4.6
Units
Upper Limit
6.0
6.0
pH units
Applicable from
01/02/1996
01/02/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
7.36
7.36
Units
Upper Limit
7.44
7.44
kpa
Applicable from
01/02/1996
01/02/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
9.5
9.5
Units
Upper Limit
12.0
12.0
Applicable from
01/02/1996
01/02/1996
pH
Reference Ranges
pO2
Reference Ranges
Specimen Type
Lower Limit
Units
Hydrogen Ion Conc
Reference Ranges
Lower Limit
mmol/L
Blood Gases
Blood Gases
Stat Ionised Ca
Units
mmol/L
Stat Na
Units
mmol/L
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
135.0
135.0
Units
Upper Limit
142.0
142.0
mmol/L
Applicable from
07/02/1996
07/02/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Upper Limit
108
108
Applicable from
07/02/1996
07/02/1996
Stat.Hct
Lower Limit
100
100
Units
Stat.K
Units
mmol/L
Stat.Cl
Reference Ranges
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
3.50
3.50
Units
Upper Limit
5.00
5.00
mmol/L
Applicable from
07/02/1996
07/02/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
22
22
Upper Limit
26
26
Applicable from
01/02/1996
01/02/1996
Std.Bicarb
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Blood Gases
Blood Group
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Minimum volume 2ml
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Refrigeration at 4°C - Samples stored for 6 days
Long Term Stability
Not Possible
Special Requirements:
Tests
A1 CELLS
Units
ABO + RH(D) GROUP
Units
ANTI-A
Units
ANTI-B
Units
ANTI-D
Units
B CELLS
Units
CTL-NEG
Units
For patient specific reference intervals please refer to printed report or IT systems
Blood Group
Bone Alkaline Phosphatase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
U/L
Upper Limit
44.0
Date Result Returned:
Lower Limit
14.0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Bone ALP (ACT)
Reference Ranges
Sex
Male
Start Age
0 Years
End Age
110 Years
Applicable from
01/06/2013
For patient specific reference intervals please refer to printed report or IT systems
Bone Alkaline Phosphatase
Bone Profile
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.3ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Includes calcium, phosphate, ALP, total protein and albumin. A fasting sample is
preferable when investigating disorders of calcium metabolism
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Alb/Glob Ratio
Units
g/L
Albumin
Units
g/L
Reference Ranges
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
IU/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Days
29 Days
16 Years
0 Days
29 Days
16 Years
End Age
28 Days
5844 Days
110 Years
28 Days
5844 Days
110 Years
Lower Limit
70
60
30
70
60
30
Units
Upper Limit
380
425
130
380
425
130
mmol/L
Applicable from
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
2.20
2.20
Units
Upper Limit
2.60
2.60
mmol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
2.03
2.03
Units
Upper Limit
2.45
2.45
g/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
Applicable from
21/06/2012
21/06/2012
Sex
Female
Start Age
0 Years
End Age
100 Years
Lower Limit
0
Upper Limit
1
Applicable from
28/09/2000
Alk.Phos :
Reference Ranges
Ca(Alb Corr)
Reference Ranges
Calcium
Reference Ranges
Globulin
Reference Ranges
Haemolysis index
Reference Ranges
Bone Profile
Bone Profile
Male
0 Years
100 Years
0
Units
1
28/09/2000
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Units
Upper Limit
3
3
mmol/L
Applicable from
28/09/2000
28/09/2000
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
0 Days
29 Days
1 Years
16 Years
0 Days
29 Days
1 Years
16 Years
End Age
28 Days
365 Days
16 Years
115 Years
28 Days
365 Days
16 Years
115 Years
Lower Limit
1.3
1.3
0.9
0.8
1.3
1.3
0.9
0.8
Units
Upper Limit
2.6
2.4
1.8
1.5
2.6
2.4
1.8
1.5
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
Upper Limit
80
80
Applicable from
12/12/2011
12/12/2011
Lipaemia Index
Reference Ranges
Phosphate
Reference Ranges
Total Protein
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Bone Profile
CA 125
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (assayed twice a week)
Investigation Comments:
For use as a marker in monitoring clinically proven cases of ovarian tumours. Tumour
markers are not sufficiently sensitive or specific to use for screening.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Immulite 2000
Tests
Units
CA-125 (Abbott)
Reference Ranges
Sex
Female
Start Age
0 Years
End Age
120 Years
Lower Limit
0
KU/L
Upper Limit
35.0
Applicable from
31/01/2012
For patient specific reference intervals please refer to printed report or IT systems
CA 125
CA 15-3
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
For use as a marker in monitoring clinically proven cases of established breast cancer.
Tumour markers are not sufficiently sensitive or specific to use for screening.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
kU/L
Upper Limit
30
30
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
CA15-3 :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
CA 15-3
CA 19-9
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
For use as a marker in monitoring clinically proven cases of established pancreatic
cancer. Tumour markers are not sufficiently sensitive or specific to use for screening.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Immulite 2000
Tests
Units
CA 19-9 (Abbott)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
0
0
kU/L
Upper Limit
37.0
37.0
Applicable from
31/01/2012
31/01/2012
For patient specific reference intervals please refer to printed report or IT systems
CA 19-9
Cadmium (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
10ml
Request Form:
Specimen:
Pathology Combined
Urine
Availabilty:
Investigation Comments:
In general blood cadmium is a better indicator of short and medium term exposure.
Urine Cadmium may not rise until years after exposure has started and can
continue to rise for many years after exposure ceases. Send unused tube from
same batch.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Blood Cadmium
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
nmol/L
For patient specific reference intervals please refer to printed report or IT systems
Cadmium (urine)
Caeruloplasmin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Copper binding serum protein. Used in conjunction with serum copper levels, to
diagnose Wilson's disease.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
g/L
Upper Limit
0.27
0.41
0.47
0.27
0.60
0.27
0.41
0.47
0.27
0.60
Date Result Returned:
Lower Limit
0.09
0.14
0.24
0.18
0.20
0.09
0.14
0.24
0.18
0.20
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Caeruloplasmin
Reference Ranges
Sex
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Start Age
0 Months
4 Months
1 Years
10 Years
14 Years
0 Months
4 Months
1 Years
10 Years
14 Years
End Age
4 Months
12 Months
10 Years
13 Years
115 Years
4 Months
12 Months
10 Years
13 Years
115 Years
Applicable from
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
01/04/2014
For patient specific reference intervals please refer to printed report or IT systems
Caeruloplasmin
Calcitonin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
SST
2ml
Either Plain or Gold SST
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Calcitonin is useful for monitoring medullary thyroid carcinoma, not for screening or
diagnosis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes
Long Term Stability
Not Possible
Special Requirements:
Patient must be fasted. Take on ice, transport immediately to laboratory
Tests
Units
ng/L
Upper Limit
4.8
11.8
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Calcitonin:
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Applicable from
02/08/2012
02/08/2012
For patient specific reference intervals please refer to printed report or IT systems
Calcitonin
Calprotectin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
Specimen:
Faeces
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
See long term storage
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Faecal Calprotectin :
Units
ug/g faeces
Lower Limit
0
0
Units
Upper Limit
50
50
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Calprotectin
Carbohydrate Deficient Transferrin Alcohol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Serum CDT :
Units
%
Upper Limit
2.6
2.6
Testing Laboratory:
Lower Limit
0.0
0.0
Units
Date Result Returned:
Units
Enquiry Line:
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Serum CDT :
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
%
Lower Limit
0.0
0.0
Units
Upper Limit
2.6
2.6
Applicable from
01/11/2011
01/11/2011
Applicable from
01/11/2011
01/11/2011
For patient specific reference intervals please refer to printed report or IT systems
Carbohydrate Deficient Transferrin Alcohol
Carboxyhaemoglobin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Heparin
Volume Required:
0.2ml
Full EDTA - Heparin or Blood gas sample
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Measures % of carbon monoxide bound to haemoglobin.Unlikely to be significantly
increased if oxygen saturation >85%
Unlikely to be significantly increased if oxygen saturation >85%
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes for blood gas
Long Term Stability
Not Possible
Special Requirements:
Do not leave air space in bottle.
IL GEM OPL
Tests
Units
Carboxy Hb.
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Start Age
0 Years
End Age
100 Years
Units
Func.O2 Saturation
Reference Ranges
Sex
Female
Lower Limit
Units
Met. Hb.
Reference Ranges
Lower Limit
Sex
Female
Start Age
0 Years
End Age
100 Years
Lower Limit
%
Upper Limit
<5
<5
%
Applicable from
19/03/1996
19/03/1996
Upper Limit
Applicable from
19/03/1996
%
Upper Limit
Applicable from
19/03/1996
For patient specific reference intervals please refer to printed report or IT systems
Carboxyhaemoglobin
Carcinoembryonic Antigen
CEA
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
CEA
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
CEA (Abbott)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
0.0
0.0
ng/mL
Upper Limit
5.0
5.0
Applicable from
31/01/2012
31/01/2012
For patient specific reference intervals please refer to printed report or IT systems
Carcinoembryonic Antigen
Carotene
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
A precursor of vitamin A but levels do not always reflect vitamin A status. High values
can be used to rule out steatorrhoea but low-normal levels lack specificity.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Protect from light and send to laboratory within one hour.
Tests
Carotene:
Units
For patient specific reference intervals please refer to printed report or IT systems
Carotene
Catecholamines (24hr urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
24hr Urine
Volume Required:
10ml
24hr Urine container with Acid Preservative
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only
Investigation Comments:
Test used in the diagnosis of phaeochromocytomaSample will be rejected if pH of
24hr urine >3.5
Sample will be rejected if pH of 24hr urine >3.5
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
24 hour collection required in adult patients. For a 24 hour collection, all of the urine should
be collected over the 24 hour period. It is important that the sample is refridgerated during
this time period. There should be an ACID preservative in the
Perkin Elmer HPLC
Tests
24 hr.Urine Volume
Units
Litres
Adrenaline
Units
umol/24hr
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Dopamine
Reference Ranges
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0.42
0.42
Units
Upper Limit
3.00
3.00
umol/24hr
Applicable from
04/03/1996
04/03/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
Applicable from
04/03/1996
04/03/1996
Units
Upper Limit
<60
<60
umol/24hr
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
6
6
Units
Upper Limit
55
55
umol/24hr
Applicable from
04/03/1996
04/03/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0.5
0.5
Units
Upper Limit
55.0
55.0
umol/24hr
Applicable from
04/03/1996
04/03/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0.08
0.08
Units
Upper Limit
0.45
0.45
mmol/24hr
Applicable from
04/03/1996
04/03/1996
HMMA
Reference Ranges
HVA
Reference Ranges
Noradrenaline
Reference Ranges
U.Creat.Exc.
Applicable from
04/03/1996
04/03/1996
Units
Upper Limit
<0.11
<0.11
umol/24hr
Sex
Female
Male
HIAA
Reference Ranges
Lower Limit
For patient specific reference intervals please refer to printed report or IT systems
Catecholamines (24hr urine)
Catecholamines (paediatric random urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
1ml
Obtain special container from lab as it needs to be acidified
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Test used in the diagnosis of phaeochromocytoma and neuroblastomaSample will be
rejected if pH of urine >3.5
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Random collection required in children. Sample must be colleted into acid preservate.
Containers available from laboratory.
Perkin Elmer HPLC
Tests
Adren
Units
umol/mmol creatinine
Dopam
Units
umol/mmol creatinine
HMMA
Units
umol/mmol creatinine
HVA
Units
umol/mmol creatinine
Noradren
Units
umol/mmol creatinine
U.Creat.Conc.
Units
mmol/L
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
Upper Limit
9.4
14.2
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Catecholamines (paediatric random urine)
CD 34
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
EDTA
9ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant referral required
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
CD4/8 RESULTS
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
CD 34
CD4/8
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
9ml
Request Form:
Specimen:
EDTA
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
CD4/8 RESULTS
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
CD4/8
Chicken Pox (VZ)
VZV
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Chicken Pox (VZ) IgG
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Contact laboratory for urgent testing
Investigation Comments:
If pregnant / immunocompromised include contact / rash history
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If contact in pregnancy please state gestation with date and nature of contact.
Tests
Lot No.
Units
Varicella Zoster IgG Antibody :
Units
Vidas Test Value
Units
For patient specific reference intervals please refer to printed report or IT systems
Chicken Pox (VZ)
Chlamydia
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Universal
Endocervical Swab
Volume Required:
Endocervical Swab / Self Taken Swab / Urethral Swab / Self Taken Swab
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Eye, Cervical, Urethral or first void urine
Availabilty:
Investigation Comments:
Send in either swab or 2ml of first void urine in a UPT. Send Blue swab for occular
infections
Swabs and containers available from Pathology reception.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
CHLAMYDIA TRACHOMATIS
Units
Lot No.
Units
TEL NO
Units
For patient specific reference intervals please refer to printed report or IT systems
Chlamydia
Chlamydia Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Must have clinical details i.e. Respiratory / Infertility
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
C. pneumoniae (TW183 Strain) Titre:
Units
C. psittaci (EAE Strain) Titre:
Units
C. trachomatis (L2 Strain) Titre:
Units
Chlamydia Group/ LGV CFT Titre:
Units
Chlamydia psittaci DNA
Units
Chlamydia trachomatis DNA
Units
Date result received
Units
Date sent
Units
Psittacosis/ LGV group CFT Titre:
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Result comment:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Chlamydia Serology
Chloride
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the investigion of pyloric stenosis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
Chloride
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
95
95
mmol/L
Upper Limit
108
108
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Chloride
Cholecystectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Cholecystectomy
Chromogranin A
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
pmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
60
60
pmol/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
150
150
Applicable from
03/03/2011
03/03/2011
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Chromogranin A :
Reference Ranges
Chromogranin B :
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Chromogranin A
Clobazam
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Plain
Heparin
0.5ml
Red Plain or Green Heparin
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
An anti-convulsant drug. Sample taken immediately before a dose, at least 5 days after
initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tubes with gel separators are NOT acceptable.
Tests
Clobazam
Units
Date Result Returned:
Units
Desmethyl clobazam :
Units
Enquiry Line:
Units
Testing Laboratory:
Units
umol/L
umol/L
For patient specific reference intervals please refer to printed report or IT systems
Clobazam
Clostridium Difficile Screen
C-Diff
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
.
Units
C. difficile (GDH)
Units
For patient specific reference intervals please refer to printed report or IT systems
Clostridium Difficile Screen
Clotting Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Coagulation Screen
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Includes PT and APTT tests and Finrinogen
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Special Requirements:
Tests
APTT
Reference Ranges
Units
secs
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Lower Limit
25.0
25.0
Units
Upper Limit
36.5
36.5
g/L
Applicable from
09/12/2011
09/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Upper Limit
4.5
4.5
Unit
Applicable from
04/04/2014
04/04/2014
INR
Lower Limit
1.5
1.5
Units
Prothrombin Time
Units
secs
Lower Limit
9.4
9.4
Units
Upper Limit
12.5
12.5
Fibrinogen
Reference Ranges
Reference Ranges
Ratio
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Applicable from
14/12/2011
14/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Clotting Screen
Complement C1Q
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Must be frozen within 2 hours and transported on ice to reference laboratory
Tests
Units
mg/L
Upper Limit
250
250
Date Result Returned:
Lower Limit
50
50
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Complement C1q
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
01/06/2011
01/06/2011
For patient specific reference intervals please refer to printed report or IT systems
Complement C1Q
Complement C5-C9 Levels
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Deficiency - discuss with consultant immunologist
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Separate and freeze with 1-2 hours of taking blood
Tests
Complement C5:
Units
Complement C6:
Units
Complement C7
Units
Complement C8:
Units
Complement C9:
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Complement C5-C9 Levels
Complement Haemolysis 50
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Complement deficiency, recurrent Neisserial infections
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Separate and freeze with 1-2 hours of taking blood
Tests
Units
U/mL
Upper Limit
46
46
Date Result Returned:
Lower Limit
23
23
Units
Enquiry Line:
Units
Testing Laboratory:
Units
CH50 Complement Function Test :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Complement Haemolysis 50
Complement Levels (C3 and C4)
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Diagnosis of SLE, Glomerulonephritis, Vasculitis, RA
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
g/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.75
0.75
Units
Upper Limit
1.65
1.65
g/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.14
0.14
Upper Limit
0.54
0.54
Applicable from
12/12/2011
12/12/2011
Complement C3c
Reference Ranges
Complement C4
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Complement Levels (C3 and C4)
Copper
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Trace Element
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used as a screening test for Wilson's or Menke's diseases
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Also request Caeruloplasmin
Tests
Copper
Reference Ranges
umol/L
Sex
Female
Female
Female
Female
Female
Male
Male
Male
Start Age
0 Months
6 Months
1 Years
13 Years
49 Years
0 Months
6 Months
1 Years
End Age
6 Months
12 Months
13 Years
49 Years
115 Years
6 Months
12 Months
115 Years
Lower Limit
5.9
3.8
11.0
11.0
11.0
5.9
3.8
11.0
Units
Upper Limit
16.3
23.8
27.2
38.9
27.2
16.3
23.8
27.2
umol/L
Applicable from
09/01/2015
09/01/2015
09/01/2015
09/01/2015
09/01/2015
09/01/2015
09/01/2015
09/01/2015
Sex
Female
Female
Female
Female
Female
Male
Male
Male
Start Age
0 Months
6 Months
1 Years
13 Years
49 Years
0 Months
6 Months
1 Years
End Age
6 Months
12 Months
12 Years
49 Years
115 Years
6 Months
12 Months
115 Years
Lower Limit
5.9
3.8
11.0
11.0
11.0
5.9
3.8
11.0
Units
Upper Limit
16.3
23.8
27.2
38.9
27.2
16.3
23.8
27.2
Applicable from
01/01/2015
01/01/2015
01/01/2015
01/01/2015
01/01/2015
01/01/2015
01/01/2015
01/01/2015
Copper ( by ICP)
Reference Ranges
Units
Date Result Returned:
For patient specific reference intervals please refer to printed report or IT systems
Copper
Copper (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
24hr Urine
1ml
Must be collected into plastic container
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only
Investigation Comments:
Useful only in diagnosing or assessing treatment for Wilson’s disease
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Minus 20°C
Special Requirements:
Tests
24hr Urine Copper :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Urine Volume :
Units
umol/24h
ml
For patient specific reference intervals please refer to printed report or IT systems
Copper (urine)
Cortisol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
A random cortisol measurement is of limited use in diagnosing pituitary or adrenal
disease. Please contact the laboratory if protocol is required.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Blood sample should be collected before 10.00am
Tests
Units
Cortisol
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
101
101
nmol/L
Upper Limit
536
536
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Cortisol
Cows Milk Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
For cows milk intolerance, IgG antibodies.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Alpha-Lactalbumin:
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Units
mg/L
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Lower Limit
0
0
0
Units
Upper Limit
20
20
20
mg/L
Applicable from
22/07/2003
22/07/2003
22/07/2003
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Lower Limit
0
0
0
Units
Upper Limit
30
30
30
mg/L
Applicable from
22/07/2003
22/07/2003
22/07/2003
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
100 Years
100 Years
100 Years
Upper Limit
50
50
50
Applicable from
22/07/2003
22/07/2003
22/07/2003
Date Result Returned:
Lower Limit
0
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Beta-Lactoglobulin:
Reference Ranges
Casein:
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Cows Milk Antibodies
C-Reactive Protein
CRP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
An acute phase protein synthesized by the liver. Increases in concentration follow acute
or chronic inflammation, most commonly associated with bacterial infections,
autoimmune disease, tissue necrosis and malignancy, myocardial infarction and trauma.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
C Reactive Protein
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
mg/L
Upper Limit
5
5
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
C-Reactive Protein
Creatine Kinase
CK
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Present in heart muscle, skeletal muscle and brain. Outdated as a marker of MI
(Troponin should be measured). Useful as an indicator of muscle damage.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Creatine Kinase :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
25
40
IU/L
Upper Limit
200
320
Applicable from
01/11/2011
01/11/2011
For patient specific reference intervals please refer to printed report or IT systems
Creatine Kinase
Creatinine (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Z10
24hr Urine
Volume Required:
3ml
Request Form:
Pathology Combined
Specimen:
24hour Urine or Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Part of urine U&E profile. Not a good indicator of early renal disease. In random urine
samples, is useful for indicating how concentrated the specimen is when interpreting
other urinary tests.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
U.Creat.Conc.
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
mmol/L
Upper Limit
9.4
14.2
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Creatinine (urine)
Creatinine Clearance
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
24hr Urine
Volume Required:
3ml Urine and 2ml Blood
Request Form:
Pathology Combined
Specimen:
24hour Urine & Venous blood
Availabilty:
Routine hours only
Investigation Comments:
Used to assess GFR. An estimated GFR (eGFR) can be calculated from a single blood
sample in most adult patients with stable renal function. Creatinine clearance may be
required to assess renal function prior to the administration of certain reno-toxic drug
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Venous blood sample must be taken during the collection period for the 24 Hour urine. Avoid
vigorous exercise during collection period.
Abbott Architect
Tests
Units
ml/Min.
P.Creat
Lower Limit
88
97
Units
Upper Limit
128
137
umol/L
U.Creat.Conc.
Units
mmol/L
Lower Limit
3.9
5.1
Units
Upper Limit
9.4
14.2
L/24 Hr
Cr.Clearance
Reference Ranges
Reference Ranges
Urine Volume
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
16 Years
16 Years
End Age
100 Years
100 Years
End Age
115 Years
115 Years
Applicable from
22/03/1996
22/03/1996
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Creatinine Clearance
Cryoglobulins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Plain
Plain
Volume Required:
8ml
2 Plain tubes required either 4ml or 6ml and 1 extra EDTA at 4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Cryoglobulins are immunoglobulins that exhibit the phenomenon of insolubility when
cooled below 370C. Common symptoms include purpura, arthralgia and Raynaud's
phenomenon.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
37°C As soon as possible
Long Term Stability
Not possible
Special Requirements:
Samples must be kept at 37°C until processed by the laboratory. Must contact the laboratory
before collecting blood and to be taken in Phlebotomy.
Abbott Architect
Tests
Cryoglobulin:
Units
IgA (Stored at 37C)
Units
g/L
Lower Limit
0.01
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
0.01
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
Units
Upper Limit
0.08
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
0.08
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
g/L
Applicable from
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
Lower Limit
Upper Limit
Applicable from
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
0 Days
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
Sex
Start Age
End Age
IgA(Stored at 4C)
Reference Ranges
Cryoglobulins
Cryoglobulins
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
0 Days
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
0 Days
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
0.01
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
0.01
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
Units
0.08
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
0.08
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
g/L
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
End Age
14 Days
42 Days
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
14 Days
42 Days
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
Lower Limit
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
Units
Upper Limit
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
0 Days
15 Days
End Age
14 Days
42 Days
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
14 Days
42 Days
Lower Limit
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
5.0
3.9
Upper Limit
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
17.0
13.0
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
IgG (Stored at 37C)
Reference Ranges
IgG (stored at 4C)
Reference Ranges
Cryoglobulins
Cryoglobulins
Male
Male
Male
Male
Male
Male
Male
Male
Male
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
Units
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
g/L
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
Lower Limit
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
Units
Upper Limit
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
Lower Limit
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
Upper Limit
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
IgM (Stored at 37C)
Reference Ranges
IgM(Stored at 4C)
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Cryoglobulins
Cryoprecipitate Issue
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
If no previous sample for Group
Issued as Group Specific so Group and Save will need to be provided if not had
one previously.
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Issued under instruction from Consultant Haematologist - Refer to separate Transfusion
policy unless massive haemorrhage.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
COMPATIBILITY TEST
Units
CRYO ISSUE
Units
FRACTION NUMBER - CRYO
Units
PRODUCT - CRYO
Units
UNIT GROUP - CRYO
Units
UNIT NUMBER - CRYO
Units
For patient specific reference intervals please refer to printed report or IT systems
Cryoprecipitate Issue
CSF Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Cerebro-Spinal Fluid
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Culture Result:
Units
Isolate 1
Units
Isolate 2
Units
Results at 24h:
Units
SENT FOR PCR?
Units
Y for complete S for extra sens :
Units
For patient specific reference intervals please refer to printed report or IT systems
CSF Culture
CSF Glucose and Protein
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Fluoride Oxalate
Universal
Volume Required:
Universal and Grey top
Request Form:
Pathology Combined
Specimen:
Cerebro-Spinal Fluid
Availabilty:
Routine hours & On Call
Investigation Comments:
CSF glucose is decreased in bacterial meningitis. Elevated CSF protein is found in
conditions which disrupt the blood-CNS barrier, e.g. meningitis, encephalomylelitis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Not possible
Special Requirements:
Collect samples for glucose into fluoride oxalate tubes. If multiple samples are being
collected, refer to QR-COM-004 (to be amended) for order of collection. Label samples with
order of collection, and protect from light if investigating for xanthochro
Tests
Appearance
Units
CSF Protein
Units
g/L
Lower Limit
0.15
0.15
Units
Upper Limit
0.40
0.40
Reference Ranges
Pandys Test
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
CSF Glucose and Protein
CSF Microscopy
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Cerebro-Spinal Fluid
Availabilty:
Routine hours & On Call
Investigation Comments:
Include relevant clinical details
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be placed in the pathology reception fridge and the oncall microbiologist contacted through switchboard.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Do not use air transport tube
Always contact the laboratory when sending specimens. Ideally collect the CSF sample in 3
consecutive universal containers. Labelled 1 to 3 accordingly. Ensure bottles 1 & 3 are sent
to Microbiology
Tests
Appearance
Units
Gram
Units
RBC
Units
Specimen number
Units
Supernatant
Units
WBC
Units
WBC Differential
Units
For patient specific reference intervals please refer to printed report or IT systems
CSF Microscopy
Cyclosporin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
An immunosuppressant, frequently used in transplant medicine. Take sample
immediately before dose, at least one week after initiation of therapy or dose change.
Sample sent to patient's transplant hospital. Please state on request.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Not possible
Special Requirements:
Take blood sample just before dose (ie trough level)
Tests
Cyclosporin
Units
ug/L
Cyclosporin (LCTMS)
Units
ug/L
Date Result Returned:
Units
Enquiry Line:
Units
Ref. Range given
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Cyclosporin
Cystectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Cystectomy
Cystic Fibrosis Genotype
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
EDTA
5ml
Request Form:
Pathology Combined
Pink Molecular Genetics form preferred
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Test detects the commonest mutations in the european population. Negative result
does not conclusively exclude the diagnosis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not possible
Special Requirements:
Tests
Cystic Fibrosis - CFTR gene :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Cystic Fibrosis Genotype
Cytogenetics
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Heparin
4.5ml
Request Form:
Specimen:
Specific Green Cytogenetics Form
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
For patient specific reference intervals please refer to printed report or IT systems
Cytogenetics
Cytomegalovirus Antibody
CMV
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
CMV IgG antibody :
Units
CMV IgM antibody :
Units
Lot No.
Units
Vidas Test Value
Units
For patient specific reference intervals please refer to printed report or IT systems
Cytomegalovirus Antibody
D-Dimer
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
For Deep Vein Thrombosis or Pulmonary Embolism
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Special Requirements:
"Wells Score" or equivalent must be quoted on all requests
Tests
D-Dimer
Reference Ranges
Wells/BTS Score
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Units
ug FEU/ml
Lower Limit
0.0
0.0
Units
Upper Limit
0.5
0.5
Applicable from
07/09/2013
07/09/2013
For patient specific reference intervals please refer to printed report or IT systems
D-Dimer
Dehydroepiandrosterone Sulphate
DHEAS
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the investigation of precocious or delayed puberty in children/teenagers, and
hirsuitism or virilisation in adult females.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
DHEA Sulphate
Reference Ranges
umol/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
20 Years
40 Years
60 Years
20 Years
40 Years
60 Years
End Age
40 Years
60 Years
115 Years
40 Years
60 Years
115 Years
Lower Limit
1.2
1.9
0.3
3.2
1.9
0.7
Units
Upper Limit
10.3
14.4
3.5
17.4
14.4
7.8
umol/L
Applicable from
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
1 Months
1 Years
5 Years
11 Years
15 Years
20 Years
25 Years
35 Years
45 Years
55 Years
65 Years
0 Days
7 Days
1 Months
1 Years
5 Years
11 Years
15 Years
20 Years
25 Years
35 Years
45 Years
End Age
6 Days
28 Days
12 Months
4 Years
10 Years
14 Years
19 Years
24 Years
34 Years
44 Years
54 Years
64 Years
70 Years
6 Days
28 Days
12 Months
4 Years
10 Years
14 Years
19 Years
24 Years
34 Years
44 Years
54 Years
Lower Limit
0.7
0.2
0.9
0.9
0.7
0.2
1.7
3.6
2.6
2.0
1.5
0.8
0.9
0.7
0.2
0.9
0.9
0.7
0.5
1.2
6.5
4.6
3.8
3.7
Upper Limit
8.2
8.6
5.8
7.5
5.7
4.6
13.4
11.1
13.9
11.1
7.7
4.9
2.1
8.2
8.6
5.8
7.5
5.7
6.6
10.4
14.6
16.1
13.1
12.1
Applicable from
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
01/05/2012
DHEA-S
Reference Ranges
Units
Dehydroepiandrosterone Sulphate
Dehydroepiandrosterone Sulphate
Male
Male
55 Years
65 Years
DHEAS
64 Years
70 Years
1.3
6.2
9.8
7.7
01/05/2012
01/05/2012
For patient specific reference intervals please refer to printed report or IT systems
Dehydroepiandrosterone Sulphate
DIC Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Special Requirements:
Must be requested with FBC or platelet count
Tests
APTT
Reference Ranges
Units
secs
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Lower Limit
25.0
25.0
Units
Upper Limit
36.5
36.5
ug FEU/ml
Applicable from
09/12/2011
09/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Lower Limit
0.0
0.0
Units
Upper Limit
0.5
0.5
g/L
Applicable from
07/09/2013
07/09/2013
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Upper Limit
4.5
4.5
Unit
Applicable from
04/04/2014
04/04/2014
INR
Lower Limit
1.5
1.5
Units
Platelets
Units
x 10^9/L
D-Dimer
Reference Ranges
Fibrinogen
Reference Ranges
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
140
140
Units
Upper Limit
450
450
secs
Applicable from
04/04/2014
04/04/2014
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Lower Limit
9.4
9.4
Units
Upper Limit
12.5
12.5
Applicable from
14/12/2011
14/12/2011
Prothrombin Time
Reference Ranges
Ratio
For patient specific reference intervals please refer to printed report or IT systems
DIC Screen
Differential WBC
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Lab may reflex a manual differential to be performed from a blood film if appropriate.
FBC must be performed.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Baso
Reference Ranges
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Units
Upper Limit
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
x 10^9/L
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
<0.0
<0.0
Units
Upper Limit
Applicable from
04/04/2014
04/04/2014
Eosin
Reference Ranges
x 10^9/L
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Blast
Reference Ranges
Units
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
Lower Limit
0.2
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.2
0.01
x 10^9/L
Upper Limit
0.9
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.9
0.7
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Differential WBC
Differential WBC
Male
Male
Male
Male
Male
Male
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
0.01
0.01
0.01
0.01
0.01
0.01
Units
0.7
0.7
0.7
0.7
0.7
0.7
x 10^9/L
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
2.7
2.0
4.0
5.0
5.5
1.5
1.5
1.5
2.7
2.0
4.0
5.0
5.5
1.5
1.5
1.5
Units
Upper Limit
11.0
17.0
12.0
10.0
8.0
4.0
4.0
4.0
11.0
17.0
12.0
10.0
8.0
4.0
4.0
4.0
x 10^9/L
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
<0.0
<0.0
Units
Upper Limit
Applicable from
04/04/2014
04/04/2014
x 10^9/L
Lymph
Reference Ranges
Metamyelo
Reference Ranges
Mono
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
0.4
0.3
0.2
0.2
0.2
0.2
0.2
0.2
0.4
0.3
0.2
0.2
0.2
0.2
0.2
0.2
Units
Upper Limit
3.1
2.7
1.5
1.5
1.5
1.5
1.5
0.95
3.1
2.7
1.5
1.5
1.5
1.5
1.5
0.95
x 10^9/L
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Upper Limit
Applicable from
04/04/2014
04/04/2014
N.RBC
Lower Limit
<0.0
<0.0
Units
x 10^9/L
Neut
Units
x 10^9/L
Myelocyte
Reference Ranges
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
Lower Limit
4.5
1.5
1.5
1.5
2.0
2.0
2.0
2.0
4.5
1.5
Upper Limit
13.2
10.0
7.0
7.0
6.0
6.0
6.0
7.5
13.2
10.0
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Differential WBC
Differential WBC
Male
Male
Male
Male
Male
Male
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Promyelocytes
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
1.5
1.5
2.0
2.0
2.0
2.0
Units
Lower Limit
<0.0
<0.0
7.0
7.0
6.0
6.0
6.0
7.5
x 10^9/L
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Upper Limit
Applicable from
04/04/2014
04/04/2014
For patient specific reference intervals please refer to printed report or IT systems
Differential WBC
Digoxin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Small paediatric sample / plasma samples are only reliable for 24hrs in fridge
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Drug used in the treatment of congestive heart failure. For monitoring response to the
dose, the sample must be taken 6 to 8 hours post dose.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take sample 6h post dose.
Tests
Units
Digoxin
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
End Age
115 Years
115 Years
Lower Limit
1.0
1.0
Lower Limit
0.5
0.5
nmol/L
Upper Limit
2.6
2.6
Upper Limit
2.0
2.0
Applicable from
02/02/1996
02/02/1996
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Digoxin
Diptheria Antibody
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Diptheria antitoxin level assay:
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
IU/ml
For patient specific reference intervals please refer to printed report or IT systems
Diptheria Antibody
Direct Antiglobulin Test
DAT
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
2ml
Minimum volume 2ml - Paediatric EDTA sample acceptable
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4°C for 6 days
Long Term Stability
Not possible
Special Requirements:
Tests
DIRECT COOMBS TEST
Units
For patient specific reference intervals please refer to printed report or IT systems
Direct Antiglobulin Test
Direct Antiglobulin Test - Screen
DAT
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Minimum volume 2ml - Paediatric EDTA sample acceptable
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Short Term Stability
4°C for 6 days
Long Term Stability
Not possible
Special Requirements:
Tests
C3c
Units
C3d
Units
Control
Units
IgA
Units
IgG
Units
IgM
Units
For patient specific reference intervals please refer to printed report or IT systems
Direct Antiglobulin Test - Screen
Endomysial Antibodies (IgA)
EMA
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Useful test for screening for coeliac disease. Results reported as Strongly Positive /
Positive / Weakly Positive / Negative. IgA deficient patients will be negative for
endomysial antibody
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
If patients are IgA deficient an IgG endomysical antibody screen may be done, this is less
specific and sensitive. Children 5 and under who are endomysial negative will be tested for
IgA & IgG TTG
IF16
Tests
IgG Endomysial Ab:
Units
For patient specific reference intervals please refer to printed report or IT systems
Endomysial Antibodies (IgA)
Endoscopy Water
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Universal
100ml
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Control:
Units
Machine Identifier:
Units
Mean TVC:
Units
TVC Duplicate:
Units
TVC Sample:
Units
For patient specific reference intervals please refer to printed report or IT systems
Endoscopy Water
Enterobius Microscopy
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Sellotape
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Sellotape
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Microscopy:
Units
For patient specific reference intervals please refer to printed report or IT systems
Enterobius Microscopy
Enterovirus PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Echo virus type
Units
Echovirus RNA
Units
Enterovirus PCR RNA
Units
Parechovirus RNA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Enterovirus PCR
Enterovirus Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Enterovirus IgM Antibody
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Enterovirus Serology
Eosinophilic Cationic Protein
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Eosinophilic inflammation (eg. Asthma). Plasma or Haemolysed samples should not be
used. Allow to clot for 60 minutes before separating.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
If serial samples are taken If serial samples are taken they should be at the same ambient
temperature to minimise viability due to the artifactual release of ECP by Eosinophil
breakdown which is accelerated at higher temperatures.
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Eosinophil Cationic Protein:
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Units
ug/L
Lower Limit
0.0
0.0
Units
Upper Limit
15.0
15.0
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Eosinophilic Cationic Protein
Erythrocyte Sedimentation Rate
ESR
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
4.5ml
Only 4.5ml size samples
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C Samples over 24hrs unsuitable for t
Special Requirements:
Starrsed ESR Analyser
Tests
Units
Comment
Units
mm
ESR West
Lower Limit
1
1
Units
Upper Limit
15
10
mm
Pipette No
Units
Sed.Time
Units
Mins
Temp
Units
Deg C
ESR
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
29/03/2000
29/03/2000
For patient specific reference intervals please refer to printed report or IT systems
Erythrocyte Sedimentation Rate
Ethanol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Fluoride Oxalate
3ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the differential diagnosis of an unconscious patient, to confirm ethanol
intoxication and in the management of ethylene glycol or other alcohol poisoning. Only
for the clinical management of intoxicated patients.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
Always allow bottle to completely fill
Tests
Ethanol
Units
mg/100ml
For patient specific reference intervals please refer to printed report or IT systems
Ethanol
Ethylene Glycol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Fluoride Oxalate
3ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away) (Consultant approval required On Call)
Investigation Comments:
Please contact laboratory. Test not performed on site.
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Please contact laboratory. Test not performed on site. Random urine sample also required.
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Ethylene Glycol :
Units
Testing Laboratory:
Units
mg/L
For patient specific reference intervals please refer to printed report or IT systems
Ethylene Glycol
Extended Broth Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Extended Culture Result:
Units
Isolate 1
Units
Isolate 2
Units
Isolate 3
Units
TERMINAL SUB DATE:
Units
TURBID SUB DATE:
Units
For patient specific reference intervals please refer to printed report or IT systems
Extended Broth Culture
Extended Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Result
Units
For patient specific reference intervals please refer to printed report or IT systems
Extended Culture
Factor V Leiden
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Citrate
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Only done via referral to Consultant Haematologist
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Factor V Leiden defect
Units
Units
Factor V Leiden Screen (APC-R)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
2.20
2.20
Upper Limit
3.70
3.70
Applicable from
01/01/2014
01/01/2014
For patient specific reference intervals please refer to printed report or IT systems
Factor V Leiden
Faecal Elastase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
Specimen:
Faeces
Availabilty:
Routine hours only (sent away)
Investigation Comments:
For the investigation and monitoring of exocrine pancreatic insufficiency.
Storage Requirements:
See short term storage
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Minimum 10g
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Faecal Elastase :
Units
ugEl/g stool
Lower Limit
>200
>200
Units
Upper Limit
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Faecal Elastase
Faecal Occult Blood
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Faeces
Volume Required:
Walnut size piece, do not overfill container
Request Form:
Pathology Combined
Specimen:
Faeces
Availabilty:
Routine hours only
Investigation Comments:
Test only available for paediatric cases
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Faecal Occult Blood
Units
For patient specific reference intervals please refer to printed report or IT systems
Faecal Occult Blood
Faecal Parasites
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Faeces
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
CONCENTRATED OCP
Units
CRYPTOSPORIDIUM CYSTS
Units
OCP MEASUREMENT
Units
um
For patient specific reference intervals please refer to printed report or IT systems
Faecal Parasites
Faeces Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Faeces
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be placed in the pathology reception fridge.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Please provide information regarding recent foreign travel and antibiotic use. Clostridium
difficile toxin test performed on in-patient samples, patients over 65yrs or if history of
antibiotic-associated diarrhoea. Rotavirus tested on samples from children <5 years. Repeat
samples for microbiological clearance not usually required - Microbiologists will advise if
necessary.
Tests
:
Units
0157 LATEX
Units
ANTISERA
Units
CAMP MORPH APPEARANCE
Units
Isolate 1
Units
Isolate 2
Units
MALDI ID
Units
MALDI VALUE
Units
SEL
Units
SORB
Units
UREA
Units
VITEK/API NUMBER
Units
XLD
Units
Y for complete S for extra sens :
Units
For patient specific reference intervals please refer to printed report or IT systems
Faeces Culture
Faeces Microscopy
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Faeces
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
CRYPTOSPORIDIUM
Units
WET FILM
Units
ZN STAIN
Units
For patient specific reference intervals please refer to printed report or IT systems
Faeces Microscopy
Fallopian tube
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Fallopian tube
Farmers Lung Precipitins
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Farmers Lung disease, Extrinsic Allergic Alveolitis, mushroom workers lung
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
A.Fumigatus:
Units
Date Result Returned:
Units
Enquiry Line:
Units
Farmers Lung pptns:
Units
M.Faenii:
Units
mg/L
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
60
60
mg/L
Applicable from
09/11/2012
09/11/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
60 Years
60 Years
Lower Limit
0
0
Units
Upper Limit
60
60
Applicable from
09/11/2012
09/11/2012
T.Vulgaris:
Reference Ranges
Testing Laboratory:
For patient specific reference intervals please refer to printed report or IT systems
Farmers Lung Precipitins
Ferritin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Stored iron represents about 25% of total iron in the body and most of this is stored as
ferritin. Ferritin plays a significant role in the absorption, storage and release of iron.
Ferritin is found in serum in low concentrations and is directly proportional to the body's
iron stores.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Ferritin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
10
22
ug/L
Upper Limit
204
275
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Ferritin
Fibrinogen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Used to detect or assist in monitoring bleeding tendency. Will also be requested by lab
staff as appropriate if abnormality suspected.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Special Requirements:
Tests
Units
Fibrinogen
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
1.5
1.5
g/L
Upper Limit
4.5
4.5
Applicable from
04/04/2014
04/04/2014
For patient specific reference intervals please refer to printed report or IT systems
Fibrinogen
Filaria
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Filaria Elisa
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Filaria
FK506 Tacrolimus
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
4.5ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
FK506 :
Units
Testing Laboratory:
Units
ug/L
For patient specific reference intervals please refer to printed report or IT systems
FK506 Tacrolimus
Flecanide
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
Heparin
1ml
Gold or Green
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Flecanide :
Units
ug/L
Upper Limit
700
700
Testing Laboratory:
Lower Limit
200
200
Units
Date Result Returned:
Units
Enquiry Line:
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Flecanide :
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
ug/L
Lower Limit
200
200
Units
Upper Limit
700
700
Applicable from
20/05/1999
20/05/1999
Applicable from
20/05/1999
20/05/1999
For patient specific reference intervals please refer to printed report or IT systems
Flecanide
Fluid Analysis
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
2ml
Request Form:
Pathology Combined
Specimen:
Fluid
Availabilty:
Routine hours only
Investigation Comments:
Includes -
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
F. Albumin
Units
g/L
F. Bicarb
Units
mmol/L
F. Cl
Units
mmol/L
F. Globulin
Units
g/L
F. Glucose
Units
mmol/L
F.Amylase
Units
U/L
F.Creatinine
Units
umol/l
F.Potassium
Units
mmol/L
F.Sodium
Units
mmol/L
F.Tot. Prot
Units
g/L
F.Urate
Units
umol/L
F.Urea
Units
mmol/L
Spec. Name
Units
For patient specific reference intervals please refer to printed report or IT systems
Fluid Analysis
Folate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Useful in the investigation of macrocytic anaemia. Also useful to evaluate the nutritional
status in some patients to monitor the effectiveness of treatment for B12 or folate
deficiency.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Light sensitive - keep specimen in the dark and send sample to lab as soon as possible
Abbott Architect
Tests
Units
Folic Acid Assay
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Units
Folic Acid Assay
Reference Ranges
Lower Limit
3.1
3.1
Lower Limit
3.1
3.1
ug/L
Upper Limit
20.5
20.5
Applicable from
01/10/2011
01/10/2011
ug/L
Upper Limit
20.5
20.5
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Folate
Follicle Stimulating Hormone
FSH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.15ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the assessment of ovarian failure (menopause), pituitary dysfunction and
infertility.Levels vary through menstrual cycle. Sample blood between days 2-7 of the
cycle (follicular phase)
Most informative on day 3 of cycle
Levels vary through menstrual cycle. Sample blood between days 2-7 of the cycle
(follicular phase)
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Levels vary through menstrual cycle. Sample blood between days 2-7 of the cycle (follicular
phase)
Abbott Architect
Tests
Units
Follicle-stimulating hormone
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.95
IU/L
Upper Limit
11.95
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Follicle Stimulating Hormone
FOQ Referral - Antenatal
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Consorts D.O.B.
Units
Consorts Hosp No
Units
Consorts name
Units
Consorts Postcode
Units
Corsorts Address
Units
Units
pg
Upper Limit
39.0
36.5
34.0
31.0
30.0
30.0
30.0
32.0
39.0
36.5
34.0
31.0
30.0
30.0
30.0
32.0
MCH Screen :
Lower Limit
31.0
28.5
24.0
23.0
24.0
24.0
24.0
27.0
31.0
28.5
24.0
23.0
24.0
24.0
24.0
27.0
Units
Screen Declined ?
Units
MCH
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
For patient specific reference intervals please refer to printed report or IT systems
FOQ Referral - Antenatal
Free Light Chains
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Serum Free Kappa and Lambda Light Chains
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Free lambda
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
20 Years
20 Years
End Age
115 Years
115 Years
Units
mg/L
Lower Limit
5.7
5.7
Units
Upper Limit
26.3
26.3
Applicable from
01/01/2011
01/01/2011
For patient specific reference intervals please refer to printed report or IT systems
Free Light Chains
Free T3
Department:
FT3
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Units
pmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
2.6
2.6
Units
Upper Limit
5.7
5.7
pmol/L
Applicable from
01/10/2011
01/10/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
9.0
9.0
Units
Upper Limit
19.0
19.0
mU/L
Applicable from
01/10/2011
01/10/2011
Start Age
0 Days
1 Years
0 Days
1 Years
End Age
366 Days
110 Years
366 Days
110 Years
Lower Limit
0.35
0.35
0.35
0.35
Upper Limit
4.94
4.94
4.94
4.94
Applicable from
01/10/2011
01/10/2011
01/10/2011
01/10/2011
Free T3
Reference Ranges
Free T4
Reference Ranges
Thyroid Stimulating Hormone
Reference Ranges
Sex
Female
Female
Male
Male
Free T3
Reference Ranges
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
2.6
2.6
Units
Upper Limit
5.7
5.7
pmol/L
Applicable from
01/10/2011
01/10/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
9.0
9.0
Units
Upper Limit
19.0
19.0
mU/L
Applicable from
01/10/2011
01/10/2011
Start Age
0 Days
1 Years
0 Days
1 Years
End Age
366 Days
110 Years
366 Days
110 Years
Lower Limit
0.35
0.35
0.35
0.35
Upper Limit
4.94
4.94
4.94
4.94
Applicable from
01/10/2011
01/10/2011
01/10/2011
01/10/2011
Thyroid Stimulating Hormone
Reference Ranges
pmol/L
Sex
Female
Male
Free T4
Reference Ranges
Units
Sex
Female
Female
Male
Male
For patient specific reference intervals please refer to printed report or IT systems
Free T3
Fresh Frozen Plasma Issue
FFP
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Minimum 2ml
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Blood group must have been established, if not Group & Save must be sent.
Consultant Haematologist approval only, unless massive haemorrhage protocol
activated.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Refrigeration at 4°C - Samples stored for 6 days
Long Term Stability
Special Requirements:
Tests
COMPATIBILITY TEST
Units
FFP ISSUE
Units
FRACTION NUMBER - FFP
Units
PRODUCT - FFP
Units
UNIT GROUP - FFP
Units
UNIT NUMBER - FFP
Units
For patient specific reference intervals please refer to printed report or IT systems
Fresh Frozen Plasma Issue
Full Blood Count
FBC
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Includes automated White Blood Cell Differential
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Sysmex
Tests
Units
.
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
0.530
0.450
0.300
0.370
0.340
0.350
0.360
0.370
0.530
0.450
0.300
0.370
0.340
0.340
0.360
0.420
Units
Upper Limit
0.670
0.650
0.360
0.410
0.400
0.410
0.420
0.470
0.670
0.650
0.360
0.410
0.400
0.400
0.420
0.520
g/L.
Applicable from
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
12/03/1996
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female (Pregnant)
Female (Pregnant)
Male
Male
Male
Male
Male
Start Age
0 Days
6 Days
3 Months
1 Years
3 Years
6 Years
10 Years
12 Years
10 Years
12 Years
0 Days
6 Days
3 Months
1 Years
3 Years
End Age
6 Days
90 Days
12 Months
3 Years
6 Years
10 Years
12 Years
115 Years
12 Years
115 Years
6 Days
90 Days
12 Months
3 Years
6 Years
Lower Limit
162
154
108
113
117
117
122
115
122
122
162
154
108
113
117
Upper Limit
206
204
118
123
137
137
142
160
142
160
206
204
118
123
137
Applicable from
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
Haematocrit
Reference Ranges
Haemoglobin
Reference Ranges
Full Blood Count
Full Blood Count
Male
Male
Male
FBC
6 Years
10 Years
12 Years
10 Years
12 Years
115 Years
120
122
126
Units
135
142
180
pg
29/04/2013
29/04/2013
29/04/2013
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
31.0
28.5
24.0
23.0
24.0
24.0
24.0
27.0
31.0
28.5
24.0
23.0
24.0
24.0
24.0
27.0
Units
Upper Limit
39.0
36.5
34.0
31.0
30.0
30.0
30.0
32.0
39.0
36.5
34.0
31.0
30.0
30.0
30.0
32.0
g/L
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
340
330
300
290
310
310
310
310
340
330
300
290
310
310
310
310
Units
Upper Limit
380
370
360
350
350
350
350
350
380
370
360
350
350
350
350
350
fL
Applicable from
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
29/04/2013
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
99.0
88.0
80.0
70.0
79.0
78.0
77.0
78.0
99.0
88.0
80.0
70.0
79.0
77.0
78.0
78.0
Units
Upper Limit
117.0
110.0
96.0
86.0
95.0
94.0
93.0
100.0
117.0
110.0
96.0
86.0
95.0
94.0
96.0
100.0
x 10^9/L
Applicable from
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
03/03/2001
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
140
140
Units
Upper Limit
450
450
x 10^12/L
Applicable from
04/04/2014
04/04/2014
Sex
Female
Start Age
0 Days
End Age
7 Days
Lower Limit
4.1
Upper Limit
6.1
Applicable from
10/01/1996
MCH
Reference Ranges
MCHC
Reference Ranges
MCV
Reference Ranges
Platelets
Reference Ranges
RBC
Reference Ranges
Full Blood Count
Full Blood Count
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
FBC
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
4.1
3.9
3.9
3.9
4.0
4.1
4.2
4.1
4.1
3.9
3.9
3.9
4.0
4.1
4.4
Units
6.1
5.2
5.4
5.4
5.3
5.3
5.4
6.1
6.1
5.2
5.3
5.4
5.3
5.3
6.0
%
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
RDW
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Start Age
1 Years
1 Years
1 Years
End Age
115 Years
115 Years
115 Years
Lower Limit
11
11
11
Units
Upper Limit
16
16
16
x 10^9/L
Applicable from
10/01/1996
10/01/1996
10/01/1996
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female (Pregnant)
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
1 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Lower Limit
9.0
5.0
6.0
6.0
5.0
5.0
5.0
4.0
4
9.0
5.0
6.0
5.0
5.0
5.0
5.0
4.0
Upper Limit
30.0
21.0
15.0
15.0
12.0
12.0
12.0
12.0
18
30.0
21.0
15.0
12.0
12.0
12.0
12.0
12.0
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
WBC
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Full Blood Count
Full HLA Type
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA X-Match
EDTA X-Match
4ml
Contact Laboratory - need 2 x 4ml
Request Form:
NHSBT
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant Referral Required - sent to NHSBT
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Minimum 7 days
Tests
Samples sent to:
Units
For patient specific reference intervals please refer to printed report or IT systems
Full HLA Type
Galactosaemia Screen
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
This screening test is used to screen for a rare genetic metabolic disorder affecting
carbohydrate metabolism. Test not valid if patient transfused within the last 3 months.
Please contact the laboratory for further advice.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Not available out of hours. Please arrange for sample to arrive in lab before 3pm.
Tests
Galactose-1-Phosphate Uridyl Transferase
Units
For patient specific reference intervals please refer to printed report or IT systems
Galactosaemia Screen
Gamma Glutamyl Transferase
GGT
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Gamma GT
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Alk.Phos :
Reference Ranges
IU/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Days
29 Days
16 Years
0 Days
29 Days
16 Years
End Age
28 Days
5844 Days
110 Years
28 Days
5844 Days
110 Years
Lower Limit
70
60
30
70
60
30
Units
Upper Limit
380
425
130
380
425
130
U/L
Applicable from
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
9
12
Upper Limit
36
64
Applicable from
12/12/2011
12/12/2011
GGT
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Gamma Glutamyl Transferase
Gastrectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Gastrectomy
General Sensitivity
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Amikacin
Units
Amoxicillin
Units
Aztreonam
Units
Cefaclor
Units
Cefepime
Units
Cefotaxime
Units
Cefpodoxime
Units
Ceftazidime
Units
Cefuroxime
Units
Cephalexin
Units
Chloramphenicol
Units
Ciprofloxacin
Units
Co-Amoxiclav
Units
Colistin
Units
Cotrimoxazole
Units
Ertapenem
Units
Gentamicin
Units
Isolate 1
Units
Meropenem
Units
General Sensitivity
General Sensitivity
Piperacillin/Tazobactam
Units
Ticarcillin
Units
Tigecycline
Units
Tobramycin
Units
Trimethoprim
Units
Y for complete S for extra sens :
Units
For patient specific reference intervals please refer to printed report or IT systems
General Sensitivity
Gentamicin Assay
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Please complete "Assay Request Forms" in full, specific labels for assay samples are
available. These can be obtained from Pathology Reception. Assays with incomplete
dosing and specimen details will be rejected.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date of last dose:
Units
Date of sample collection:
Units
Dosage Frequency
Units
Dosage Given
Units
Dose (Pre or Post):
Units
Dosing Regimen:
Units
FILED BY MICRO BMS
Units
Gentamicin
Units
Received full details?
Units
Time of last dose:
Units
Time of sample collection:
Units
mg/l
mg/L
For patient specific reference intervals please refer to printed report or IT systems
Gentamicin Assay
Glomerular Basement Membrane Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Rapidly progressive Glomerulonephritis and Goodpasture's syndrome
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Positive results to be sent to reference labs for confirmation and level
Tests
Glom.Base Membrane
Units
For patient specific reference intervals please refer to printed report or IT systems
Glomerular Basement Membrane Antibodies
Glucose
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Fluoride Oxalate
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Used in the assessment of glycaemic control.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
Tests
Units
Glucose
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
3.3
3.3
mmol/L
Upper Limit
6.0
6.0
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Glucose
Glucose Tolerance Test
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Fluoride Oxalate
Fluoride Oxalate
Volume Required:
1ml
2 x fluoride Oxalate containers required
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the assessment of glycaemic control.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Sample disposed of after 24 hrs
Special Requirements:
Tests
Units
120 Min Glucose :
Units
Fasting Glucose
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
3.3
3.3
mmol/L
mmol/L
Upper Limit
6.0
6.0
Applicable from
01/02/2011
01/02/2011
For patient specific reference intervals please refer to printed report or IT systems
Glucose Tolerance Test
Glucose-6-Phosphate Dehydrogenase
G6PD
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant referral required.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
G6PD
Units
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
4.5
4.5
Units
Upper Limit
10.0
10.0
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Glucose-6-Phosphate Dehydrogenase
Glutamic Acid Decarboxylase Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
GAD Ab :
Units
U/ml
Lower Limit
0.0
0.0
0.0
Units
Upper Limit
5.0
5.0
5.0
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Testing Laboratory:
Start Age
0 Years
0 Years
0 Years
End Age
110 Years
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Glutamic Acid Decarboxylase Antibodies
Glycogen Storage Disorders
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Contact referral lab before sending any specimens
Includes Glucose-6-Phosphatase and other enzymes
Take sample on ice, keep upright at all times. Must arrive at referral lab within 3
hours of collection.
Storage Requirements:
Short Term Stability
On ICE
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Glycogen Storage Disorders
Gonorrhoea Culture
GC
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Swab
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Charcoal Transport Swab
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
API NH
Units
B-lactamase
Units
CLED
Units
Culture Result:
Units
E-Test
Units
Gram
Units
Isolate 1
Units
MALDI ID
Units
MALDI VALUE
Units
OXIDASE
Units
PHADEBACT:
Units
For patient specific reference intervals please refer to printed report or IT systems
Gonorrhoea Culture
Growth Hormone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
This test is used as part of an evaluation of pituitary function. A random GH result is can
be difficult to interpret as levels vary throughout the day and many factors are known to
influence GH secretion. Suggest measure growth hormone only as part of d
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Immulite 2000
Tests
Growth- Hormone
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Growth Hormone (ug/L)
mU/L
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0.1
0.1
Units
Upper Limit
13
13
mU/L
Applicable from
13/03/1996
13/03/1996
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
Upper Limit
Applicable from
05/05/2014
05/05/2014
Growth Hormone (mU/L)
Reference Ranges
Units
Units
ug/L
For patient specific reference intervals please refer to printed report or IT systems
Growth Hormone
Growth Hormone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
This test is used as part of an evaluation of pituitary function. A random GH result is can
be difficult to interpret as levels vary throughout the day and many factors are known to
influence GH secretion. Suggest measure growth hormone only as part of d
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Immulite 2000
Tests
Growth- Hormone
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Growth Hormone (ug/L)
mU/L
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0.1
0.1
Units
Upper Limit
13
13
mU/L
Applicable from
13/03/1996
13/03/1996
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
Upper Limit
Applicable from
05/05/2014
05/05/2014
Growth Hormone (mU/L)
Reference Ranges
Units
Units
ug/L
For patient specific reference intervals please refer to printed report or IT systems
Growth Hormone
GUM Microscopy & Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
CERVICAL:
Units
OTHER:
Units
PHADEBACT:
Units
RECTAL:
Units
SITE
Units
SUB PREP:
Units
THROAT:
Units
URETHRAL:
Units
VAGINAL:
Units
For patient specific reference intervals please refer to printed report or IT systems
GUM Microscopy & Culture
Gut Hormone Screen
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Fasting sample only. Calcium and U&E required for interpretation
Storage Requirements:
Refer to long Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes
Long Term Stability
Minus 20°C
Special Requirements:
Send sample on ice. Contact lab before sending.
Tests
Units
CART:
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Chromogranin A :
Reference Ranges
Lower Limit
pmol/L
Applicable from
02/01/2012
02/01/2012
Units
Upper Limit
<85
<85
pmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
60
60
pmol/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
150
150
Applicable from
03/03/2011
03/03/2011
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Chromogranin B :
Reference Ranges
Units
pmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
40
40
pmol/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
50
50
pmol/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
300
300
pmol/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
150
150
Applicable from
03/03/2011
03/03/2011
Gastrin :
Reference Ranges
Glucagon :
Reference Ranges
PP :
Reference Ranges
Somatostatin :
Reference Ranges
Testing Laboratory:
Gut Hormone Screen
Gut Hormone Screen
Units
VIP :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
pmol/L
Upper Limit
30
30
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Gut Hormone Screen
Haemoglobin A1c
HbA1c
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Biochemist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
1.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Follow NSF guidance on using HbA1c to monitor diabetes.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
TOSOH
Tests
Units
HbA1c
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Units
HbA1c (IFCC)
Reference Ranges
Lower Limit
Lower Limit
20
20
%
Upper Limit
<6.2
<6.2
mmol/mol
Applicable from
13/02/1996
13/02/1996
Upper Limit
42
42
Applicable from
06/06/2013
06/06/2013
For patient specific reference intervals please refer to printed report or IT systems
Haemoglobin A1c
Haemoglobinopathy Screening
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
8ml
EDTA x 2
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Performed as requested including FOQsand non urgent Sickle screens
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
24hrs - Store at 4°C until sent to Reference lab
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Haemoglobin A2
Units
%
Upper Limit
3.4
3.4
3.4
Haemoglobin Electrophoresis
Lower Limit
1.5
1.5
1.5
Units
Haemoglobin F
Units
%
Upper Limit
2.5
2.5
2.5
Haemoglobin Structure
Lower Limit
0.0
0.0
0.0
Units
Sickle Test for Haemoglobin S
Units
Testing Laboratory:
Units
Zinc Protoporphyrin
Units
Reference Ranges
Reference Ranges
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Sex
Female
Female (Pregnant)
Male
Sex
Female
Male
Start Age
0 Years
0 Years
0 Years
Start Age
1 Years
1 Years
1 Years
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
110 Years
End Age
110 Years
110 Years
110 Years
End Age
120 Years
120 Years
Lower Limit
30
30
Applicable from
06/12/2006
06/12/2006
06/12/2006
Applicable from
06/10/2006
06/10/2006
06/10/2006
umol/molHb
Upper Limit
80
80
Applicable from
01/01/2015
01/01/2015
For patient specific reference intervals please refer to printed report or IT systems
Haemoglobinopathy Screening
Haptoglobin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Decreased levels in patients with normal liver function is likely to be due to an inacrease
in intravascular haemolysis. Levels may also be low in liver disease. Haptoglobin is an
acute phase protein and may be elevated due to inflammation or infection.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
Haptoglobin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.40
0.50
g/L
Upper Limit
1.60
2.00
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Haptoglobin
Helicobacter Pylori Antigen
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Faeces
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Faeces
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Cut Off:
Units
H.pylori stool antigen
Units
O.D.:
Units
For patient specific reference intervals please refer to printed report or IT systems
Helicobacter Pylori Antigen
Hepatitis A IgM
Hep A
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Part of acute Hepatitis investigation screen
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Hepatitis A IgM antibody :
Units
Lot No.
Units
Vidas Test Value
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis A IgM
Hepatitis B Antibody (post Vacc)
Hep B
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Should be tested 6-8 weeks after final dose of Hepatitis B vaccination. Please give
vaccination history to allow interpretation.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
HBsAb level :
Units
Hepatitis B surface ANTIBODY :
Units
OD :
Units
mIU/mL
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis B Antibody (post Vacc)
Hepatitis B Confirmation
HbsAg
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
HBsAg (2) Quantification
Units
Hep B e Antibody Index
Units
Hep B e Antigen Index
Units
Hep B s Antigen Neutralisation
Units
Hep B surface Antigen sorin
Units
Hep B Total Core Antibody
Units
Hepatitis B core IgM Antibody (Anti-HBc IgM) :
Units
Hepatitis B e Antibody (Anti-HBe) :
Units
Hepatitis B e Antigen (HBe Ag) :
Units
Hepatitis B surface antigen (2) :
Units
Hepatitis B surface antigen (HBsAg) :
Units
IS THIS REPORTABLE?
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
IU/ML
Hepatitis B Confirmation
Hepatitis B Confirmation
WHO SENT?
HbsAg
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis B Confirmation
Hepatitis B Core Antibody
HbcAg
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Hepatitis B core Total Antibody (Anti-HBc) :
Units
Lot No. :
Units
Vidas Test Value :
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis B Core Antibody
Hepatitis B Surface Antigen
HbsAg
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Part of acute Hepatitis investigation screen
Hepatitis B surface antigen tested as screen in acute or chronic infection.
Hepatitis B core antibody and Hepatitis e antigen/antibody tested dependent on results
and clinical history
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
O.D. :
Units
Cut Off :
Units
Hepatitis B Surface Antigen (HBsAg)
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis B Surface Antigen
Hepatitis C Antibody
HepC
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Part of acute Hepatitis investigation screen
Positive 6 weeks after acute infection
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
O.D. :
Units
Cut Off :
Units
Result:
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis C Antibody
Hepatitis C Confirmation
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
HCV Antibody (Bio Rad)
Units
HCV Antigen/Antibody
Units
Hep C Antibody
Units
IS THIS REPORTABLE?
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference lab
Units
Reference Lab No.
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis C Confirmation
Hepatitis C Genotyping and Subtyping
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
HCV genotyping/subtyping: Type
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference lab
Units
Reference Lab No.
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis C Genotyping and Subtyping
Hepatitis C Viral Load PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
HCV PCR Lower Detection Limit
Units
IU/ml
HCV Quantification Log
Units
Log IU/ml
HCV Quantification Number
Units
IU/ml
HCV RNA quantitation
Units
HCV RNA IU/ml
HCV RNA quantitation:
Units
Hep C RNA
Units
IS THIS REPORTABLE?
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference lab
Units
Reference Lab No.
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis C Viral Load PCR
Hepatitis E
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Hepatitis E IgG Antibody
Units
Hepatitis E IgM Antibody
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Hepatitis E
Hereditary Spherocytosis Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Hereditary Spherocytosis Screen
Units
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
4.5
4.5
Units
Upper Limit
10.0
10.0
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Hereditary Spherocytosis Screen
HIT Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Requires immediate transport to Sheffield
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
HIT (Elisa screen):
Units
HIT IgG
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
0
0
U/ml
Upper Limit
1.0
1.0
Applicable from
01/10/2014
01/10/2014
For patient specific reference intervals please refer to printed report or IT systems
HIT Screen
HIV Combined AbAg
HIV
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Patient consent essential, pre-test counselling may be arranged with GUM. Can be tested
urgently if required, following discussion with Microbiologist.
Tests
Cut Off:
Units
HIV 1+2 Antibody/ Antigen:
Units
O.D.:
Units
For patient specific reference intervals please refer to printed report or IT systems
HIV Combined AbAg
HIV Confirmation
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
HIV 1 + 2 Antibody
Units
HIV Ab by Line Immunoassay
Units
HIV Antigen/Antibody Screen
Units
HIV Antigen/Antibody Screen (2)
Units
HIV Antigen/Antibody Screen (3)
Units
IS THIS REPORTABLE?
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
HIV Confirmation
HLA B27
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
2ml
Blood Bank and NHSBT form
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Sent to NHSBTS
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
7 days minimum
Tests
Samples sent to:
Units
For patient specific reference intervals please refer to printed report or IT systems
HLA B27
HLA B57
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
4ml
Blood Bank and NHSBT form
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Sent to NHSBTS
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
7 days minimum
Tests
Samples sent to:
Units
For patient specific reference intervals please refer to printed report or IT systems
HLA B57
Homocysteine
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Used in the investigation of early CHD and stroke and in patients who have a family
history of CHD or stroke but no other known risk factors. Can also be used to
investigate folate and vitamin B12 deficiency and for the diagnosis and monitoring of
homocysteinaemia
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Separate within 1 hour of collection
Long Term Stability
Minus 20°C
Special Requirements:
Patient must be fasted overnight. Samples must be separted within one hour of collection.
Please inform lab before collection.
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Homocysteine :
Units
umol/L
Lower Limit
0
0
Units
Upper Limit
16
18
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
17/02/2010
17/02/2010
For patient specific reference intervals please refer to printed report or IT systems
Homocysteine
Human Chorionic Gonadotrophin (Tumour Marker)
HCG
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
HCG should be used to diagnose and monitor treatment of an established germ cell
(ovarian/testicular tumour only). The test must not be used to screen for tumours. This
is the same test used to detect pregnancy therefore the possibility of other diagnose
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
Units
Tumour HCG
Reference Ranges
IU/L
Units
HCG (tumor marker)
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
Upper Limit
<5
<2
IU/L
Applicable from
14/03/1996
14/03/1996
Upper Limit
<2.6
<1.3
Applicable from
01/03/2014
01/03/2014
For patient specific reference intervals please refer to printed report or IT systems
Human Chorionic Gonadotrophin (Tumour Marker)
Hydatid Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Hydatid ELISA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Hydatid Serology
IgD
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Hyper IgD syndrome, periodic fever syndrome
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
IgD
Units
KU/L
Lower Limit
2
2
Units
Upper Limit
100
100
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Applicable from
01/04/2012
01/04/2012
For patient specific reference intervals please refer to printed report or IT systems
IgD
Immunoglobulin E
IgE
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
A normal total IgE does not exclude allergy, nor does a raised value prove allergy.
Hyper IgE syndrome/ atopic eczema/Wiskott–Aldrich syndrome / allergic
bronchopulmonary aspergillosis / lymphoma and parasitic infections.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Unicap
Tests
Units
Serum IgE:
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female (Pregnant)
Female (Pregnant)
Female (Pregnant)
Female (Pregnant)
Female (Pregnant)
Female (Pregnant)
Female (Pregnant)
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
1 Days
3 Months
1 Years
5 Years
10 Years
15 Years
0 Days
1 Days
3 Months
1 Years
5 Years
10 Years
15 Years
0 Days
1 Days
3 Months
1 Years
5 Years
10 Years
15 Years
End Age
1 Days
93 Days
12 Months
5 Years
10 Years
15 Years
100 Years
1 Days
93 Days
12 Months
5 Years
10 Years
15 Years
100 Years
1 Days
93 Days
12 Months
5 Years
10 Years
15 Years
100 Years
Lower Limit
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
kU/L
Upper Limit
5
11
29
52
63
75
81
5
11
29
52
63
75
81
5
11
29
52
63
75
81
Applicable from
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
14/10/1996
For patient specific reference intervals please refer to printed report or IT systems
Immunoglobulin E
Immunoglobulins (CSF)
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
Universal
2ml
2ml serum in SST and 1ml Cerebro-Spinal Fluid
Request Form:
Pathology Combined
Specimen:
Cerebro-Spinal Fluid & Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Suspected dementia disease, CNS infections or multiple sclerosis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
CSF and Blood must be sent together. Contamination of CSF with blood during lumbar
puncture renders last uninterpretable
Tests
CSF Albumin:
Units
CSF IgG/Alb Ratio:
Units
Reference Ranges
CSF IgG:
Lower Limit
0.2
0.2
Units
CSF:Serum IgG/Alb Ratio:
Units
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
End Age
110 Years
110 Years
Date Result Returned:
Lower Limit
0.2
0.2
Units
Enquiry Line:
Units
Oligoclonal Bands:
Units
Applicable from
03/03/2011
03/03/2011
Upper Limit
0.7
0.7
Applicable from
03/03/2011
03/03/2011
Units
g/L
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
33
35
Units
Upper Limit
47
47
g/L
Applicable from
03/03/2011
03/03/2011
Sex
Female
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
1 Years
2 Years
3 Years
6 Years
15 Years
1 Years
2 Years
3 Years
6 Years
End Age
2 Years
3 Years
6 Years
15 Years
110 Years
2 Years
3 Years
6 Years
15 Years
Lower Limit
3.1
3.7
4.9
5.4
6.0
3.1
3.7
4.9
5.4
Upper Limit
13.8
15.8
16.1
16.1
16.0
13.8
15.8
16.1
16.1
Applicable from
03/03/2011
03/03/2011
03/03/2011
03/03/2011
03/03/2011
03/03/2011
03/03/2011
03/03/2011
03/03/2011
Serum IgG:
Reference Ranges
Upper Limit
0.7
0.7
mg/L
Sex
Female
Male
Serum Albumin:
Reference Ranges
mg/L
Immunoglobulins (CSF)
Immunoglobulins (CSF)
Male
Testing Laboratory:
15 Years
110 Years
6.0
Units
16.0
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Immunoglobulins (CSF)
Immunoglobulins (IgG, IgA, IgM)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Diagnosis and monitoring of primary and secondary immunodeficiencies: monitoring
patients receiving replacement therapies, myeloma screen
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Albumin
Reference Ranges
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
115 Years
115 Years
115 Years
Lower Limit
5
5
5
Units
Upper Limit
25
25
25
g/L
Applicable from
09/02/2000
09/02/2000
09/02/2000
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
g/L
Applicable from
21/06/2012
21/06/2012
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Start Age
0 Days
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
0 Days
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
14 Days
Lower Limit
0.01
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
0.01
Upper Limit
0.08
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
0.08
Applicable from
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
Globulin
Reference Ranges
Immunoglobulin A
Reference Ranges
g/L
Sex
Female
Female
Female
Male
Male
Male
Glob gap
Reference Ranges
Units
Immunoglobulins (IgG, IgA, IgM)
Immunoglobulins (IgG, IgA, IgM)
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
14 Days
42 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
110 Years
0.02
0.05
0.1
0.15
0.2
0.3
0.3
0.4
0.5
0.7
0.8
0.7
Units
0.15
0.4
0.5
0.7
0.7
1.2
1.3
2.0
2.4
2.5
2.8
4.0
g/L
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
12/07/2001
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
End Age
14 Days
42 Days
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
14 Days
42 Days
82 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
115 Years
Lower Limit
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
Units
Upper Limit
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
115 Years
Upper Limit
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
0.2
0.4
0.7
1.0
1.6
2.1
2.2
2.0
1.8
1.9
1.9
2.0
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Tot Ig
Lower Limit
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
0.05
0.08
0.15
0.2
0.4
0.6
0.5
0.5
0.5
0.5
0.5
0.5
Units
Total Protein
Units
g/L
Immunoglobulin G
Reference Ranges
Immunoglobulin M
Reference Ranges
Immunoglobulins (IgG, IgA, IgM)
Immunoglobulins (IgG, IgA, IgM)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
Upper Limit
80
80
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Immunoglobulins (IgG, IgA, IgM)
Inhibin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Used in the diagnosis and monitoring of granulosa cell tumours of the ovary or sertoli
cell tumours of the testis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Inhibin A
Units
pg/mL
Inhibin B
Units
pg/mL
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Inhibin
INR & Anti Coagulant Dosing
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553176
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
Citrate
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Patient MUST be referred to Anticoagulant clinic prior to sample being sent.
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
INR
Units
Next Appointment
Units
Next Dose
Units
Unit
mg
For patient specific reference intervals please refer to printed report or IT systems
INR & Anti Coagulant Dosing
Insulin-like Growth Factor
IgF1
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used to identify diseases and conditions caused by deficiencies and over-production of
growth hormone, to detect pituitary disease and to monitor effectiveness of growth
hormone replacement. May be requested as part of a pituitary function test.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Patient must be fasted overnight.
Immulite 2000
Tests
Units
Ins.Like.Growth.Factor
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Start Age
1 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
26 Years
31 Years
36 Years
41 Years
46 Years
51 Years
56 Years
61 Years
66 Years
71 Years
End Age
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
26 Years
31 Years
36 Years
41 Years
46 Years
51 Years
56 Years
61 Years
66 Years
71 Years
76 Years
Lower Limit
55
51
49
49
50
52
57
64
74
88
111
143
183
220
237
226
193
163
141
127
116
117
115
109
101
94
87
81
75
69
64
ug/L
Upper Limit
327
303
289
283
286
297
316
345
388
452
551
693
850
972
996
903
731
584
483
424
358
329
307
284
267
252
238
225
212
200
188
Applicable from
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
Insulin-like Growth Factor
Insulin-like Growth Factor
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
IgF1
76 Years
81 Years
1 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
26 Years
31 Years
36 Years
41 Years
46 Years
51 Years
56 Years
61 Years
66 Years
71 Years
76 Years
81 Years
81 Years
99 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
26 Years
31 Years
36 Years
41 Years
46 Years
51 Years
56 Years
61 Years
66 Years
71 Years
76 Years
81 Years
99 Years
Insulin-Like Growth Factor -1
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
2 Months
5 Years
6 Years
9 Years
12 Years
16 Years
21 Years
25 Years
40 Years
55 Years
2 Months
5 Years
6 Years
9 Years
12 Years
16 Years
21 Years
25 Years
40 Years
55 Years
End Age
60 Months
6 Years
9 Years
12 Years
16 Years
21 Years
25 Years
40 Years
55 Years
100 Years
60 Months
6 Years
9 Years
12 Years
16 Years
21 Years
25 Years
40 Years
55 Years
100 Years
59
55
55
51
49
49
50
52
57
64
74
88
111
143
183
220
237
226
193
163
141
127
116
117
115
109
101
94
87
81
75
69
64
59
55
Units
Lower Limit
33.5
33.5
79.8
87.4
188.4
267.5
149.1
107.8
92.7
54.0
27.4
27.4
54.9
85.2
115.4
247.3
187.9
96.4
88.3
54.6
177
166
327
303
289
283
286
297
316
345
388
452
551
693
850
972
996
903
731
584
483
424
358
329
307
284
267
252
238
225
212
200
188
177
166
ug/L
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
15/02/2006
Upper Limit
171.8
171.8
244.0
399.3
509.9
470.8
332.3
246.7
244.6
204.4
113.5
113.5
206.4
248.8
498.2
481.7
400.0
227.8
209.9
185.7
Applicable from
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
01/05/2013
For patient specific reference intervals please refer to printed report or IT systems
Insulin-like Growth Factor
Intrinsic Factor Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Will also be requested by staff as indicated by other results - Pernicious anemia (5070%), antral gastritis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Intrinsic Factor Antibody
Units
For patient specific reference intervals please refer to printed report or IT systems
Intrinsic Factor Antibodies
Iron
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.15ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used in cases of suspected overdose and to monitor iron staus in renal patients. For
evaulation of iron status, request FBC, ferritin and transferrin.
Ferritin is a better indicator of iron storage and in cases of iron overload
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Iron
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
9.0
11.6
umol/L
Upper Limit
30.4
31.3
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Iron
Islet Cell Antibodies
ICAB
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
4ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Islet Cell Antibody:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Islet Cell Antibodies
Jak-2
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant approval required
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
RESULT
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Jak-2
Karyotype
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Comments:
Units
Date Result Returned:
Units
Enquiry Line:
Units
Report for:
Units
Result:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Karyotype
Kleihauer
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
EDTA X-Match
See comments
1 x 7ml Pink and 1 x 4ml Lavender
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
KLEIHAUER
Units
Kleihauer Negative Control
Units
Kleihauer Positive Control
Units
For patient specific reference intervals please refer to printed report or IT systems
Kleihauer
Lactate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Fluoride Oxalate
Volume Required:
0.3ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Used in the investigation of hypoglycaemia, sepsis and metabolic disorders.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes
Long Term Stability
Not Possible
Special Requirements:
Send immediately to laboratory.
On Ice
Tests
Units
Haemolysis index
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Units
Upper Limit
1
1
mmol/L
Applicable from
28/09/2000
28/09/2000
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.50
0.50
Upper Limit
2.20
2.20
Applicable from
12/12/2011
12/12/2011
Lactate
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Lactate
Lactate (CSF)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
5ml
Request Form:
Pathology Combined
Specimen:
Cerebro-Spinal Fluid
Availabilty:
Routine hours only - Must pre-arrange with the laboratory
Investigation Comments:
Use with blood lactate in the investigation of meningitis.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Transport on Ice - Up to 10 minutes
Long Term Stability
Special Requirements:
Send immediately to laboratory.
Tests
Units
CSF Lactate
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
1.20
1.20
mmol/L
Upper Limit
2.10
2.10
Applicable from
20/03/1996
20/03/1996
For patient specific reference intervals please refer to printed report or IT systems
Lactate (CSF)
Lactate Dehydrogenase
LDH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.3ml
Request Form:
Pathology Combined
Specimen:
Venous blood
Availabilty:
Routine hours only
Investigation Comments:
Used in the investigation of tissue damage. Should only used as a general marker of
cellular injuray as it is not useful for determining which specific cells are damaged. May
be used in the monitoring of megaloblastic and pernicious anaemia, leukaemia a
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Lactate Dehydrogenase :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
125
125
U/L
Upper Limit
243
243
Applicable from
09/12/2011
09/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Lactate Dehydrogenase
Lactate Dehydrogenase (fluid)
FLDH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
1ml
Request Form:
Pathology Combined
Specimen:
Fluid
Availabilty:
Routine hours only
Investigation Comments:
Used as a factor in Light's criteria in the differentiation in pleural fluid between a
transudate and exudate.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
LDH
Units
Spec. Name
Units
U/L
For patient specific reference intervals please refer to printed report or IT systems
Lactate Dehydrogenase (fluid)
Lamotrigine
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
3ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
An anti-convulsant drug. Sample taken immediately before a dose, at least 5 days after
initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take blood sample just before dose (ie trough level)
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Lamotrigine
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
mg/L
Lower Limit
3
3
Units
Upper Limit
15
15
Applicable from
13/08/2012
13/08/2012
For patient specific reference intervals please refer to printed report or IT systems
Lamotrigine
Laryngectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Laryngectomy
Laxative Screen (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Urine Anthraquinones
Units
Urine Bisacodyl
Units
Urine Danthron
Units
Urine Phenolphtalein
Units
Urine Rhein (Senna)
Units
For patient specific reference intervals please refer to printed report or IT systems
Laxative Screen (urine)
Lead (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only
Investigation Comments:
Only useful if either the patient has been given a chelating agent or is working working
with an alkyl compound
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
EMU
Tests
Exposure
Units
Lead
Units
Sent
Units
umol/L
For patient specific reference intervals please refer to printed report or IT systems
Lead (urine)
Legionella Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Part of atypical pneumonia scree.
State date of onset of symptoms. Send paired sera 10-14 days apart.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Legionella PCR DNA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Legionella Serology
Legionella Urine Antigen
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Urine
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Kit Lot No. :
Units
QC passed?
Units
Result:
Units
Test performed by:
Units
For patient specific reference intervals please refer to printed report or IT systems
Legionella Urine Antigen
Lipid Profile
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Lipid profile includes triglyceride, total cholesterol, LDL cholesterol. HDL cholesterol and
a total cholesterol / HDL cholesterol ratio. LDL cholesterol is a calculated parameter.
Calculation invalid if Triglyceride > 4.6 mmol/L or non-fasting blood sa
Calculated value. Calculation invalid if Triglyceride > 4.6 mmol/L or non-fasting blood
sample received for testing
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Patient should be fasting if LDL cholesterol required.
Tests
Units
Cholesterol
Reference Ranges
Sex
Female
Male
Start Age
1 Years
1 Years
End Age
99 Years
99 Years
Units
HDL-Cholesterol
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
Units
Triglyceride
Reference Ranges
Lower Limit
Units
Non-HDL C
Reference Ranges
Lower Limit
Units
LDL
Reference Ranges
Lower Limit
Upper Limit
Applicable from
17/01/1996
17/01/1996
mmol/L
Upper Limit
Applicable from
30/03/2015
30/03/2015
Upper Limit
Applicable from
30/03/2015
30/03/2015
Units
HDL-Ratio
Reference Ranges
Lower Limit
mmol/L
Lower Limit
mmolL
Upper Limit
Applicable from
30/03/2015
30/03/2015
mmol/L
Upper Limit
Applicable from
17/03/2015
17/03/2015
mmol/L
Upper Limit
Applicable from
30/03/2015
30/03/2015
For patient specific reference intervals please refer to printed report or IT systems
Lipid Profile
Listeria PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Listeria PCR
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Listeria PCR
Lithium
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
A drug used in the treatment of bipolar disorders. Sample taken 12-18h post dose, at
least 5 days after initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take blood sample 12-18h post dose.
Tests
Units
Dosage
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
Frequency
Units
Hours Post Dose
Units
Units
Lithium
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.4
0.4
mg
Upper Limit
Applicable from
02/02/1996
02/02/1996
hours
mmol/L
Upper Limit
1.0
1.0
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Lithium
Liver Function Test
LFT
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Alb/Glob Ratio
Units
g/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
IU/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Days
29 Days
16 Years
0 Days
29 Days
16 Years
End Age
28 Days
5844 Days
110 Years
28 Days
5844 Days
110 Years
Lower Limit
70
60
30
70
60
30
Units
Upper Limit
380
425
130
380
425
130
U/L
Applicable from
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
55
55
umol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
9
9
g/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
Applicable from
21/06/2012
21/06/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Upper Limit
1
1
Applicable from
28/09/2000
28/09/2000
Albumin
Reference Ranges
Alk.Phos :
Reference Ranges
ALT
Reference Ranges
C.Bilirubin
Reference Ranges
Globulin
Reference Ranges
Haemolysis index
Reference Ranges
g/L
Liver Function Test
Liver Function Test
LFT
Units
Lipaemia Index
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Units
Upper Limit
3
3
umol/L
Applicable from
28/09/2000
28/09/2000
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
0 Days
2 Days
14 Days
1 Years
0 Days
2 Days
14 Days
1 Years
End Age
2 Days
14 Days
365 Days
115 Years
2 Days
14 Days
365 Days
115 Years
Lower Limit
0
0
0
0
0
0
0
0
Units
Upper Limit
21
21
21
21
21
21
21
21
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
Upper Limit
80
80
Applicable from
12/12/2011
12/12/2011
T.Bilirubin
Reference Ranges
Total Protein
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Liver Function Test
Liver, Kidney and Smooth Muscle Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
AMA -PBC, APC - Pernicious Anaemia (PA), ASM/LUM - Autoimmune chronic active
hepatitis (AICAH)
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
APC result cannot be interpreted if AMA present
Tests
Anti-Gastric Parietal
Units
Anti-Mitochondrial
Units
Anti-Smooth Muscle
Units
Liver/Kidney Microsome
Units
For patient specific reference intervals please refer to printed report or IT systems
Liver, Kidney and Smooth Muscle Antibodies
Luteinising Hormone
LH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Assesment of ovarian failure, pituitary dysfunction and infertility. Do not use in the
investigation of the menopause.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
In female patients, levels vary throughout menstrual cycle. Samples should be taken
between days 2-7 of the cycle (follicular phase).
Tests
Units
Lutrophin
Reference Ranges
Sex
Male
Start Age
0 Years
End Age
110 Years
Lower Limit
0.57
IU/L
Upper Limit
12.07
Applicable from
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Luteinising Hormone
Lymphocyte Subsets
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant Approval Required.
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Units
Cells/uL
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
1130
1130
Units
Upper Limit
3300
3300
Cells/uL
Applicable from
01/01/2012
01/01/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
120
120
Units
Upper Limit
600
600
Cells/uL
Applicable from
01/01/2012
01/01/2012
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
120
120
Units
Upper Limit
640
640
Cells/uL
Applicable from
01/01/2012
01/01/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
750
750
Units
Upper Limit
2510
2510
Cells/uL
Applicable from
01/01/2012
01/01/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
430
430
Units
Upper Limit
1690
1690
Cells/uL
Applicable from
01/01/2012
01/01/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
220
220
Units
Upper Limit
1210
1210
Applicable from
01/01/2012
01/01/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Lower Limit
0.850
0.850
Upper Limit
2.80
2.80
Applicable from
01/01/2012
01/01/2012
Absolute Lymphocytes:
Reference Ranges
CD16/56 NK Cells
Reference Ranges
CD19 B-Lymphocytes
Reference Ranges
Sex
Female
Male
CD3 T-Lymphocytes
Reference Ranges
CD3/4 T-Helpers
Reference Ranges
CD3/8 T-Suppressors
Reference Ranges
CD4:8 RATIO
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Lymphocyte Subsets
M2 Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Primary Biliary Cirrhosis
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
ANA (Mouse block) :
Units
Anti Mitochondrial Ab :
Units
Anti Smooth Muscle Ab :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Gastric Parietal Cell Ab
Units
LKM Ab :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
M2 Antibodies
Macroprolactin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Diluted prolactin
Units
mU/L
Macro prolactin
Units
mU/L
Monomeric Prolactin
Units
mU/L
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
109
73
Units
Upper Limit
557
407
mU/L
Applicable from
01/10/2011
01/10/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Upper Limit
557
407
%
Applicable from
01/10/2011
01/10/2011
Recovery
Lower Limit
109
73
Units
Recovery Factor
Units
Prolactin
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Macroprolactin
Malaria Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Send samples to laboratory as soon as possible to preserve integrity of any parasites.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
The requesting doctor will be contacted should this result be positive.
Please state geographical location involved
Inform the lab you are sending this test
Tests
Malaria Screen
Units
Malaria Screen
Units
For patient specific reference intervals please refer to printed report or IT systems
Malaria Screen
Manganese
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Minus 20°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
nmol/L
Upper Limit
210
210
Date Result Returned:
Lower Limit
73
73
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Blood Manganese
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
120 Years
120 Years
Applicable from
01/01/2012
01/01/2012
For patient specific reference intervals please refer to printed report or IT systems
Manganese
Mannose Binding Protein
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Mannose Binding Lectin
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Mannose Binding Lectin :
Units
mg/L
Lower Limit
1.0
1.0
Units
Upper Limit
4.0
4.0
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
01/07/2011
01/07/2011
For patient specific reference intervals please refer to printed report or IT systems
Mannose Binding Protein
Manual Antibody Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Request Form:
Blood Bank
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Antibody Screen
Units
Screening Cell 1
Units
Screening Cell 2
Units
Screening cell 3
Units
For patient specific reference intervals please refer to printed report or IT systems
Manual Antibody Screen
Maternity Anti-D Issue
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Blood Bank
Specimen:
Availabilty:
Routine hours only
Investigation Comments:
Not requested as a test in the normal way; Anti-D is issued by ward and then blood
bank is informed retrospectively and then the information is logged.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
BATCH NUMBER
Units
DATE OF ISSUE
Units
EXPIRY DATE
Units
For patient specific reference intervals please refer to printed report or IT systems
Maternity Anti-D Issue
Measles PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Swab
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Urine, Throat swab (in viral transport media), Venous Blood (SST)
Availabilty:
Investigation Comments:
Test designed for diagnosis of acute infection and not for determining immunity.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Measles virus RNA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Measles PCR
Mercury (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
5ml
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Blood is better indicator of exposure to mercury or exposure to alkyl mercury
compounds. Urine can be used to test for exposure to metallic mercury and incorganic
forms of mercury but it cannot be used to deterrmine exposure to methyl mercury.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
EMU
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Urine Creatinine :
Units
Urine Hg / Cre Ratio :
Reference Ranges
Urine Mercury :
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
mmol/L
Units
nmol/mmol (Creat)
Lower Limit
0
0
Units
Upper Limit
5.5
5.5
nmol/L
Applicable from
10/03/2011
10/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Mercury (urine)
Metabolic Screen (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
20ml
Request Form:
Pathology Combined
Specimen:
Random Urine - 5ml minimum
Availabilty:
Routine hours only
Investigation Comments:
Includes screening test for muco-polysaccharides, amino acids, organic acids, and
other metabolic abnormalities. Please give clinical details indicating nature of the
problems, e.g. acidosis, neurological abnormalities, developmental delay, etc. All ab
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Clinical details are essential to aid interpretation. If requesting as part of investigation for
hypoglycaemia, sample needs to be first urine voided following hypoglycaemic episode.
Tests
Units
DMB
Reference Ranges
U.Cys/Homocys
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
mg/mmol Cr
Upper Limit
Applicable from
09/06/2014
09/06/2014
Units
For patient specific reference intervals please refer to printed report or IT systems
Metabolic Screen (urine)
Methotrexate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Heparin
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Methotrexate is used in the treatment of cancer, autoimmune diseases and in medical
abortions. It acts by inhibiting the metabolism of folic acid.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Contact Reference Lab before collection - Chemical Pathology Sheffield Childrens Hospital
0114 277404
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Units
Methotrexate
Reference Ranges
Sex
Female
Testing Laboratory:
Start Age
0 Years
End Age
115 Years
Lower Limit
umol/L
Upper Limit
Applicable from
23/09/1997
Units
For patient specific reference intervals please refer to printed report or IT systems
Methotrexate
Microalbumin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Z10
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Used as a screening tool for the early detection of kidney disease occurring as a
complication of diabetes or hypertension. Also known as albumin / creatinine ratio
(ACR)
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
EMU
Tests
Units
U.Albumin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
U.Albumin/creatinine ratio
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
Units
U.Creat.Conc.
Reference Ranges
Lower Limit
Lower Limit
3.9
5.1
mg/L
Upper Limit
Applicable from
12/12/2011
12/12/2011
mg/mmol Cr
Upper Limit
<3.5
<2.5
mmol/L
Applicable from
04/03/2004
04/03/2004
Upper Limit
9.4
14.2
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Microalbumin
Molecular Genetics (Marrow)
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Consultant referral required for all bone marrow investigations
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
For patient specific reference intervals please refer to printed report or IT systems
Molecular Genetics (Marrow)
Mumps Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Include clinical details
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Mumps IgG Antibody
Units
Mumps IgM Antibody
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Mumps Serology
Mumps Virus PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Swab
Volume Required:
Urine / Salivary Viral Swab
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Mumps virus RNA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Mumps Virus PCR
Mycobacteria Identification & Senstivity
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Amikacin
Units
Ciprofloxacin
Units
Clarithromycin
Units
Cotrimoxazole
Units
Date result received:
Units
Date sent:
Units
Doxycycline
Units
Ethambutol
Units
Flucloxacillin
Units
Imipenem
Units
Isoniazid
Units
Linezolid
Units
Moxifloxacin
Units
Pyrazinamide
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference lab no:
Units
Reference lab:
Units
Mycobacteria Identification & Senstivity
Mycobacteria Identification & Senstivity
Rifampicin
Units
Streptomycin
Units
Sulphonamides
Units
Tigecycline
Units
Tobramycin
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Mycobacteria Identification & Senstivity
Mycology Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Transport packet
Universal
Volume Required:
Please refer to special requirements
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Skin, Nail, Hair
Availabilty:
Daily
Investigation Comments:
None applicable
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not applicable
Special Requirements:
Specimens should be collected using appropriate CE marked leak proof containers e.g.
Sterile Universal or commercially available packets e.g. Dermapak, designed specifically for
the collection and transport of skin, nail and hair samples.
Tests
Culture result:
Units
Isolate 1:
Units
Isolate 2:
Units
For patient specific reference intervals please refer to printed report or IT systems
Mycology Culture
Mycology Identification
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
Sterile Universal
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Skin scrapings, nail, or hair
Availabilty:
Routine hours only
Investigation Comments:
Interim report issued with microscopy result. Full culture result may take one month or
longer. Samples optimally collected before antifungal therapy.
Storage Requirements:
Store at room temperature.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Swab skin and nails with 70% alcohol before collection. Skin scrapings best taken from outer
edge of lesion.Specify toe or finger nail, include material from any discoloured or dystrophic
parts cut as far back as possible through the entire thickness - include any crumbly material.
Hair should be plucked out and skin scales included.
Tests
Date result received:
Units
Date sent:
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference lab no:
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Mycology Identification
Mycology Microscopy
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Transport packet
Universal
Volume Required:
Please refer to special requirements
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Skin, Nail, Hair
Availabilty:
Daily
Investigation Comments:
None applicable
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not applicable
Special Requirements:
Specimens should be collected using appropriate CE marked leak proof containers e.g.
Sterile Universal or commercially available packets e.g. Dermapak, designed specifically for
the collection and transport of skin, nail and hair samples.
Tests
Microscopy:
Units
Specimen type:
Units
Structures seen:
Units
For patient specific reference intervals please refer to printed report or IT systems
Mycology Microscopy
Mycoplasma Antibody
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Tested on acute respiratory screen samples.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Kit Lot No. :
Units
Mycoplasma Gel Particle Agglutination Titre :
Units
For patient specific reference intervals please refer to printed report or IT systems
Mycoplasma Antibody
Myositis Screen
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
EDTA
2ml
Need 2ml serum in Gel tube or 2ml Plasma is EDTA or Li Hep tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Myositis, Inflammatory Myopathies inc Dermatomyositis, Juvenile Myositis, Polymyositis
and Inclusion body myositis
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Anti Nuclear Antibody-Hep2
Units
Anti-EJ Ab :
Units
Anti-Jo-1 Ab :
Units
Anti-Ku Ab :
Units
Anti-Mi-2 Ab :
Units
Anti-OJ Ab :
Units
Anti-PL-12 Ab :
Units
Anti-PL-7 Ab :
Units
Anti-PM-SCL 100 Ab :
Units
Anti-PM-SCL-75 Ab :
Units
Anti-SRP Ab :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Myositis Screen
Near patient INR
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553176
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
INR
Units
Tested by:
Units
Unit
For patient specific reference intervals please refer to printed report or IT systems
Near patient INR
Nerve Cell Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml (Preferably 4ml)
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Autoimmune neuropathies
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Amphiphysin Ab :
Units
Anti-CV2/CRMP-5 Ab :
Units
Anti-PNMA2 (Ma2/Ta) Ab :
Units
Anti-Tr Ab :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Neuronal nuclei Ab,Anti-Hu/Ri :
Units
Purkinji cell Ab,Anti-Yo :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Nerve Cell Antibodies
Neuronal Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Neuronal (Hu) Ab:
Units
Neuronal (Ri) Ab:
Units
Purkinje (Yo) Ab:
Units
Sent:
Units
For patient specific reference intervals please refer to printed report or IT systems
Neuronal Antibodies
Nipple cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Universal Cytospin
Volume Required:
Universal of fluid/ smear on slide
Request Form:
Histology WPR2580
Specimen:
Fluid or smear on slide
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Nipple cytology
Nitroblue tetrazolium
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
Request Form:
Pathology Combined
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Nitroblue Tetrazolium :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Nitroblue tetrazolium
Norovirus
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Faeces
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Norovirus:
Units
For patient specific reference intervals please refer to printed report or IT systems
Norovirus
NTx (Bone Marker)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
N-telopeptide
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
5ml
Request Form:
Pathology Combined
Specimen:
Urine
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Urine SMV NTX/Creat Ratio :
Units
nM BCE/mmol Creat
For patient specific reference intervals please refer to printed report or IT systems
NTx (Bone Marker)
Oesophagectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Oesophagectomy
Oestradiol
E2
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used mainly in the evaluation of ovarian function for the investigation of precicious
puberty in girls, gynaecomastia in males and amenorrhoea, abnormal menstruation or
infertility in adult females. May also be used to monitor menopausal HRT given as 17-
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Specimens should be sent to the laboratory without delay during normal hours.
Tests
Units
Oestradiol
Reference Ranges
Sex
Male
Start Age
0 Years
End Age
110 Years
Lower Limit
40
pmol/L
Upper Limit
161
Applicable from
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Oestradiol
Organic Acids (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
10ml
Request Form:
Pathology Combined
Specimen:
Random Urine - 5ml minimum volume
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Included as part of the Metabolic Screen
Part of the Metabolic Screen
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Org Acids Line 3
Units
Org Acids line 4
Units
Org Acids line2
Units
Organic Acids
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Organic Acids (urine)
Organism Identification
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
(Isolate 1)
Units
ANTIBIOTIC RESISTANCE MECHANISM
Units
API NUMBER
Units
Cefodoxime + Clav:
Units
Cefpirome + Clav:
Units
Cefpirome:
Units
Further result:
Units
Modified - Hodge Test
Units
VITEK/API NUMBER
Units
Zone diam (mm) Cefpodoxime:
Units
For patient specific reference intervals please refer to printed report or IT systems
Organism Identification
Osmolality (serum)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Used in the differential diagnosis of hyponatraemia, diabetes insipidus and inappropriate
secretion of ADH. A high serum osmolality may indicate the presence of a drug or
toxin. Once pseudohyponatraemia has been ruled out, further assessment of plasma o
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Vitech Scientific Osmo
Tests
Calculated Osmo.
Reference Ranges
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
285
285
Units
Upper Limit
295
295
mOsm/Kg
Applicable from
14/03/1996
14/03/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
<15
<15
Units
Upper Limit
Applicable from
14/03/1996
14/03/1996
P.Osmolality
Reference Ranges
mOsm/Kg
Sex
Female
Male
Osmotic gap
Reference Ranges
Units
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
285
285
mOsm/kg H2O
Upper Limit
295
295
Applicable from
01/02/1996
01/02/1996
For patient specific reference intervals please refer to printed report or IT systems
Osmolality (serum)
Osmolality (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours & On Call
Investigation Comments:
Useful aid to the interpretation of an abnormal serum osmolality to determine the renal
concentrating ability.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Calculated U.Osmo.
Reference Ranges
mOsm/Kg
Upper Limit
900
900
mOsm/kg H2O
Applicable from
14/03/1996
14/03/1996
Upper Limit
900
900
Applicable from
01/02/1996
01/02/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
300
300
Units
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
300
300
U.Osmolality
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Osmolality (urine)
Otoblot
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
68kD Inner Ear Protein (OTOblot test) :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Otoblot
Oxalate (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
24hr Urine
Volume Required:
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Part of the urine stone screen to investigate cause of renal stones
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
A 24h collection is most helpful. Collect 24h sample in acid preservative (red top bottle)
On arrival in lab, acidify promptly with HCl to ph <2
Tests
mmol/L
Creatinine (Assayed at BCH) :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Oxalate / Creat Ratio :
Units
mmol/mol creatinine
Oxalate :
Lower Limit
15.0
11.0
6.0
2.0
15.0
11.0
6.0
2.0
Units
Upper Limit
260.0
120.0
150.0
83.0
260.0
120.0
150.0
83.0
mmol/L
Oxalate/period (24h) :
Units
mmol
Sample type :
Units
Testing Laboratory:
Units
Reference Ranges
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
0 Days
366 Days
1461 Days
12 Years
0 Days
366 Days
1461 Days
12 Years
End Age
365 Days
1460 Days
4379 Days
110 Years
365 Days
1460 Days
4379 Days
110 Years
Applicable from
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
01/06/2011
For patient specific reference intervals please refer to printed report or IT systems
Oxalate (urine)
Paediatric Split Bilirubin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Also known as conjugated bilirubin. Conjugated bilirubin performed on all total bilirubin
results greater than 50µmol/L
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
C.Bilirubin
Reference Ranges
umol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Units
Upper Limit
9
9
umol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Start Age
0 Days
2 Days
14 Days
1 Years
0 Days
2 Days
14 Days
1 Years
End Age
2 Days
14 Days
365 Days
115 Years
2 Days
14 Days
365 Days
115 Years
Lower Limit
0
0
0
0
0
0
0
0
Upper Limit
21
21
21
21
21
21
21
21
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
T.Bilirubin
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Paediatric Split Bilirubin
Pancreas biopsy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Pancreas biopsy
Paracetamol & Salicylate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Blood sample should be collected at least 4 hours after a single overdose, or as soon as
possible if more than one overdose has been taken within the last one or two days. See
BNF for guidance on treatment limits. (addition 64 onwards)
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Important to know time of drug ingestion. Take blood sample 4 hours after overdose
Tests
Paracetamol
Reference Ranges
mg/L
Sex
Female
Male
Start Age
100 Years
100 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Units
Upper Limit
1
1
mg/L
Applicable from
01/02/1996
01/02/1996
Sex
Female
Female
Male
Male
Start Age
0 Years
16 Years
0 Years
16 Years
End Age
16 Years
100 Years
16 Years
100 Years
Lower Limit
0
0
0
0
Upper Limit
290
290
290
290
Applicable from
01/02/1996
01/02/1996
01/02/1996
01/02/1996
Salicylate
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Paracetamol & Salicylate
Parathyroid Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Autoimmune Hypoparathyroidism.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Parathyroid Antibody:
Units
Sent:
Units
For patient specific reference intervals please refer to printed report or IT systems
Parathyroid Antibodies
Parathyroid Hormone
PTH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used to investigate the cause of hyper and hypocalcaemia. Result should be interpreted
with the serum calcium result.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not Possible
Special Requirements:
Refrigerate samples as soon as received in laboratory (prior to analysis)
Abbott Architect
Tests
Units
Parathyroid Hormone
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
1.6
1.6
pmol/L
Upper Limit
7.2
7.2
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Parathyroid Hormone
Parvovirus Serology
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
State date of onset and nature of symptoms. Indicate if patient is pregnant and
gestation.
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Parvovirus IgG Antibody :
Units
Parvovirus IgM Antibody :
Units
Value
Units
For patient specific reference intervals please refer to printed report or IT systems
Parvovirus Serology
Peritoneal fluid cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10 °C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Peritoneal fluid cytology
Pharmacy Sterility Tests
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
50ml Bag (40ml)
Units
Identified as:
Units
Syringe Five (2ml)
Units
Syringe Four (2ml)
Units
Syringe One (2ml)
Units
Syringe Three (2ml)
Units
Syringe Two (2ml)
Units
Vial One (20ml)
Units
Vial Three (12ml)
Units
Vial Two (20ml)
Units
For patient specific reference intervals please refer to printed report or IT systems
Pharmacy Sterility Tests
Phenobarbitone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
An anti-convulsant drug. Sample taken immediately before a dose, at least 21 days
after initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take blood sample just before dose (ie trough level)
Tests
Units
Phenobarbitone
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
End Age
115 Years
115 Years
Lower Limit
80
80
Lower Limit
10
10
umol/L
Upper Limit
160
160
Upper Limit
40
40
Applicable from
02/02/1996
02/02/1996
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Phenobarbitone
Phenytoin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
An anti-convulsant drug. Sample taken immediately before a dose, at least 21 days
after initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take blood sample just before dose (ie trough level)
Tests
Units
Phenytoin
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
End Age
115 Years
115 Years
Lower Limit
40
40
Lower Limit
5
5
umol/L
Upper Limit
80
80
Upper Limit
20
20
Applicable from
12/12/2011
12/12/2011
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Phenytoin
Pituitary Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Lymphocytic hypophysitis, Autoimmune pituitary disease, Empty cell syndrome and
some pituitary tumours
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Pituitary Antibody:
Units
Sent:
Units
For patient specific reference intervals please refer to printed report or IT systems
Pituitary Antibodies
Placental Alkaline Phosphatase
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
For use as a marker in monitoring clinically proven cases of seminoma tumours.
Tumour markers are not sufficiently sensitive or specific to use for screening.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Placental ALP
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
U/L
Lower Limit
0.0
0.0
Units
Upper Limit
0.5
0.5
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Placental Alkaline Phosphatase
Plasma Viscosity
PV
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Should only be requested if ESR and CRP are not appropriate
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Plasma Viscosity
Units
mPa/s
Lower Limit
1.50
1.50
1.50
1.50
1.50
Units
Upper Limit
1.72
1.72
1.72
1.72
1.72
Reference Ranges
Sex
Female
Female
Female (Pregnant)
Male
Male
Testing Laboratory:
Start Age
1 Days
1 Years
1 Years
1 Days
1 Years
End Age
365 Days
115 Years
115 Years
365 Days
115 Years
Applicable from
12/01/1996
12/01/1996
12/01/1996
12/01/1996
12/01/1996
For patient specific reference intervals please refer to printed report or IT systems
Plasma Viscosity
Platelets Issue
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Blood Bank
Specimen:
Availabilty:
Routine hours & On Call
Investigation Comments:
Blood Group must have been established. If not, Group and Save must be sent
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Request must be authorised by Consultant Haematologist with the exception of massive
haemorrhage protocol
Tests
COMPATIBILITY TEST
Units
FRACTION NUMBER - PLATELETS
Units
PLATELET ISSUE
Units
PRODUCT - PLATELETS
Units
UNIT GROUP - PLATELETS
Units
UNIT NUMBER - PLATELETS
Units
For patient specific reference intervals please refer to printed report or IT systems
Platelets Issue
Pleural fluid cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Pleural fluid cytology
Pneumococcal PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Streptococcus pneumoniae DNA
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Pneumococcal PCR
PNH Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Consultant approval required.
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Diagnosis:
Units
For patient specific reference intervals please refer to printed report or IT systems
PNH Screen
Polyoma JC Virus PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Urine
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
JC virus haemagg inhibition
Units
Polyoma JC virus DNA
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Polyoma JC Virus PCR
Pool Water Analysis
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
API
Units
Control
Units
cfu/100ml
COUNT 1
Units
cfu/100ml
Duplicate
Units
cfu/100ml
Location
Units
Mean TVC
Units
OX+ G-R
Units
Pseudomonas aeruginosa isolated
Units
cfu/ml
cfu/100ml
For patient specific reference intervals please refer to printed report or IT systems
Pool Water Analysis
Porphyria Screen (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
EDTA
Universal
Volume Required:
1ml
Collect Porphyria screening kit from laboratory
Request Form:
Pathology Combined
Specimen:
Random Urine / Faeces / Blood
Availabilty:
Routine hours only
Investigation Comments:
Measure U&E and LFT also
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Samples need to be kept in darkContact laboratory for advice and sample collection kit
Contact laboratory for advice and sample collection kit
Tests
Total Faecal Porphyrins
Units
Total Urine Porphyrins
Units
Units
U.Creat.Conc.
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
mmol/L
Upper Limit
9.4
14.2
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Porphyria Screen (urine)
Porphyrins
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Porphyrin Result :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Porphyrins
Pregnancy Test (serum)
BHCG
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Used for investigation of pregnancy states.
Give LMP or gestational age on request form. Urine test recommended for standard
pregnancy test
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Give LMP or gestational age on request form if possible.
Tests
Units
Beta HCG
Reference Ranges
Sex
Female
Start Age
0 Years
End Age
100 Years
Lower Limit
IU/L
Upper Limit
<5
Applicable from
23/04/2012
For patient specific reference intervals please refer to printed report or IT systems
Pregnancy Test (serum)
Pregnancy Test (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
1ml
Request Form:
Pathology Combined
Specimen:
Mid Stream Urine
Availabilty:
Routine hours only
Investigation Comments:
Urine samples should be fresh early morning specimen. Routine test has a cut-off at 25
IU/L
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Urine Pregnancy
Units
For patient specific reference intervals please refer to printed report or IT systems
Pregnancy Test (urine)
Procalcitonin
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
PROCALCITONIN
Units
TIME SAMPLE TAKEN:
Units
ng/mL
For patient specific reference intervals please refer to printed report or IT systems
Procalcitonin
Procollagen Type III Peptide
P3NP
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
2ml
Red top container is ONLY suitable for this test
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Serum P3NP concentrations is a strong predictive indicator of the development of
hepatic fibrosis in patients treated with high dose methotrexate. Current guidelines on
the use of methotrexate in psoriasis suggest P3NP measurements be carried out
annually
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Do not use gel separator tubes
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Procoll 3 NP
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Testing Laboratory:
Start Age
0 Years
2 Years
4 Years
11 Years
15 Years
20 Years
0 Years
2 Years
4 Years
11 Years
15 Years
20 Years
End Age
2 Years
4 Years
10 Years
14 Years
19 Years
100 Years
2 Years
4 Years
10 Years
14 Years
19 Years
100 Years
Units
ug/L
Lower Limit
10
5
5
8
2
1.7
10
5
5
5
8
1.7
Units
Upper Limit
50
15
10
15
8
4.2
50
15
10
10
20
4.2
Applicable from
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
20/08/1998
For patient specific reference intervals please refer to printed report or IT systems
Procollagen Type III Peptide
Progesterone
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
SST
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Test used to assess the probability of ovulation.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Levels vary through menstrual cycle.Blood should be sampled between days 19 -25 of the
menstrual cycle (mid-luteal phase)
Blood should be sampled between days 19 -25 of the menstrual cycle (mid-luteal phase)
Tests
Day of cycle
Units
Progesterone
Units
nmol/L
For patient specific reference intervals please refer to printed report or IT systems
Progesterone
Prolactin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Levels can be increased by stress, exercise and sleep. If result greater than 600 mU/L
sample will be tested for the presence of macroprolactin
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Prolactin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
109
73
mU/L
Upper Limit
557
407
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Prolactin
Prophylax Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Request Form:
Specimen:
Blood Bank
Venous Blood
Availabilty:
Investigation Comments:
Reflex test for establishing presence of anti- D immunoglobin - Cannot be requested by
users
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Prophylax Result
Units
Screening cell 1
Units
Screening cell 2
Units
Screening cell 3
Units
Screening cell 4
Units
Screening cell 5
Units
Screening cell 6
Units
For patient specific reference intervals please refer to printed report or IT systems
Prophylax Screen
Prostate Specific Antigen
PSA
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
For use in the diagnosis and monitoring of prostatic cancer. This is not a screening
test. Raised levels can occur in males with benign prostatic hypertrophy and with
malignant prostate tissue.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Blood sample should be taken either immediately before a digital recatl examination or at
least a week efter examination.
Tests
Units
Prost.Spec.Antigen
Reference Ranges
Sex
Male
Male
Male
Male
Start Age
0 Years
30 Years
60 Years
70 Years
End Age
30 Years
60 Years
70 Years
115 Years
Lower Limit
0
0
0
ng/ml
Upper Limit
3.0
4.0
5.0
Applicable from
15/12/2003
15/12/2003
15/12/2003
15/12/2003
For patient specific reference intervals please refer to printed report or IT systems
Prostate Specific Antigen
Prostatectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Prostatectomy
Protein (24hr urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
24hr Urine
Volume Required:
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only
Investigation Comments:
Estimates protein losses through the kidney and is used in the investigation of patients
with renal failure, pre-eclampsia and nephrotic syndrome.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
For a 24 hour collection, all of the urine should be collected over the 24 hour period. It is
important that the sample is refridgerated during this time period.
Tests
24 Hr Urine Volume.
Units
Litres
U.Protein Conc.
Units
g/L
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Units
U.Protein Exc.
Reference Ranges
Lower Limit
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0
0
Upper Limit
<0.15
<0.15
g/24hrs
Applicable from
19/02/1996
19/02/1996
Upper Limit
0.15
0.15
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Protein (24hr urine)
Protein (random urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
3ml
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Important for diagnosis and treatment of diseases associated with renal, cardiac and
thyroid function
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
U.Creat.Conc.
Reference Ranges
Upper Limit
9.4
14.2
g/L
Applicable from
12/12/2011
12/12/2011
Upper Limit
<0.15
<0.15
mg/mmol Cr
Applicable from
19/02/1996
19/02/1996
Upper Limit
15
15
Applicable from
09/12/2011
09/12/2011
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
Units
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Units
Urine protein/creatinine ratio
Reference Ranges
mmol/L
Sex
Female
Male
U.Protein Conc.
Reference Ranges
Units
Sex
Female
Male
Lower Limit
0
0
For patient specific reference intervals please refer to printed report or IT systems
Protein (random urine)
Protein C
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
By arrangement with Consultant Haematologist
Investigation Comments:
Usually only available as part of a full Thrombophilia Screen
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
24 months frozen at Minus 70°C
Special Requirements:
MDA
Tests
Protein C Antigen
Reference Ranges
Sex
Female
Male
Sex
Female
Male
IU/ML
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
0.83
0.83
Units
Upper Limit
1.50
1.50
IU/ML
Applicable from
04/04/2014
04/04/2014
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.79
0.79
Upper Limit
1.61
1.61
Applicable from
01/04/2009
01/04/2009
Protein C Chromogenic
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Protein C
Protein Electrophoresis (serum)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
For the investigation of multiple myeloma, LPD, Immunodeficiency, Paraprotein
Neuropathy
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If multipul myelema suspected an early morning urine sample should also be sent for Bence
Jones Protein analysis
Sebia Hydrasys
Tests
Albumin
Reference Ranges
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
35
35
Units
Upper Limit
50
50
g/L
Applicable from
15/01/1996
15/01/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
g/L
Applicable from
21/06/2012
21/06/2012
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
End Age
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
110 Years
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
110 Years
Lower Limit
0.10
0.15
0.20
0.3
0.30
0.40
0.50
0.70
0.80
0.70
0.70
0.10
0.15
0.20
0.30
0.30
0.40
0.50
0.70
0.80
0.80
0.80
Upper Limit
0.50
0.70
0.70
1.20
1.20
2.00
2.40
2.50
2.80
4.00
4.00
0.50
0.70
0.70
1.20
1.30
2.00
2.40
2.50
2.80
4.00
4.00
Applicable from
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
Immunoglobulin A
Reference Ranges
g/L
Sex
Female
Male
Globulin
Reference Ranges
Units
Protein Electrophoresis (serum)
Protein Electrophoresis (serum)
Units
g/L
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
15 Days
43 Days
3 Months
7 Months
10 Months
1 Years
2 Years
3 Years
6 Years
16 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
End Age
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
110 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
110 Years
Lower Limit
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
Units
Upper Limit
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
g/L
Applicable from
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
End Age
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
110 Years
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
110 Years
Upper Limit
1.00
1.60
2.10
2.20
2.00
1.80
1.90
1.90
2.00
1.00
1.60
2.10
2.20
2.00
1.80
1.90
1.90
2.00
g/L
Applicable from
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
Monoclonal Ig
Lower Limit
0.20
0.40
0.60
0.50
0.50
0.50
0.50
0.50
0.50
0.20
0.40
0.60
0.50
0.50
0.50
0.50
0.50
0.50
Units
Monoclonal Isotype
Units
ProElectrophoresis
Units
Immunoglobulin G
Reference Ranges
Immunoglobulin M
Reference Ranges
Units
Total Protein
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
g/L
Upper Limit
80
80
Applicable from
15/01/1996
15/01/1996
For patient specific reference intervals please refer to printed report or IT systems
Protein Electrophoresis (serum)
Protein Electrophoresis (urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
10ml
Request Form:
Pathology Combined
Min 5ml, preferred 10 ml
Specimen:
Early morning Urine
Availabilty:
Routine hours only
Investigation Comments:
Also known as Bence Jones Protein analysis
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Not possible
Special Requirements:
Tests
% of Total U.Protein
Units
%
Monoclonal Ig
Units
g/L
Monoclonal Isotype
Units
Pro.Electrophoresis
Units
Units
U.Protein Conc.
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
200 Years
200 Years
Lower Limit
0.00
0.00
g/L
Upper Limit
0.15
0.15
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Protein Electrophoresis (urine)
Protein Immunofixation
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Test used to detect and identify abnormal monoclonal proteins
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Sebia Hydrasys
Tests
Units
g/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
35
35
Units
Upper Limit
50
50
g/L
Applicable from
15/01/1996
15/01/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
g/L
Applicable from
21/06/2012
21/06/2012
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
End Age
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
110 Years
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
9 Years
12 Years
13 Years
45 Years
110 Years
Lower Limit
0.10
0.15
0.20
0.3
0.30
0.40
0.50
0.70
0.80
0.70
0.70
0.10
0.15
0.20
0.30
0.30
0.40
0.50
0.70
0.80
0.80
0.80
Units
Upper Limit
0.50
0.70
0.70
1.20
1.20
2.00
2.40
2.50
2.80
4.00
4.00
0.50
0.70
0.70
1.20
1.30
2.00
2.40
2.50
2.80
4.00
4.00
g/L
Applicable from
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
Sex
Start Age
End Age
Lower Limit
Upper Limit
Applicable from
Albumin
Reference Ranges
Globulin
Reference Ranges
Immunoglobulin A
Reference Ranges
Immunoglobulin G
Reference Ranges
Protein Immunofixation
Protein Immunofixation
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
0 Days
15 Days
43 Days
3 Months
7 Months
10 Months
1 Years
2 Years
3 Years
6 Years
16 Years
0 Days
15 Days
43 Days
3 Months
6 Months
9 Months
1 Years
2 Years
3 Years
6 Years
16 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
110 Years
14 Days
42 Days
84 Days
6 Months
9 Months
12 Months
2 Years
3 Years
6 Years
15 Years
110 Years
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
5.0
3.9
2.1
2.4
3.0
3.0
3.1
3.7
4.9
5.4
6.0
Units
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
17.0
13.0
7.7
8.8
9.0
10.9
13.8
15.8
16.1
16.1
16.0
g/L
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
End Age
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
110 Years
6 Months
9 Months
12 Months
3 Years
6 Years
12 Years
15 Years
45 Years
110 Years
Upper Limit
1.00
1.60
2.10
2.20
2.00
1.80
1.90
1.90
2.00
1.00
1.60
2.10
2.20
2.00
1.80
1.90
1.90
2.00
g/L
Applicable from
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
01/07/2013
Monoclonal Ig
Lower Limit
0.20
0.40
0.60
0.50
0.50
0.50
0.50
0.50
0.50
0.20
0.40
0.60
0.50
0.50
0.50
0.50
0.50
0.50
Units
Monoclonal Isotype
Units
ProElectrophoresis
Units
Total Protein
Units
Immunoglobulin M
Reference Ranges
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Sex
Female
Male
Start Age
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
3 Months
6 Months
9 Months
1 Years
3 Years
6 Years
12 Years
15 Years
45 Years
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
g/L
Upper Limit
80
80
Applicable from
15/01/1996
15/01/1996
For patient specific reference intervals please refer to printed report or IT systems
Protein Immunofixation
Prothrombin Time
PT
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Citrate
Volume Required:
4.5ml
Must be filled to the blue line on the side of the tube
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
Special Requirements:
Tests
Units
INR
Units
Prothrombin Time
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
130 Years
130 Years
Lower Limit
9.4
9.4
Unit
secs
Upper Limit
12.5
12.5
Applicable from
14/12/2011
14/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Prothrombin Time
PT Allele
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Citrate
4.5ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Consultant only request - Part of Thrombophilia Screen.
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 70°C
Special Requirements:
Tests
Prothrombin 20210A Allele
Units
For patient specific reference intervals please refer to printed report or IT systems
PT Allele
Pyruvate Kinase Screen
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
4.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Samples sent to Kings College Hospital (020 32999000)
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Refrigerate sample
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
G6PD
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
4.5
4.5
Units
Upper Limit
10.0
10.0
Applicable from
03/03/2011
03/03/2011
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
4.5
4.5
Units
Upper Limit
10.0
10.0
Applicable from
03/03/2011
03/03/2011
PYRUVATE KINASE
Reference Ranges
Sex
Female
Male
Testing Laboratory:
For patient specific reference intervals please refer to printed report or IT systems
Pyruvate Kinase Screen
Rabies
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
Rabies FAVN Ab for human bite
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Rabies
Renin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Heparin
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (sent away)
Investigation Comments:
Normally requested as aldosterone and renin to investigate secondary causes of
hypertension. Reference ranges are only reported for Random levels.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
Stable as whole blood for 4 hours at room temperature. Samples should be received in
the laboratory within 3 hours.
Long Term Stability
Minus 20°C
Special Requirements:
Stable as whole blood for 4 hours at room temperature. Samples should be received in the
laboratory within 3 hours
Tests
Comment
Units
Date Result Returned:
Units
Enquiry Line:
Units
Plasma Renin Activity (PRA) :
Units
Posture
Units
Testing Laboratory:
Units
pmol/mL/Hr.
For patient specific reference intervals please refer to printed report or IT systems
Renin
Respiratory Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Sputum
Other specimens may be processed with prior arrangement
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Culture Result:
Units
FOR CON AUTH
Units
GROWTH
Units
Isolate 1
Units
Isolate 2
Units
Isolate 3
Units
Isolate 4
Units
MALDI ID
Units
MALDI VALUE
Units
Non.sig.isolate 1:
Units
Non.sig.isolate 2:
Units
Not isolated:
Units
Patient located on:
Units
PLATES FOR RE-INCUBATION
Units
Site:
Units
Specimen Type:
Units
SUB ISOL 2
Units
SUB ISOL 4
Units
Respiratory Culture
Respiratory Culture
SUB ISOL3
Units
To follow:
Units
Y for complete S for extra sens :
Units
For patient specific reference intervals please refer to printed report or IT systems
Respiratory Culture
Respiratory Syncitial Virus
RSV
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Nasopharyngeal aspirate
Availabilty:
Investigation Comments:
Storage Requirements:
Specimens should be sent to the laboratory without delay during normal hours. Outside
of normal hours samples should be refrigerated.
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Kit Lot No. :
Units
QC passed?
Units
Respiratory Syncytial Virus
Units
Test performed by:
Units
For patient specific reference intervals please refer to printed report or IT systems
Respiratory Syncitial Virus
Reticulocytes
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Reticulocytes continue to mature 'In Vitro' therefore samples should be used for same
day analysis only. Performed in conjunction with FBC.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Tests
RBC
Reference Ranges
Sex
Female
Female
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Start Age
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
0 Days
7 Days
90 Days
1 Years
3 Years
6 Years
10 Years
12 Years
End Age
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
7 Days
90 Days
366 Days
3 Years
6 Years
10 Years
12 Years
115 Years
Sex
Female
Male
Start Age
1 Years
1 Years
End Age
115 Years
115 Years
Retic Percent
x 10^12/L
Lower Limit
4.1
4.1
3.9
3.9
3.9
4.0
4.1
4.2
4.1
4.1
3.9
3.9
3.9
4.0
4.1
4.4
Units
Upper Limit
6.1
6.1
5.2
5.4
5.4
5.3
5.3
5.4
6.1
6.1
5.2
5.3
5.4
5.3
5.3
6.0
%
Units
Reticulocyte Count
Reference Ranges
Units
Lower Limit
10
10
Applicable from
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
10/01/1996
x 10^9/L
Upper Limit
100
100
Applicable from
04/04/2014
04/04/2014
For patient specific reference intervals please refer to printed report or IT systems
Reticulocytes
Rhesus and K Phenotype
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
EDTA X-Match
2ml
Not requested by Users
Request Form:
Specimen:
Blood Bank
Venous Blood
Availabilty:
Investigation Comments:
Requested by Blood Bank before provision of blood to certain patient groups and/or
establishing presence of all antibodies
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Anti-C
Units
ANTI-E
Units
Anti-K
Units
PROBABLE GENEOTYPE
Units
PROBABLE PHENOTYPE
Units
For patient specific reference intervals please refer to printed report or IT systems
Rhesus and K Phenotype
Rheumatoid Factor
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Rheumatoid factor (RF) is sensitive but not specific for rheumatoid arthritis since this
autoantibody can be associated with other autoimmune disorders.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Rheumatoid Factor :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
IU/mL
Upper Limit
30
30
Applicable from
01/11/2011
01/11/2011
For patient specific reference intervals please refer to printed report or IT systems
Rheumatoid Factor
Rubella Confirmation
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
B-2 Microglobin (Internal Control Gene)
Units
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Rubella Avidity Index
Units
Rubella Avidity Qualitative
Units
Rubella IgG Antibody
Units
Rubella IgG EIA (Siemens Enzygnost Optical density
Units
Rubella IgG EIA Qualitative
Units
Rubella IgG Quantitative
Units
Rubella IgM antibody :
Units
Rubella IgM EIA ( Microimmune)
Units
Rubella IgM EIA (Siemens Enzygnost) Optical density
Units
Rubella IgM EIA (siemens Enzygnost) Qualitative result
Units
Rubella RT-PCR
Units
%
IU/mL
Cut off > 0.200
Rubella Confirmation
Rubella Confirmation
Rubella virus RNA
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Rubella Confirmation
Salivary gland aspiration cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal Cytospin
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Salivary gland aspiration cytology
Salivary gland excision
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Salivary gland excision
Selenium
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Trace Element
Volume Required:
5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Interpreting selenium concentration in 'sick' individuals is very problematic. Studies
show selenium and zinc concentrations decrease as CRP increases. Recommend only
assess selenium in individuals with CRP less than 15ng/L. Please refer to nutrition
guidelines
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C (In plastic tube)
Special Requirements:
Tests
Date Result Returned:
Units
Selenium
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.61
0.61
umol/L
Upper Limit
1.24
1.24
Applicable from
08/08/2014
08/08/2014
For patient specific reference intervals please refer to printed report or IT systems
Selenium
Semen Analysis - Infertility
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Semenology Andrology
Request
Container(s):
Volume Required:
Universal
Single complete ejaculate
Sterile Universal, Toxicity tested
Request Form:
Histology WPR2580
Specimen:
Semen - single whole ejaculate
Incomplete or leaking samples are unsuitable for investigation and will not be
processed
Availabilty:
Histopathology, DRI – Monday to Friday between 9.00am to 12.00pm (noon)
(except Bank holidays).
Sample must reach the Histopathology lab at DRI within 1 hour of production.
BDGH patients are advised to deliver samples directly to Histopathology spec
Investigation Comments:
Initial examination of the sample should be performed by the lab within 1 hour of
production
Storage Requirements:
Body temperature. Following production keep the sample warm by placing close to the
body or in a pocket and deliver to Histopathology, DRI within 1 hour of production
Short Term Stability
Body Temperature - Sample must reach laboratory within 1 hour of production
Long Term Stability
Not possible
Special Requirements:
Deliver to Histopathology reception, DRI within 1 hour of production. Presence of patient is
required to complete additional paperwork. All high risk specimens should be clearly
marked 'danger of infection' on both form and pot.
Tests
Abstinence period:
Units
Agglutination proportion:
Units
Agglutination Type:
Units
Aggregation :
Units
Appearance:
Units
Bacteria :
Units
BPAS
Units
Crystals :
Units
Cytotoxicity tested container:
Units
Ejaculation/analysis interval:
Units
Excess round cells ( >10 /FIELD) :
Units
Liquefaction:
Units
Morphology: Normal
Units
%
Motility Immotile (IM):
Units
%
Semen Analysis - Infertility
Semen Analysis - Infertility
Motility Non-progressive (NP):
Units
%
Motility Progressive (PR):
Units
%
pH:
Units
RBC's :
Units
Sperm concentration (Million per mL):
Units
Total sperm count: (Million per ejaculate):
Units
Viscosity:
Units
Vitality Vital:
Units
%
Vitality Dead:
Units
%
Volume :
Reference Ranges
Sex
Male
Was the whole sample collected?
Start Age
0 Days
End Age
0 Days
Units
mL
Lower Limit
1.5
Units
Upper Limit
6
Applicable from
05/02/2013
For patient specific reference intervals please refer to printed report or IT systems
Semen Analysis - Infertility
Semen Analysis - Post Vasectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Semenology Andrology
Request
Container(s):
Universal
Volume Required:
Single complete ejaculate
Sterile Universal, Toxicity tested
Request Form:
Histology WPR2580
Specimen:
Semen - single whole ejaculate
Incomplete or leaking samples are unsuitable for investigation and will not be
processed
Availabilty:
DRI - Monday to Friday between 9.00 and 12.00
BDGH – Monday to Friday between 10.45am and 11.15am, for onward
transport to DRI
(except Bank holidays)
Investigation Comments:
Samples must be delivered to Histopathology, DRI within 4 hours of production.
Patients are required to produce two, consecutive, clear samples (i.e. no sperm seen)
following vasectomy at pre-determined intervals. If two clear samples are provided then t
Storage Requirements:
Body Temperature. Following production the sample should be kept warm by placing
the container in a pocket close to the body and delivered to the laboratory as soon as
possible.
Short Term Stability
Body Temperature
Long Term Stability
Not possible
Special Requirements:
Deliver to Histopathology reception, DRI within 4 hours of production. Delivery to Pathology
reception, BDGH within 1 hour of production for onward transport to DRI.
Incomplete of leaking samples will not be processed.
Presence of patient is required to complete additional paperwork.
All high risk specimens should be clearly marked ‘danger of infection’ on both form and pot.
Tests
Appearance:
Units
Centrifuge (Thin prep) :
Units
Cytotoxicity tested container:
Units
Ejaculation/analysis interval:
Units
Liquefaction:
Units
Motile:
Units
Units
mL
Upper Limit
6
Was the whole sample collected?
Lower Limit
1.5
Units
Wet film
Units
Volume :
Reference Ranges
:
Sex
Male
Start Age
0 Days
End Age
0 Days
Applicable from
05/02/2013
For patient specific reference intervals please refer to printed report or IT systems
Semen Analysis - Post Vasectomy
Serotonin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
5 Hydroxytryptamine
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Send FBC result with sample
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Serotonin :
Units
nmol/10*9 platlets
Lower Limit
0
0
Units
Upper Limit
7.0
7.0
Reference Ranges
Sex
Female
Male
Testing Laboratory:
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Serotonin
Sex Hormone Binding Globulin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Measurement of SHBG is only necessary to estimate the amount of bioavailable
testosterone available to the body's tissues.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Free Androgen Index
Reference Ranges
Start Age
0 Years
End Age
110 Years
Lower Limit
0.6
Units
Upper Limit
8
nmol/L
Applicable from
01/10/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
19.8
13.5
Units
Upper Limit
155.2
71.4
nmol/L
Applicable from
01/10/2011
01/10/2011
Sex
Female
Start Age
0 Years
End Age
110 Years
Lower Limit
0.38
Upper Limit
1.97
Applicable from
01/06/2013
Testosterone
Reference Ranges
%
Sex
Female
SHBG
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Sex Hormone Binding Globulin
Sex Hormone Binding Globulin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Measurement of SHBG is only necessary to estimate the amount of bioavailable
testosterone available to the body's tissues.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
SHBG
Reference Ranges
nmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
19.8
13.5
Units
Upper Limit
155.2
71.4
nmol/L
Applicable from
01/10/2011
01/10/2011
Sex
Male
Start Age
0 Years
End Age
110 Years
Lower Limit
6
Upper Limit
30
Applicable from
02/10/2011
Testosterone :
Reference Ranges
Units
For patient specific reference intervals please refer to printed report or IT systems
Sex Hormone Binding Globulin
Sirolimus
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
EDTA
4.5ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Sirolimus :
Units
Testing Laboratory:
Units
ng/ml
For patient specific reference intervals please refer to printed report or IT systems
Sirolimus
Skeletal Muscle Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Myasthenia Gravis, Thymoma
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Skeletal Muscle Ab:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Skeletal Muscle Antibodies
Small bowel resection
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Small bowel resection
Sperm Cell Antibody
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Infertility
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Sperm Antibody :
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Sperm Cell Antibody
Sputum cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Sterile universal
Request Form:
Histology WPR2580
Specimen:
Sputum
Availabilty:
Mon to Fri - sample to arrive at DRI before 4.00pm
Investigation Comments:
Samples are only accepted from chest physicians
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Sputum cytology
Stone Analysis
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
24hr Urine
Volume Required:
Request Form:
Specimen:
24h urine
Availabilty:
Routine hours only
Investigation Comments:
Urinary screen to investigate cause of renal stones. Includes calcium, phosphate,
oxalate, creatinine, urate and electrolytes.
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Two 24h collections are required; one in acid (red top) and one plain collection (blue or white
top).
Tests
Date Result Returned:
Units
Description
Units
Enquiry Line:
Units
Major component
Units
Minor Component
Units
Size
Units
Source of calculus
Units
Testing Laboratory:
Units
Date Result Returned:
Units
Description
Units
Enquiry Line:
Units
Major component
Units
Minor Component
Units
Size
Units
Source of calculus
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Stone Analysis
Sweat Test
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Contact Laboratory for appointment. Collecting device taken by lab staff
performing the procedure.
Request Form:
Pathology Combined
Specimen:
Sweat
Availabilty:
Routine hours only
Investigation Comments:
This test is performed to rule out cystic fibrosis as a cause of the patient's symptoms
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not possible
Special Requirements:
Sweat tests should be deferred in babies less than 7 days old and/or less than 3kg in weight.
The test shoud not be performed on children who are dehydrated, systemically unwell or who
have marked eczema or oedema. Please contact the lab on ext 3131 to the procedure. NB
Risk of burn with the procedure.
Tests
Units
Conductivity
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
>1
>1
Units
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
Units
Rate of Sweat prod.
Reference Ranges
Sweat Chloride
Reference Ranges
Lower Limit
mmol/L
Upper Limit
<60
<60
ml/sqM/min
Applicable from
21/03/1996
21/03/1996
Upper Limit
Applicable from
15/11/2005
15/11/2005
mmol/L
Upper Limit
<40
<40
Applicable from
21/03/1996
21/03/1996
For patient specific reference intervals please refer to printed report or IT systems
Sweat Test
Synovial fluid analysis
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Synovial fluid analysis
Syphillis Antibodies
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
C/O :
Units
O.D. :
Units
Result:
Units
For patient specific reference intervals please refer to printed report or IT systems
Syphillis Antibodies
Tau Protein
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
1ml
Request Form:
Specimen:
SST
Pathology Combined
Nasal Fluid & Serum
Availabilty:
Investigation Comments:
Freeze as soon as possible after collection.
Used to differentiate nasal fluid from CSF.
Serum sample must always be sent with the fluid.
Storage Requirements:
Short Term Stability
Minus 20°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
B-2-Transferrin (Tau) :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Tau Protein
TB Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Sputum
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Culture Result:
Units
For patient specific reference intervals please refer to printed report or IT systems
TB Culture
Theophylline
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.4ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Drug with bronchial smooth muscle relaxing effects, used in the treatment of chronic
asthma and bronchospasm.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Timing of sample relative to dose is not important for interpretation but should be maintained
as constant as possible within a series of measurements.
Please state TIME of sample on request form
Abbott Architect
Tests
Units
Theophylline
Reference Ranges
Reference Ranges
Sex
Female
Female
Female
Male
Male
Male
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Months
2 Months
1 Years
0 Months
2 Months
1 Years
Start Age
0 Days
61 Days
1 Years
0 Days
61 Days
1 Years
End Age
2 Months
12 Months
100 Years
2 Months
12 Months
100 Years
End Age
60 Days
365 Days
115 Years
60 Days
365 Days
115 Years
Lower Limit
33
55
55
33
55
55
Lower Limit
6
10
10
6
10
10
umol/L
Upper Limit
61
111
111
61
111
111
Upper Limit
11
20
20
11
20
20
Applicable from
02/02/1996
02/02/1996
02/02/1996
02/02/1996
02/02/1996
02/02/1996
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Theophylline
Thiopurine Methyltransferase
TPMT
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
4.5ml
The sample must not be frozen and should be stored at room temperature before
dispatch
Request Form:
Pathology Combined
Specimen:
Routine hours only (Sent away)
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Units
TPMT :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
26
26
pmol/h/mgHb
Upper Limit
50
50
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Thiopurine Methyltransferase
Thyroglobulin
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Thyroglobulin is useful for monitoring follicular thyroid cancers, not for screening or
diagnosis. Test includes anti-thyroglobulin antibodies.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Units
IU/ml
Upper Limit
115
115
Date Result Returned:
Lower Limit
0
0
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Anti - TG
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
Thyroglobulin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
1.4
1.4
Applicable from
03/03/2011
03/03/2011
ug/L
Upper Limit
78.0
78.0
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Thyroglobulin
Thyroid Antibodies
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Found in patients with Grave's disease (60%), Hashimoto's (90%) and primary
myxoedema
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Anti- Thyroid Peroxidase
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
IU/mL
Upper Limit
<5.61
<5.61
Applicable from
01/05/2012
01/05/2012
For patient specific reference intervals please refer to printed report or IT systems
Thyroid Antibodies
Thyroid aspiration cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal Cytospin
Less than 20ml
Request Form:
Histology WPR2580
Specimen:
Fluid
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly. Ensure left and right samples from the
same patient are clearly labelled.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Thyroid aspiration cytology
Thyroidectomy
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Histology Pot
Sample must be fully immersed in formalin
Request Form:
Histology WPR2580
Specimen:
Tissue biopsy / resection
Availabilty:
Monday to Friday
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Room Temperature - do not refrigerate
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
12 - 28°C (Ambient Temperature)
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Thyroidectomy
Tissue / Fluid Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Tissue / Fluid
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Special Requirements:
Tests
Culture Result:
Units
GROWTH
Units
Isolate 1
Units
Isolate 2
Units
Isolate 3
Units
Isolate 4
Units
MALDI ID
Units
MALDI VALUE
Units
Not isolated:
Units
Patient located on:
Units
PLATES FOR RE-INCUBATION
Units
Site:
Units
Specimen Type:
Units
SUB ISOL 2
Units
SUB ISOL 4
Units
SUB ISOL3
Units
To follow:
Units
Y for complete S for extra sens :
Units
Tissue / Fluid Culture
Tissue / Fluid Culture
For patient specific reference intervals please refer to printed report or IT systems
Tissue / Fluid Culture
Tissue Transglutaminase
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
0.25ml
Request Form:
Pathology combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Only performed on children <5 yrs old with a negative ENDO result
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
IgG TTG useful for IgA deficient patients with suspected Coeliac disease. IgA TTG may be
falsely positive especially in liver disease
Tests
Date Result Returned:
Units
IgA t-Transglutaminase:
Units
U/ml
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0
0
Units
Upper Limit
7
7
U/ml
Applicable from
12/12/2014
12/12/2014
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
0
0
Upper Limit
7
7
Applicable from
19/02/2014
19/02/2014
IgG t-Transglutaminase:
Reference Ranges
Sex
Female
Male
For patient specific reference intervals please refer to printed report or IT systems
Tissue Transglutaminase
Tobramycin Assay
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
On Request - Referred test to Microbiology Dept, RHH, Sheffield
Investigation Comments:
Please complete "Assay Request Forms" in full, specific labels for assay samples are
available. These can be obtained from Pathology Reception. Assays with incomplete
dosing and specimen details will be rejected.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received:
Units
Date sent:
Units
Dosing Regime:
Units
Reference lab no:
Units
Reference lab:
Units
Time of last dose:
Units
Time of sample collection:
Units
Tobramycin level
Units
WHO SENT?
Units
mg/l
For patient specific reference intervals please refer to printed report or IT systems
Tobramycin Assay
Topiramate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
Heparin
0.5ml
Analysis on Saliva can also be undertaken
Request Form:
Pathology Combined
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Topiramate Dose
Units
Topiramate level
Reference Ranges
Topiramate time
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Units
mg/L
Lower Limit
5
5
Units
Upper Limit
20
20
Applicable from
01/09/2012
01/09/2012
For patient specific reference intervals please refer to printed report or IT systems
Topiramate
Total Protein & Albumin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On call
Investigation Comments:
Part of LFT and Bone Profile
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
g/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
g/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
23
23
Units
Upper Limit
40
40
g/L
Applicable from
21/06/2012
21/06/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
60
60
Upper Limit
80
80
Applicable from
12/12/2011
12/12/2011
Albumin
Reference Ranges
Globulin
Reference Ranges
Total Protein
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Total Protein & Albumin
Toxoplasma Confirmation
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Microbiologist or Infection Control
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Specimen:
Pathology Combined
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Toxoplasma Dye Test
Units
Toxoplasma IgG Antibody
Units
Toxoplasma IgG avidity
Units
Toxoplasma IgM (EIA)
Units
Toxoplasma IgM Antibody
Units
Toxoplasma ISAGA IgA
Units
Toxoplasma ISAGA IgM
Units
Toxoplasma Total Ab (Latex)
Units
WHO SENT?
Units
IU/ml
For patient specific reference intervals please refer to printed report or IT systems
Toxoplasma Confirmation
Transferrin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.5ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Transferrin is the major plasma transport protein for iron. Measure with iron and ferritin
in the assessment of iron status.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
TIBC
Units
umol/L
Transferrin
Units
g/L
Lower Limit
2.0
2.0
Units
Upper Limit
3.2
3.2
%
Reference Ranges
Transferrin sat
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Transferrin
Troponin I
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Heparin
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
This test measures cardiac specific troponin I (cTnI), which is elevated post MI. Levels
of cardiac troponin can increase in the blood within 3 or 4 hours after the attack and
may remain high for 10 to 14 days. Grossly haemolysed samples will not be assayed.
Haemolysed samples will not be assayed
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Haemolysed samples will not be assayed. Take sample 12 hours post chest pain.
Tests
Hrs post
Units
Troponin I
Units
ng/L
For patient specific reference intervals please refer to printed report or IT systems
Troponin I
Tryptase
Department:
Immunology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
SST
2ml
Purple or Gold
Request Form:
Pathology Combined
Specimen:
Plasma
Availabilty:
Routine hours only
Investigation Comments:
Anaphyaxis - mast cell syndromes such as mastocytosis
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Samples should be collected within 1 hour of anaphylactic reaction and subsequently at 3
and 24 hours. Rheumatoid factor may interfere with assay.
Tests
Date Result Returned:
Units
Enquiry Line:
Units
IgG :
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
Testing Laboratory:
Units
Tryptase :
Units
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
2.0
2.0
g/L
Upper Limit
Applicable from
01/08/2014
01/08/2014
ug/L
Upper Limit
14.0
14.0
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Tryptase
Uncrossmatched Blood Issue
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
Volume Required:
Speak to blood bank: Sample maybe required
Request Form:
Blood Bank
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
COMPATIBILITY TEST
Units
FRACTION NUMBER
Units
PRODUCT
Units
UNIT GROUP
Units
UNIT NUMBER
Units
UN-X-MATCHED ISSUE
Units
For patient specific reference intervals please refer to printed report or IT systems
Uncrossmatched Blood Issue
Urea & Electrolytes
U&E
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.25ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Aki Status
Reference Ranges
Sex
Female
Male
Start Age
18 Years
18 Years
End Age
110 Years
110 Years
Lower Limit
AKI Status :
Units
AKI Status NHS :
Units
AKI Status NTH :
Units
Units
umol/L
Start Age
0 Days
8 Days
28 Days
1 Years
14 Years
16 Years
0 Days
7 Days
28 Days
1 Years
14 Years
16 Years
End Age
7 Days
28 Days
365 Days
14 Years
16 Years
110 Years
7 Days
28 Days
365 Days
14 Years
16 Years
110 Years
Lower Limit
0
0
0
0
0
0
0
0
0
0
0
0
Units
Upper Limit
107
76
54
90
94
90
107
76
54
66
94
104
umol/L
Applicable from
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
05/06/2006
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Male
Start Age
0 Days
8 Days
29 Days
1 Years
14 Years
16 Years
0 Days
8 Days
29 Days
End Age
7 Days
28 Days
365 Days
14 Years
16 Years
110 Years
7 Days
28 Days
365 Days
Lower Limit
31
24
21
23
41
49
31
24
21
Upper Limit
107
76
54
66
94
90
107
76
54
Applicable from
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
01/11/2011
Creatinine :
Reference Ranges
Applicable from
05/03/2015
05/03/2015
Sex
Female
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Male
Creatinine
Reference Ranges
Upper Limit
>2
>2
Urea & Electrolytes
Urea & Electrolytes
Male
Male
Male
U&E
1 Years
14 Years
16 Years
14 Years
16 Years
110 Years
eGFR
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Sex
Female
Male
Start Age
0 Years
0 Years
Sex
Female
Male
Sex
Female
Female
Female
Female
Male
Male
Male
Male
Applicable from
02/05/2006
02/05/2006
mL/min/1.73^2
Lower Limit
0
0
Units
Upper Limit
1
1
mmol/L
Applicable from
28/09/2000
28/09/2000
End Age
115 Years
115 Years
Lower Limit
3.5
3.5
Units
Upper Limit
5.3
5.3
mmol/L
Applicable from
12/12/2011
12/12/2011
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
133
133
Units
Upper Limit
146
146
mmol/L
Applicable from
12/12/2011
12/12/2011
Start Age
0 Days
29 Days
1 Years
16 Years
0 Days
29 Days
1 Years
16 Years
End Age
28 Days
365 Days
16 Years
115 Years
28 Days
365 Days
16 Years
115 Years
Lower Limit
0.8
1.0
2.5
2.5
0.8
1.0
2.5
2.5
Upper Limit
5.5
5.5
6.5
7.8
5.5
5.5
6.5
7.8
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Urea
Reference Ranges
Upper Limit
Units
Sodium
Reference Ranges
01/11/2011
01/11/2011
01/11/2011
Applicable from
02/05/2006
02/05/2006
Potassium
Reference Ranges
Lower Limit
66
94
104
mL/min/1.73^2
Upper Limit
Haemolysis index
Reference Ranges
Lower Limit
Units
eGFR-EPI
Reference Ranges
23
41
64
Units
For patient specific reference intervals please refer to printed report or IT systems
Urea & Electrolytes
Urea & Electrolytes (24hr urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
24hr Urine
Volume Required:
Request Form:
Pathology Combined
Specimen:
24hour Urine
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
For a 24 hour collection, all of the urine should be collected over the 24 hour period. It is
important that the sample is refridgerated during this time period. There should be NO
preservative in the container. Please refer to instructions on containe
Do not use air transport tube
Tests
24 Hr Urine Volume.
Units
Litres
U.Chloride Conc.
Units
mmol/L
U.Chloride Exc.
Units
mmol/24hr
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
110
110
Units
Upper Limit
250
250
mmol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Lower Limit
3.9
5.1
Units
Upper Limit
9.4
14.2
mmol/24hr
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Upper Limit
14.1
21.3
mmol/L
Applicable from
12/12/2011
12/12/2011
U.Potassium Conc.
Lower Limit
5.9
7.7
Units
U.Potassium Exc.
Units
mmol/24hr
U.Sodium Conc.
Lower Limit
25
25
Units
Upper Limit
125
125
mmol/L
U.Sodium Exc.
Units
mmol/24hr
U.Urea Conc.
Lower Limit
40
40
Units
Upper Limit
220
220
mmol/L
U.Urea Exc.
Units
mmol/24hr
U.Creat.Conc.
Reference Ranges
U.Creat.Exc.
Reference Ranges
Reference Ranges
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Sex
Female
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
Start Age
0 Years
End Age
115 Years
115 Years
End Age
115 Years
115 Years
End Age
115 Years
Lower Limit
428
Upper Limit
714
Applicable from
12/12/2011
12/12/2011
Applicable from
12/12/2011
12/12/2011
Applicable from
12/12/2011
Urea & Electrolytes (24hr urine)
Urea & Electrolytes (24hr urine)
Male
0 Years
115 Years
428
714
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Urea & Electrolytes (24hr urine)
Urea & Electrolytes (random urine)
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Universal
Volume Required:
10ml
Mid Stream Urine Container
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Do not use air transport tube
Special Requirements:
Tests
Units
U.Chloride Conc.
mmol/L
Units
mmol/L
U.Potassium Conc.
Lower Limit
3.9
5.1
Units
Upper Limit
9.4
14.2
mmol/L
U.Sodium Conc.
Units
mmol/L
U.Urea Conc.
Units
mmol/L
U.Creat.Conc.
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
115 Years
115 Years
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Urea & Electrolytes (random urine)
Uric Acid
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
0.2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Raised in various conditions including gout, renal failure & toxaemia of pregnancy. May
also be elaved in patients undergoing chemotherpay or radiation therapy.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Urate
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
140
200
umol/L
Upper Limit
360
430
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Uric Acid
Urinary Free Cortisol
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
24hr Urine
5ml
Can use Universal or Plain 24 hour Urine
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Urine Free Cortisol (24h) :
Units
nmol/24h
Urine Free Cortisol :
Lower Limit
0
0
Units
Upper Limit
165
165
nmol/L
Urine Volume :
Units
Litres
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Urinary Free Cortisol
Urinary Steroid Profile
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
Universal
24hr Urine
20ml
Preferred sample is a portion of a 24 hour urine.
A random sample may be used for the diagnosis of inborn errors of metabolism or
if a 24 hour sample is difficult to collect, but the interpretation may be limited.
Request Form:
Pathology Combined
Specimen:
Random Urine
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Short Term Stability
4 - 10°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Comment :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
For patient specific reference intervals please refer to printed report or IT systems
Urinary Steroid Profile
Urine Culture
Department:
Microbiology
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Isolate 1
Units
Isolate 2
Units
RBC
Units
SQ COPY
Units
Urine Culture:
Units
WBC
Units
Y for complete S for extra sens :
Units
Y for complete with sens :
Units
YEAST COPY
Units
/HPF
For patient specific reference intervals please refer to printed report or IT systems
Urine Culture
Urine cytology
Department:
Histology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553130 (3130)
01302 553130 (3130)
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
Less than 20ml
Sterile universal
Request Form:
Histology WPR2580
Specimen:
Urine
Availabilty:
Mon to Fri - sample to arrive at DRI before 4.00pm
Investigation Comments:
Not suitable for frozen section or DIF. Refer to relevant sections of handbook
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
If a number of samples are removed from the same patient during a single procedure they
should be placed in separate containers and labelled as to their site of origin. Only one
request form is required, listing specimens clearly.
All high risk specimens should be clearly marked ‘Danger of infection’ on both form and pot.
Tests
For patient specific reference intervals please refer to printed report or IT systems
Urine cytology
Urine Dipstix
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
95% of cases in this time
Request
Container(s):
Volume Required:
Request Form:
Specimen:
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
U. Ketone
Units
U.Ascorbic acid
Units
U.Bilirubin
Units
U.Blood
Units
U.Glucose
Units
U.Leucocytes
Units
U.Nitrite
Units
U.pH
Units
U.Protein
Units
U.Specific Gravity
Units
U.Urobilinogen
Units
pH Units
For patient specific reference intervals please refer to printed report or IT systems
Urine Dipstix
Urine Heavy Metal Screen
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Universal
Volume Required:
5ml
Request Form:
Pathology Combined
Specimen:
Urine
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
Minus 20°C
Long Term Stability
Minus 20°C
Special Requirements:
Tests
Creatinine (Assayed at Leeds & Bradford) :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Random Urine Lead :
Units
Testing Laboratory:
Units
Urine Hg/Cre Ratio :
Reference Ranges
Urine Mercury :
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
mmol/L
ug/L
Units
nmol/mmol (creat)
Lower Limit
0
0
Units
Upper Limit
5.5
5.5
nmol/L
Applicable from
01/04/2011
01/04/2011
For patient specific reference intervals please refer to printed report or IT systems
Urine Heavy Metal Screen
Valproate
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours & On Call
Investigation Comments:
Measurement of valproate is not useful for therapeutic drug monitoring. Indications for
measurement are restricted to ?compliance and ?toxicity.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
Valproic Acid
Reference Ranges
Reference Ranges
Sex
Female
Male
Sex
Female
Male
Start Age
0 Years
0 Years
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
End Age
115 Years
115 Years
Lower Limit
350
350
Lower Limit
50
50
umol/L
Upper Limit
700
700
Upper Limit
100
100
Applicable from
02/02/1996
02/02/1996
Applicable from
12/12/2011
12/12/2011
For patient specific reference intervals please refer to printed report or IT systems
Valproate
Very Long Chain Fatty Acids
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
VLCFA
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Heparin
Volume Required:
EDTA
1ml
Green or Purple
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Screening tests for peroxisomal disorders. Test includes phytanic acid.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
C24/C22 Ratio
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.44
0.44
Units
Upper Limit
0.97
0.97
Applicable from
22/03/2011
22/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Upper Limit
0.030
0.030
Applicable from
22/03/2011
22/03/2011
Date Result Returned:
Lower Limit
0.005
0.005
Units
Docosanoate (C22)
Units
umol/L
Upper Limit
112
112
Enquiry Line:
Lower Limit
15
15
Units
Hexacos. (C26)
Units
umol/L
C26/C22 Ratio
Reference Ranges
Reference Ranges
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.33
0.33
Units
Upper Limit
1.50
1.50
umol/L
Applicable from
22/03/2011
22/03/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.2
0.2
Units
Upper Limit
19.3
19.3
umol/L\
Applicable from
05/08/2014
05/08/2014
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
0.00
0.00
Units
Upper Limit
1.88
1.88
Applicable from
22/03/2011
22/03/2011
Start Age
End Age
Phytanate
Reference Ranges
Pristinate
Reference Ranges
Testing Laboratory:
Units
Tetracos. (C24)
Reference Ranges
Applicable from
22/03/2011
22/03/2011
Sex
Lower Limit
umol/L\
Upper Limit
Applicable from
Very Long Chain Fatty Acids
Very Long Chain Fatty Acids
Female
Male
VLC Fatty Acids
0 Years
0 Years
115 Years
115 Years
14
14
Units
80
80
22/03/2011
22/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Very Long Chain Fatty Acids
Vigabatrin
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Plain
Volume Required:
Heparin
1ml
Red or Green
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
An anti-convulsant drug. Routine monitoring of blood levels is unnecessary. Sample
taken immediately before a dose, at least ?? days after initiation of treatment.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take blood sample just before dose (ie trough level)
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Vigabatrin :
Units
Reference Ranges
Sex
Female
Female (Pregnant)
Male
Start Age
0 Years
0 Years
0 Years
End Age
110 Years
110 Years
110 Years
Lower Limit
5
5
5
mg/L
Upper Limit
35
35
35
Applicable from
19/03/2003
19/03/2003
19/03/2003
For patient specific reference intervals please refer to printed report or IT systems
Vigabatrin
Vitamin A & E
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
Heparin
1ml
Gold or Green
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Protect from light and send to laboratory within one hour.
Tests
Cholesterol :
Units
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Triglyceride :
Units
mmol/L
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
110 Years
110 Years
Lower Limit
0.45
0.45
Units
Upper Limit
1.88
1.88
umol/L
Applicable from
07/04/2011
07/04/2011
Sex
Female
Female
Female
Female
Female
Male
Male
Male
Male
Male
Start Age
0 Years
1 Years
7 Years
13 Years
20 Years
0 Years
1 Years
7 Years
13 Years
20 Years
End Age
1 Years
6 Years
12 Years
19 Years
110 Years
1 Years
6 Years
12 Years
19 Years
110 Years
Lower Limit
0.5
0.7
0.91
0.91
0.84
0.5
0.7
0.91
0.91
0.84
Units
Upper Limit
1.5
1.5
1.71
2.51
3.6
1.5
1.5
1.71
2.51
3.6
umol/L
Applicable from
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Months
1 Months
16 Years
0 Months
1 Months
16 Years
End Age
1 Months
192 Months
110 Years
1 Months
192 Months
110 Years
Lower Limit
4.6
9
11.6
4.6
9
11.6
Units
Upper Limit
14.0
28
35.5
14.0
28
35.5
Applicable from
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
Start Age
End Age
Lower Limit
Upper Limit
Applicable from
Vit A
Reference Ranges
Vit E
Reference Ranges
Vitamin E lipid corr ratio
Reference Ranges
mmol/L
Sex
Vitamin A & E
Vitamin A & E
Female
Female
Female
Female
Male
Male
Male
Male
1 Years
7 Years
13 Years
20 Years
1 Years
7 Years
13 Years
20 Years
6 Years
12 Years
19 Years
110 Years
6 Years
12 Years
19 Years
110 Years
3
2
2
3.9
3
2
2
3.9
5
5
4
5.9
5
5
4
5.9
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
06/05/2014
For patient specific reference intervals please refer to printed report or IT systems
Vitamin A & E
Vitamin B12
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
If result less than 120 ng/L sample will automatically be tested for Intrinsic Factor
antibodies
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature) - 4 to 6 hours
Long Term Stability
4 - 10°C
Special Requirements:
Abbott Architect
Tests
Units
Vitamin B12
Reference Ranges
Sex
Female
Male
Start Age
16 Years
16 Years
End Age
110 Years
110 Years
Lower Limit
187
187
ng/L
Upper Limit
883
883
Applicable from
01/10/2011
01/10/2011
For patient specific reference intervals please refer to printed report or IT systems
Vitamin B12
Vitamin B6
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Short Term Stability
Long Term Stability
Special Requirements:
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Testing Laboratory:
Units
Units
Whole Blood Vitamin B6 :
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
40
40
nmol/L
Upper Limit
100
100
Applicable from
03/03/2011
03/03/2011
For patient specific reference intervals please refer to printed report or IT systems
Vitamin B6
Vitamin C
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Measurement of vitamin C in plasma reflects recent dietary intake and is a poor index of
tissue stores. Subclinical deficiency is common in the elderly housebound. Since
ascorbic acid is cheap and non-toxic, a therapeutic trial of vitamin supplementatio
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Special treatment of sample required. Contact lab before collecting.
Tests
Date Result Returned:
Units
Enquiry Line:
Units
Leuc Vit C
Units
Testing Laboratory:
Units
Units
Vitamin C (Plasma)
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
26.1
26.1
umol/10^9 WBC
umol/L
Upper Limit
84.6
84.6
Applicable from
01/01/2015
01/01/2015
For patient specific reference intervals please refer to printed report or IT systems
Vitamin C
Vitamin D 25 OH
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
SST
Volume Required:
1ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Useful when assessing calcium homeostasis
Storage Requirements:
Refer to Short Term Stabilit
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Units
nmol/L
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
>75
>75
Units
Upper Limit
g/L
Sex
Female
Female
Female
Male
Male
Male
Start Age
0 Years
1 Years
16 Years
0 Years
1 Years
16 Years
End Age
1 Years
16 Years
115 Years
1 Years
16 Years
115 Years
Lower Limit
30
30
35
30
30
35
Units
Upper Limit
45
50
50
45
50
50
mmol/L
Applicable from
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
2.20
2.20
Units
Upper Limit
2.60
2.60
mmol/L
Applicable from
12/12/2011
12/12/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
2.03
2.03
Upper Limit
2.45
2.45
Applicable from
12/12/2011
12/12/2011
25-OH Vitamin D
Reference Ranges
Albumin
Reference Ranges
Ca(Alb Corr)
Reference Ranges
Calcium
Reference Ranges
Applicable from
01/04/2012
01/04/2012
For patient specific reference intervals please refer to printed report or IT systems
Vitamin D 25 OH
Whipples Disease PCR
Department:
Virology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
01909 502493 (2493)
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Volume Required:
SST
1ml
Request Form:
Pathology Combined
When requesting investigations for Microbiology please do
not mix with samples for other departments. It is essential
that when requesting Virology investigations that a separate
request form is completed to accompany the sample.
Specimen:
Venous Blood
Availabilty:
Investigation Comments:
Storage Requirements:
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Tests
Date result received
Units
Date sent
Units
REF LAB DATE REC
Units
REF LAB DATE REPORTED
Units
Reference Lab No
Units
Reference lab:
Units
Whipples
Units
WHO SENT?
Units
For patient specific reference intervals please refer to printed report or IT systems
Whipples Disease PCR
White Cell Enzymes
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Screening tests for lysosomal storage disorders.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
24hrs - Store at 4°C until sent to Reference Lab
Long Term Stability
Not possible
Special Requirements:
Do not collect sample after midday on Thursday, or on Friday.
Tests
Acid Esterase
Reference Ranges
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
350
350
Units
Upper Limit
2000
2000
umol/g.h
Applicable from
08/08/2012
08/08/2012
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
50
50
Units
Upper Limit
250
250
umol/g.h
Applicable from
12/08/1996
12/08/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
10
10
Units
Upper Limit
50
50
umol/g.h
Applicable from
12/08/1996
12/08/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
100
100
Units
Upper Limit
800
800
umol/g.h
Applicable from
01/06/2011
01/06/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
50
50
Units
Upper Limit
250
250
umol/g.h
Applicable from
01/05/2004
01/05/2004
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
100
100
Units
Upper Limit
400
400
umol/g.h
Applicable from
12/08/1996
12/08/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
1.0
1.0
Units
Upper Limit
5.0
5.0
umol/g.h
Applicable from
12/08/1996
12/08/1996
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
100
100
Upper Limit
800
800
Applicable from
01/10/1997
01/10/1997
A-Galactosidase
Reference Ranges
A-Mannosidase
Reference Ranges
Aryl Sulphatase A
Reference Ranges
B-Galactosidase
Reference Ranges
B-Glucosidase
Reference Ranges
B-Glucuronidase
Reference Ranges
umol/g.h
Sex
Female
Male
A-Fucosidase
Reference Ranges
Units
White Cell Enzymes
White Cell Enzymes
Units
umol/L.H
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
600
600
Units
Upper Limit
3500
3500
umol/L.H
Applicable from
01/05/2004
01/05/2004
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Upper Limit
1500
1500
Applicable from
01/05/2004
01/05/2004
Date Result Returned:
Lower Limit
150
150
Units
Enquiry Line:
Units
Galactocerebrosidase
Units
umol/g.h
B-Hexosaminidase
Reference Ranges
B-Mannosidase
Reference Ranges
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
0.8
0.8
Units
Upper Limit
4.0
4.0
umol/L.H
Applicable from
01/08/2011
01/08/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
100 Years
100 Years
Lower Limit
10
10
Units
Upper Limit
60
60
umol/g.h
Applicable from
12/08/1996
12/08/1996
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
5
5
Units
Upper Limit
50
50
umol/L.H
Applicable from
01/06/2011
01/06/2011
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
50
50
Units
Upper Limit
250
250
umol/g.h
Applicable from
02/08/2011
02/08/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
110 Years
110 Years
Lower Limit
4
4
Units
Upper Limit
120
120
umol/g.h
Applicable from
01/05/2011
01/05/2011
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
1
1
Units
Upper Limit
10
10
Applicable from
01/05/2004
01/05/2004
Glycoaspariginase
Reference Ranges
NAC-Galactosaminidase :
Reference Ranges
Sex
Female
Male
Plasma B Hexosamindas A (Tay -Sachs Disease) :
Reference Ranges
Sex
Female
Male
Plasma Chitotriosidase :
Reference Ranges
Sphingomyelinase
Reference Ranges
Testing Laboratory:
For patient specific reference intervals please refer to printed report or IT systems
White Cell Enzymes
Xanthochromia Screen
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
Request
Container(s):
Volume Required:
Universal
1ml
Request Form:
Pathology Combined
Specimen:
CSF
Availabilty:
Routine hours only
Investigation Comments:
Test used to rule out subarachnoid haemorrhage as the cause of a sudden onset
headache in CT negative patients, when the CSF sample is taken at least 12 hours after
the onset of headache.
Record on request form 1. Date and time of onset of symptoms, 2. Date and time of
lumbar puncture, 3. Result of CT Scan
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Take sample at least 12 hours after onset of headache. Protect from light. Send sample to
lab ASAP. Do not use vacuum tube. Take blood sample for LFTs.
Cam Spec M550 Spect
Tests
CSF Xanthochromia Screen
Units
For patient specific reference intervals please refer to printed report or IT systems
Xanthochromia Screen
Zinc
Department:
Clinical Biochemistry
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Clinical Biochemist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
Trace Element
Volume Required:
2ml
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only (Sent away)
Investigation Comments:
Interpreting zinc concentrations in 'sick' individuals is very problematic. Studies show
zinc and selenium concentrations decrease as CRP increases. Recommend only
assess zinc in individuals with CRP less than 15ng/L. Plasma zinc responds to intake in
individuals.
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
Not possible
Special Requirements:
Tests
Date Result Returned:
Units
Zinc
Units
umol/L
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
7.20
7.20
Units
Upper Limit
20.43
20.43
umol/L
Applicable from
08/01/2015
08/01/2015
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
7.20
7.20
Upper Limit
20.43
20.43
Applicable from
01/01/2015
01/01/2015
Zinc ( by ICP)
Reference Ranges
For patient specific reference intervals please refer to printed report or IT systems
Zinc
Zinc Protoporphyrin
Department:
Haematology
Turnaround Time Band
Contact:
Clinical Contact:
01302 553131 (3131)
Consultant Haematologist
95% of cases in this time
This test is processed at an external centre, contact the laboratory if further details of external centre required
Request
Container(s):
EDTA
Volume Required:
1ml
Can also use Citrate / Heparin Tubes
Request Form:
Pathology Combined
Specimen:
Venous Blood
Availabilty:
Routine hours only
Investigation Comments:
Storage Requirements:
Refer to Short Term Stability
Short Term Stability
12 - 28°C (Ambient Temperature)
Long Term Stability
4 - 10°C
Special Requirements:
Haemolysed / Icteric Samples not accepted. Patients on Riboflavin may give falsely raised
results
Tests
Units
Zinc Protoporphyrin
Reference Ranges
Sex
Female
Male
Start Age
0 Years
0 Years
End Age
115 Years
115 Years
Lower Limit
30
30
Upper Limit
80
80
Applicable from
17/12/2014
17/12/2014
For patient specific reference intervals please refer to printed report or IT systems
Zinc Protoporphyrin
Tests
Advice
About Us
Requesting
Departments
PAT/T 2
v.5
Blood Transfusion Policy
This procedural document supersedes: PAT/T 2 v.4 – Blood Transfusion Policy
Did you print this document yourself?
The Trust discourages the retention of hard copies of policies and can only guarantee that the
policy on the Trust website is the most up-to-date version. If, for exceptional reasons, you need to
print a policy off, it is only valid for 24 hours.
Written/revised by:
Gill Bell – Chief Biomedical Scientist, Blood
Transfusion
Authorised by:
Youssef Sorour – Chair Hospital Transfusion
Committee (HTC) – June 2014
Contributors:
Approved by:
Mary Oakes, Richard Stott
Hospital Transfusion Committee
Approval date:
August 2014
Date issued:
30 October 2014
Next review date:
August 2016
Target Audience
Trust wide; all personnel involved in the
transfusion process
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 1 of 64
May 2014
PAT/T 2
v.5
Summary of changes to the Blood Transfusion Policy:
Version
Date
Brief Summary of Changes
Author
Version 5
May 2014
Major changes throughout policy, including:
 Reference updates
 Hyperlinked contents
 Change to wording of golden rules including new rule 8
concerning Massive Haemorrhage recognition.
 Addition of a point on Massive Haemorrhage recognition to
the summary.
 Policy 3 addition of a small section on requesting HLA
matched products for renal transplant patients.
 Policy 4 please read this section due to the extent of the
changes, which include the addition of a section on the 2
sample rule and changes to sample expiry.
 Policy 7 now refers to use of Teletrack system.
 Policy 10 Clarified Methylene Blue treated (MBT) FF and
Cryoprecipitate should be given to neonates, children and
young adults born after 1 January 1996. Previous guidance
was under 16 years only.
 Policy 10 change to disposal of blood product bags
 Policy 12 please read this section due to the extent of the
changes
 Policy 15 title change from Kleihauer to FMH testing much
more detail to this entire policy. Added a section on intraoperative cell salvage at delivery. Addition of a section on
management of transfusion of D positive blood components
to D negative girls or women of childbearing potential.
 Replacement of appendices 2 & 3 with new updated versions
related to acute transfusion reactions.
 Change to appendix 5 MHP regarding recognition and
activation
Gill Bell & Youssef
Sorour
Version 4
January 2012








Gill Bell &
Youssef Sorour


Major changes throughout policy, including:
Reference updates
Addition of “Golden Rules” section
Addition of section on consent (policy 1)
Addition of section on good blood management (policy 2)
Collection of samples now renamed venepuncture (policy 6)
Addition of section on requesting blood products (policy 4)
Policy 7 (Collection of blood products) amended to include
collection from a BARS controlled fridge.
Massive haemorrhage (was policy 15) now appendix 5 major
changes; rewritten.
Addition of 3 new appendices, appendix 2 Administration of
blood components – key action points, appendix 3
Transfusion Reaction flow chart, appendix 4 FFP dosage
poster.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 2 of 64
May 2014
PAT/T 2
Version 3
August 2009

Review date extended to March 2010 to accommodate
the implementation of the BARS project.
Version 3
January 2008

Reiterated in the Introduction the Trusts commitment
to the competency assessment of all staff involved in
the transfusion process.
Reiterated in Policy 6 - The administration of blood
products that only the blood product pack and the
patient’s identity band are to be used as part of the final
bedside check, not the compatibility form.

Version 3
Oct 2007








Reviewed and formatted in line with the policy
“Development and Management of Approved
Procedural Documents (APDs) within the Trust”
Minor changes/amendments made throughout for
better clarity.
Addition of an introduction.
Addition of a paragraph on how we will monitor
compliance and effectiveness.
Expansion of the section “The Kleihauer and use of
anti-D immunoglobulin” for greater clarity – no
procedural changes.
Reference now made to Prothrombin Complex
Concentrate (PCC) and recombinant activated factor
VII in the section technical aspects of blood transfusion
– products already authorised for use within the Trust.
Section on abdominal aortic aneurysms and the section
on massive obstetric haemorrhage now combined to
produce the section on massive bleeds – as agreed by
the Hospital Transfusion Committee (September 2007).
Addition of a section on patient transfers with blood
products to try and ensure greater compliance in this
problematic area and provide a point of reference for
the policy PAT PA 24 Transfer of Patients and their
Records.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
v.5
Gill Bell
Gill Bell
Page 3 of 64
May 2014
PAT/T 2
Contents
v.5
Page
References
5
Introduction
6
Monitoring Compliance and Effectiveness
6
Contacts
6
Golden Rules
7
Summary
8
Policy 1
Consent
9
Policy 2
Good Blood Management
10
Policy 3
Prescribing Blood Products
11
Policy 4
Requesting Blood Products
13
Policy 5
Positive Identification of Patients
15
Policy 6
Venepuncture
16
Policy 7
Collection of Blood Products
19
Policy 8
Returning to Blood Bank of Blood Products
21
Policy 9
Administration of Blood Products and Traceability
22
Policy 10
Technical Aspects of Administration of Blood Products
25
Policy 11
Care and Monitoring of Patients
30
Policy 12
Reporting of Adverse Events following or during Transfusion
32
Policy 13
Documentation of Transfusions
35
Policy 14
Jehovah’s Witness, Patient or Family refusal of Blood Transfusion
36
Policy 15
FMH testing & the use of Anti-D Immunoglobulin
41
Policy 16
Transfer of Patients with Blood Products
48
Appendix 1
Neonates and Children
50
Appendix 2
Classification of Acute Transfusion Reactions
57
Appendix 3
Transfusion Reaction Flow chart and Signs / symptoms of ATR
59
Appendix 4
FFP dosage poster
62
Appendix 5
Massive Haemorrhage
63
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 4 of 64
May 2014
PAT/T 2
v.5
REFERENCES
This policy is written in accordance with the following guidelines and policies:
BCSH Guidelines

BCSH guideline for the use of anti-D immunoglobin for the prevention of haemolytic disease of
the fetus and newborn 2014

Red cells in critical care 2012

Guidelines for pre-transfusion compatibility procedures in blood transfusion laboratories 2012

Guideline on the investigation and management of Acute Transfusion Reactions 2012

Guidelines on the use of irradiated blood components 2010

The administration of blood components 2009

Guidelines for the estimation of fetomaternal haemorrhage 2009

Transfusion guidelines for neonates and older children 2004 (amended 2007)

Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant 2004
(amended 2007)

Guidelines for the use of platelet transfusions 2003
Trust Policies
PAT/T 8
Policy for Specimen and Request Form Labelling
PAT/PS 7
Patient Identification Policy
PAT/PA 2
Policy for Consent to Examination or Treatment
PAT/PA 19
Mental Capacity Act 2005 Policy and Guidance
PAT/PA 24
Policy for the Transfer of Patients and their Records
NPSA Safer Practice Notice
Right Patient, Right Blood SPN14 (9 November 2006)
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 5 of 64
May 2014
PAT/T 2
v.5
INTRODUCTION
Errors in the requesting, supply and administration of blood lead to significant risks to patients.
Errors either in the collection or labelling of the sample for blood grouping and compatibility
testing, or in the laboratory, or to failure of the final pretransfusion checks account for a number of
patient deaths in the UK each year. The incidence of `wrong blood in tube' episodes has changed
little over several decades. This contrasts with the dramatic reductions in other hazards of
transfusion such as viral transmission. The introduction nationally of the requirement for 2 separate
samples prior to transfusion should help to address this.
Variation in the practice of the administration of blood is remains increasingly evident from audit,
both local and national and from the annual Serious Hazards of Transfusion (SHOT) reports.
Consequently the Trust is committed to the use of competency assessment of all staff involved in
the transfusion process and is committed to the targets set by the NPSA Safety notice 14 (Right
patient, right blood).
This policy is based on recognised guidelines and provides the Trust with local procedures for the
ordering and administration of blood products and the management of transfused patients.
MONITORING COMPLIANCE AND EFFECTIVENESS

The Hospital Transfusion Team will ensure that systematic audit and review of the transfusion
process is undertaken and will report outcomes to the Hospital Transfusion Committee.

This will include participation in the programme for national comparative audit of blood
transfusion as well as local and regional audits.

The Hospital Transfusion Committee will review all serious adverse transfusion events /
reactions which must be notified direct to blood bank staff in addition to the Trust’s incident
reporting system; DatixWeb.
CONTACTS

Blood Bank
DRI
BDGH
Ext 3779
Ext 2452
The Hospital Transfusion Team:

Blood Bank Manager
DRI
Ext 6187

Transfusion Practitioner
DRI
Ext 6115
 Consultant Haematologist
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Contact via Switchboard
Page 6 of 64
May 2014
PAT/T 2
v.5
GOLDEN RULES OF THIS POLICY
1. All staff involved in the transfusion process must be aware of this policy.
2. All staff involved in the transfusion process should understand their role and
responsibilities.
3. Role specific training requirements must be met; the competencies are
mandatory.
4. Ensure transfusion is appropriate and alternatives have been explored.
5. All transfusion documentation must be completed.
6. Recognise and manage transfusion reactions.
7. Always report untoward transfusion events / reactions to the Blood Bank and
Datix Web.
8. Recognition of Massive Haemorrhage; if you need emergency uncrossmatched
(historically O RhD Negatives) you need to activate the Massive Haemorrhage
protocol.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 7 of 64
May 2014
PAT/T 2
v.5
SUMMARY
1.
All samples must be handwritten and labelled to include surname, forenames, date of birth,
district number / NHS number, (identification numbers from other hospitals are not
acceptable), date and ward. 6 ml of blood is required for grouping and crossmatching (pink
top EDTA). Addressographs may be used on request forms, do not use Addressograph
Labels on Samples. Both the sample and request form must be signed by the person taking
the sample.
2.
Urgent requests must also be telephoned to the Blood Bank. Do not write "ASAP" for time
required. The sample and request form must be brought directly to Blood Bank and presented
to a member of blood bank staff
3.
Blood products must be prescribed on blood prescription sheet WPR26561.
4.
When a unit of blood is transfused to a patient the sticker from the blood tag must be signed
by two nursing or medical staff one with responsibility for the actual administration of the
blood. The start and finish time must be recorded and the sticker attached to the prescription
sheet. The tear off tag must have the “patient identity confirmed by:” box filled in and then this
tag must be returned to Blood Bank immediately.
5.
It is extremely important that the units of blood are transfused in expiry date order. Some
units of blood will have a shorter expiry time and must be used before other units; some of the
requested units may indeed not be needed and can then be returned and used for other
patients. Blood products must not be removed from the Blood Bank until you are ready to
start the transfusion, the pre-transfusion checks must have been performed and ensure that
the patient has adequate venous access.
6.
If after the blood is collected a problem arises which prevents immediate transfusion, the unit
must be returned to the Blood Bank within 30 minutes of collection and Blood Bank staff
informed. There have been instances of blood being left on the ward for hours and having to
be discarded. Such wastage of this valuable resource must be avoided.
7.
Each unit of blood should be used within four hours of removal from the blood fridge or
validated blood transit box. It is essential that medical / nursing staff check that the drip is
running satisfactorily; and if it isn't, that this is rectified in order that the unit of blood may be
given within the required time. Transfusion of Platelets, FFP and Cryoprecipitate should be
commenced within 30 minutes of removal from the blood fridge or validated blood transit box
and transfused over 20 to 30 minutes.
8.
Recognise trigger and activate pathway for management of massive haemorrhage.; if you
need emergency uncrossmatched (historically O RhD Negatives) you need to activate the Massive
Haemorrhage protocol. Communication with the Blood Bank is essential to ensure
blood products are made available as quickly as possible.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 8 of 64
May 2014
PAT/T 2
v.5
POLICY 1 - CONSENT
Patients have the right to know about the treatment being offered and the available alternatives.
This should be done in a timely and understandable manner. It is essential to follow the Trust
policies on consent (PAT/PA 2 Policy for Consent to Examination or Treatment) and the provisions
of the mental capacity act (PAT/PA 19 Mental Capacity Act 2005 Policy and Guidance ).

Patients must be given information regarding the risks/benefits and alternatives, including the
option of no transfusion. This is the responsibility of a doctor; however, signed consent is not
required.

It is helpful to provide patients with an information sheet outlining the risks and benefits of
blood transfusion. For example, NHS Blood & Transplant produce a number of patient
information leaflets; these are available from the Transfusion Practitioner.

If a patient refuses a transfusion the Doctor in charge of the patient should be informed and any
blood product on the ward immediately returned to the Blood Bank.
It is recommended that the following information is documented in the case notes using blood
prescription sheet WPR26561:






The discussion with the patient. (Details of the information provided to the patient)
Reason for transfusion (clinical and laboratory data)
The administration of the transfusion and any complications
The clinical outcome
Consent to proceed
If unable to obtain consent prior to transfusion, document retrospective notification
Wherever consent is not possible i.e. in an emergency or for an unconscious patient, the decision to
treat must be documented in the patient’s medical notes detailing why the transfusion is judged to
be in the best interests of the patient. Any known advance directives, DNAR decisions and
consultations regarding the patient’s rights under the mental capacity legislation must be taken into
account and included in the entry in the notes.
In addition, if a patient is unable to give consent prior to transfusion they should be provided with
information retrospectively to comply with SABTO recommendations (Oct 2011).
Post Transfusion; complete patient discharge list and inform GP, transfusion episodes should be
recorded in the discharge summary.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 9 of 64
May 2014
PAT/T 2
v.5
POLICY 2 – GOOD BLOOD MANAGEMENT
Good blood management is defined as management of the patient at risk of transfusion so as to
minimise the need for allogeneic transfusion.
Blood products should only be prescribed when the clinician is satisfied that the risk of not
transfusing is likely to be greater than the risk of transfusing.
Questions to think about before prescribing a transfusion:
Have you acted on an up to date result?
Have you reviewed the clinical condition of your patient?
Is intervention required?
Is transfusion the only appropriate intervention?
Are the blood products prescribed on blood prescription sheet WPR26560?
Have you documented in the medical notes why you made the decision to transfuse?
Does the patient have the mental capacity required to be able to make an informed decision regarding
the transfusion?
Have you discussed the need for transfusion with the patient, and advised them of all known risks and
obtained informed verbal consent?
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 10 of 64
May 2014
PAT/T 2
v.5
POLICY 3 – PRESCRIBING BLOOD PRODUCTS

Blood can only be prescribed by a doctor or advanced nurse practitioner (who has completed a
recognised Hospital Transfusion Team approved nurse authorisation course specific to blood
products). Both groups of have staff must also complete the organisational NPSA competency
based package for prescribing blood and blood products. Competencies are recorded on Oracle
Learning Management (OLM).

All staff prescribing must be aware of the risks / benefits of transfusion.

Training – all staff prescribing blood products must have the appropriate training /
competencies completed as identified by the NPSA and follow both local and national
guidelines; failure to do so may result in requests being rejected. In addition advanced nurse
practitioners must complete a recognised Hospital Transfusion Team approved nurse
authorisation course specific to blood products.

The prescription for blood and blood products must be signed and dated by the prescriber on
the appropriate blood prescription sheet (WPR26561).

It is essential that the prescription sheet contains the patient identification details surname,
first name, date of birth, patient identification number.

It is essential that all documentation provides a unique identification of the patient
(See policy 5).
The prescription must document the following:









Consent obtained
Retrospective notification of transfusion if consent not obtained.
What components are to be transfused
Date of transfusion
The volume/number of units to be transfused
The rate of transfusion for red cells is usually 1.5 - 2 hours. Transfusion must be completed
within 4 hours of removal from the Blood Fridge or authorised sealed blood product transit
box.
The rate of transfusion is 20 - 30 minutes for an adult therapeutic dose of platelets / bag of
fresh frozen plasma (FFP) or Cryoprecipitate.
Any other special instructions or requirements e.g. Irradiated, HLA matched or CMV
negative products required and the reason. Blood Bank must be made aware of any special
requirements prior to transfusion.
Requirement for any concomitant drugs.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 11 of 64
May 2014
PAT/T 2
v.5
Requesting HLA Matched Products for Renal Transplant Patients
Only patients with confirmed live donors require HLA matched products. This is required to
maintain the match between the live donor and the recipient. The provision of HLA matched
products can take 3-5 working days and will require timely planning with the Blood Bank.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 12 of 64
May 2014
PAT/T 2
v.5
POLICY 4 - REQUESTING BLOOD PRODUCTS

Blood can only be requested by a Doctor or authorised non-medical staff e.g. midwife or nurse
with the appropriate training / competencies completed.

All telephone requests must be followed by a written request form, failure to do so will result in
a delay in blood product provision.
Timing and viability of Blood Bank samples
Transfusion or pregnancy may stimulate the production of unexpected antibodies against red cell
antigens through either a primary or secondary immune response. The timing of samples selected
for crossmatching or antibody screening should take account of this, as it is not possible to predict
when or whether such antibodies will appear. It is also important to note that all cellular blood
components contain residual red cells and may elicit an immune response.
When performing transfusion serology the age of the stored sample and how it is stored is
important, as increase in age of refrigerated sample correlates with decrease in complement
activity and potency of RBC antibodies. Previously transfused and pregnant patients pose a special
problem as they may be in the process of mounting an immune response to a foreign RBC antigen
and hence an antibody may be developing in vivo that is not present in the pre-transfusion sample.
To ensure that the specimen used for compatibility testing is representative of a patient’s current
immune status, serological studies should be performed using blood collected no more than 3 days
in advance of the actual transfusion when the patient has been transfused or pregnant within the
preceding 3 months, or when such information is uncertain or unavailable.
The 3 days includes the dereservation period, e.g. if the sample was 1day old when crossmatched,
the blood would have to be transfused within 2 days.
Where there has been no transfusion or pregnancy within the preceding 3 months, the sample is
valid for up to 7 days. See Table 1 for summary of sample validity.
Key Recommendations: Serological studies should be performed using blood collected no
more than 3 days in advance of the actual transfusion when the patient has been transfused or
pregnant within the preceding 3 months
Table 1. Working limits for use of stored whole blood for pre-transfusion testing
Sample Storage Temperature
EDTA whole Blood
Patient Type
4°C
Patient transfused or pregnant in last 3 months
Up to 3 days
Patient not transfused and not pregnant in last 3 months
Up to 7 days
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 13 of 64
May 2014
PAT/T 2
v.5
The 2 sample prior to Transfusion Rule
General principles
This national recommendation is based on the evidence from –



The BEST studies as referenced in BCSH Guidelines for pre-transfusion compatibility
procedures in blood transfusion laboratories.
National data from the IBCT and the Near Miss chapters in recent SHOT reports (SHOT, 1996
to 2010) – 386 cases of “wrong blood in tube” (WBIT) were reported as near misses in 2010.
Local data confirms an unacceptable number of WBIT cases among patients where it can be
detected due to having a historical group on record.
Those taking samples for transfusion need to understand that the second sample is required due to
the possibility of inadequate patient identification and labelling errors which lead to an
unacceptable risk of WBIT.
Whenever possible a second sample should be obtained and tested before issue of red cells. The
urgency of the situation should always be considered, as delays in provision of blood could
compromise patient outcome.
Concerns have been expressed that the two samples may be taken at the same time and one
“saved” to send to the transfusion laboratory at a later time. The process detailed below will assure
that the two samples have been taken independently of one another.
Key Recommendation
A second sample should be requested for confirmation of the ABO group of a first time patient prior
to transfusion, where this does not impede the delivery of urgent red cells or other components
Urgent Situations
In an urgent situation when it is not possible to obtain a second sample, group-specific red cells
should not be issued without a second ABO check on the first sample.
Action Required:
First Sample
Can be historical i.e. >7 days old or taken on the same day as the 2nd sample.
Second Sample
Must be a separate venepucture event with new patient ID checks performed. Must be sent to the
laboratory site which will perform the blood issue. Ideally this would be performed by a different
member of staff but this is not mandatory.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 14 of 64
May 2014
PAT/T 2
v.5
POLICY 5 - POSITIVE IDENTIFICATION OF PATIENTS
Positive identification of the patient is essential and is based on:

Direct questioning of the patient - by asking them to state their surname, first name and date of
birth. This must always be done where the patient is judged capable of giving an accurate,
reliable response. Staff should never lead the patient, the answer yes is not sufficient to
establish correct identification.

Checking the details on the patient’s identification wristband, match those on the request form.
All in-patients and all patients undergoing a transfusion must have an ID band complying with
the current Patient Identification Policy (PAT/PS 7).

All patients including unconscious and unknown patients must have a patient identification
number and an ID wristband with this number. When additional details become available the
Blood Bank must be informed but details must not be changed mid incident.

No wristband – no transfusion
Positive identification of the patient must occur prior to

Venepuncture

Transfusion of blood and blood products
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 15 of 64
May 2014
PAT/T 2
v.5
POLICY 6 - VENEPUNTURE
Samples to be taken by a Doctor or a member of staff with a valid competency in venepuncture.
All patients being sampled must be positively identified.
Sample tubes should not be pre labelled.
The collection of the blood sample from the patient into the sample tubes and the sample
labelling should be performed as one continuous uninterrupted event, involving one patient and
one trained and competent healthcare worker only, samples to be labelled at the bedside using
information taken from the patient’s ID wristband.
The Request Form
The request form must be completed in full (Addressograph labels may be used) and include:

Full name – surname and forename.

District number and/or NHS number may be used. Hospital numbers from other hospitals are not
acceptable as they do not uniquely identify the patient on PAS. The NHS number must be available
for the issue of blood products using BARS.

Date of birth.

Patients location

Consultant

Number and type of blood products required.

Date and time required.

Patient’s diagnosis / clinical details (include pregnancy status).

Reason for the request (clinical indication) including most recent haemoglobin and or platelet
count if applicable, include date tested.

Any special requirements (e.g. Irradiated, HLA matched, CMV negative).

Date and time bled.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 16 of 64
May 2014
PAT/T 2
v.5

Gender.

Requestors name and signature.

The request form should be signed by the person drawing the sample.

Date of last transfusion.

Any known antibodies

If pregnant within the last 6 months and Rh D negative please state the dates and doses of any
prophylactic Anti-D immunoglobulin administered during this pregnancy.
The Sample

Addressograph labels must not be used.

The patient must be positively identified at the time a sample is taken (Policy 5)

The sample tube must be labelled immediately after the blood has been taken (at the patients
bedside), sample tubes must not be pre-labelled.

Never copy details from the request form onto sample tubes.
The sample tube must be labelled with the following details taken from the ID band:

Full name - surname and forename.

District number, NHS number, Hospital numbers from other hospitals are not acceptable.

Date of Birth.

Gender.

Signature of person taking the blood sample.

Ward or Clinical area.

Date sample taken.

Time sample taken.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 17 of 64
May 2014
PAT/T 2
v.5
The Unconscious and or Unknown Patient including Major Incident Patients.

The minimum identification for an unconscious unknown patient is the district number and the
gender of the patient. Follow the Trust protocol for the identification of unconscious patients.
This level of identification is essential even for use of the emergency group O blood packs.

Avoid changing the details of the unknown patient mid incident / acute treatment; this would
result in samples with the new details being required to obtain further blood products. The
original wristband must be left in place until all merges are complete, this will mean two
wristbands may be in place for a short time.

Wristbands must not be removed if you intend to continue transfusing blood products labelled
with the original details. Either complete their infusion with the original wristband in place and
use this for all checks or return unused products to Blood Bank.
Incorrectly labelled samples or request forms

The Blood Bank will not accept any sample where the request form or sample are
inadequately or incorrectly labelled.

A substantial number of requests arrive with labelling or request form errors. This can
contribute to serious errors and delays in blood product provision. In clinical emergency
situations group O blood will be available for the patient while the sampling and labelling
process is repeated correctly.
Samples and forms cannot be amended, even in a clinical emergency a new sample and form
must be provided
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 18 of 64
May 2014
PAT/T 2
v.5
POLICY 7 - COLLECTION OF BLOOD PRODUCTS
Good documentation of the blood audit trail is mandatory and a legal requirement
Before collection, ensure the patient is ready to start the transfusion, baseline observations taken
and has patent venous access.
Key Points
When collecting the blood component from the laboratory or blood refrigerator

Ensure person collecting components has been trained and has a valid competency

Take authorised documentation containing the patient's core identifiers and bar coded NHS
number e.g. an addressograph label. This must still be done even if Teletrack is used to organise
collection.

Check core patient identifiers with the label on the blood component.

Core patient identifiers, date and time of collection and staff identification details must
whenever possible be recorded using the BARS system. If BARS fails or room temperature
products are collected, staff must sign the register for each unit removed with the date and
time.

The component should be delivered to the clinical area and given directly to the staff
responsible for transfusion without delay.
Staff authorised to collect Blood Products

Only staff that have been fully trained and competency assessed in the collection of blood
products can collect products from the Blood Bank / Blood fridges.

Blood collection training to be arranged through the Trust’s Transfusion Practitioner using NPSA
competency based packages.
Re-assessment is required 3 yearly. Departmental/CSU
managers to contact the Transfusion Practitioner to arrange collection training for staff.
Collection training must be recorded on OLM.
Collection of Blood Products from a BARS controlled Blood Fridge

Collection can be arranged using the Teletrack system however, the staff member removing the
blood from the Blood Bank must have documentation containing a barcoded addressograph
label. The label includes the patient’s identification details including full name, date of birth,
district number and a barcoded NHS number.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 19 of 64
May 2014
PAT/T 2

Blood product collection slips are available from the Transfusion Practitioner.

At the BARS Box; Blood Removal (No cold box)
o
o
o
o
o
o
o
o
o
v.5
Scan "Blood Removal"
Scan "Staff ID"
Scan "No Cold Box"
Scan "Patient ID" on patient’s addressograph label brought from clinical area (NHS number
available as a barcode on the load list if necessary).
Fridge unlocks if units are available.
Remove selected unit from fridge.
Scan donation number on the blood pack not the tag or any accompanying paperwork,
(Patient / unit information is displayed)
For multiple patient removals: enter next patient's number in window at bottom of screen
then scan selected units.
"End Input"

The blood product identification details (blood group and donation number and expiry date)
must also be checked with the details on the compatibility label (blood tag) attached to the unit.

It is extremely important that the units of blood are transfused in expiry date order. This is
because some units of blood will have a shorter expiry time and must be used before other
units.
Receipt of Blood Products on the Ward

The blood must be immediately handed to the person responsible for administrating the
transfusion and not left on the Nurses station

N.B. Blood must only be stored in designated Blood Bank fridges and not in the Ward, drug or
domestic fridges.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 20 of 64
May 2014
PAT/T 2
v.5
POLICY 8 - RETURNING BLOOD PRODUCTS TO BLOOD BANK
Returning Blood Products
Unboxed Single Units

Blood and blood products should be transfused as soon as possible after delivery to the ward /
clinical area i.e. within 30 minutes of leaving the blood fridge

If after collection of the blood a problem arises which prevents immediate transfusion, the unit
must be returned to Blood Bank within 30 minutes of collection.
Boxed Units e.g. unused or part used MPH packs

The transit box containing the units should be handed directly to a member of Blood Bank Staff
There have been instances of blood being left on the ward/clinical area untransfused resulting in
wastage of this valuable resource, this must be avoided.
Blood Products returned for disposal

If blood has been out of the fridge for more than 30 minutes and there is no prospect of its
immediate use, the hospital blood bank should be informed. The blood must be returned to the
blood bank for disposal due to the risk of bacterial growth and breach of the cold chain
regulations.

The blood product for disposal must never be placed in a Blood Bank fridge; it must always be
handed directly to a member of Blood Bank staff.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 21 of 64
May 2014
PAT/T 2
v.5
POLICY 9 - ADMINISTRATION OF BLOOD PRODUCTS AND TRACEABILITY
Key Points





Final check must be conducted next to the patient by the same trained and competent
licensed healthcare professional who administers the component.
All patients receiving a transfusion must be positively identified.
All patient core identifiers on the patient's identification wristband must match the details
on the blood component label.
All blood components should be administered using a blood administration set with integral
mesh filter.
Transfusion should be completed within 4 hours of leaving temperature controlled storage.
Staff Responsible
Blood components are excluded from the current legal definition of medicinal products and the
requirement for prescription by a registered medical practitioner but are viewed as medicines for
administration purposes. Blood components should only be administered by a licensed
professional such as doctor (GMC registered), or a nurse holding current registration of the NMC
Professional Register as a Registered General Nurse (RGN), Registered Sick Children's Nurse (RSCN),
Registered Midwife (RM) or Operation Department Practitioner (ODP) who has completed the
organisational NPSA based competency package in Receipt/Administration of blood and blood
products. Competencies must be recorded on OLM.
Receipt of blood products in the clinical area

The blood group and unit number of the blood product must be identical to that described on
the attached blood tag label.

The blood or blood component must be checked for compliance with any special requirements
as specified on the prescription sheet e.g. Irradiated, CMV negative.

The blood or blood component must be checked to ensure that it has not and will not have
passed its expiry date during the transfusion period i.e. in date at the start and end of
transfusion.
Inspection of Blood or Blood Products
It is essential that staff administering blood or blood products inspect each unit prior to transfusion
and return the unit to the Blood Bank if any defects are found.
The inspection should pay attention to:

The integrity of the pack by checking for leaks at the port or seams.

Evidence of haemolysis in the plasma or at the interface between red cells and plasma.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 22 of 64
May 2014
PAT/T 2

Evidence of unusual discoloration or turbidity.

The presence of large clots.
v.5
Responsibility for the identity check of the Patient and the Blood Product

Although two members of staff may be involved in the checking procedure it is recommended
that one member of staff should be responsible for carrying out the identity check of the
patient and the unit of blood at the patient's bedside.

The member of staff must be a doctor, or a nurse holding current registration of the GMC
Professional Register as a Registered General Nurse (RGN), Registered Sick Children's Nurse
(RSCN) or Registered Midwife (RM).
The final bed side check
This is ESSENTIAL and is based on: Tag & Bag, Tag & Wristband Checks
Only the labelled blood product and the patient’s wristband are to be used as part of the final
bedside check, not the prescription sheet.
Always start by direct questioning of the patient to establish positive identification. Ask their
surname, first name and date of birth in the case of patients who are judged capable of giving an
accurate reliable response. Checking this information against the wristband is mandatory.

Check the details on the patient’s wristband match the blood tag label
The surname, first name, gender, date of birth and unique identification number must be
identical with the blood tag label attached to the blood component.

Check the blood tag label is attached to the correct bag by checking the donation number,
product type and blood group of both match.

Any discrepancies identified by these checks should be reported to Blood Bank immediately
and the transfusion delayed until clarification of any point is made.

The transfusion of blood and blood components should begin as soon as possible.

The minimum identification for an unconscious unknown patient is the NHS or district number
and the gender of the patient. Follow the Trust protocol for the identification of unconscious
patients.

The prescription sheet must be readily available during the transfusion. The ideal location may
vary from one clinical area to another, but a local policy should exist defining this location. The
report must then be filed in the medical notes following completion.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 23 of 64
May 2014
PAT/T 2
v.5
Traceability
The return of the blood tags is mandatory.

The completed detachable blood tag must immediately be returned to Blood Bank following
the completed transfusion. This is to enable full traceability and to ensure the Trust fulfils its
legal requirements as defined by BSQR 2005.

The peel off sticker from the blood tag must be attached to the prescription sheet
(WPR26561).

The start and finish time of the transfusion must be recorded on the blood prescription sheet
(WPR26561).

The efficacy/ outcome/ benefit of this transfusion must be recorded in the patients notes
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 24 of 64
May 2014
PAT/T 2
v.5
POLICY 10 - TECHNICAL ASPECTS OF THE ADMINISTRATION OF BLOOD
PRODUCTS
Giving sets
 Adhere to strict aseptic techniques when handling blood or blood components.
 Blood products should be transfused through a sterile giving set designed for the procedure.
 Filter size; 170 – 200 micron filter is required.
 Drugs must not be added to blood products under any circumstances.
Red Cells (RBC) (SAGM Volume 220 – 340ml)

Electronic infusion pumps may damage blood cells and should not be used for administration of
red cells unless the manufacturers have verified them as safe to use for this purpose, staff have
been trained in their use and all maintenance requirements are met.

To prevent bacterial growth a new giving set must be used after 12 hours or after 3 units
whichever is earlier. Some giving sets may be issued with different instructions, if the usage life
of a giving set is shorter always follow the manufacturers instructions.

Start transfusion as soon as the unit is received from Blood Bank.

Each unit of blood must be used within a maximum of four hours from leaving the Blood Bank
fridge or validated sealed blood storage box, usually red cells are transfused over 2-3 hours.

Washing through the remainder of the blood in the line with Sodium Chloride 0.9% is not
recommended.

All blood products are leucocyte depleted.

Usually supplied as packed red cells in additive solution (SAGM).

Red cells can be irradiated, HLA matched, HT, K, Hb S or CMV negative for specific patient
groups. Blood Bank must be notified of any special requirements.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 25 of 64
May 2014
PAT/T 2
v.5
Plasma Products
Please note all plasma products must be inspected at the bedside and examined as with red cells.
Any suspect colouration or particulate suspension must be reported to Blood Bank immediately and
the unit returned to Blood Bank, do not transfuse.
Platelets (PLT) (Mean Volume 202ml)

A standard blood or platelet giving set should be used for the administration of platelets.

Platelets should be transfused through a new clean standard blood or platelet giving set (not
one already used for blood).

Never put platelets in a fridge.

Start infusion as soon as the pack is received from the Blood Bank.

Infuse stat or maximum time 30 minutes in an adult.

In paediatrics infuse over 60 minutes via the designated pump (unless specifically directed
otherwise in emergency situations).

Children under the age of 16 should whenever possible receive apheresis platelets rather than
pooled platelets.

Issued following authorisation by Consultant Haematologist (unless Massive Haemorrhage
Protocol activated. (See appendix 5)

Platelets can be irradiated, HLA matched, HT or CMV negative for specific patient groups. Blood
Bank must be notified of any special requirements.
Rh D Negative Female of Child Bearing Age:
If Rh D positive Platelets have to be given in a clinical emergency where a delay in waiting for RhD
negative platelets would increase risk to the patient, prophylactic anti-D immunoglobulin must be
given at a dose of 250 IU immediately, by intramuscular injection, after platelet transfusion.
This 250 IU dose is enough to cover five successive adult therapeutic doses of RhD positive platelets
over a period of up to six weeks.
Nevertheless, if a unit of RhD positive platelets has been given and followed by anti-D prophylaxis,
and if further treatment with platelet concentrates is required, RhD negative platelets are still
preferred and recommended.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 26 of 64
May 2014
PAT/T 2
v.5
Fresh Frozen Plasma (FFP) (Mean Volume 271ml)

Filter size; 170 – 200 micron filter is required (blood giving set).

Do not refreeze. Use within 4 hours if maintained at 22ºC ± 2ºC or 24 hours if stored at 4ºC
(extended storage will result in a decline in labile coagulation factors).

Issued following authorisation by Consultant Haematologist (unless Massive Haemorrhage
Protocol activated. (See appendix 5)

Start infusion as soon as the pack is received from the Blood Bank

Infuse each bag over not more than 20-30 minutes.

Neonates, children and young adults born after 1 January 1996 are issued non-UK MB FFP.

See appendix 4 FFP dosage poster
Cryoprecipitate (CRYO) (Mean Volume Pooled pack 164ml)

Filter size; 170 – 200 micron filter is required (blood giving set).

Issued following authorisation by Consultant Haematologist (unless Massive Haemorrhage
Protocol activated. (See appendix 5)

Infuse stat or maximum time 30 minutes in an adult.

In paediatrics infuse over 60 minutes via the designated pump (unless specifically directed
otherwise in emergency situations).

One bag of pooled Cryoprecipitate is equivalent to five single units.

Never put Cryoprecipitate in a fridge

Do not refreeze. Use within 4 hours maintained at 22ºC ± 2ºC

Neonates, children and young adults born after January 1996 are issued non-UK MB
Cryoprecipitate.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 27 of 64
May 2014
PAT/T 2
v.5
Prothrombin Complex Concentrate (PCC)

Prothrombin Complex Concentrate (PCC) e.g. Beriplex is used for the rapid reversal of warfarin
therapy. The formulary is available on the intranet.

Out of hours PCC is located in A&E, Pharmacy emergency store

The request for Prothrombin Complex Concentrate must be approved by a Consultant
Haematologist, who will also advise on dose.

Baseline INR/coagulation screen must have been performed
Indications for use:

Immediate reversal required for intracranial haemorrhage (subarachnoid or intracerebral
haemorrhage) or other life threatening haemorrhage.

Reversal required within one hour for major urgent surgical procedure.
Cannula
A 20 gauge cannula is the minimum size required for transfusion in an adult. The size of cannula
chosen can affect the speed at which the blood can be transfused.
Blood Warmers

Blood should only be warmed using a specifically designed regularly maintained and calibrated
commercial device with a visible thermometer and audible warning following manufacturer’s
instructions.
A blood warmer is indicated:
-1
h -1 in adults.

At flow rates of >50mL kg

At flow rates of >15ml kg –1 h –1 in children.

For exchange transfusions.

For patients with clinically significant cold agglutinins
Drugs

Drugs must never be added to blood products under any circumstances.

Drugs should not be administered through the same cannula when transfusion of blood or
blood products is in progress.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 28 of 64
May 2014
PAT/T 2
v.5
Disposal of Blood Bags
On completion of the transfusion the empty bag and tubing should be disposed as follows

The Blood Bank, Chatsfield Suite, Theatres and A/E all sites & are to dispose of transfused bags
and tubing via anatomical waste
All Anatomical bins must also be labelled as “Blood bag waste”
(Yellow bin Red lid)

Ward Areas
Empty transfused blood and blood product bags and tubing are to be disposed of via the offensive
hygiene waste i.e. yellow bag with black stripe.
Snip bag and allow to drain naturally into sluice, then put bag and tubing into Yellow bag with Black
Stripe.
(Yellow bag/Black stripe)

Following Massive Transfusions on Ward Areas
If 10 to 20 products (red cell, platelets, FFP or Cryoprecipitate) are transfused in an emergency
situation then all bags to be disposed of in the Anatomical waste stream i.e. yellow bin with red lid.
(Yellow bin Red lid)
All Anatomical bins must also be labelled as “Blood bag waste”
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 29 of 64
May 2014
PAT/T 2
v.5
POLICY 11 - CARE AND MONITORING OF PATIENTS
All patients should be transfused in clinical areas where they can be directly observed, and where
staff are trained in the administration of blood components and the management of transfused
patients, including the emergency treatment of anaphylaxis.
Key Points
Neonatal and child observations see separate Appendix 1
Adults
Observations should be undertaken for every unit transfused. Minimum monitoring of the patient
should include:








Regular visual observation throughout the transfusion episode
Pre transfusion pulse (P), blood pressure (BP), temperature (T), respiratory rate (RR) and O2
saturation. To be taken no more than 60 minutes before starting transfusion
A complete set of vital signs should be taken 15 minutes after the start of each component
transfusion for all patients.
For a stable patient repeat vital signs at the halfway mark.
More frequent observations may be required e.g. rapid transfusion, or patients who are
unable to complain of symptoms which would raise suspicion of a developing transfusion
reaction
If the patient shows signs or symptoms of a possible transfusion reaction, the vital signs should
be monitored immediately, recorded, and appropriate action taken. Vital signs must continue
to be monitored every 5 - 15 minutes depending on severity of reaction and until the possible
reaction has resolved.
Post transfusion observations should be taken and recorded not more than 60 minutes after
the end of the component transfusion
Patients should be observed during the subsequent 24 hours for or, if discharged, counselled
about the possibility of late adverse reactions. Clinical areas should ensure that systems are in
place to ensure patients have 24 hour access to clinical advice
Staff Responsible

The member of staff responsible for the care and monitoring of the patient during the
transfusion must be a nurse holding current registration of the NMC Professional Register as a
Registered General Nurse (RGN), Registered Sick Children's Nurse (RSCN), a Registered
Midwife (RM) or a doctor.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 30 of 64
May 2014
PAT/T 2

v.5
They must take charge of the patient during the transfusion and be responsible for ensuring
that all care and monitoring of the patient is performed.
Observation of the Patient

It should be stressed to the patient the importance of reporting any adverse effects that they
may feel, including shivering, rashes, flushing, and shortness of breath, pain in the extremities
or in the loins.

Visual observation of the patient is often the best way of assessing the condition of the patient
during transfusion. Transfusions should be given in clinical areas where patients can be readily
observed by members of the clinical staff, patients should be able to alert staff if they
experience any adverse effects.

The start and finish time of the transfusion must be recorded on the peel off sticker from the
blood tag which is attached to the blood prescription sheet (WPR26561).

Vital signs – temperature, pulse, blood pressure, respirations and O2 saturation must be
measured and recorded as follows:
o Before the start of each unit of blood or blood component, 15 minutes after commencing,
half way through and at the end of each transfusion episode.
o Further observations during the transfusion of each unit of blood or blood product are at
the discretion of each clinical area and need only be taken should the patient become
unwell or show signs of a transfusion reaction or if advised by Blood Bank.
o Unconscious patients are more difficult to monitor for signs of transfusion reactions and
therefore it is recommended routine observation patterns should continue.
Completion of transfusion episode

If a further blood component unit is prescribed
o

If no further units are prescribed
o
o

Repeat the administration/identity check with each unit.
Remove the blood administration set and dispose of bag and tubing
Ensure all transfusion documentation is completed and the tag is returned
immediately to Blood Bank.
Return any unused blood products to Blood Bank.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 31 of 64
May 2014
PAT/T 2
v.5
POLICY 12 - REPORTING OF ADVERSE EVENTS/ REACTIONS FOLLOWING OR
DURING TRANSFUSION
See Appendix 2 and Appendix 3 Transfusion Reaction Flow chart.
Initial treatment of ATR is not dependent on classification but should be directed by symptoms and
signs. Treatment of severe reactions should not be delayed until the results of investigations are
available.
Patients should be asked to report symptoms which develop within 24 hours of completion of the
transfusion.
Initial clinical assessment
Initial clinical assessment seeks to quickly identify those patients with serious or life threatening
reactions so that immediate treatment/resuscitation can be initiated.
Appendix 2 provides a practical guide to recognition and Appendix 3 initial management of
suspected ATR.
Immediate management of ATR
If a patient develops new symptoms or signs during a transfusion, this should be stopped
temporarily, but venous access maintained. Identification details should be checked between the
patient, their identity band and the compatibility label of the blood component. Perform visual
inspection of the component and assess the patient with standard observations.
Mild Adverse Reactions
For patients with mild reactions, such as pyrexia (temperature of > 38 oC and a rise of 1-2oC),
and/or pruritus or rash but without other features, the transfusion may be continued with
appropriate treatment and direct observation.

If at any time a transfusion reaction is suspected, the doctor in charge of the patient should be
contacted by the nurse responsible for the patient during the transfusion and should review
the patient promptly.

Any adverse events should be recorded in the patient’s notes and logged on the blood
prescription sheet (WPR26561).

It is the doctor’s responsibility to ensure the adverse reaction is reported to Blood Bank.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 32 of 64
May 2014
PAT/T 2

v.5
It is the responsibility of Blood Bank staff to report the event to senior Blood Bank staff or the
Transfusion Practitioner to enable external reporting to SABRE (Serious Adverse Blood
Reactions and Events) and/ or SHOT if appropriate.
Patients with mild isolated febrile reactions may be treated with oral paracetamol (500-1000mg in
adults). Patients with mild allergic reactions may be managed by slowing the transfusion and
treatment with an antihistamine.
Standard observations
The patient s pulse rate, blood pressure, temperature and respiratory rate should be monitored
and abnormal clinical features such as fever, rashes or angioedema frequently assessed. A patient
who has experienced a transfusion reaction should be observed directly until the clinical picture has
improved
Severe Adverse Reactions
Management is guided by rapid assessment of symptoms, clinical signs and severity of the reaction.

The transfusion must be stopped immediately.

The blood administration set should be changed and venous access maintained using Sodium
Chloride 0.9% running slowly to keep the vein open.

The patients physician must be informed

A Consultant Haematologist must be informed.

The reaction should be reported immediately to the Blood Bank, who will issue a Transfusion
Reaction Investigation sheet. Follow the instructions carefully, complete the sheet and return
to Blood Bank as instructed along with any remaining blood products which may have been
involved in the reaction

The vital signs should be monitored immediately, recorded, and appropriate action taken. Vital
signs must continue to be monitored every 5 - 15 minutes depending on severity of reaction
and until the possible reaction has resolved.

The volume and colour of any urine passed should be recorded in the patient’s notes.
Anaphylaxis
Anaphylaxis should be treated with intramuscular adrenaline (epinephrine) according to UKRC
guidelines. Patients who are thrombocytopenic or who have deranged coagulation should also
receive intramuscular adrenaline if they have an anaphylactic reaction
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 33 of 64
May 2014
PAT/T 2
v.5
Hypotension
If a patient being transfused for haemorrhage develops hypotension, careful clinical risk assessment
is required. If the hypotension is caused by haemorrhage, continuation of the transfusion may be
life-saving. In contrast, if the blood component is considered the most likely cause of hypotension,
the transfusion must be stopped or switched to an alternative component and appropriate
management and investigation commenced.
Febrile symptoms of moderate severity
If a patient develops sustained febrile symptoms or signs of moderate severity (temperature > 39oC
or a rise of > 2oC and/or systemic symptoms such as chills, rigors, myalgia, nausea or vomiting),
bacterial contamination or a haemolytic reaction should be considered.
Investigation of a Suspected Severe Transfusion Reaction

The completed form and samples should be sent immediately to the Blood Bank with the
Blood Product bag/s and giving set.

Samples required are group & save, FBC, U/E, LFT, coagulation screen, blood cultures.

Blood Bank will report on its investigation as soon as possible.

No further transfusion of units currently cross-matched should undertaken until the Blood
Bank investigation is complete – this may be mitigated by the Consultant Haematologist
depending on circumstances.
Documentation of Severe Adverse Events / Reactions

Any adverse events should be recorded in the patient’s notes and logged on the blood
prescription sheet (WPR26561).

Report via DatixWeb.

All adverse events related to blood / blood product transfusion will be reviewed by the
Hospital Transfusion Committee.

Serious adverse events should be reported to the MHRA via SABRE (Serious Adverse Blood
Reactions and Events) and to SHOT (Serious Hazards of Transfusion) via the Blood Bank.

Suspected cases of transfusion-transmitted infection / TRALI should be reported immediately
to the local Transfusion Centre via the Blood Bank.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 34 of 64
May 2014
PAT/T 2
v.5
POLICY 13 - DOCUMENTATION OF TRANSFUSIONS
Full documentation of transfusions is mandatory and a legal requirement.
Documentation in the Patients Notes
A permanent record of the transfusion must be held in the patient’s medical notes, including the
following.


A complete record of the transfusion on the blood prescription sheet (WPR26561), with the
following information
o
Start and finish time of the transfusion on the blood prescription sheet.
o
The indication for the transfusion.
o
The type and number of blood products used.
o
The efficacy/ outcome/ benefit of this transfusion must be recorded in the
patients notes
o
The occurrence and management of any adverse effect.
o
The peel off sticker from the blood tag must be attached to the prescription
sheet
The sheets used for nursing observations during the transfusion.
Documentation to be returned to Blood Bank
The return of the tags is mandatory

The completed detachable blood tag must be returned to Blood Bank immediately following
transfusion to enable full traceability and ensure the Trust fulfils its legal requirements as
defined by BSQR 2005.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 35 of 64
May 2014
PAT/T 2
v.5
POLICY 14 - JEHOVAH’S WITNESS, PATIENT OR FAMILY REFUSAL OF BLOOD
TRANSFUSION
Some people may refuse blood transfusion for a variety of reasons. The aim of this policy is to
ensure that Jehovah’s Witnesses beliefs are acknowledged and respected and to provide
information with regard to the treatment of all patients who refuse Blood transfusion.
If refusal by non Jehovah’s Witnesses is based on fear of transfusion transmitted infection, the risks
should be clearly explained.
Refusal of blood transfusion should be carefully documented in the patient’s medical notes by the
consultant / most senior doctor present, with the reasons given together with date, time and
signature.
Jehovah’s Witnesses have definite objections to blood transfusions for both religious and medical
reasons. Witnesses rule out the transfusion of red cells, whole blood, fresh frozen plasma, platelets
and white cells, Pre-donation (PAD) and may refuse to donate bone marrow/ stem cells. Anti-D
immunoglobulin and Cryoprecipitate may be accepted and should be offered where appropriate.
In many cases without prior anaemia pre-operative Erythropoietin therapy is unnecessary unless
blood loss is likely to be in excess of 1000ml. In such patients post-operative iron and folate
supplement will restore the lost red cells over a few weeks.
However, in cases where blood loss of more than 500 ml is likely, the following actions should be
considered:
Major elective surgery
E.g. orthopaedic, should only be done after visiting pre-assessment clinic at least 4 weeks prior to
surgery and liaison between surgeon, anaesthetist and consultant haematologist to consider
strategies and get approval from the patient. Other clinical situations would need to be discussed
with the consultant haematologist

At this visit the FBC, Reticulocytes, Ferritin, B12 & folate must be checked.
Pre-operative treatment with Erythropoietin

Preoperative Erythropoietin 40,000 units subcutaneously weekly for 3 weeks + 40,000 units
post op day 1. This dosage is for an adult (55-80Kg), outside this range discuss with Consultant
Haematologist.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 36 of 64
May 2014
PAT/T 2
v.5

Start Erythropoietin 4 weeks prior to planned surgery – this date should not be changed once
pre op treatment started due to its expense.

Check FBC, reticulocytes & ferritin after 2 weeks of Erythropoietin therapy
Iron & folate supplementation pre op and post op.
Use of IV Iron may be preferable to oral iron. Folic acid should also be given orally at 5 mg daily.
Intra-operative cell salvage or Post-operative salvage
Consider the use of intra-operative cell salvage or post-operative salvage from wound drains if
acceptable to the patient. This should be documented on the patient consent form.
NB. Preoperative haemodilution is often acceptable to the JW patients and this possibility should be
explored.
Tranexamic acid, Prothrombin Complex Concentrate
May be suitable interventions, and should be explored as appropriate with the consent of the
Witness. All plasma derivatives can be considered and consent to transfuse is a matter of personal
choice for the individual patient.
Sampling
Consider the impact of blood sampling; are all the tests requested indicated? Could microtainers be
used?
Communication
Any of the above measures may be used but again there needs to be good communication between
surgeon, anaesthetist and consultant haematologist and the local liaison team if necessary.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 37 of 64
May 2014
PAT/T 2
v.5
Jehovah’s Witnesses Hospital Liaison Team
Contact the local Jehovah’s Witnesses Hospital Liaison Committee with regard to alternative care or
to locate doctors experienced in the management of Witnesses.
Local Liaison Team Contact Details
Richard Colley
Tel:
01142 899263
Mobile:
07598957852
[email protected]
Rory Tamplin
Tel:
01246 769675
Mobile:
07841235868
[email protected]
Alternatively contact:
Hospital Information Services
IBSA House,
The Ridgeway,
London
NW7 1RN
[email protected]
24-Hour Contact Number:
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
(020) 8906 2211
Page 38 of 64
May 2014
PAT/T 2
v.5
Treatment of Jehovahs Witnesses
Children
If a child is judged to be of sufficient age and maturity to fully understand the implications of their
beliefs, they should be treated as previously stated.
If however elective or emergency treatment of a child is required and this is against the parents or
guardians wishes then the following questions should be addressed:

Has the Hospital Liaison Team been contacted and asked for assistance?

Have the parents / guardians been given the full details regarding the need for treatment?

Have ALL non-blood medical management options been fully explored?

Is there another hospital willing to treat without blood?
Once all these questions have been addressed and it is still felt that treatment is essential then a
court order should be sought. The parents or guardians should be immediately notified of the
intent to obtain such an order and invited to attend any case conference, which takes place. The
support of a minimum of two practitioners of consultant status is required to seek the order and it
should be limited to the immediate medical incident.
Medical Treatment
 Abortion
Deliberate abortion is unacceptable. If, at the time of birth a choice has to be made between
the life of the mother and that of the child, it is up to the individuals concerned to make that
decision.
 Cell Salvage
Many Jehovah’s Witnesses will accept cell salvage, providing the system used is constantly
linked to the patient’s circulatory system and there is no storage of the patient’s blood.

Sampling
Consider the impact of blood sampling; are all the tests requested indicated? Could
microtainers be used?
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 39 of 64
May 2014
PAT/T 2

v.5
Proactive Patient Management
Planning, good communication and documentation are essential. Proactive and responsive
management of bleeds is critical.

Blood Transfusion
Jehovah’s Witnesses believe that blood transfusion is forbidden by Biblical commands and
therefore will refuse the transfusion of blood, plasma, white cells and platelets.
However, these beliefs do not absolutely rule out the use of products plasma derivatives such
as albumin, immunoglobulins and anti-haemophilic preparations. Each Witness will decide
whether he / she will accept these products.

Heart Bypass
Some Witness patients permit the use of heart-lung machines when the pump is primed with
non-blood fluids and blood is not stored in the process.

Haemodialysis
This is a matter for each witness patient to decide for him or herself. A closed circuit should be
used with no blood prime or storage.

Haemodilution
Induced haemodilution is a matter for the witness patient to decide according to his / her
conscience when a closed circuit is used and no blood storage is involved. Jehovah’s Witnesses
do not accept preoperative collection and storage of blood and its later transfusion
(autologous).

Plasma Derivatives
Such as albumin, Anti-D immunoglobulin, Cryoprecipitate and anti-haemophilic preparations
are not forbidden and should be offered, although some witnesses may conscientiously refuse
them.

Expanders
Plasma volume expanders are acceptable e.g. Sodium Chloride 0.9%.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 40 of 64
May 2014
PAT/T 2
v.5
POLICY 15 - FMH TESTING & THE USE OF ANTI-D IMMUNOGLOBULIN
Purpose
To provide healthcare professionals with practical guidance on the use of use of anti-D Ig as
immunoprophylaxis to prevent sensitisation to the D antigen during pregnancy or at delivery for the
prevention of haemolytic disease of the fetus and newborn (HDN)
Potentially sensitising events in pregnancy












Amniocentesis, chorionic villus biopsy and cordocentesis
Antepartum haemorrhage/Uterine (PV) bleeding in pregnancy
External cephalic version
Abdominal trauma (sharp/blunt, open/closed)
Ectopic pregnancy
Evacuation of molar pregnancy
Intrauterine death and stillbirth
In-utero therapeutic interventions (transfusion, surgery, insertion of shunts, laser)
Miscarriage, threatened miscarriage
Therapeutic termination of pregnancy
Delivery – normal, instrumental or Caesarean section
Intra-operative cell salvage
Dose Required
This is dependent on the gestation of the foetus and the volume of fetal cells in the maternal
circulation, as guided by fetomaternal haemorrhage (FMH) tests.
A FMH test is performed when the gestation is above 20 weeks. It is required to detect fetal cells in
the maternal circulation and, if present, to estimate the volume of FMH to allow calculation of
additional anti-D doses required to clear the fetal cells.
The dose calculation is traditionally based on 125 IU anti-D Ig/mL fetal red cells for IM
administration e.g. a dose of 500 IU, IM is considered sufficient to treat a FMH of up to 4mL fetal
red cells. Where it is necessary to give additional doses of anti-D Ig, as guided by tests for FMH.
Following potentially sensitising events, anti-D Ig should be administered as soon as possible and
always within 72 h of the event. If, exceptionally, this deadline has not been met some protection
may be offered if anti-D Ig is given up to 10 days after the sensitising event.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 41 of 64
May 2014
PAT/T 2
v.5
If FMH >4mL is detected, follow-up samples are required at 72 h following an intramuscular (IM)
dose of anti-D to check for clearance of fetal cells.
Potentially sensitising events in pregnancies of less than 12 weeks gestation

In pregnancies<12 weeks gestation, anti-D Ig prophylaxis is only indicated following ectopic
pregnancy, molar pregnancy, therapeutic termination of pregnancy and in cases of uterine
bleeding where this is repeated, heavy or associated with abdominal pain.

If indicated the minimum dose for confirmed D negative women who are not known to be
already sensitised to D should be 250 IU. FMH testing is not required.
Potentially sensitising events in pregnancies of 12 weeks to less than 20 weeks
gestation

A maternal blood group and antibody screen should be performed to determine or confirm the
Rh D group and check for the presence of anti-D.

If anti-D is identified, further history should be obtained and investigation undertaken to
determine whether this is immune or passive (as a result of previous injection of anti-D Ig). If
no clear conclusion can be reached as to the origin of the anti-D detected, then the woman
should continue to be offered anti-D prophylaxis on the assumption that it may be passive.

Women with indeterminate Rh D typing results should be treated as D negative until
confirmatory testing is completed.

A test for FMH is NOT required before 20 weeks gestation.
Samples Required
1 x 6ml pink EDTA sample.
Dose Required
A minimum anti-D Ig dose of 250 IU should be administered within 72 h of the event.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 42 of 64
May 2014
PAT/T 2
v.5
Potentially sensitising events in pregnancies of 20 weeks gestation to term
There is an additional requirement to assess the volume of FMH.
Samples required

1 x 6 ml pink EDTA sample.

1 x 4 ml purple EDTA sample (taken within 2 hrs of the sensitising event)
Samples should be taken prior to anti-D administration.
Dose required

A minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event

If a FMH of >4mL is indicated, a larger dose of anti-D will be required. The Blood Bank will advise
on the dose required and further testing.
Prophylaxis following birth of a D positive child or intrauterine death

Following birth, ABO and Rh D typing should be performed on cord blood and if the baby is
confirmed to be D positive, all D negative, previously non-sensitised women should be offered
at least 500 IU of anti-D Ig within 72 h following delivery. Maternal samples should be tested
for FMH and additional dose(s) given as guided by FMH tests

If a cord sample is not collected for any reason, a heel prick sample from the baby should be
obtained as soon as possible.

Direct Antiglobulin Test (DAT) should be performed if haemolytic disease of the newborn is
suspected or anticipated because of a low cord blood haemoglobin concentration &/or the
presence of maternal immune red cell antibodies.

Maternal samples for confirmatory ABO and D type and FMH testing should be collected after
sufficient time has elapsed for any FMH to be dispersed in the maternal circulation. A period of
30- 45 minutes is considered adequate and the samples should ideally be taken within 2 h of
delivery primarily to ensure that the sample is taken prior to woman’s discharge from the
hospital.

Following birth of a D positive infant at least 500 IU anti-D immunoglobulin (IM) must be
administered to the woman if the FMH is ≤ 4 mL.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 43 of 64
May 2014
PAT/T 2
v.5

Additional dose of anti-D immunoglobulin is necessary for larger FMH with the dose to be
administered by intramuscular route. The Blood Bank will advise on the dose required and further
testing.

In the event of an intrauterine death (IUD), where no sample can be obtained from the baby, an
appropriate dose of prophylactic anti-D Ig should be administered to D negative, previously
non-sensitised women within 72 h of the diagnosis of IUD, irrespective of the time of
subsequent delivery

Postpartum anti-D immunoglobulin prophylaxis should not be affected by previous routine
antenatal anti-D prophylaxis (RAADP) or by antenatal anti-D given for a sensitising event.
Samples required

Maternal Samples
1 x 6ml pink EDTA sample
1 x 4 ml EDTA taken within 2 hrs of the sensitising event

Cord Samples
1 x 6 ml pink EDTA sample
Dose Required

A minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event.

If a FMH of >4mL is indicated, a larger dose of anti-D will be required. The Blood Bank will
advise on the dose required and further testing.
Prevention of anti-D formation in the event of recurrent uterine bleeding in Dnegative women during pregnancy
Recurrent uterine bleeding before 12 weeks gestation:

Evidence that women are sensitised after uterine bleeding in the first 12 weeks of pregnancy
where the fetus is viable and the pregnancy continues is scant.

Therefore anti-D immunoglobulin is not necessary in women with threatened miscarriage with
a viable fetus where bleeding completely stops before 12 weeks gestation.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 44 of 64
May 2014
PAT/T 2

v.5
However it may be prudent to administer 250 IU anti-D Immunoglobulin where bleeding is
heavy or repeated or where there is associated abdominal pain particularly if these events
occur as gestation approaches 12 weeks. The period of gestation should be confirmed by
ultrasound.
Recurrent uterine bleeding between 12 and 20 weeks gestation
D-negative women with recurrent PV bleeding between 12 and 20 weeks gestation should be given
250 IU anti-D immunoglobulin at a minimum of 6 weekly intervals.
Recurrent uterine bleeding after 20 weeks gestation

Anti-D immunoglobulin 500 IU should be given at a minimum of 6 weekly intervals.

Estimation of FMH by kleihauer technique should be carried out at a minimum of 2 weekly
intervals.

If the FMH is positive, additional dose of anti-D immunoglobulin (500 IU minimum, more if FMH
exceeds 4mls) should be offered regardless of the presence or absence of passive anti-D in
maternal plasma, and FMH should be retested after 72 hours .

If the FMH is negative and anti-D is present in the maternal plasma and anti-D immunoglobulin
as been given in the last 6 weeks no further anti-D immunoglobulin is required at this point.

If there is no anti-D present in the maternal plasma a 500IU dose of anti-D immunoglobulin
should be given.
Intra-operative Cell Salvage (ICS)

When intra-operative cell salvage (ICS) is used for Caesarean section, reinfused blood may
contain fetal red cells. Published literature using different cell salvage apparatus, techniques
and volume of blood reinfused suggests that the volume of fetal red cells in re-infused blood
varies from 1 to 20mL.

Since the volume of fetal red cells in ICS blood is variable and can be relatively large, it is
recommended that a minimum anti-D Ig dose of 1500 IU be administered to D negative,
previously nonsensitised women after reinfusion of salvaged red cells, if the cord blood group
is D positive (or if the cord group cannot be established for whatever reason).

Maternal samples should be taken for estimation of FMH 30–45 min after the re-infusion of
salvaged red cells, and additional dose(s) of anti-D administered if necessary, and appropriate
follow-up FMH testing performed.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 45 of 64
May 2014
PAT/T 2

v.5
It is important that clinicians inform the transfusion laboratory if ICS has been used to ensure
that correct dose of anti-D Ig is issued
Routine Antenatal Anti-D Prophylaxis (RAADP)

Rh D negative mothers who are not sensitised should receive 1500 IU of anti-D immunoglobulin
by intramuscular injection at 28 weeks gestation.

It is important that the 28-week sample for blood group and antibody screen is taken prior to
the first routine prophylactic anti-D Ig injection being given. This forms the second screen
required in pregnancy as stated in the BCSH Guidelines for Blood Grouping and Red Cell
Antibody Testing during pregnancy

Routine Antenatal Anti-D Ig Prophylaxis (RAADP) should be regarded as a separate entity and
administered regardless of, and in addition to, any anti-D Ig that may have been given for a
potentially sensitising event

It has been shown that following RAADP anti-D immunoglobulin can cross the placenta, enter
the fetal circulation and bind to fetal D antigen sites.

A positive DAT in itself is not diagnostic of HDN. However if it is positive, the infant’s
haemoglobin and bilirubin levels should be checked to diagnose/exclude HDN.
Management of Transfusion of D Positive Blood Components to D Negative Girls or
Women of Childbearing Potential
D Positive Platelet Transfusions

Whenever possible, D negative platelets should be transfused to D negative girls or women of
child bearing potential, who need a platelet transfusion.

Occasionally, if the appropriate product is not available or its availability would cause
unacceptable delay, it may be necessary to transfuse D positive platelets. In these
circumstances, prophylaxis against possible sensitisation to the D antigen by red cells
contaminating the platelet product should be given.

A dose of 250 IU anti-D immunoglobulin should be sufficient to cover up to five adult
therapeutic doses of D positive platelets given within a 6-week period.

In severely thrombocytopenic patients with platelet count of ≤30 × 109/L, anti-D Ig should be
given subcutaneously.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 46 of 64
May 2014
PAT/T 2
v.5
Inadvertent Transfusion of D Positive Blood
Less than 15mL Transfused
When less than 15mL have been transfused, the appropriate dose of IM anti-D Ig may be given. The
Blood Bank will advise on the dose required and further testing.
More than 15mL Transfused

When more than 15mL have been transfused, it is preferable to use the larger anti-D
immunoglobulin preparation (1500 or 2500IU); however, IV anti-D immunoglobulin is the
preparation of choice, achieving adequate plasma levels immediately.

IM only preparations of anti-D immunoglobulin must not be given IV.

The quantitation of D positive red cells should be performed by flow cytometry (FC) after 48h if
an IV dose of anti-D has been given or 72 h if an IM dose has been given and further anti-D Ig
given until there are no detectable D positive red cells in circulation.

When more than one unit of D positive blood has been transfused, a red cell exchange
transfusion should be considered to reduce the load of D positive red cells in the circulation
and the dose of anti-D Ig required to prevent immunisation.

In this situation advice should be sought from a specialist in Transfusion Medicine, and the
patient should be counselled regarding the implications of both non-intervention (for future
pregnancies) and of treatment, including any hazards from receiving donated blood, the
exchange procedure itself and of larger doses of anti-D Ig, including IV anti-D Ig.

A single blood-volume red cell exchange transfusion will achieve a 65–70% reduction in D
positive red cells; a double volume exchange will achieve an 85–90% reduction. Shortly after
the exchange transfusion, the residual volume of D positive red cells should be estimated using
FC.

Passive anti-D Ig given in large doses may remain detectable and tests for immune anti-D may
not be conclusive for several months.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 47 of 64
May 2014
PAT/T 2
v.5
POLICY 16 - TRANSFER OF PATIENTS WITH BLOOD PRODUCTS
Blood is not normally crossmatched for transfer with patients, blood products will only be
transferred for use in transit in extremely urgent cases such as an ECMO transfer.
When blood is transferred with a patient, the Trust remains legally responsibility for full traceability
of the blood products we provided for the patient.
The escort team must include members of staff competent in transfusion and treatment of
transfusion complications including anaphylaxis.
External Transfers (Hospital to Hospital)
Transfer from Bassetlaw (BDGH) to Doncaster (DRI)

The transfer team must contact BDGH Blood Bank; during the working day phone ext 2452, out
of hours bleep the on-call Haematology BMS via switchboard.

The transfer team must ensure Blood Bank have received a request to package blood for
transfer. If blood is not already crossmatched, immediately despatch a sample and/or request
form to BDGH Blood Bank.

Blood products can only be packaged by Blood Bank staff in validated blood transit boxes with
appropriate transfer documentation.

Blood will not be sent to DRI separately from the patient.

The transfer team have responsibility for ensuring full traceability of any blood products used in
transit.

The transfer team must complete all accompanying transfusion related paperwork including the
blood tags and ensure that all the paperwork is sent to Blood Bank at the receiving site.

Any unused units and/or the blood transit box must be taken directly to Blood Bank at the
receiving site.
Transfer from Mexborough Montagu to Doncaster (DRI)

The transfer team must contact the on site lab on ext 5235 and DRI Blood Bank; during the
working day phone ext 3779, out of hours bleep the on-call Haematology BMS via switchboard.

The transfer team must ensure crossmatched blood is available for transfer.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 48 of 64
May 2014
PAT/T 2
v.5

Blood products can only be packaged by authorised staff in validated blood transit boxes with
appropriate transfer documentation.

The transfer team have responsibility for ensuring full traceability of any blood products used in
transit.

The transfer team must complete all accompanying transfusion related paperwork including the
blood tags and ensure that all the paperwork is sent to Blood Bank at the receiving site.

Any unused units and/or the blood transit box must be taken directly to Blood Bank at the
receiving site.
Transfer to Hospitals outside the Trust

The transfer team must contact Blood Bank during the working day, out of hours bleep the oncall Haematology BMS via switchboard.

The transfer team must ensure Blood Bank have received a request to package blood for
transfer. If blood is not already crossmatched, immediately despatch a sample and/or request
form to Blood Bank.

Blood products can only be packaged by Blood Bank staff in validated blood transit boxes with
appropriate transfer documentation.

Blood will not be sent to the receiving hospital separately from the patient.

The transfer team have responsibility for ensuring full traceability of any blood products used in
transit.

The transfer team must complete all accompanying transfusion related paperwork including the
blood tags and ensure that all the paperwork is returned to Blood Bank at the sending site.

Any unused units and/or the blood transit box must be taken directly to Blood Bank at the
receiving site.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 49 of 64
May 2014
PAT/T 2
v.5
APPENDIX 1 - NEONATES AND CHILDREN
Summary
Definitions



Neonate – child less than 28 days
Infant – greater than 28 days but less than 1 year
Child – age 1 year and above
Rate of Infusion




RBC
PLT
FFP
CRYO
10ml-20ml/kg
15ml/kg
10-15ml/kg
5ml/kg
Volume Required
desired Hb (g/L) - actual Hb (g/L) x weight (kg) x 3 = mls
10
Prior to Collection of Blood Products
•
•
•
•
•
•
•
Prescribe products
Obtain Consent
Verify patient identification
Cannula/Patency
Ensure patient’s sample sent to lab
Perform observations
Check blood is ready for collection
Equipment
Volumes less than 50mls use syringe driver with appropriate blood pump tubing.
If A/E need to transfuse neonate/child A/E staff must contact neonatal unit or children’s ward for
appropriate pump and blood tubing.
 Prior to connecting IV line to patient, purge lower part of line using the settings on the pump. Whilst
purging, gently massage air vent until blood reaches end of line.
 Amount to be infused to child must be in the syringe. Clamp red port to blood bag. Check volume and
rate of infusion on pump settings prior to connecting line to patient.
Volumes greater than 50ml use Baxter or Alaris pump with appropriate tubing. If pump and tubing not
available in A&E, obtain from A3 Children’s Unit.
Observations
Perform before the start of each unit, then every 15 minutes following commencement for 1st hour, every
30 minutes for 2nd hour and hourly thereafter and at the end of each transfusion episode.
Patient Identification
Patient identification and blood product verification must be done at bedside. This is mandatory and is
based on: Tag & Bag, Tag & Wristband Checks.
Author
Gill Bell
Title
Blood Transfusion Policy
Document No.
PAT/T2 v.5
Page 50 of 64
May 2014
REF:REF:
PAT/T
2 v.5
PAT/T
2 v.5
Red cell volume and rate for neonates and children

Paediatric packs of O RhD negative (cde/cde) / O RhD positive) dependant on neonate’s
Rh D type), CMV, Kell and HT negative are used for neonatal transfusions

CMV negative blood should be used for all transfusions to infants in the first year of life.

All intra-uterine transfusions (IUTs) and exchange transfusions in the neonatal period
should be irradiated. The same applies to top-up transfusions in neonates if there has been
an IUT or exchange transfusion or when the child has proven or suspected
immunodeficiency
Clinical situation:
Aim for HB threshold (g/L:
Anaemia in the first 24 hours of life
Ventilated more than 30% oxygen
Ventilated less than 30%oxygen
NCPAP more than 30% oxygen
NCPAP less than 30% oxygen
In low flow oxygen e.g. nasal prongs
In air*
>120g/L
>120g/L
>100g/L
>100g/L
> 80g/L
> 80g/L
> 70g/L
Volume and rate of administration for infants <45kg
Volume
Rate
Total volume prescribed ÷ 4 hours = hourly
Vol (mls) = ((desired Hb – actual Hb) x
weight (kg) x 3) ÷10
rate
Children > 45kg weight
Volume
Rate
1 unit (= approximately 260mls -350mls)
Author
Title
Document
No.
Gill Bell
Total unit volume ÷ 4 hours = hourly rate
(can be given over 3 hours if tolerated)
Page 51 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
Platelet indications for neonates and children

Apheresis derived and not pooled Platelets are used for children under 16 years of age.

For neonates should be CMV negative
Neonatal indications
Asymptomatic
Threshold platelet count
(x109/L)
<50
<30
<100
- pre-term (<37 weeks)
- term
Symptomatic
- major organ bleeding
e.g. haematuria
- minor bleeding e.g.
<50
petechiae, bruising
Indications for prophylactic platelet transfusion in children as a result of reduced production.
(x109/L)
<10
<20 and one or more of the
Severe mucositis
following
Disseminated intravascular coagulation (DIC)
Anticoagulant therapy
Platelets likely to fall <10 before next evaluation
Risk of bleeding due to a local tumour infiltration
20–40 and one or more of
DIC in association with induction therapy for leukaemia
the following
Extreme hyperleucocytosis
Prior to lumbar puncture or central venous line insertion
Volume and flow rates
Volume and rate of administration for infants and children
Rate
Volume
Children weighing <15 kg 10–20 ml/kg
Children weighing >15 kg Single apheresis
unit
Author
Title
Document
No.
Gill Bell
Over 60 minutes
Page 52 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
FFP Volume and rate
Children 16 years and under should receive only Pathogen Reduced Plasma (PRP) sourced from the
USA. Non-UK sourced Methylene blue treated FFP (NON-UK MB-FFP) is available in small packs.
Volume and rate of administration
Volume
Rate
10 to 20 ml/kg
*
Haemorrhage due to haemorrhagic DN
Coagulopathy and bleeding or risk from invasive
procedure
Over 60 minutes
*Also consider Vitamin K
Efficacy is unpredictable and it may be helpful to recheck clotting function after administration
Definitions



Neonate – child less than 28 days
Infant – greater than 28 days but less than 1 year
Child – age 1 year and above
Pre-administration Checks






Consent obtained
Completed prescription to transfuse
Check patient wearing correct wristband; confirm identifiers are correct (including cot card, notes)
Check IV access patent
Check pre transfusion observations done
A person trained in blood collection available. (Provide them with written patient information e.g.
barcoded addressograph label)
Author
Title
Document
No.
Gill Bell
Page 53 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
Equipment Required





Sterile gloves
Apron
Blood product giving set2% chlorhexidine in 70% isopropyl
50ml syringe
Extension set and pump.
Record Baseline Observations (the infant should be on a heart monitor)





Temperature,
Pulse
Respiratory rate
Blood pressure
O2 saturation
Receipt of Products and Bedside Checks
Transfusion must be started within 30 minutes of the blood product leaving the blood fridge









Assemble equipment
Patient blood group to be checked on PAS
Blood product to be checked by 2 members of staff at the bedside
Check red tag donation number (G number) against donation number on the bag. If any discrepancy
DO NOT proceed.
Check red tag patient details against patient’s wristband. If any discrepancy DO NOT proceed.
Check patient details with parent or guardian (if no parent / guardian available identify patient from
notes with another staff member). If any discrepancy DO NOT proceed.
Check integrity of the blood product; expiry date, CMV status and appearance (clots / discolouration).
If any discrepancy DO NOT proceed.
Verify the product to be transfused from the prescription, check for any special requirements.
Commence the transfusion as below.
Administering the Blood Product via a Syringe Driver

Attach blood administration set, extension set and 50ml syringe

Spike blood bag and fill chamber
Author
Title
Document
No.
Gill Bell
Page 54 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5

Draw blood into syringe, press purge on pump to fill lower section of giving set line. Close the white
Clamp.

Ensure syringe contains volume of blood prescribed. Close red clamp to the blood bag.

Both nurses check the pump settings, volume to be transfused and the rate as prescribed.

Flush cannula with Sodium Chloride 0.9% to ensure it is patent.

Use 2% chlorhexidine in 70% isopropyl to clean hub, and attach extension set to cannula using non
touch technique.

Commence transfusion.

Both nurses should sign the adhesive portion of the red tag which is placed on the prescription sheet in
the notes. The front portion of the red tag should be signed and dated and sent back to the lab
immediately to Blood Bank.

Diuretic therapy should be administered as prescribed and output recorded as necessary.

Once transfusion is completed observation of temperature, apex and respirations should
be recorded.
 Flush cannula with 2mls of normal saline for paeds or till T piece clear for neonates.
 On completion of the transfusion the empty bag and tubing are to be disposed of in a yellow bag black
stripe.
Administering Blood Product Volumes Greater than 50ml via a Blood Pump for a Child

Using Blood pump giving set.

Spike blood bag, fill chamber and line.

Set pump to prescribed volume and transfusion rate

2 nurses to verify settings

Clean hub with 2% chlorhexidine in 70% isopropyl prior to connecting to patients cannula using nontouch technique.
Neonatal/ Infant/ Child Observations during Transfusion
(The infant should be on a heart monitor)
Observations to be done pre transfusion and 15 minutes following commencement of the transfusion,
observations to be recorded every 15 minutes for the first 60 minutes, then every 30 minutes for the next
hour then hourly until completion. Observations must be documented on PAWS or Neonatal specific paper
work. During this period stay in sight and sound of the infant. These minimum criteria for observations
apply to a stable child. If the child is not stable, observations must be done more frequently in accordance
with the (PAWS) Paediatric Advanced graded response strategy and clinical judgement.
Author
Title
Document
No.
Gill Bell
Page 55 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
Reactions
 Pyrexia <2 degrees rise
Inform paediatrician and Blood Bank, give paracetamol and resume infusion at a slower rate.
 Pyrexia >2 degrees
Observe for other signs and symptoms; inability to maintain saturations, bradycardia, tachycardia,
respiratory distress, rigors. Hypotension, localised redness / itching / tracking
Any of the above inform paediatrician and Blood Bank, stop transfusion and return unit to Blood Bank
along with a blood samples. Complete transfusion reaction form (available from Blood Bank) and liaise
with Blood Bank.
Additional notes
 Embrace – blood on route is acceptable via a syringe driver.
 Time critical transfers. Any other ambulance other than Embrace. Blood must be packed in a validated
sealed blood transit box. Blood and blood products cannot be transfused during transfer of patient.
Blood in box must go directly to the receiving hospital’s Blood Bank.
 Blood product collection can be requested via Teletrack.
Author
Title
Document
No.
Gill Bell
Page 56 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
APPENDIX 2 – ISBT/IHN CLASSIFICATION OF ATRs
Author
Title
Document
No.
Gill Bell
Page 57 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
Comparison of TRALI and TACO
For patients who develop respiratory distress during or shortly after transfusion, and who do not have
evidence of wheeze or stridor, the following table may be of help in determining a cause.
In addition to the categories of TRALI and TACO, SHOT is now collecting cases of transfusion associated
dyspnoea (TAD). The International Haemovigilance Network (IHN) defines TAD as being characterized
by respiratory distress within 24 hours of transfusion that does not meet the criteria of TRALI, TACO, or
allergic reaction. Respiratory distress should be the most prominent clinical feature and should not be
explained by the patient s underlying condition or any other known cause. There are currently no other
known distinguishing features to aid diagnosis of TAD.
Author
Title
Document
No.
Gill Bell
Page 58 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
Author
Title
Document
No.
REF: PAT/T 2 v.5
Gill Bell
Page 59 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
APPENDIX 3 CONT ….
Symptoms and signs of acute transfusion reactions (ATR)
Fever and related symptoms or signs
Although characteristic of FNHTR, pyrexia and other symptoms or signs of an inflammatory response (myalgia,
malaise, nausea, chills or rigors) may also occur in acute haemolysis, TRALI and bacterial transfusion-transmitted
infection (TTI).
Transfusion can often be continued in patients with mild FNHTR but differentiation from other causes is not
always straightforward. Life-threatening haemolysis due to ABO incompatibility is unlikely if the correct unit of
blood has been given. Acute haemolysis due to other antibodies may occasionally present with immediate clinical
features suggesting a severe or moderate febrile reaction during the transfusion, with signs of haemolysis
appearing later. TRALI can be reasonably excluded if the patient has no respiratory symptoms.
The possibility of bacterial TTI should always be considered as early appropriate treatment is life-saving. Several
authors report this to be more likely if the rise in temperature is 2ºC or more .In the 16 confirmed reports of
bacterial TTI to SHOT between 2005 and 2010, all patients had symptoms or signs in addition to pyrexia and, in
the five cases where a specific temperature was stated this was either 39ºC or above or associated with a rise of
greater than 2ºC.
Inspection of the implicated unit is important as discolouration or abnormal particles are suggestive of
contamination
Skin lesions and rashes
Urticaria is commonly seen with allergic reactions but other types of skin change may occur, such as
maculopapular rashes, erythema or flushing. In some transfusion reactions there is no visible rash but itching is
reported by the patient.
Angio-oedema
This describes localized, non-pitting, oedema of the subcutaneous or submucosal tissues and usually indicates an
allergic reaction. The eyelids and mouth are most often affected, less commonly throat and tongue. If angiooedema occurs, the transfusion must be stopped immediately and the patient promptly assessed and treated.
Dyspnoea
Shortness of breath is a non-specific symptom and successful management relies on careful clinical examination
supported by the results of investigations such as radiology and measurement of oxygen saturation/blood gases.
Possible causes include allergy, TRALI, TACO and TAD. Stridor and wheeze suggest an allergic reaction but also
occur in patients with TACO and have been reported once, associated with chills and rigors, in bacterial TTI.
Author
Title
Document
No.
Gill Bell
Page 60 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
Pulmonary oedema with clinical signs of basal crackles and radiological evidence suggest a diagnosis of TACO or
TRALI and helps exclude allergy. Low oxygen saturation is not diagnostic of a specific condition, although it gives
information on severity.
The possibility that clinical features are related to the patient s underlying illness must be kept in mind.
Anaphylaxis
The UK Resuscitation Council advises that a precise definition of anaphylaxis is not important for emergency
treatment. An anaphylactic reaction involves a severe, life-threatening, generalised or systemic hypersensitivity
reaction characterised by rapidly developing airway and/or breathing and/or circulation problems usually
associated with skin and mucosal changes.
Hypotension
This is defined as a drop in systolic and/or diastolic blood pressure of greater than 30 mm Hg. It is a common and
non-specific feature of acute haemolysis, severe allergic reaction, bacterial contamination or TRALI. It occurs
rarely as an isolated finding and some cases have been attributed to the generation of bradykinin and
angiotensin when blood components were exposed to the charged surface of leucoreduction filters. Patients
taking ACE inhibitors and those with a genetic defect which prevents bradykinin breakdown were most at risk.
In addition hypotension may be associated with the patient’s underlying condition, especially haemorrhage, so
careful clinical risk assessment is required when deciding to stop the transfusion for this indication.
Bleeding diathesis of acute onset
This is highly suggestive of disseminated intravascular coagulation (DIC) especially when there is oozing from
wounds or intravenous line insertion sites. It is most likely in severe acute haemolysis (especially ABO
incompatibility) or bacterial contamination and is an alert that the transfusion must be stopped immediately and
rapid clinical assessment undertaken.
Tingling around the face and lips
This is a recognised herald symptom of angioedema but may also occur in patients who are hyperventilating or
during a plasma or red cell exchange procedure with citrate anticoagulant due to a fall in ionised calcium.
Pain
Patients with febrile reactions often complain of generalised muscular and bone aches, probably due to release
of inflammatory cytokines. Acute haemolytic reactions, particularly those due to ABO incompatibility, may be
characterised by pain at the infusion site, abdomen, chest and loins. Chest pain can also be an occasional feature
of anaphylactic reactions, possibly due to myocardial ischemia.
Severe Anxiety
This is often reported in serious transfusion reactions. A feeling of impending doom has been described in acute
haemolysis and bacterial transfusion-transmitted infection and should always initiate urgent review of the
patient. However, mild anxiety is common in patients being transfused, especially for the first time.
Author
Title
Document
No.
Gill Bell
Page 61 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
APPENDIX 4
Fresh Frozen Plasma (FFP) Dosage
Fresh Frozen Plasma (FFP) has optimal value when transfused at the appropriate dose. The
recommended adult therapeutic dose of FFP is 15ml/kg, and the dose of FFP should
always be at least 10ml/kg; however a national audit showed in clinical practice 40% of adults
received a FFP dose <10ml/kg.
The prescribed dose of FFP should be guided by clinical situation and coagulation results.
Calculations for One Adult Therapeutic Dose FFP
FFP dose
Volume / Units†
Patient Weight (kg)
15ml/kg
Units FFP
Up to 60 kg
900 ml
3
65 kg
975 ml
70 kg
1050 ml
75 kg
1125 ml
80 kg
1200 ml
85 kg
1275 ml
90 kg
1350 ml
95 kg
1425 ml
100+ kg
1500 ml
4
5
†
Volume of FFP in a unit is variable, mean FFP unit volume 273mls (rounded up to 275mls for ease of calculation).
This document is intended as a guide to the appropriate adult dose of FFP, it is not a
directive, and should not be used in place of clinical assessment.
Caution should be exercised if using this chart for calculating FFP volumes for overweight
patients as the volume suggested may be an over estimation and may risk fluid overload.
Protocols for the Management of Massive Haemorrhage contain alternative strategies for the
adult dose of FFP; please refer to Appendix 5 Massive Haemorrhage Protocol as appropriate.
Author
Title
Document
No.
Gill Bell
Page 62 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
REF: PAT/T 2 v.5
APPENDIX 5
MASSIVE HAEMORRHAGE PROTOCOL
Explanatory Notes:
1.
Recognise trigger and activate pathway for management of massive haemorrhage.
If you need the emergency O RhD Negatives you need to activate the Massive Haemorrhage protocol.
2. Allocate team roles
Team leader
Communication lead dedicated person for communication with other teams, especially the transfusion
laboratory and support services not the most junior member of the team
Sample taker / investigation organiser / documenter
Transporter - porter, member of team from clinical area
3. Complete request forms / take blood samples, label samples correctly /recheck labelling
FBC Crossmatch PT, APTT, Fibrinogen U+E, Calcium
4. Request blood / blood components
Communication lead to contact laboratory and inform the BMS of the following:
Activation of the massive haemorrhage protocol using the trigger phrase “I would like to activate the
Massive Haemorrhage Protocol “
Your name, location and ext number / bleep number
The patient’s details: ideally surname, forename, District number.
Order massive haemorrhage pack 1 (MHP1)
Contact Blood Bank if blood has been transferred in with the patient from another Trust or patient is being
transferred to another Trust
5. The clinical / laboratory interface
Communication lead to arrange for transport of samples / request form to the laboratory
BMS to ring communication lead when blood / blood components are ready
Communication lead to arrange to collect blood and blood components from the Blood Bank.
Abnormal results or advice required – Clinical Lead contact Consultant Haematologist
6. Communicate stand down of pathway to Blood Bank BMS and return any unused products to Blood Bank
immediately.
Take repeat bloods at the end of event
Continue to monitor patient closely for signs of re-bleed.
7. Ensure documentation is complete
Clinical area: monitoring of vital signs, timings of blood samples, communications, transfusion documentation
in patient case notes, return traceability information to Blood Bank (Tags / emergency O RhD Negative slips),
Blood Bank: keep record of communications / telephone requests on worksheet, MHP issued (including O
RhD negatives)
Transfusion Practitioner: completion of audit proforma, ideally within 24 hours.
Author
Title
Document
No.
Gill Bell
Page 63 of 64
Blood Transfusion Policy
PAT/T2 v.5
May 2014
Massive HaemorrhageREF: PAT/T 2
v.5
Patient bleeding / collapses. Ongoing severe bleeding eg: 150 mls/min. Clinical shock
Activate Massive Haemorrhage Protocol
Most senior clinician in charge to contact Blood Bank, using the trigger
phrase “I would like to activate the Massive Haemorrhage Protocol “
STOP THE
BLEEDING
Transfusion lab 3779 (DRI) 2452 (BDGH)
Out of hours bleep Haematology BMS.
(Consultant Haematologist not required to activate protocol)
Take bloods and send to lab:
XM FBC PT, APTT, fibrinogen U+E, Ca2+
Collect MHP 1
Haemorrhage Control
Direct pressure / tourniquet
if appropriate
Stabilise fractures
Surgical intervention –
consider damage control
surgery
Interventional radiology
Endoscopic techniques
Obstetric techniques
Haemostatic Drugs
Tranexamic acid 1g bolus
IV followed by 1g after 3
hrs
Vit K and Prothrombin
complex concentrate (PCC)
for warfarinised patients and
Other haemostatic agents
discuss with Consultant
Haematologist
Cell salvage
Red cells*
4 units
FFP
4 units
Platelets
1 unit
*Emergency group O blood or group
specific blood or XM blood may be
issued; dependent on group & save status
Give MHP 1
MHP 2
Red cells
FFP
Platelets
Cryopreciptate
4 units
4 units
1 unit
2 pooled packs
Prevent Hypothermia
Use fluid warming device
Used forced air warming
blanket
Consider 10 mls Calcium
chloride 10% over 10 mins
FBC, PT, APTT, fibrinogen
Abnormal results or advice
required – contact Consultant
Haematologist
Aims for therapy
Hb
80-100 g/L
Platelets
>75 x 109/l
PT ratio
< 1.5
APTT ratio <1.5
Fibrinogen >1g/l
(>2g/l Obstetric)
Ca2+
> 1.8mmol/l
Temp
> 36oC
pH
> 7.35 (on ABG)
Monitor for hyperkalaemia
Give MHP 2
STAND DOWN
Give MHP 2
Reassess
Proceed or Standown
Suspected continuing haemorrhage
should be considered when
requiring further transfusion
patient stable
Take repeat bloods as above and
Author
Gill Bell
deliver
to lab in exchange for MHP 3
Title
Blood Transfusion Policy
Document
PAT/T2 v.5
MHP = massive
No.
haemorrhage pack
Give MHP 3
Give MHP 2
Breathing
Circulation
Reassess
Proceed or Stand down
Suspected continuing haemorrhage
requiring further transfusion
Take repeat bloods as above and
deliver to lab in exchange for MHP 2
If available & appropriate
Thromboprophylaxis
RESUSCITATE
Airway
•Inform lab
•Return unused
components
•Complete
documentation (including
blood tags &
audit
Page
64data)
of 64
•Take repeat bloods at the
end of event
May 2014
PAT/T 61
Telephoned Pathology Results
This is a new procedural document, please read in full
Did you print this document yourself?
The Trust discourages the retention of hard copies of policies and can only guarantee
that the policy on the Trust website is the most up-to-date version. If, for exceptional
reasons, you need to print a policy off, it is only valid for 24 hours.
Author/reviewer: (this
version)
Sarah Bayliss – General Manager, Pathology
Date written/revised:
7 June 2013
Approved by:
Patient Safety Review Group
Date of approval:
7 June 2013
Date issued:
24 June 2013
Next review date:
June 2015
Target audience:
Clinical and Pathology staff, Trust-wide and in
Primary Care
Page 1 of 12
v.1
PAT/T 61
v.1
Amendment Form
Please record brief details of the changes made alongside the next version number. If
the procedural document has been reviewed without change, this information will still
need to be recorded although the version number will remain the same.
Version
Version 1
Date
Issued
24 June
2013
Brief Summary of Changes
This is a new procedural document, please
read in full
Page 2 of 12
Author
S Bayliss
PAT/T 61
v.1
Contents
Page
No.
Section
1
Introduction
4
2
Purpose
4
3
Duties and Responsibilities
4
4
Procedure
5
5
Training/Support
9
6
Monitoring Compliance with the Procedural Document
9
7
Definitions
10
8
Equality Impact Assessment
10
9
Associated Trust Procedural Documents
10
10
References
11
Flowchart for Telephone Pathology Results
12
Appendix 1
Page 3 of 12
PAT/T 61
1.
v.1
INTRODUCTION
This policy has been developed to ensure that all staff
• understand the significance of telephoned pathology results
• are clear about the actions they need to take
• know the timescale within which they must act
This policy does not replace the essential requirement for each clinician to be
responsible for promptly accessing and acting on the result of every investigation they
request, but is designed to provide a safety net for the highlighting of ‘highly significant’
findings i.e. those that fall outside the critical limits as defined by the laboratory. These
limits have been developed following guidance issued by the Royal College of
Pathologists (document number G025, Nov 2010). The limits are based on the first
abnormal set of results or on repeat results that have shown a markedly significant
change for an individual patient. It is anticipated that immediate medical evaluation is
required for patients with such results. The laboratory does NOT telephone all abnormal
results, only those outside the critical limits.
The electronic requesting and reporting system (also known as Order Comms or ICE)
provides a reliable electronic means of accessing pathology results. ICE includes a ‘flag’
for highlighting reports that include an abnormal result, but it remains incumbent on
requestors to actively search for the results of all pathology investigations they have
requested. It is also the responsibility of the requesting clinical team to have proper
handover arrangements in place to review and act on abnormal results ‘out of hours’ or
when a particular clinician is away. A ‘green tick’ against a result in ICE indicates that
someone has viewed the result, but NOT necessarily that they have acted upon it.
Therefore, the Trust recommends that clinicians should electronically ‘file’ reports once
they have reviewed them AND taken the required action.
2.
PURPOSE
Results outside the laboratory critical limits require urgent clinical evaluation and
appropriate action. This policy is designed to introduce designated pathways between
Pathology and requesting clinicians and their teams, and to minimise the risk of serious
harm to patients resulting from significant pathology results being overlooked, even
though they have been correctly reported. It defines timescales within which staff are
expected to act.
3.
DUTIES AND RESPONSIBILITIES
This policy covers the communication of critically abnormal pathology results to Trust
and Primary Care staff. This includes:• Trust employees
• Agency/Locum/Bank Staff
• Primary Care staff
Page 4 of 12
PAT/T 61
v.1
It is the responsibility of each member of staff involved in the requesting, reporting
and review of pathology tests:- to comply with the standards set out in this guidance
- to work within their own competence
- to report all issues regarding the communication of urgent pathology results
(including near miss events) using the Trust’s Incident Reporting procedures.
Any such issues should be discussed at relevant CSU Clinical Governance Groups and
any identified actions that result from the incidents should be implemented.
It is the responsibility of each member of staff and individual clinical departments to
ensure they adhere to the training and audit requirements set out in Sections 5 and 6 of
this guidance.
Trust Board: The Board, via the Chief Executive, is ultimately responsible for ensuring
that systems are in place that effectively manage the risks associated with critically
abnormal pathology results
Medical Director: is responsible for implementing patient management strategies
throughout the Trust that include appropriate and timely requesting and review of
pathology tests
Clinical Directors: are responsible for implementing patient management strategies
throughout the Trust that include appropriate and timely requesting and review of
pathology tests, and have proper handover arrangements in place to review and act on
abnormal results when a particular clinician is not available/away.
Consultant Medical Staff: are responsible for ensuring that their team, including junior
staff, read and understand this policy, and adhere to the principles contained in it at all
times.
Ward and Department Managers: are responsible for ensuring implementation
within their area, and for ensuring all staff who work within the area adhere to the
principles at all times.
Clinical Site Managers: are responsible for identifying an appropriate clinician to
evaluate a patient with a critically abnormal result, when the responsible consultant
cannot be contacted and the escalation process has been implemented.
Primary Care Clinical Commissioning Groups: are responsible for implementing
patient management strategies throughout Primary Care that include appropriate and
timely requesting and review of pathology tests, and have proper handover
arrangements in place to review and act on abnormal results when a particular clinician
is not available/away.
4.
PROCEDURE
Pathology staff
Pathology staff will urgently telephone results that fall outside the laboratory critical limits
as follows:
Page 5 of 12
PAT/T 61
v.1
In-patients: will phone to the patient location i.e. ward, and will ask to speak to a doctor
or nurse. They may give the results to another member of ward staff if a
doctor or nurse is unavailable.
Out-patients: will phone the secretary of the named consultant (or the patient location if
they are likely to still be present on a hospital site)
Primary Care patients: will phone the GP practice (or out-of hours GP service if practice
is closed)
Pathology staff will attempt to telephone the results, using all the available numbers on
ICE or the request form and/or those listed for the consultant/GP or patient location, on
at least three occasions, a few minutes apart. If this is unsuccessful within 30 minutes
they will follow the Pathology Escalation Procedure. They will log successful calls as per
Pathology SOP-COM-046.
Pathology staff will use the SBAR Communication Script for communicating results
that fall outside the laboratory critical limits as follows:
Situation:
Hello, this is (name). I’m calling from Pathology with a critical result that
needs urgent action for patient (name/number)
Do you have this patient on your ward/clinic/surgery?
If yes: the result is (value), the abnormal result is (name), and the normal
reference range for this patient is (range). Ask for receiver to repeat back
information to ensure understanding.
If no: review request details & PAS & phone to correct location/doctor
Background: The results should be accessible electronically via ICE/ your practice
system
Assessment: covered in ‘situation’
Recommendation: These results need urgent review and action. If the doctor is not
available within one hour you must follow the Trust policy for escalating
telephoned pathology results.
Pathology staff will ask receiver to repeat key information to ensure understanding, take
their name and log all details as per Pathology SOP-COM-046
Pathology Escalation Procedure
Pathology staff must follow this escalation procedure if they have been unable to contact
the consultant/GP or patient location within 30 minutes.
In-patients and Out-patients:
1. First level escalation to Specialist Registrar of the Clinical Service Unit (CSU) or
department from which the request originated (Bleep via switchboard)
2. Second level escalation to Consultant on-call (Bleep via switchboard)
3. Third level escalation to Clinical Site Manager (Bleep via switchboard)
Page 6 of 12
PAT/T 61
v.1
Pathology staff will ask receiver to repeat key information to ensure understanding, take
their name and log all details in the Telephone Module of the Pathology IT system as per
Pathology SOP-COM-046
Primary care patients (GP Practice closed or cannot be contacted):
Pathology staff will phone results to the deputising service (typically this is the out of
hours service located in the respective A&E departments and the GP contact lines will
redirect calls to the appropriate one). When telephoning results in these circumstances,
staff will use the SBAR script and will provide the following additional information:
•
•
•
•
The date and time of the request if available
The name of the requesting physician and/or the practice number
As much clinical history as is available
Contact address for the patient, and telephone number if known
Staff will record all information as per Pathology SOP-COM-046
In line with Pathology standard operating procedures, Pathology staff will inform the
requesting GP of the information provided to the ‘Out of hours GP service’ as soon as
possible after the event.
Clinical staff receiving telephoned pathology results
Staff must record information from the phone call (in patient notes or on locally agreed
documentation) , detailing the patient ID, the result that falls outside the laboratory critical
limits, the reference range, the time the call was received, the name of the Pathology
member of staff, their own name and any other relevant information. They must
communicate the information to a doctor as soon as possible, but no longer than one
hour after the phonecall, using the SBAR tool as follows:
Situation: Hello, this is (name). I have received a telephone call from Pathology with a
critical result that needs urgent review/action for patient (name/number) and
location (name). The abnormal result is xxx, value yyy and reference range zzz
Background: I have the following additional information about the patient…….
Assessment: covered in ‘situation’
Recommendation: I need you to urgently review the electronic results on ICE, with
reference to the clinical condition of the patient, and take immediate
appropriate action
Actions should be recorded in writing in the patient notes, and/or using the electronic
‘notepad’ function on ICE.
Consultants/Doctors should electronically ‘file’ reports on ICE once they have reviewed
them AND taken the required action.
Page 7 of 12
PAT/T 61
v.1
If the doctor/clinician is not available within one hour, you must follow this escalation
procedure:
In-patients and Out-patients:
1. First level escalation to duty doctor/Specialist Registrar
1.1. Bleep the appropriate duty doctor according to the site and CSU involved
Use the SBAR Communication Script for communicating the results that fall
outside the laboratory critical limits:
Situation:
Hello, this is (name). I have received a telephone call from Pathology with a
critical result that needs urgent review/action for patient (name/number) and
location (name). Consultant/doctor (name) or location (name) have failed
to respond to my attempts to contact them with the urgent result. The
abnormal result is xxx, value yyy and reference range zzz.
Background: I have the following additional information about the patient….
Assessment: covered in ‘situation’
Recommendation: I need you to urgently review the electronic results on ICE, with
reference to the clinical condition of the patient, and take immediate
appropriate action.
2. Second level escalation to Consultant on-call
2.1. In the event that the first level escalation is unsuccessful, staff should pass the
result to the Consultant on-call for action and investigation (Bleep via
switchboard)
3. Third level escalation to Clinical Site Manager
3.1. In the event that the second level escalation is unsuccessful, staff should pass
the result to the Clinical Site Manager, who will identify an appropriate clinician to
provide action and investigation (Bleep via switchboard)
Consultant/Doctor actions
On receipt of a telephoned pathology result, the Consultant/Doctor should urgently
review the results electronically on ICE, along with patient notes (if available), and
determine if urgent treatment is required. Actions should be recorded in writing in the
patient notes, and/or using the electronic ‘notepad’ function on ICE.
If the patient has left the hospital, and the Consultant/Doctor determines that urgent
treatment is required, the Consultant/Doctor should:
o Attempt to telephone the patient, using all known contact details, to arrange for
them to attend for urgent treatment
o If this is unsuccessful, they should telephone the next of kin, as listed on PAS
o If this is unsuccessful:
- In normal working hours, they should telephone the GP to request their
assistance in contacting the patient.
Page 8 of 12
PAT/T 61
v.1
- Out of hours, they should contact Police to request their assistance in contacting
the patient.
Actions should be recorded in writing in the patient notes, and/or using the electronic
‘notepad’ function on ICE.
5.
TRAINING/SUPPORT
Each staff member is accountable for his or her practice and should always act in such a
way as to promote and safeguard the well being and interest of patients. Staff will receive
instructions and direction regarding the requesting, review and communication of
critically abnormal pathology results from a number of sources:o Corporate Induction
o Trust Policies and Procedures available on the intranet
o Ward/departmental/line managers
6.
MONITORING COMPLIANCE WITH THE PROCEDURAL
DOCUMENT
The Pathology CSU Management Team will review this policy in the following
circumstances:• When new national or international guidance is received.
• When newly published evidence demonstrates need for change to current
practice.
• Every three years routinely.
Responsibility for implementation of this policy lies with the Clinical Director of each
CSU.
Incidents where non-compliance with this policy is noted, and are considered an
actual or potential risk, should be documented on an Adverse Incident and near miss
report form.
What is being Monitored
Who will carry out
the Monitoring
How often
How Reviewed/
Where Reported to
Did Pathology staff phone
the urgent result within 30
minutes?
Pathology CSU
Quarterly
Pathology CSU
Management Team
Did Clinical staff receiving
the urgent result record
the information and
communicate it to a
relevant doctor within one
hour
Clinical CSUs
Quarterly
Clinical CSU
Management Team or
Clinical Governance
Group
Page 9 of 12
PAT/T 61
7.
v.1
DEFINITIONS
BMS: Biomedical Scientist
Critical limits: specific action limits for pathology tests or analytes. Results falling
outside these for the first time, or repeat results that have shown a markedly significant
change for an individual patient, may require immediate medical intervention, including
admission to hospital or change in the patient’s treatment
CSU: Clinical Service Unit
DBH: Doncaster & Bassetlaw Hospitals NHS Foundation Trust
Highly significant findings: results that fall outside the critical limits as defined by the
laboratory (follow guidance issued by the Royal College of Pathologists)
IBMS: Institute of Biomedical Science
ICE: “Integrated Clinical Environment” web-based applications for electronic requesting
and reporting. Available for Pathology and Medical Imaging at DBH
NHS: National Health Service
SBAR: Situation, Background, Assessment, Recommendation communication tool, as
recommended by the NHS Institute for Innovation and Improvement
SOP: Standard Operating Procedure
8.
EQUALITY IMPACT ASSESSMENT
An Equality Impact Assessment (EIA) has been conducted on this procedural document
in line with the principles of the Equality Analysis Policy (CORP/EMP 27) and the Fair
Treatment For All Policy (CORP/EMP 4).
The purpose of the EIA is to minimise and if possible remove any disproportionate
impact on employees on the grounds of race, sex, disability, age, sexual orientation or
religious belief. No detriment was identified.
A copy of the EIA is available on request from the HR Department.
9.
ASSOCIATED TRUST PROCEDURAL DOCUMENTS
Standard Operating Procedure, Pathology SOP-COM-045 Communication of critical
pathology results
Standard Operating Procedure, Pathology SOP-COM-046 Telephone Answering and
Results Service
Trust Policy CORP/COMM 1 - Approved Procedural Documents, Development and
Management Process
Trust Policy CORP/EMP 04 - Fair Treatment For All
Trust Policy PAT/PA 19 - Mental Capacity Act 2005 Policy and Guidance
Trust Policy PAT/PA 28 - Privacy and Dignity Policy
Trust Policy PAT/PA 31 - Handover Policy
Page 10 of 12
PAT/T 61
v.1
10. REFERENCES
•
•
•
IBMS (1997) Giving Results over the Telephone and Facsimile
NHS Institute for Innovation and Improvement (2008) SBAR: Situation,
Background, Assessment, Recommendation
Royal College of Pathologists (document G025, Nov 2010) Out-of hours reporting
of markedly abnormal laboratory test results to primary care: Advice to
pathologists and those that work in laboratory medicine
Page 11 of 12
APPENDIX 1 - FLOWCHART
PAT/T 61
v.1
Appendix 1: Flowchart for telephoned pathology results PAT/T61
Pathology result outside laboratory critical limits
Pathology staff phone result to requesting clinician/secretary/location
No answer within 30 minutes
Clinician/secretary/location answers call within 30 minutes
Pathology staff escalates and phones Specialist Registrar
No answer answered
Pathology staff member gives abnormal result using SBAR script and documents call
Pathology staff escalates and phones oncall Consultant
No answer answered
Pathology staff escalates and phones Clinical Site Manager
answered
Staff receiving the call documents the information and identifies appropriate doctor within 1 hour
No Doctor available within one hour
Doctor available within one hour
Staff receiving the call informs Doctor of abnormal result using SBAR
Staff escalates and phones Specialist Registrar
answered
Doctor reviews electronic report on ICE, evaluates patient and documents action taken
Page 12 of 12
No answer Staff escalates and phones oncall Consultant
answered
No answer Staff escalates and phones Clinical Site Manager
answered
Directorate of Pathology
Timing of samples and interpretation for measurement of Carbamazepine.
KEY FACTS - Carbamazepine
Sample timing - Immediately before taking the dose, at least 5 days after initiation of treatment or a dose
change.
Therapeutic range. Now reported in mass units as required by the national harmonization project (& with
standardized range).
•
•
•
4 – 12 mg/L for single drug use. (in previous units was 20 - 50 umol/L)
4 – 8 mg/L when used in multidrug combination (Originally 17 - 34 umol/L)
Results will be telephoned as a critical result if they are 25mg/L or higher.
Bioavailability of oral dose - Peak plasma concentration typically about 3 Hrs post dose (Highly variable).
Metabolism - Carbamazepine is metabolised almost completely to a variety of active & inactive metabolites by
the hepatic mixed function oxidase system. Metabolism is induced by Carbamazepine itself, Phenytoin and
Phenobarbitone. Initial elimination half time is about 35 Hrs decreasing to about 20 Hrs after a few weeks
treatment.
Lamotrigine co-administration may inhibit metabolism & precipitate toxicity.
Distribution - Carbamazepine distributes rapidly with a volume of distribution of 0.8 - 1.9 L/Kg.
Protein binding - About 75% of circulating Carbamazepine and metabolites are bound to proteins, therefore
there is potential for increase in the free fraction whenever other protein bound drugs are co-administered.
Elimination - Urinary excretion of metabolites and conjugated metabolites
Timing of Carbamazepine measurements after starting treatment or a dose change.
Carbamazepine is usually commenced gradually over three or four weeks to avoid initial adverse effects during
equilibration. These occur because carbamazepine induces it's own metabolism. Initial dose is typically 1/4 to
1/3 the final maintenance dose, increasing by 1/4 or 1/3 the full dose per week. The main limitation in
monitoring Carbamazepine is the need to ensure stable metabolic activity before measurements are taken this
requires at least 5 days after the commencement or last dose change of either carbamazepine or other
interacting drug.
Timing of Carbamazepine measurements relative to taking the dose.
Remember. Drug concentrations are not stable from dose to dose at any time after the dose unless the
required time has elapsed since commencing treatment or the last dose change.
The concentration of Carbamazepine is most stable and correlates with therapeutic effects close to the time of
taking the next dose. Values measured at this time have been used to derive the therapeutic range and this
timing should also be used in taking samples to direct changes in dose. Specimens taken substantially before
this timing will yield inappropriately high results due to incomplete distribution into peripheral tissues and may
result in selection of an inappropriately low dose.
Interpretation of results for Carbamazepine.
Before interpreting a result check the specimen timing was correct
Author
Title
Document No.
Richard Stott
Carbamezapine
PD-UserHbk-015 ver2.0
Page 1 of 2
25/3/2013
Due to combined effects on metabolism and competition for protein binding, Therapeutic range depends on
whether Carbamazepine is used as a single drug or in combination with other drugs.
4 – 12 mg/L for single drug use. (20 - 50 umol/L)
4 – 8 mg/L when used in multidrug combination (17 - 34 umol/L)
Some patients may show adequate therapeutic effects at concentrations below 20 umol/l and there is no
indication for increasing the dose in these individuals to achieve levels within the quoted ranges.
Toxicity can occur within these ranges in some individuals and can probably be avoided by maintaining
Carbamazepine levels below 9.6mg/L (40 umol/L). Expect severe toxicity about 48 mg/L (200 umol/L).
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
4. Clinical pharmacokinetics of carbamazepine. Clinical Pharmacokinetics 3, 128 (1978)
Author
Title
Document No.
Richard Stott
Carbamezapine
PD-UserHbk-015 ver2.0
Page 2 of 2
09/04/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Cyclosporin / Ciclosporin.
This page is divided into sections as follows:•
•
•
Timing of measurements after starting therapy or a dose change.
Timing of measurements relative to taking the dose.
Interpretation of results.
KEY FACTS - Cyclosporin
•
Cyclosporin is extensively metabolised & assays respond differently to the metabolites.
Therapeutic ranges depend on the organ which was transplanted & the assay used & the practice of
the transplant centre. All samples are sent to the hospital which was responsible for the original
surgery. For new patients, please include details of the transplant centre with the request.
•
Specimens for monitoring treatment of autoimmune disease are sent to Northern General Hospital,
Sheffield.
•
Many centers do not return results to us but advise on dose adjustments directly to the requesting
physician or patient.
Sample type - Requires whole blood due to cyclosporin accumulating in red cells. Anticoagulant is typically
EDTA (Lavender top tube) but King's College Hospital require Li heparin (Green top).
Sample timing - Immediately before taking the dose, at least 1 week after initiation of treatment or dose
change.
Therapeutic range - Depends on the assay used, time since transplantation & organ transplanted.
Toxic & therapeutic effects are not well correlated with concentration.
Bioavailability of oral dose - 10 - 60% Peak values typically 1 - 8 Hrs post dose. Absorbtion is affected by
intestinal motility, particularly diarrhea which can cause marked decline in absorbtion. Reduced bile flow also
slows absorbtion.
Metabolism - Cyclosporin is metabolised in the liver by the mixed function oxidase system. More than 30
metabolites, some of which are active. Metabolism highly variable with some evidence of diurnal rhythm.
Typical elimination half life is 6 Hrs.
Metabolites are excreted in bile (less than 1% in urine) and may be re-absorbed. Cyclosporin metabolism is
therefore altered by liver disfunction.
Distribution - 1.0 - 13.0 l/Kg Extensively distributed, mainly in lipid rich tissues.
Timing of Cyclosporin measurements after starting treatment or a dose change.
Due to the extensive distribution into fatty tissues steady state is reached after about 1 week in most patients.
Some individuals may require longer if particularly obese.
Timing of Cyclosporin measurements relative to taking the dose.
Remember. Drug concentrations are not stable from dose to dose at any time after the dose unless the
required time has elapsed since commencing treatment or the last dose change.
Due to the variability in absorbtion both between patients and between doses in the same patient, the
concentration of Cyclosporin is most stable close to the time of taking the next dose. Values measured at this
time have been used to derive the therapeutic range and this timing should also be used in taking samples to
direct changes in dose. Specimens taken substantially before this timing will yield inappropriately high results
due to incomplete distribution into peripheral tissues and may result in selection of an inappropriately low dose.
To avoid the effects of diurnal variation repeat samples should be taken at the same time of day if possible.
Author
Title
Document No.
Richard Stott
Cyclosporin
PD-UserHbk-014 ver 1.0
Page 1 of 2
25/3/2013
Interpretation of results for Cyclosporin.
Most centres advise on dose adjustments directly on the requesting clinician or patient. This is based on the
assumption that specimen timing is correct. Therefore it is essential that those taking the sample use the
correct timings
Specimens for monitoring treatment of autoimmune disease are sent to Northern General Hospital, Sheffield.
Their target concentrations are
• 155 ug/L Ulcerative colitis
• 100 ug/L for renal transplants.
• Cardiac transplant - Initially 300 ug/L decreasing to 200 ug/L.
For new patients, it is essential that details of the transplant centre are included with the request.
References
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
4. NGH target range data was a personal communication by Dr Gray, NGH clinical chemistry Dept.
29/1/1998.
Author
Title
Document No.
Richard Stott
Cyclosporin
PD-UserHbk-014 ver 1.0
Page 2 of 2
25/3/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Digoxin.
This page is divided into sections as follows: • Common indications for measurement.
• Timing of measurements after start of treatment or a dose change.
• Timing of measurements relative to taking the dose.
• Interpretation of results.
• Symptoms, Actions and future measurements in the event of OVERDOSE.
You may also want to review the Pharmacy formulary site page about Digoxin and the page about Importance
of specimen timing in therapeutic drug monitoring.
KEY FACTS - Digoxin
Sample timing - At least 6 hours post dose (IV or Oral dosing) and at least1 week after initiation of treatment
or dose change (Longer if renal function is abnormal) Can also be measured after 1st maintenance dose if IV
loading dose used.
Therapeutic range – 0.5 – 2.0 ug/L (Previously reported as 1.0 - 2.6 nmol/L)
Almost always get toxic effects at or above 2.3 ug/L (3.0 nmol/L). Results will be telephoned if they are >2.5
ug/L and are correctly timed relative to the dose as will samples with K< 2.5 mmol/L and digoxin > 0.78 ug/L.
Bioavailability of oral dose - 40 - 75% from tablets depending on preparation Up to 80% for Elixir. Lowered by
co-administration of drugs which affect GI motility (E.g. Metoclopramide), Malabsorbtion syndromes lower
bioavailability. Either may result in sub therapeutic effects from a previously adequate dose.
Metabolism - Most patients metabolize less than 20% of dose. About 10% of individuals metabolize significant
proportion of dose, yielding active metabolites, which may not be measured. This can be a cause of toxicity
despite a 'therapeutic range' result.
Distribution - Effectively two compartments - central (Blood, kidney, liver) - Peripheral (Skeletal and cardiac
muscle) At equilibrium, peripheral compartment has 15 - 30 times central concentration therefore very
significant errors are possible due to sampling too early after dose.
Elimination - Excretion via kidneys. Half-life typically 40 hours. Deterioration in renal function leads to
increased Half life (up to 100 hrs or more) and is a common cause of toxicity.
Creatinine clearance
(Measured or e-GFR)
90 ml/min
60 ml/min
35 ml/min
15 ml/min
5 ml/min
Elimination half life
1.6 days
2 days
2.5 days
3 days
3.2 days
Time to steady state
6 days
8 days
10 days
12 days
13 days.
Common indications for measurement of DIGOXIN.
Monitoring of Digoxin is not indicated in the majority of patients on maintenance treatment when a
clear therapeutic effect has been obtained.
Monitoring is valuable in the following circumstances• Poor initial response. Measurement indicates whether the patient is compliant, what concentration
the current dose is achieving and indicates how much of an increase in dose is likely to be safe.
• Poor response after initial good response. Measurement indicates whether the patient is compliant
and may indicate the need for an increased dose.
• To decide if continued therapy is required. A patient on long-term digoxin treatment with
concentrations less than 0.5 ug/L (1.0 nmol/L) is unlikely to deteriorate if digoxin is stopped.
• When changing dose of interacting drugs. Adding or removing interacting drugs will alter the
therapeutic efficacy of a constant digoxin dose, monitoring will indicate the required dose change to
maintain therapeutic benefit. E.g. Diuretics, Quinidine, Metaclopromide.
Author
Title
Document No.
Richard Stott
Digoxin
PD-UserHbk-016 ver2.0
Page 1 of 5
25/3/2013
•
•
When renal function is changing. Deteriorating renal function is a common cause of toxicity.
Monitoring will result in early warning of changing concentrations and allows appropriate dose
adjustment.
Suspected toxicity. Monitoring digoxin may confirm the presence of a toxic level but should be
accompanied by investigations (K, Ca, Mg, Creatinine and Thyroid functions) to exclude alterations in
tissue sensitivity.
Timing of DIGOXIN measurements after start of treatment or a dose change.
Treatment is usually commenced using the 'Maintenance dose' of digoxin in patients with mild cardiac
symptoms. Where rapid onset of symptom control is essential, there will be an initial 'loading dose' (0.75 to 1.0
mg) usually given as an IV infusion over several hours. This achieves the steady state condition very rapidly.
The first 'Maintenance dose' is given the appropriate time later and monitoring can commence after this dose.
In treatment with 'Maintenance' doses (Typically 125 - 250 micrograms twice daily), the elimination half-life of
digoxin regulates the accumulation between doses.
If there is no loading dose, between three and five half lives are required before the difference between current
and 'steady state' concentrations becomes less than the assay imprecision (Typically 5 - 10% CV). In normal
individuals the half-life is 40 hours and therefore a period of at least1 week should be allowed before checking
the concentrations achieved.
Caution Renal function leads to increased half-life (100 hrs or more in Anuria) which can prevent steady
state being achieved within a practical time.
Creatinine clearance Elimination half life Time to steady state
90 ml/min
1.6 days
6 days
60 ml/min
2 days
8 days
35 ml/min
2.5 days
10 days
15 ml/min
3 days
12 days
5 ml/min
3.2 days
13 days
This timing limitation applies equally to both increases and decreases in dose so monitoring in renal failure
patients can be problematical.
Timing of DIGOXIN measurements relative to taking the dose.
Digoxin distribution after an IV dose closely matches a two compartment mathematical model. The central
compartment represents rapidly equilibrating tissues with good blood supply (Blood, kidney, liver) while the
peripheral compartment represents less well perfused tissues (Skeletal and cardiac muscle). We are taking the
sample from the central compartment whereas the response to digoxin occurs in the other compartment;
therefore the concentrations in the two compartments must reach equilibrium before the sample is taken. This
is essentially complete by 6 hours after the dose (Oral or IV) and therefore the sample can be taken any time
between 6 hours and the next dose. Digoxin is rapidly absorbed and therefore the kinetics of oral dosing is
similar to IV. The Distribution phase of digoxin imposes the limitation on sample timing after the doses.
Caution
At equilibrium, the peripheral compartment has 15 - 30 times the central concentration therefore very
significantly increased concentrations will occur due to sampling too early after dose. Any dose change based
on these measurements could result in sub therapeutic concentration and return of the patient's original
symptoms.
Interpretation of results for DIGOXIN.
•
•
-Before interpreting a result check the specimen timing was correct
-Therapeutic ranges for Digoxin are poorly defined. The concentration does correlate well with certain
measurable cardiac parameters (ECG results and systolic time intervals) but these do not relate closely
to overall therapeutic outcome.
Little or no therapeutic effect is seen at digoxin levels of less than 0.5 ug/L (1.0 nmol/L).
Toxicity almost always occurs above 2.3 ug/L (3.0 nmol/L).
The generally accepted 'Therapeutic target' is 0.5 – 2.0 ug/L (1.0 - 2.6 nmol/L).
Some patients may benefit from carefully increasing the dose to give concentrations above 2.0
ug/L if no adverse effects become evident.
Author
Title
Document No.
Richard Stott
Digoxin
PD-UserHbk-016 ver2.0
Page 2 of 5
25/3/2013
•
The sensitivity of myocardium to digoxin is altered by several co-existing factors, which hamper the
interpretation of digoxin levels.
1. Potassium Hypokalaemia is associated with an enhanced response and is the commonest
cause of toxic symptoms. Potassium should always be measured when toxicity is suspected
and any hypokalaemia corrected prior to adjusting the digoxin dose. this may resolve the
apparent toxicity. Digoxin levels cannot be interpreted in the presence of hypokalaemia.
2. Calcium and Magnesium Hypercalcaemia and hypomagnesaemia are also associated with
increased sensitivity and should be corrected prior to monitoring digoxin.
3. Thyroid function Hypothyroidism increases sensitivity to digoxin and Hyperthyroidism
decreases it, making interpretation difficult in patients with thyroid disease.
4. Age. Elderly patients are more sensitive to digoxin than young patients.
•
•
Caution - Pregnancy, Renal failure and liver failure.
There are a number of 'Digoxin like factors' which accumulate in these conditions. These may cross
react in some assays (But not all) and can produce apparently therapeutic values on patients who are
not taking digoxin or 'Toxic' concentrations in a well controlled patient without toxic symptoms. The
identity of these factors is not well known and a particular digoxin assay may be affected by any
combination of the conditions. Concentrations must be carefully interpreted in conjunction with clinical
assessment of the patient's symptoms
Causes, Symptoms and Treatment in the event of OVERDOSE.
•
•
Causes of Digoxin OVERDOSE.
Toxic effects are common and can be Severe or Fatal. Diagnosis should depend on a careful clinical
examination and should not be entirely based on digoxin measurement as toxic symptoms may occur
within the therapeutic range and a few patients may require apparently 'Toxic' concentrations for
optimal symptom relief. Common causes of toxicity include: o Metabolic abnormalities.
o Renal failure (Especially gradual onset).
o Effects of other drugs.
Metabolic abnormalities.
Response to a fixed digoxin concentration is dependent on other biochemical parameters including
Potassium, Calcium and Magnesium. Symptoms of toxicity may appear or be exacerbated when the
patient has co-existing hypokalaemia, Hypercalcaemia, Hypomagnesaemia or hypothyroidism. All of
these conditions increase the sensitivity of the myocardium to digoxin. This can result in 'Toxic'
symptoms when the digoxin concentration is within the 'Therapeutic' range. Treatment with non
potassium sparing diuretics is probably the most common cause of toxicity in a previously stable
patient. In most patients with increased sensitivity to digoxin, the underlying abnormality can be treated
rapidly and the 'Digoxin toxicity' will resolve without requiring a dose change.
Renal failure.
Renal excretion of digoxin is the main elimination route for parent drug and active metabolites. In
normal individuals the half life is 40 hours and the individual dose is likely to have been established
under these conditions. Any significant deterioration in renal function will extend the elimination half-life
resulting in clearance of less of each dose before the next dose is taken.
Creatinine clearance Elimination half life Time to steady state
90 ml/min
60 ml/min
35 ml/min
15 ml/min
5 ml/min
1.6 days
2 days
2.5 days
3 days
3.2 days
6 days
8 days
10 days
12 days
13 days
Therefore failing renal function leads to a gradual increase in digoxin concentration throughout the dose - dose
cycle. Large doses are commonly divided into a twice daily regimen to minimize the occurrence of toxic
symptoms therefore the initial onset of extra symptoms will be gradual and will be observed for a progressively
longer period after each dose. These become continual as the renal failure (and concentration increase)
becomes more severe. By the time the patient becomes anuric, the elimination half life will be increased to 100
hrs or more producing a several fold increase in the digoxin concentrations at all times and there may be a very
Author
Title
Document No.
Richard Stott
Digoxin
PD-UserHbk-016 ver2.0
Page 3 of 5
25/3/2013
large excess of digoxin accumulated in the tissues. Renal failure also introduces a potential confounding effect
as there are a number of 'Digoxin like factors' which accumulate in renal failure (Also found in pregnancy and
liver failure). These may cross react in some assays (But not all) and can produce apparently 'Toxic'
concentrations in a well controlled patient without toxic symptoms.
Caution
Symptoms may be exacerbated where the patient is also treated with non potassium sparing diuretics as this
can result in hypokalaemia and increased sensitivity of the myocardium to digoxin. This can result in 'Toxic'
symptoms when the digoxin concentration is within the 'Therapeutic' range. Most treatments which resolve the
renal failure and / or rectify the resulting metabolic disturbances will be highly effective in reducing the toxicity of
digoxin by improving the clearance. Resolution of the renal failure will rapidly correct the toxicity allowing the
patient to continue on the previous dose, however a dose reduction will often be required until adequate renal
function can be restored. Haemodialysis is effective in treating moderate toxicity due to renal failure but it
mainly acts by ensuring normal tissue sensitivity via avoiding or correcting Hypokalaemia, Hypercalcaemia and
Hypomagnesaemia. It is not possible to remove significant amounts of digoxin by dialysis due to the relatively
large amounts of digoxin contained in the extravascular compartment (Volume of distribution is 4 - 10 L/Kg).
Effects of other drugs.
A number of drugs alter the handling of digoxin by changing absorption and excretion of the parent compound.
Treatment with or changes in dose of these drugs may result in alterations in availability of digoxin with
potentially 'Toxic' concentrations resulting.
1. Starting diuretics (Non-K sparing).
2. Starting Antimalarials (e.g. Quinine, Chloroquine),NSAIDs, Anti arrhthmics (e.g. Amiodarone,
Quinidine) etc
3. Stopping drugs, which increase GI motility/prevent absorption. (e.g.. Metaclopramide, Cholestyramine).
Giving conventional therapeutic doses of drugs in these categories can result in doubling or greater increase in
digoxin concentrations with potentially toxic effect.
In these situations monitoring of digoxin after the change (or before and after) may enable alteration in the dose
of digoxin to maintain the previous symptom control despite the alteration in digoxin handling.
Symptoms of Digoxin OVERDOSE.
• Loss of appetite, Anorexia (Experienced by 60% of individuals with toxic levels), Nausea (60%) and
vomiting (50%). 'Maintenance' doses are often given twice daily to minimize these symptoms.
• Giddiness.
• Visual disturbance including colour distortion to green / yellow (Less than 15%).
• Increased Urine / Faecal frequency (6%).
• Cardiac Arrhythmia / Conduction defects (70 -95% of toxic individuals). Sinus bradicardia, Ventricular
extrasystole, First / Second degree AV block are common. Ventricular / Atrial tachicardia less common.
Treatment of Digoxin OVERDOSE.
The most common causes of 'Toxic' symptoms are readily correctable metabolic abnormalities including
Hypokalaemia, Hypercalcaemia, Hypomagnesaemia and Hypothyroidism. Where these conditions exist, the
fastest treatment for digoxin toxicity is to correct the metabolic abnormality. The symptoms will normally resolve
rapidly and the patient can continue with the previous digoxin dose.
Treatment of chronic digoxin overload is more difficult due to the fairly high volume of distribution (4 - 10 L/Kg
depending on renal function), therefore the majority of the digoxin is located in the peripheral tissues. This
makes it difficult to remove substantial amounts using Haemofiltration, Haemoperfusion or dialysis. Patients
with mild symptoms can often be treated by cessation of the digoxin dose, correction of any electrolyte
abnormalities and allowing the excretion of the excess via the kidneys. In the event of massive accumulation of
digoxin requiring rapid treatment, there is a specific antidote. 'Digibind' is a fragment of an antibody raised
against digoxin, this remains in the circulation and binds all of the free digoxin. This results in a blood free
digoxin concentration of 0 and promotes rapid movement of digoxin out of the tissues. The digoxin recovered in
this way is then rapidly excreted via the kidneys. There are several problems with this therapy
1. Cost.
2. The dose must be carefully calculated according to the amount of digoxin in the patient. Monitoring
may be required prior to giving the dose.
3. Digibind persists in the patient for a considerable time. This makes it difficult to re-establish digoxin
therapy.
Author
Title
Document No.
Richard Stott
Digoxin
PD-UserHbk-016 ver2.0
Page 4 of 5
25/3/2013
4. Digibind in the sample prevents measurement of digoxin using most assays (Depending on the
method, results range from 0 up to 100 fold the normal). This makes it impossible to monitor the
treatment and difficult to re-establish digoxin treatment. Please indicate any Digibind treatment on the
clinical details section of the request forms.
5. Digibind administration may also result in the patient producing antibodies against Sheep proteins,
these could produce immunological problems if second treatments were required and have the
potential to interfere in other immunoassays.
Interpretation of results for DIGOXIN.
Therapeutic ranges are poorly defined. The concentration does correlate well with certain measurable cardiac
parameters (ECG results and systolic time intervals) but these do not relate closely to overall therapeutic
outcome.
Little or no therapeutic effect is seen at digoxin levels of less than 0.5 ug/L and toxicity almost always occurs
above 2.3 ug/L. The generally accepted 'Therapeutic target' is 0.5 - 2.0 ug/L although some patients may
benefit from carefully increasing the dose to give concentrations above 2.0 ug/L if no adverse effects become
evident. The sensitivity of myocardium to digoxin is altered by several co-existing factors, which hamper the
interpretation of digoxin levels.
1. Potassium Hypokalaemia is associated with an enhanced response and is the commonest cause of
toxic symptoms. Potassium should always be measured when toxicity is suspected and any
hypokalaemia corrected prior to adjusting the digoxin dose. this may resolve the toxicity. Digoxin levels
cannot be interpreted in the presence of hypokalaemia.
2. Calcium and Magnesium Hypercalcaemia and hypomagnesaemia are also associated with increased
sensitivity.
3. Thyroid function Hypothyroidism increases sensitivity to digoxin and Hyperthyroidism decreases it,
making interpretation difficult in patients with thyroid disease.
4. Age Elderly patients are more sensitive to digoxin than young patients.
Caution
- Pregnancy, Renal failure and liver failure. There are a number of 'Digoxin like factors' which accumulate in
these conditions. These may cross react in some assays (But not all) and can produce apparently therapeutic
values on patients who are not taking digoxin or 'Toxic' concentrations in a well controlled patient without toxic
symptoms. The identity of these factors is not well known and a particular digoxin assay may be affected by
any combination of the conditions. Concentrations must be carefully interpreted in conjunction with clinical
assessment of the patient's symptoms.
References
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Digoxin., by - P. Keys. In - Individualizing Drug Therapy. Vol. 3. (Taylor, W.J. and Finn, A.L. Editors)
Gross Townsend, Frank INC, New York. Library of Congress No 81-82052
Author
Title
Document No.
Richard Stott
Digoxin
PD-UserHbk-016 ver2.0
Page 5 of 5
25/3/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Lamotrigine.
This page is divided into sections as follows:• Timing of measurements after starting therapy or a dose change.
• Timing of measurements relative to taking the dose.
• Interpretation of results.
You may also want to review the Pharmacy formulary site page about anticonvulsants and the page about
Importance of specimen timing in therapeutic drug monitoring.
KEY FACTS - Lamotrigine
Samples are sent to an external reference laboratory so take some time to return. Any queries should be
directed to the laboratory performing the analysis.
Sample timing - Immediately before taking the dose, at least 5 days after initiation of treatment or dose change
(Normal individual on Lamotrigine only).
15 days if co-administered with Valproate.
Therapeutic range – 1.0 – 15 mg/L (Previously reported as 3.9 - 15.6 umol/L) Levels much higher than this are
often required for adequate control and are generally well tolerated.
Bioavailability of oral dose - > 95% absorbed. Volume of distribution 1.2 L/Kg.
Peak concentrations about 3 Hrs post dose.
Metabolism - >90% dose metabolised by conjugation. Follows first order kinetics with half life around 24 Hrs.
Enzyme inducing drugs (eg Phenytoin & Carbamazepine) reduce the half life to about 15 Hrs. Valproate
extends to about 60 Hrs. Lamotrigine may precipitate Carbamazepine toxicity by inhibiting metabolism.
Timing of Lamotrigine measurements after starting treatment or a dose change.
The half life of elimination of lamotrigine is normally 24 Hrs so a period of 5 days should be allowed between
commencing treatment or changing dose before any monitoring of levels is attempted. In the case of cotreatment with Valproate, this time must be extended to 15 days because of the prolonged elimination time. Coadministration with both inhibitory & stimulatory drugs gives half life about 24 Hrs. Withdrawal of the inducing
drug from such a mix results in marked increases in Lamotrigine & Valproate. Unless checking for potentially
toxic levels, the same timing criteria must be applied to routine monitoring of any other
anticonvulsants in the regimen.
Timing of Lamotrigine measurements relative to taking the dose.
Remember: Drug concentrations are not stable from dose to dose at any time after the dose unless the
required time has elapsed since commencing treatment or the last dose change, this may be a considerable
time where multiple drugs are co-administered and must be determined based on the longest half life of the coadministered drugs.
The concentration of Lamotrigine and other anticonvulsants is most stable and correlates with therapeutic
effects close to the time of taking the next dose. Values measured at this time have been used to derive
therapeutic ranges and this timing should also be used in taking samples to direct changes in dose. Specimens
taken substantially before this timing will yield inappropriately high results due to incomplete distribution into
peripheral tissues and may result in selection of an inappropriately low dose.
Interpretation of results for Lamotrigine.
Before interpreting a result check the specimen timing was correct
Remember: Drug concentrations are not stable from dose to dose at any time after the dose unless the
required time has elapsed since commencing treatment or the last dose change.
The concentration of Lamotrigine is most stable and correlates with therapeutic effects close to the time of
taking the next dose. Values measured at this time have been used to derive the therapeutic range and this
timing should also be used in taking samples to direct changes in dose. Specimens taken substantially before
Author
Title
Document No.
Richard Stott
Lamotrigine
PD-UserHbk-017 v2
Page 1 of 2
26/3/2013
this timing will yield inappropriately high results due to incomplete distribution into peripheral tissues and may
result in selection of an inappropriately low dose.
The use of lamotrigine as adjunctive therapy means that levels & clinical effects may be influenced by other
anticonvulsants. All anticonvulsants in the regimen should be monitored at the same time and all results used in
any decision about dose adjustment.
Therapeutic range - 1.0 – 15 mg/L (Previously reported as 3.9 - 15.6 umol/L)
Levels much higher than this are often required for adequate control. Levels of 50 - 100 umol/L have been
encountered in patients with refractory seizures without documented adverse effects.
There is no good trial data supporting lamotrigine therapeutic range. This is partially due to the difficulty in
defining adequate seizure control due to lamotrigine when used as adjunctive therapy (Often with more than 1
other anticonvulsant) in patients who have proven difficult to control with other drugs.
There is little evidence of correlation of side effects with any particular lamotrigine concentrations.
References
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
4. Rambeck & Wolf. Lamotrigine clinical pharmacokinetics. Clin. Pharmacokinet 1993, 25; 433 - 443.
5. Brodie. Lamotrigine. Lancet 339: 1397 - 1400. 1992.
6. Patsalos, P.N. (1999) New antiepileptic drugs. Ann. Clin. Biocem. 36, 10 - 19.
Author
Title
Document No.
Richard Stott
Lamotrigine
PD-UserHbk-017 v2
Page 2 of 2
09/04/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Lithium.
This information page is divided into sections as follows:• Timing of measurements relative to taking the dose.
• Interpretation of results.
• Symptoms, Actions and future measurements in the event of OVERDOSE.
You may also want to review the Pharmacy formulary site page about Lithium and the page about Importance
of specimen timing in therapeutic drug monitoring.
Department of Psychiatry Guidelines which cover Lithium use.
KEY FACTS - Lithium.
Sample timing - At least 12 hours post dose. At least 5 days to 2 weeks after initiation of treatment or dose
change, Longer time for older patients (Assumes Normal renal function).
Therapeutic range - 0.5 - 1.0 mmol/L
Results will be telephoned as a critical result at 1.5 mmol/L or higher unless the specimen timing is obviously
inappropriate.
Bioavailability of oral dose - 100% within 2 Hrs from conventional preparations.
Massive doses of sustained release preparations can result in recurrent toxicity over several days due to
continued absorbtion.
Metabolism - Lithium is not metabolised.
Distribution - Lithium distributes into total body water (0.6 L/Kg) reaching equilibrium within 24 hours after the
first dose.
Elimination - Excretion via kidneys. About 80% filtered in glomerulus and reabsorbed in proximal tubule. Half
life ranges from 18 hours in young patients to 36 Hrs in older patients with intact renal function. Clearance
depends on GFR and proximal tubule reabsorbtion. Handling is similar to Sodium therefore reclamation is
increased in dehydration or sodium depletion. At toxic levels, Li can induce nephrogenic diabetes insipidus,
resulting in increased free water loss and dehydration. This induces a vicious circle of decreased Li clearance,
increased free water loss & worsening dehydration. Non-steroidal anti inflammatory drugs, Thiazide and loop
diuretics can reduce Li excretion precipitating toxicity.
There are specific guidelines issued by the department of Psychiatry which cover Lithium use. These should be
consulted before commencing therapy as they include pre-treatment assessments, contraindications to
lithium therapy, actions in the event of side effects and long term monitoring arrangements.
Timing of Lithium measurements after commencing treatment or a dose change.
Between three and five half lives are required before the difference between current and 'steady state'
concentrations is less than the assay imprecision (Typically 5 - 10% CV). In normal individuals the half life is 18
to 36 hours and therefore a period of 5 days to 2 weeks should be allowed after commencement of treatment or
a substantial dose change before checking the concentrations achieved.
Timing of Lithium measurements relative to taking the dose.
Li levels are relatively stable by 12 hours after the dose (Effectively trough concentrations). This timing was
used in deriving the therapeutic ranges and it is essential that dose adjustments are made with the same timing
relative to the dose. Samples taken less than 12 hours after the dose will have inappropriately high results due
to incomplete distribution into peripheral tissues. Adjustment of patient doses using such values may result in
lower than optimum dose for that particular patient and possible earlier treatment failure.
Interpretation of results for Lithium.
Before interpreting a result check the specimen timing was correct
Ranges were originally derived for treatment of acute mania and then adopted for maintenance. A variety of
therapeutic ranges have been suggested because the effectiveness is better at higher concentrations (longer
Author
Title
Document No.
Richard Stott
Lithium
PD-UserHbk-019 ver2.0
Page 1 of 3
25/3/2013
'survival' without relapse) but does not correlate very well with concentration. Similarly Side effects are more
troublesome at high concentrations so the upper limit has gradually decreased with time as the balance is reasessed. In 1985 the National Institutes of Mental Health consensus development conference recommended
0.6 - 0.8 mmol/L. We previously used use the range which Baastrup (1980) found to be effective in 80% of
patients 0.5 – 1.0 mmol/L) and have now moved to the national harmonization range which is mandated for
electronic result transmission.
Therapeutic range - 0.4 - 1.0 mmol/L
As is suggested by the lack of consensus in the literature, an individual patient's levels should probably be
decided according to severity of side effects rather than strict concentration values.
Apparently toxic results are commonly due to sampling too early after an increase in dose or too soon after the
dose.
Common side effects
Tremor
Weight gain
Polyuria
Fatigue
Polydipsia
Aggravated Psoriasis
Nausea or Acne
Diarrhea
Hypothyroidism
Recommended actions
Review indications for Lithium Therapy
Check 12 hour level, U & Es, TFTs
Adjust dose accordingly
Omit Lithium if diarrhea persists
Before interpreting a result check the specimen timing was correct.
Causes, Symptoms and Treatment in the event of OVERDOSE.
Toxic effects are commonly caused by chronic over dosage as a consequence of alterations in renal excretion.
Toxic symptoms relate loosely to Li concentration as there appears to be an effect of duration of elevation in Li
level on severity. Creatinine clearance and other renal function indicators are usually abnormal in chronic
overdose. Deliberate self poisoning is relatively uncommon and toxicity is normally milder than chronic
overdose with similar Li levels.
Clinical Grade Typical Li mmol/L
O
0.4 - 1.3
I
1.5 - 2.5
II
III
2.5 - 3.5
>3.5
Symptoms.
No symptoms / Anxiety.
Nausea, vomiting, diarrheoa, tremors, muscle weakness, agitation,
lethargy, blurred vision, confusion, fasiculations, myoclonic twitches,
hyperreflexia, ataxia, blurred vision.
Stupor, rigidity, Parkinsonism, hypotension.
Convulsions, coma, circulatory collapse.
Individual patients may display symptoms which do not correlate with the tabulated symptoms particularly in
acute overdose. One acute overdose patient is reported with Li results of 2.7 mmol/L with no symptoms
whereas another patient died after presenting with a level of 1.2 mmol/L after having had toxic symptoms for 8
days.
Signs of Toxicity
Apathy
Ataxia
Muscle Weakness
Nystagmus
Restlessness
Coarse Tremor
Confusion
Fits
Vomiting
Renal Failure
Diarrhoea
Coma
Author
Title
Document No.
Richard Stott
Lithium
PD-UserHbk-019 ver2.0
Action
Obtain urgent level (must be absolute level)
Check U & Es urgently
IV fluids
Referral for general medical care
Renal specialist unit if renal failure develops
Discontinue Lithium immediately.
Page 2 of 3
25/3/2013
Lithium should be stopped immediately if the above toxic symptoms are experienced. It may be necessary to
admit the patient for medical observation if lithium toxicity is suspected. If hyper-reflexia and hyper-extension of
limbs, convulsions, toxic psychosis, syncope oliguria, circulatory failure or coma occur, then this is an
emergency and the patient should be admitted urgently for further medical care.
Treatment of Lithium OVERDOSE.
1. IV Rehydration is often recommended because of dehydration in chronic intoxication. This will increase
Li excretion if the initial problem was due to hypovolaemia and low GFR. This does not increase
fractional Li excretion and may take a long time to effectively clear accumulated Li. This is only suitable
for mild intoxication and response should be monitored using serial Li measurements. More aggressive
treatment is required if the level will not fall below 0.6 mmol/L within 36 hours.
2. Lithium is effectively cleared by dialysis (about 5 fold greater clearance than by rehydration alone) but
Li levels will rebound after cessation of dialysis due to the slow re-equilibration of tissue Li into
circulation. Measurement of Li 6 hours post cessation is recommended to assess the need for repeat
dialysis. Indications for dialysis include:
• Presence of Grade III symptoms.
• Li levels exceeding 4.0 mmol/L.
• Chronic intoxication with levels exceeding 2.5 mmol/L and serious cardiac / CNS
manifestations.
• Serial levels predict that Li will not be < 0.6 mmol/L within 36 Hrs despite IV rehydration.
References
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Lithium intoxication. Hansen & Amdisen. Q.J. Med. 47, 123 (1978)
4. Lithium intoxication: Clinical course and therapeutic considerations. Gadallah et al. Mineral
Electrolyte Metab. 14: 146 - 149. (1988)
5. Self-poisoning and therapeutic intoxication with lithium. Dyson et al. Human Toxicol 6: 325 - 329.
(1987)
6. Lithium pp. 1042 - 1046 in Medical Toxicology Diagnosis and Treatment of human poisoning.
(Ellenhorn and Barceloux Eds. Elsevier, New York) ( 1988)
7. Lithium PP. 427 - 431 in Goldfrank's Toxicological Emergencies. Appleton & Lange, Norwalk, Ct)
(1990)
8. Lithium. pp. 656 - 665 in Clinnical Management of Poisoning & Drug Overdose. ( Haddad &
Winchester. Eds. Saunders Co, Philadelphia) (1990)
9. Massive overdoses with sustained-release lithium carbonate preparations: Pharmacokinetic model
based on two case studies. Griedberg et al. Clin. Chem. 37: 1205 - 1209. (1991)
10. Lithium in the prophylactic treatment of recurrent affective disorders. Baastrup. In Handbook of
Lithium therapy. (Johnson Ed. ) Park Press. Baltimore (1980).
Author
Title
Document No.
Richard Stott
Lithium
PD-UserHbk-019 ver2.0
Page 3 of 3
25/3/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Phenobarbitone
This page is divided into sections as follows:• Timing of measurements after starting therapy or a dose change.
• Timing of measurements relative to taking the dose.
• Interpretation of results.
You may also want to review the Pharmacy formulary site page about anticonvulsants and the page about
Importance of specimen timing in therapeutic drug monitoring.
KEY FACTS - Phenobarbitone
Sample timing - Typical dose 60 - 180 mg taken once per day. The dose frequency is less than the elimination
half life therefore there is a considerable delay between commencing treatment or changing dose and
achieving steady state conditions.
For routine dose changes or initiation of treatment with maintenance doses allow 21 days after initiation of
treatment or dose change.
A single loading dose of 3 to 4 times the maintenance dose may be used to reach equilibrium concentrations
rapidly. Monitoring can begin immediately before the second maintenance dose.
Samples should be taken immediately before taking the dose.
Therapeutic range - 10 – 40 mg/L (Previously given as 80 - 160 umol/L).
Results of 70mg/L or above will be telephoned as critical results if the specimen timing is not obviously
incorrect.
Phenobarbitone may be effective in preventing seizures at concentrations well below the therapeutic range in
some patients (Particularly after long term treatment). Sub therapeutic levels are not necessarily an indication
for a dose increase or withdrawing the drug in patients with good control.
Bioavailability of oral dose - Peak concentration 50 - 100 hours post dose.
Metabolism - Phenobarbitone is metabolised by the liver to inactive metabolites.
Half life of elimination ranges from 50 to 120 Hrs in adults and 40 - 70 Hrs in children. This long half life
necessitates long waiting times between commencing treatment or changes in dose & monitoring.
Caution Phenobarbitine levels may increase sharply if Valproate is added to the drug regimen. Phenobarbitone
(or Primidone) dose must be reduced accordingly and monitoring of valproate & phenobarbitone may be
required.
Distribution - Volume of distribution is 0.7 - 1.0 L/Kg
Timing of Phenobarbitone measurements after starting treatment or a dose change.
Elimination half-life is variable (At least 40 Hours) and can be very long in some patients (up to 5 days),
therefore the delay required between dose adjustments and monitoring can exceed three weeks. Monitoring
prior to this may be acceptable in many patients but results should be interpreted cautiously as further increase
may occur.
Interpretation of results.
Before interpreting a result according to the therapeutic range, check the specimen timing was correct
Therapeutic range - 10 – 40 mg/L (Previously given as 80 - 160 umol/L).
CAUTION Levels correlate poorly with side effects. New patients may show marked drowsiness at levels as
low as 20 umol/L whereas long term patients may tolerate up to 260 umol/L with no ill effects.
Expect severe toxicity about 450 umol/L.
Author
Title
Document No.
Richard Stott
Phenobarbitone
PD-USerHbk-018 ver2.0
Page 1 of 2
25/3/2013
Results must be interpreted relative to clinical symptom rather than levels alone.
Phenobarbitone may be effective in preventing seizures at concentrations well below the therapeutic range in
some patients (Particularly after long term treatment). Sub therapeutic levels are not necessarily an indication
for a dose increase or withdrawal of the drug in patients with good control.
Timing of Phenobarbitone measurements relative to taking the dose.
Remember: Drug concentrations are not stable from dose to dose at any time after the dose unless the
required time has elapsed since commencing treatment or the last dose change.
The concentration of Phenobarbitone is most stable and correlates with therapeutic effects close to the time of
taking the next dose. Values measured at this time have been used to derive the therapeutic range and this
timing should also be used in taking samples to direct changes in dose. Specimens taken substantially before
this timing will yield inappropriately high results due to incomplete distribution into peripheral tissues and may
result in selection of an inappropriately low dose.
References:
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
Author
Title
Document No.
Richard Stott
Phenobarbitone
PD-USerHbk-018 ver2.0
Page 2 of 2
25/3/201309/04/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of PHENYTOIN.
This page is divided into sections as follows:Common indications for measurement.
Timing of measurements after start of treatment.
Timing of measurements after a dose change.
Timing of measurements relative to taking the dose.
Interpretation of results.
Symptoms, Actions and future measurements in the event of OVERDOSE.
You may also want to review the Pharmacy formulary site page about anticonvulsants and the page about
Importance of specimen timing in therapeutic drug monitoring.
KEY FACTS - PHENYTOIN
Sample timing - Trough level (Immediately before next dose) at least 11 days after initiation of treatment with
'maintenance' dose.
Alternatively 2 - 4 hours post loading dose. ( Requires 2 - 4 weeks to reach appropriate enzyme induction
therefore levels will fall despite initial demonstration of adequate dose) .
After initial induction, further monitoring must be at least 4 weeks post dose change.
Therapeutic range
Total phenytoin 5 – 20 mg/L (Single drug)
(Previously reported as 40 - 80 micro mol/L) For more details see
Interpretation. (Free phenytoin 3.5 - 7.5 micro mol/L)
Toxic effects are likely above 20 mg/L (80 micro mol/L) including 'Paradoxical' seizures. Results of 25 mg/L or
above will be telephoned as critical results unless the timing relative to dose is obviously inappropriate. Some
patients require high levels to achieve adequate control.
Bioavailability of oral dose Typically 90% but may vary significantly with formulation.
Take care when changing formulation as large concentration changes may occur with apparently
constant dose.
Metabolism - Hepatic oxidation. This system is saturable at drug concentrations within the target range. Dose
and blood levels are not linearly related. Phenytoin (and other drugs) also induces the enzymes so metabolism
depends on drug history.
Protein binding - about 90% protein bound but displaced by other drugs (e.g. Valproate) leading to decrease
in total phenytoin in blood but increased 'Free' phenytoin. Also lowered in pregnancy, renal disease, hepatic
disease and in Neonates. In these situations, measurement of 'Free' phenytoin may be indicated.
Elimination - Hepatic metabolism and Excretion via kidneys. Saturation of hepatic metabolism makes
elimination dependent on concentration and highly variable between individuals.
Effective half lives vary with age and drug therapy history. Typically values • 75 Hrs in pre-term neonate. 21 Hrs in term neonate.
• 7.5 Hrs in infants / children.
• 9 - 22 Hrs for adults taking single dose.
• 20 - 40 Hrs for adults on chronic therapy.
• May be up to 100 Hrs on high doses.
Deterioration in renal function may lead to increased levels of metabolite which is measured by some
assays and give misleading results.
Timing of PHENYTION measurements after a dose change.
Treatment is usually commenced using the 'Maintenance dose' of Phenytoin. In 'Status Epilepticus', rapid onset
of symptom control is essential and there will be an initial 'loading dose' usually given as an IV infusion over
Author
Title
Document No.
Richard Stott
Phenytoin
PD-UserHbk-020 ver2.0
Page 1 of 3
25/3/2013
several hours. This achieves the steady state distribution very rapidly. The first 'Maintenance dose' is given the
appropriate time later and monitoring can commence after this dose.
In treatment with 'Maintenance' doses (Starting at 3 - 4 mg/Kg (Typically 150 - 300 micrograms) either as a
once a day dose or divided into two), the elimination half-life of Phenytoin regulates the accumulation between
doses. Between three and five half-lives are required before the difference between current and 'steady state'
concentrations is less than the assay imprecision (Typically 5 - 10% CV). In normal individuals the half life is
between 20 and 40 hours and therefore a period of 11 days should be allowed before checking the
concentrations achieved. The dose is then gradually increased to achieve adequate relief from symptoms
(Typical final doses about 300 mg per day).
Timing of PHENYTOIN measurements relative to taking the dose.
Trough levels (Just before the next dose) are the most stable. These are used in defining the target range.
Interpretation of results for PHENYTION.
Before interpreting a result check the specimen timing was correct
Target range depends on the indication for phenytoin administration and the other drugs co-administered. The
range given in the laboratory computer relates to treatment of Epilepsy using phenytoin alone. See later in this
section for other indications and multi-drug therapy.
Single drug therapy for epilepsy or Trigeminal neuralgia
• Therapeutic range - Total phenytoin 5 – 20 mg/L (Single drug) - (previously reported as 40 - 80 micro
mol/L)
• Toxic effects are likely above 20 mg/L including 'Paradoxical' seizures.
• Some patients may benefit from carefully increasing the dose if no adverse effects become evident.
Notes
1. The dose and plasma concentration are not linearly related in a given patient and small dose
adjustments can lead to disproportionately large increases in levels. Monitoring is required with each
change in dose.
2. Addition, Cessation or dose adjustment of other drugs will require alterations in the dose of phenytoin
and necessitates monitoring phenytoin and all interacting anticonvulsants to adjust the doses
appropriately. (Remember that any induction / de-induction of metabolism requires up to 4 weeks to
complete, Do not adjust the dose using results from drug monitoring before this is completed.
Multi-drug therapy for epilepsy.
1. Due to drug interactions the dose of phenytoin may require alteration whenever an interacting drug is
started, stopped or the dose is changed.
2. Take great care in deciding the timing of the samples, all interacting drugs should have reached
steady state before monitoring is commenced. This requires 3 to 5 times the half-life of the slowest
drug to reach steady state. In addition the 4 weeks delay for changes in metabolic induction must be
remembered.
Free phenytoin 3.5 - 7.5 micro mol/L
Causes, Symptoms and Treatment in the event of OVERDOSE.
Causes of Phenytoin OVERDOSE.
Diagnosis should depend on a careful clinical examination and should not be entirely based on Phenytoin
measurement as toxic symptoms may occur within the therapeutic range and a few patients may require
apparently 'Toxic' concentrations for optimal symptom relief.
Common causes of toxicity include :• Too large a dose increase. In many individuals a small dose increase can lead to disproportionate
concentration increases with 'toxic' symptoms becoming evident.
Changes in dose of / addition of drugs which interact due to common metabolic pathway or
protein binding.
References
1. British National Formulary (March 1995)
Author
Title
Document No.
Richard Stott
Phenytoin
PD-UserHbk-020 ver2.0
Page 2 of 3
25/3/2013
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
Author
Title
Document No.
Richard Stott
Phenytoin
PD-UserHbk-020 ver2.0
Page 3 of 3
25/3/2013
Directorate of Pathology
Timing of samples and interpretation for measurement of Valproate.
This page is divided into sections as follows:• Timing of measurements after starting therapy or a dose change.
• Timing of measurements relative to taking the dose.
• Interpretation of results.
You may also want to review the Pharmacy formulary site page about anticonvulsants and the page about
Importance of specimen timing in therapeutic drug monitoring to see why the kinetic variability of Valproate
makes therapeutic monitoring impractical.
KEY FACTS - Valproate
Monitoring of Valproate for therapeutic adjustment is contraindicated
Valproate levels are not useful in adjusting therapeutic doses as it is impossible to derive an adequately defined
therapeutic range for use with a single measured level.
The only indication is in therapeutic failure where elevated results indicate that an alternative anticonvulsant
should be used.
Sample timing - Immediately before taking the dose, at least 3 days after initiation of treatment or dose
change. 15 days when co-administered with Lamotrigine.
Therapeutic range - A range is not well established due to poor correlation between levels and effect. Toxic
effects do not correlate with concentration.
Bioavailability of oral dose - Peak concentration about 2 Hrs post dose. Metabolism - Hepatic oxidation &
conjugation to yield active metabolites with long half lives. Onset of therapeutic effects is delayed compared to
plasma level reaching 'therapeutic' levels & persists after complete clearance of parent drug. Valproate coadministration extends the elimination half time for Lamotrigine due to competition for metabolism.
Distribution - Volume of distribution is small (0.1 - 0.4 l/Kg).
Protein binding is concentration dependent leading to non-linear relationship between dose & free drug
concentration. Valproate is displaced from binding by free fatty acids so binding (& elimination kinetics) vary
between fasted & fed states. Valproate levels may vary as much as 100% over the dose interval.
Levels are not reproducible even the same stage of successive twice daily doses.
Elimination - Half life ranges from 7 - 16 Hrs.
Both hepatic oxidation & renal excretion are highly variable and are effected by other anticonvulsants (notably
Phenytoin & Phenobarbitone).
Timing of Valproate measurements after starting treatment or a dose change.
In large groups of patients the apparent half life of elimination is between 7 and 16 hours therefore leaving 3
days after a dose change should lead to steady state concentrations of the parent drug. The validity of this half
life is minimal because most of the activity derives from active metabolites and therapeutic effects require
considerably longer than this to establish. Similarly therapeutic effects persist well after the parent drug is
eliminated from circulation.
Timing of Valproate measurements relative to taking the dose.
Remember: Valproate concentrations are not stable from dose to dose at any time after the dose due to the
effects of diurnal variation, Fed/Fasted state and interactions with other anticonvulsants. Valproate levels may
vary as much as 100% over a single dose interval and are not reproducible even at the same stage of
successive twice daily doses.
Trough levels (Just before the dose) are traditionally used for clinical convenience and the attempts at deriving
therapeutic ranges all use this timing.
Interpretation of results for Valproate.
Before interpreting a result check the specimen timing was correct
Therapeutic range – None quoted.
A range has not been well established due to poor correlation between levels and effect. Toxic effects do not
correlate with concentration.
Author
Title
Document No.
Richard Stott
Valproate
PD-UserHbk-021 ver2.0
Page 1 of 2
25/3/2013
References:
1. British National Formulary (March 1995)
2. Therapeutic Drug Monitoring. (Hallworth and Capps). ACB Venture publications, London. ISBN 0
902429 05 1
3. Individualizing Drug Therapy. Gross, Townsend, Frank INC, New York. Library of Congress No 8182052
Author
Title
Document No.
Richard Stott
Valproate
PD-UserHbk-021 ver2.0
Page 2 of 2
25/3/2013
Pathology CSU
Timing of samples for measurement of Therapeutic Drugs.
Why is correct timing of the sample important ?
For a drug measurement to be of any use at all it must be answering a specific clinical question, this often
implied rather than consciously asked. Common questions include 1. Is the dose of drug sufficient to have a therapeutic effect?
2. Is the dose of drug excessive and causing unwanted effects?
3. Is there some interaction with other drugs causing unusual behavior of the drug?
4. Has a change in the patient's condition altered drug handling and changed the therapeutic effect?
5. Is the patient taking the drug at all?
In all but the last case the answer depends to some extent on our understanding of the relationship between
dose administered, blood concentrations achieved at a certain time after the dose and the therapeutic actions
of the drug.
The blood concentration of all drugs varies with the time after each individual dose, this is dependent on two or
three processes depending on the route of administration. The concentration initially rises as drug arrives in
circulation then reaches a plateau and subsequently declines until the drug is entirely removed from circulation
or another dose is given. Where several doses are given the concentrations achieved after each dose will be
influenced by the drug remaining from prior doses and the drug will tend to accumulate until a steady state is
reached after which each new dose will behave essentially the same.
Depending on the route of administration, either two or three processes control the rates of change of drug
concentration. Each of these processes acts simultaneously on the circulating drug although a single process is
usually the dominant determinant of concentration at any time after the dose.
1. Drugs given orally have an initial absorption phase during which the dose (or a fraction of the dose) is
absorbed from the intestines. The timing and extent of absorption depends on the site of absorption of
a particular drug, rate of passage through the gut and possibly the nature and relative timing of recent
meals. These influences may result in large differences in handling of a drug between individuals and
between days within the same individual. Oral doses are absorbed and immediately presented to the
liver for possible metabolism (First pass metabolism) before reaching the systemic circulation. The
precise behavior of drugs given by the oral route may be affected by coexisting medical conditions
including diseases of the GI tract, Liver and Pancreas as well as the administration of other drugs.
2. Drugs given as a timed IV infusion have a highly predictable absorption phase and are immediately
available in circulation without being presented to the liver. Therefore the distribution of metabolites in
circulation (and hence therapeutic effects) may be very different from those obtained for the same drug
given orally.
3. Drugs given as an IV bolus do not have an absorption phase and are immediately available in
circulation.
4. Drugs given as an IM bolus have an absorption phase which depends on the rate of transport away
from the immediate site of administration which may vary considerably according to site and local blood
flow. This route also avoids first pass metabolism of the drug.
Once in circulation the drug is available for distribution into the various tissues. The extent of distribution into
particular tissues depends on several factors including the extent of protein binding, lipid solubility and active
uptake by particular tissues (eg. Hepatocytes). The extent and rate of distribution of a drug in an individual may
be affected by the proportion of body mass composed of adipose tissue (Generally a higher proportion of total
body weight in females than males and also altered by physical training and obesity.). Disease processes and
other drugs may affect the distribution phase by altering protein binding or active transport processes. This
process is also important in delivering active drug molecules to the sites of action which are rarely directly
accessible by molecules in the blood. The same processes act in reverse direction during periods of declining
drug concentration although the transport processes and rate of movement may be different.
Elimination of the drug from circulation depends on the presentation of drug molecules to sites of metabolic
alteration (Mainly hepatic but other sites may be important in specific drugs) and excretion (Mainly renal via
urine and hepatic via bile but other routes are significant in some drugs e.g. sweat, milk etc.)
Although some drugs are metabolized by processes which have fixed maximum rates or are not concentration
dependant, usually each process contributes or removes drug molecules according to first order kinetics (rate
of removal or delivery is proportional to concentration). This results in an exponential increase in blood
concentration after an oral dose which is followed by an exponential fall. This is usually not due to a single
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 1 of 6
09/04/2013
process but the differing routes of distribution and elimination can be thought of as a sequence of exponential
processes. At any time after the dose there is usually a single dominant process and the decline can be
represented by a single half life of accumulation immediately after the dose and a single half life of decline. This
is often termed the 'elimination' half life although it may not be entirely due to a single excretion or metabolic
process.
Concentration of drug after a single dose
Concentration
16
12
Elimination phase
Half life = 6
8
Absorption phase
Half life = 6
4
0
0
10
20
30
40
Time after dose
50
60
When multiple doses are given more frequently than about 5 elimination half lives apart, clearance is not
completed before the next dose is taken. Most drugs which require monitoring have an elimination half-life
similar to or shorter than the dosing interval and so drug metabolism eventually reaches steady state when the
concentrations are consistent at any particular time after the dose.
Concentration of drug when multiple doses are given
Concentration
16
12
Dose
Final trough
value = 12
Dose
8
Difference between trough level and
final trough concentration decreases
by half for each elimination half life
since first dose.
Dose
4
Dose
Elimination half life = 10 Dosing interval = 12
0
0
10
20
30
40
50
60
Time after first dose
At any fixed time after the dose the drug levels behave as if they increase with a doubling time identical to the
elimination half life, therefore results become stable after between 3 and 5 elimination half lives. After this time
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 2 of 6
09/04/2013
any further change in concentration is less than the variability in results for replicate measurements (Typically 5
- 10 % Coefficient of variation between replicates of the same sample).
Why do we only measure certain drugs.
For many drugs there is a wide margin of error between the dose at which the effects are 'Therapeutic' and
those at which 'Toxic' effects predominate or become clinically obvious due to unmistakable symptoms. Other
drugs have a narrow range of therapeutic concentrations but the toxic effects are clinically evident and the
relationship between the dose taken and its effects is consistent. Drugs with these characteristics can be given
at a standard initial dose and the dose adjusted progressively according to clinical response. These drugs do
not require concentration monitoring to ensure safety or adequate therapeutic action unless there is some form
of interaction between drugs.
Drugs which have a narrow therapeutic range in combination with one or more of the following properties will
require concentration monitoring to achieve safe levels.
• Large intra-individual variability in metabolic handling.
• Non-linear dose/response effects such as saturable metabolism.
• Poorly predictable effects of concurrent illness e.g. renal function, jaundice, electrolyte abnormalities.
• Interactions with other drugs which are co-administered.
• Absence of clinical signs of sub therapeutic or toxic concentrations (or no difference between the
signs).
The degree of variability may be sufficient to make an otherwise safe drug unpredictable under certain
conditions and concentration monitoring may be useful. As an example of the variability in individual handling of
a drug the following graph shows the concentrations achieved after a standard dose of phenytoin.
Concentration of Phenytoin in 200 individuals taking 300 mg per day
% of patients
15
Target range 10 - 20 mg/L
10
5
0
0
10
Plasma Phenytoin (mg/L)
20
30
40
50
Requirements for therapeutic drug measurements to be clinically useful. There are several basic
requirements which must be met before therapeutic monitoring can be usefully undertaken, these mainly relate
to the practicalities of obtaining a result which can be interpreted, these questions usually require the study of
large numbers of individuals to determine the suitability for monitoring.
1. Timing. There must be some time after the dose where the intra-individual variability, disease effects
and drug interactions allow a relatively steady drug concentration to be achieved. This results in greater
stability for the therapeutic ranges. This is often the 'Trough level' just before the next dose or a 'Peak
level' some time after the dose where the absorption and distribution phases are complete but
extensive elimination has not yet occurred. In situations where there are effects of other drugs given at
the same time, the implications for sampling times should be considered and sample timing modified if
necessary.
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 3 of 6
09/04/2013
2. Sample. Blood (or other sample) concentration must correlate with clinical effect. For the concentration
to be useful it must be possible to define a target range which is associated with therapeutic effects.
This is only possible if the blood concentration closely correlates with that at the active site of the drug.
For example the total concentration of a drug which is extensively protein bound in serum may be
affected by changes in protein content and fail to indicate the available amount at the receptor (In this
case the free drug may be a better measurement). Similarly the concentration within the blood may be
unrepresentative of that in a particular body compartment e.g. CSF and therefore may not indicate
therapeutic effect. Failure to achieve this correlation makes it impossible to accurately define a target
range for therapeutic effect.
3. Assay. There must be a readily available assay which measures the parent drug and / or appropriate
metabolites. The identity of the assay will determine the target range to be used. It is particularly
important to use the appropriate ranges where there are multiple metabolites as certain molecules may
be detected by one method but not another. The characteristics of the assay may also determine how
long it takes to return results and whether monitoring is available daily, weekly or only by prior
arrangement. This may alter the situations in which a drug measurement is useful. For example,
determining the next dose of a drug to be given is practical using an automated immunoassay which is
available 24 hours a day and returns results within 30 minutes but not with a manual HPLC method
which takes the whole day to get a result.
4. Interpretive information There must be a well defined target range determined for a large number of
individuals treated with the drug of interest and determined using the assay method in the laboratory
(Or one which measures the same metabolites). Where there are confounding factors such as effects
of other drugs, this should be investigated and alternative target ranges determined.
Timing of measurements after start of treatment.
From the previous section it should be apparent that drug handling by the individual patient should be at or
close to the steady state condition before monitoring will produce a result which can be usefully interpreted.
The difference between the current and steady state drug concentration halves for each elimination half life
which passes since the drug was started. For the results to be interpretable the likely error in determining the
drug concentration should be of similar magnitude or greater than any error due to failure to achieve steady
state. Therefore monitoring of most drugs should not be started until at least 3 half lives after starting the drug
administration. Taking the sample during a dose cycle prior to steady state will usually result in a falsely low
result as the drug has not yet fully accumulated in the patient. For some drugs, however, the result will be
falsely high as the drug is not yet fully distributed into the tissues. Either of these circumstances would lead to
an inappropriate decision that the patient is likely to be adequately treated or that a dose change is required.
The only exception to this general timing rule is for drugs where a loading dose is given. In this situation a large
initial dose is given to achieve therapeutic effects rapidly. This dose is calculated so that it will distribute through
the tissues to achieve the same concentrations as would result at steady state, thus achieving therapeutic
concentrations several elimination half lives earlier than with multiple 'Maintenance doses' of the drug. The first
'Maintenance dose' is then given after an equilibration time (Which may be longer than the normal time
between maintenance doses). In this situation it is valid to check the concentration is 'Therapeutic' prior to
giving the first maintenance dose.
The actual timing of the first dose cycle available for monitoring a particular drug is given in the timing details
available from that particular analysis page.
Timing of measurements after a dose change.
The rationale in determining when to monitor after a dose change is identical to that for initiation of therapy
except that there is already some drug accumulated in the system. The difference between the current and
steady state drug concentration halves for each elimination half life which passes since the dose was changed.
For the results to be interpretable the likely error in determining the drug concentration should be of similar
magnitude or greater than any error due to failure to achieve steady state. Therefore monitoring of most drugs
should not be started until at least 3 half lives. Taking the sample during a dose cycle prior to re-establishing
steady state will usually result in a falsely low result which could lead to an inappropriate decision that a further
dose change is required.
The actual timing for monitoring a particular drug is given in the timing details available from that particular
analysis page.
Timing of measurements relative to taking the dose.
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 4 of 6
09/04/2013
From the previous section it should be apparent that the drug concentration should be at a relatively constant
level in the particular patient before monitoring and that the timing should be the same as that used to produce
the 'Target range' data. Very large errors can occur if the sample timing is not within the optimum period as the
concentration may be changing rapidly. For example a sample taken two hours late may fall on a steep
exponential fall in concentration rather than the plateau and could produce a low concentration leading to an
inappropriate decision to increase the dose. Similarly, a sample taken two hours early may fall in a period of
rapid absorption with little distribution and the actual timing of samples relative to the dose is given in the timing
details available from the analysis page for each drug.
Effects of sampling at an appropriate time relative to the dose
Concentration
Sample with apparently 'Toxic' result
Target range
Sample with apparently
'sub-therapeutic'
result
Sampling interval
17 - 33 time units
0
10
20
30
40
50
60
Time after dose
Information required on the request form for drug measurements.
Certain information must be accurately recorded to enable the clinician to be able to interpret the results and
the laboratory to attach appropriate interpretative ranges. The absolute minimum information on the request
form is as follows:• Date of last change in drug dose.
• Date and time of last dose of drug.
• Date and time sample was taken (This must be within the specified time range after the last dose.
About 10% of samples for some determinations are taken too early!)
• Dose of drug and frequency of administration.
• Name of drug administered (Especially where there are several formulations e.g. fast acting, slow
release etc.)
• Names of other drugs which are co-administered (These may alter the interpretation of a result if the
drugs interfere in the metabolism of the drug being measured).
• Which drug is to be measured (We often get a long list of drugs in the clinical details box and no clear
request for measurement, your request may be ignored!).
• Reason for the request plus relevant clinical details.
Interpretation of results.
Interpretation of the results of therapeutic drug monitoring requires a combination of judgment about the
patient's clinical state, the analytical result and the 'Target range'. It must be remembered that the 'Therapeutic
range ' is only a guide, individual patients may have differences in drug distribution or transport which alter drug
availability at the receptor. As a consequence of these differences –
• Some patients achieve adequate relief of symptoms before the results are in the range (And will have
'Toxic' symptoms within the target range), in these individuals levels below the 'Therapeutic range' do
not indicate that a dose increase is required.
• Other patients may require cautious increase in dose producing results in the apparently 'Toxic' region
before adequate symptom control is achieved.
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 5 of 6
09/04/2013
Before making a decision based on the results, it is essential to consider the following data to ensure that the
appropriate sample timing limitations are complied with and that the appropriate target range is being used:
•
•
•
•
•
Current dose of drug, formulation (e.g. Slow release tablet, or liquid) and frequency of administration.
Drugs which are co-administered (These may alter the interpretation of a result if the drugs interfere in
the metabolism of the drug being measured).
Date of last change in drug dose (Check relative sample timing !).
Date and time of last dose of drug.(Check relative sample timing !).
Date and time sample was taken
Therapeutic ranges and details of sample timing restrictions are given in the timing details available from the
analysis page for each drug. The ranges given on the laboratory computer system and the main page for each
drug are appropriate to single drug treatment using the conventional formulation and normal sample timings.
The specimen timing page may have additional information about target ranges and specimen timing for other
formulations and multi drug therapy. Take care to check that you are using the most appropriate range for
the individual patient.
Drug Toxicity.
Most 'Toxic' effects are related to drug concentration in the same way as therapeutic effects and have a
threshold at which they become noticeable, The site of action for toxic effects may be different from that for
therapeutic and therefore there may be a completely different set of distribution and elimination processes,
however for most drugs the blood levels are as good at predicting toxicity as therapeutic effects. In some cases
the reason for monitoring the drug is related only to it's potential toxicity as the levels achieved are not
correlated well with therapeutic outcome (For example many antibiotics are potentially toxic but are used at
blood levels far in excess of the minimum inhibitory concentration).
The majority of drugs are metabolized at a rate which is concentration dependent therefore concentrations
change gradually. In these drugs the final concentration is linearly related to the dose and quite large dose
increases can be tolerated. The onset of toxicity due to an increased dose will be gradual as will toxic effects
precipitated by a metabolic change such as renal failure or hypokalemia.
In mild overdose, symptoms are most likely to occur during the period of peak drug concentration.
As the degree of excess increases, the concentration becomes 'Toxic' earlier after the dose and remains high
for a longer time, additional symptoms may also occur as the peak concentration increases.
Drugs with saturatable metabolism do not show a linear relationship between dose and concentration. Drug
concentrations can increase several fold after a small dose increase if it causes the delivered amount of drug to
exceed the metabolic capacity. An increase of several fold may be caused by a small fractional dose increase.
These drugs (e.g. Phenytoin, Carbamazepine) may cause continual, severe symptoms a short time after the
first inappropriately high dose. Similarly the symptoms may persist for a long period after stopping the drug
while the excess is cleared.
Author
Title
Document No.
Dr Richard Stott
Timing of Therapeutic monitoring
PD-UserHbk-022 ver 1.0
Page 6 of 6
09/04/2013
Normally, whilst on site you will be accompanied
by your host or another member of staff or you
will have been given instructions on how to reach
a department and to whom you should report.
Whilst in a department should you, for any
reason, be left on your own, do not enter any
other areas unaccompanied. Laboratories by
their very nature contain many potential hazards.
Entering them without being aware of these may
expose you to some risk. Please ensure you
wash your hands before leaving a laboratory
area.
The Trust accepts no responsibility for any loss
or damage to personal property on the Trust site.
If you suffer any loss or damge, please report it
to your host.
Fire Safety
The laboratories are well equipped with fire alarm
systems. However, these may vary depending
upon the laboratory you are visiting.
Your host will inform you of the evacuation
procedure and the assembly point. Should the
alarm sound, please leave the building with your
host and do not go to collect personal belongings.
If you are alone and the alarm sounds leave the
building by the nearest emergency exit.
Once outside proceed to the assembly point with
the other staff. Please ask a member of staff if
they can contact your host to inform them that
you are out of the building.
You may re-enter the building only on instruction
from your host once they have been given the all
clear.
Compliance with these simple instructions will
assist us in maintaining standards of safety and
reduction of risk. They will also help to ensure
that your stay is in no way marred by an accident.
Please note: Smoking is not permitted in any area
within the laboratories complex.
Pathology services encompass the Departments
of Clinical Biochemistry, Haematology,
Histopathology, Cytology, Morbid Anatomy,
Microbiology, Virology and Immunology.
Safety information for
laboratory visitors
Pathology Laboratories are situated on the
Doncaster Royal Infirmary and Bassetlaw
District General Hospital sites. Phlebotomy
services are also available on the Montagu site.
Welcome
We would like to welcome you to the Directorate of
Pathology and wish your visit to be safe and
successful.
On arrival you must ensure that you have signed
the visitor’s book to record your presence in one of
the buildings. You will be issued with a temporary
visitor’s badge whilst on the premises. Please also
ensure that you sign out when you leave and return
the visitor’s badge to the office. Your host will be
able to guide you through this procedure.
Whilst waiting we ask you to carefully read the
information in this leaflet. Its purpose is to ensure
that the high standards of safety are extended to
you and that your safety is not compromised during
your visit.
OPENING HOURS
The laboratories are generally open from
0900 - 1700 Monday to Friday.
Please see Laboratory Handbook department
sections for precise opening hours.
N
SM KING
Doncaster and Bassetlaw Hospitals NHS
Foundation Trust operates a no smoking policy
on all of its premises
Site Safety
SAMPLES - HEALTH & SAFETY
Never eat, drink or smoke when transporting specimens
and wash your hands frequently.
Carry all specimens in the approved specimen container
- not in your pockets.
If there is a specimen breakage and spillage, isolate the
area to prevent access. If you have an accident involving
contamination with a specimen, contact a senior member of
staff in the clinical or laboratory area.
The tissue fixative for routine histology specimens is 10%
formalin (a 4% solution of formaldehyde). This is a
hazardous chemical, which should be handled with care.
The laboratory can advise on storage handling and
substance monitoring.
Please refer to Trust Standard Precautions policy PAT/IC19
available on the website.
Uncontrolled copy for temporary use only
Laboratory Safety
The Directorate of Pathology is committed to
fulfilling its legal requirements under the Health and
Safety at Work Act (1974) and all other pertinent
regulations.
Therefore, you have a legal requirement to follow
any signs or instructions. You must not risk the
safety and welfare of any person on the site
including yourself. If you see any process or
practice which you consider unsafe please report it
to your host. In order to minimise any risk of
infection you must not eat, including gum or
sweets, drink or apply cosmetics except in
designated areas.
Your host will clarify any safety matter about which
you may be unclear. In the unlikely event of an
accident, or something that might contribute
towards an accident, please inform your host.
www.dbh.nhs.uk
HS-COM-007 Version 2 PT 01/04/2013
Code of Practice for Visitors to Pathology
(HS-COM-002)
Due to the nature of the work involved in diagnostic
laboratories and the hazardous substances/ agents in
use, the following regulations must be adhered to at
all times during your visit to Pathology.
Visitors must be accompanied at all times by an
experienced member of staff.
Please comply with any instructions issued by your
host during your time in Pathology.
Wear protective clothing if it is provided and find out
where you should discard it after use.
Cover all open cuts, abrasions etc. using waterproof
dressings.
Do NOT eat, drink, smoke, apply cosmetics or chew
gum during your visit and avoid hand to mouth
contact in laboratory areas.
Do NOT touch working areas or equipment unless
you are told it is safe to do so and ensure long hair is
tied back.
Before leaving the laboratory wash your hands
thoroughly. (Always ensure you wash your hands
before meal breaks).
Any accidents or incidents involving visitors must be
reported immediately to the accompanying member
off staff and subsequently to the Departmental Safety
Officer who will complete an accident form if
necessary.
On hearing the fire alarm, you must stay with your
host who will escort you to safety.
Sample Tube Guide
Sample Storage
Draw tubes in the order given
Tests
Time
Limit
Longer
term
Transport
on Ice
10 mins
Not
possible
FBC, Film
Blood Bank
Ambient
4 - 6 hrs
4 - 10° C
HbA1c
Ambient
Blood gas
syringe
Blood
EDTA
Blood
EDTA
(require
own
sample)
Transport
Short
term
requirements
Do not use
air transport
tube
Coagulation Screen, Prothrombin
SODIUM
CITRATE 1:9 Time (INR), APTT, Thrombophilia
Fill to line
essential
PLAIN
Procollagen, Lamotrigine
(No Additive)
Ambient
PTH
Ambient
4 - 6 hrs
Not
possible
ACTH
Pre-Chilled
Tube
On Ice
10 - 15
mins
Not
possible
Electrolytes
Ambient
4 - 6 hrs
Available
SST
All Biochemistry Tests not mentioned
elsewhere (1 Tube), Microbiology Tests
(1 Tube), Immunology Tests
HEPARIN
Troponin I, Chromosome Studies,
Lead, Amino Acids, Synovial fluids for
Crystals
On Ice
Blood
SST
Other Tests
Ambient
See
Tube Guide
Ambient
Blood
See
Sodium Tube Guide
Citrate 1:9
Ambient
Blood
Heparin
Blood
Fluoride
Oxalate
Blood
Culture
bottles
Glucose,
Alcohol
Ambient
Lactate
Transport
on Ice
Culture &
Sensitivity
4 - 10° C
24Hr Urine
Collection Biochemistry Ambient
Swabs
Ambient
Culture &
Sensitivity
4 - 10° C
Not
possible
Ambient
10 mins
Not
possible
FBC, Reticulocytes, Sickle Screen,
Haemoglobinopathy Screen, G6PD,
GF Test, PV, Malarial Parasites, ZPP,
RBC Folate, Marker Studies, Lead,
Complement, HbA1c, PCR Tests,
HIV / CMV Viral loads, HLA B27,
Kleihauer
EDTA
(X-Match)
Blood Group, Save Serum,
Crossmatch, Blood Group Antibodies,
Cord Blood Samples
FLUORIDE
OXALATE
Glucose, Ethanol (Alcohol), Lactate
PLAIN
(Trace
Elements)
Copper, Selenium, Zinc
On Ice
Do not use
air transport
tube
Do not use
air transport
4 - 10° C
4 - 6 hrs
tube
Do not use
Specimens
Overnight
over 24 hrs air transport
tube
will be rejected
Specimens
over 12 hrs
12 hrs
may be rejected
Ambient
Culture &
Overnight
Sensitivity Send to lab
ASAP
Biochemistry Ambient
Urine
Universal
EDTA
4 - 10° C
8 hrs max
Screen, Lupus Anticoagulant Screen
37° C
Overnight
Let's get it right !
SURNAME
FORENAME
HIGH RISK CASES
All specimens and request forms from patients known or
suspected of having Hepatitis B, Hepatitis C, HIV or other
known blood borne virus MUST be identified with "DANGER
OF INFECTION" labels. Other "high risk" infectious agents
which should be notified are listed in the Microbiology
section
BIOHAZARD
of the Laboratory Handbook.
DOB 12/12/1864
TIME1.30PMDATE 5/4/05
X2
SIG. Jo Bloggs
123 456 7890
WARD
NO.
All samples should be transported to the laboratory as soon as possible
SMITH
JOHN
Let's get it write !
Follow the Trust policy (PAT/T8) and avoid mistakes by
labelling all types of samples correctly with the
full name,date of birth and ID number
Uncontrolled copy for temporary use only - Please refer to laboratory handbook for current information
Sample Stability
Specimen
Type
Pathology services encompass the Departments of
Clinical Laboratory- Blood Transfusion,
Sciences
Clinical Biochemistry,
Haematology,
Immunology
Histopathology Histology,
Morbid Anatomy
Microbiology Microbiology,
Virology
Phlebotomy
Laboratories and Phlebotomy are situated on the
Doncaster Royal Infirmary and Bassetlaw District
General Hospital sites. Phlebotomy is also available
on the Montagu site.
OPENING HOURS
All laboratories are open routinely from 9.00 am 5.00pm Monday to Friday. Microbiology offer a
restricted service from 17:00 to 22:00 and at
weekends, and an on-call service after 22:00.
Clinical Laboratory Sciences staff work a shift style
system on a 24/7 basis.
For urgent requests after 20:00 contact the
Biomedical Scientists via the Switchboard.
PATHOLOGY ENQUIRIES
Please refer to Pathology Telephone Results Policy
(PAT/T61)
Doncaster Direct 01302 553131
Internal ext. 3131
Bassetlaw Direct 01909 502344
Internal ext. 2344
Note - Transfusion samples must have all details & be signed
Wherever possible use ICE to request Pathology tests
www.dbh.nhs.uk
PD-UserHbk-03 Version 6 - January 2015
Phlebotomy Service
In Patient Service
A morning phlebotomy service is available to the majority of
wards at BDGH and DRI seven days per week. Please note that
National Guidelines will be followed and any patient not wearing
the appropriate wristband will not be bled.
Monday to Friday
Each ward is visited by a member of the phlebotomy team who
bleeds patients as required. The phlebotomist WILL NOT return
to the ward after the morning visit.
Saturday, Sunday and Public Holidays
A limited service is available and requests should be kept to
those tests that are necessary for immediate patient
management only. The requests should be available from
07:00. The phlebotomist WILL NOT return to any ward after the
initial visit.
Out Patient Service
A phlebotomy service is provided in the outpatient departments
at BDGH, DRI and MMH Monday to Friday. The opening times
for all hospital sites are 08:00 to 17:00. This service is for the
venepuncture of outpatient and General Practitioner patients. It
is not necessary to make an appointment for blood tests with
the exception of Glucose Tolerance Tests, when appointments
must be made by phoning Pathology enquiries.
Urgent / Fast Track
With the exception of Histology, a sample will only be accepted
as urgent (or “fast track”) if the department receives a telephone
call BEFORE the sample is received. Work will be analysed as
routine if there is no phone call or if the sample is already in the
laboratory when the phone call is received.
Protocol
Telephone Pathology:
Blood Transfusion requests - DRI ext.3799, BDGH ext.2452
Microbiology requests DRI ext.3834 (Bacteriology)
DRI ext.6519 (Virology)
All other requests DRI ext.3860, BDGH ext.2450
Provide the following information:
Your name and location
Patient's name
Test(s) required and the reason for the urgent request
Details of route for result (Phone No./Bleep No./on ICE)
Send the sample to Pathology Reception either via the Tube
system, a service assistant or GP transport route.
Ensure all specimens are labelled immediately after taking
sample whilst at the patient's bedside.
Urgent histology samples should be clearly identified as such on
the request form with the inclusion of relevant clinical details
Abnormal Results
Markedly abnormal results which require urgent clinical action
will be telephoned to the requesting source (see Policy
PAT/T61). It is therefore important that the request form is
completed with the requesting doctor ID (including bleep
number).
Making a Requests
Point of Care Testing
All requests, with the exception of Histology and Blood
Transfusion, should be made using the ICE system. For
Histology and Blood Transfusion, and if ICE is not available,
complete the appropriate Pathology request form. All requests
must be fully completed with all relevant information and all
samples appropriately labelled (see Policy PAT/T8). Bag the
samples up as directed by ICE and send to the laboratory either
via the tube system, a service assistant or GP transport route. If
using a hand written request form please ensure that individual
forms are used for Microbiology or Virology requests and a
separate blood sample is sent for Virology.
Microbiology samples sent after 22:00 must be brought to the
laboratory and stored in the specimen reception refrigerator or
incubator:
Blood Cultures - Incubator
Urines, Swabs, all other Microbiology samples - Refrigerator
Point of care testing (POCT) is defined as any form of
diagnostic testing undertaken outside of an accredited
laboratory environment. There are increasing expressions of
interest in the use of POCT equipment outside the laboratory,
particularly by general practitioners. The use of POCT
equipment within the Trust is currently mainly limited to blood
gas analysis on specific wards, glucose analysis throughout
the hospital and the use of urine dipstix and pregnancy tests.
Clinical Biochemistry Profiles
BLOOD GAS PROFILE
Anaerobic Heparin Arterial Blood - Gas Syringe
pO2, pCO2, pH, Total hydrogen ion, Base excess/deficit,
Standard bicarbonate
BONE PROFILE SST
Total Protein, Albumin, Globulin, Alkaline Phosphatase,
Calcium, Adjusted Calcium, Phosphate
LIVER PROFILE SST
Total Protein, Albumin, Globulin, Alkaline Phosphatase, ALT,
Total Bilirubin,
Conjugated Bilirubin measured if total bilirubin >50µl/L
UREA & ELECTROLYTES PROFILE SST
Creatinine, Urea, Sodium, Potassium
Chloride & Bicarbonate available by specific request only
LIPID PROFILE SST
Triglyceride, Cholesterol, HDL-Cholesterol,
Calculated LDL-Cholesterol,
Cholesterol / HDL-Cholesterol ratio
THYROID FUNCTION TEST SST
TSH, Free Thyroxine (FT4)
Samples - Health & Safety
Never eat, drink or smoke when transporting specimens &
wash your hands frequently.
Carry all specimens in the approved specimen container not in your pockets.
If there is a specimen breakage and spillage, isolate the
area to prevent access and if you have an accident
involving contamination with a specimen, contact a senior
member of staff in the clinical or laboratory area.
The tissue fixative for routine histology specimens is 10%
formalin (a 4% solution of formaldehyde). This is a
hazardous chemical, which should be handled with care.
The laboratory can advise on storage, handling and
substance monitoring.
Please refer to Trust Standard Precautions policy PAT/IC19
available on the website.
Pathology has overall responsibility for the point of care use of
the blood gas analysers and glucose meters.
The Trust established a multidisciplinary Point of Care Testing
Governance Committee in September 2003 and is chaired by
Dr Jean Wardell, Consultant Biochemist and Assistant Care
Group Director - Pathology.
It is recommended that the need for POCT is always
discussed with the relevant pathology laboratory in the first
instance. A Trust Policy and Guidelines for Point of Care
Testing (CORP/RISK8) has been produced and can be
accessed from the Trust website.
For other information contact our POCT Co-ordinator on 3544
(DRI)
Pathology Report Delivery
Pathology results are available electronically via ICE and the
GP electronic links. Hard copies are returned to the requesting
location daily Monday Friday within the Trust and other
locations which do not have electronic links.
Laboratory Links
Pathology results are available to the majority of users in
electronic format. Whilst the Pathology makes every effort to
ensure the timeliness and accuracy of its reporting, there are
times when the systems fail. If you are not able to receive
results electronically or if you have any enquiries with regard
to electronic issue of results, please contact the Pathology IT
manager on 01302 553269 or email [email protected].
Transfusion Practitioner
The Trust has a Specialist Practitioner of Transfusion (SPOT)
team. They can be contacted via switchboard on pager
07659504563 Monday to Friday 09:00 to 17:00. They are
available for advice on all aspects of transfusion. and
alternatives to transfusion. They are sensitive to religious and
cultural issues surrounding transfusion of blood and products.
Quality Assurance
All departments aim to give the very highest quality of service
with the minimum of delay. To ensure this, all departments
participate in recognised external quality assurance schemes.
There are also extensive internal quality control checks.
Any problems regarding the quality of the service should be
brought to the attention of the Pathology Quality Manager on
01302 381473 or email [email protected]
Directorate of Pathology
Bassetlaw
Road Network
Hospital Site
Pathology Main Reception
Entry route
Car Park
entrance
Pay and Display Parking
Main
Reception
Pathology
QUADRANGLE
At Clinical Therapyentrance
go up stairs / lift to second floor, Pathology Laboratory
reception is slightly to the left and across from you
as you come out of the stairs.
Pathology
Specimen
Reception
Directorate of Pathology
Road Network
Hospital Site
Pay and Display Parking
Pay and Display Parking
Entry route
via Gate 3 Car Park
A&E entrance
Pathology Main Reception
Histopathology
Main
Reception
Histopathology
Proceed beyond Pathology
Main Reception, turn right
and then down stairs.
At foot of stairs turn right
through doors and enter
first doors on right.
Report to Histology
Secretaries
Pathology
Specimen
Reception
RECEPTION
Enter at Accident and
Emergency Entrance.
Turn immediately right
and then left along corridor.
Pathology Reception is
the second entrance on
the right hand side of
the corridor.
Pathology
OFFICE
STORE
OFFICE
OFFICE
WC
OFFICE
OFFICE
WC
OFFICE
PLANT ROOM
OFFICE
STORE
DARK
ROOM
CYTOLOGY
CUT-UP
CLEANER
STORE
HIGH
RISK
OFFICE
Patient &
Visitor
Reception
OFFICE
STAFF ROOM
OFFICE
HISTOLOGY
From A&E Entrance by Gate 3 Car Park
CYTOLOGY
BOOKING IN
CODE OF PRACTICE FOR VISITORS TO PATHOLOGY (VCP1)
Due to the nature of the work involved in diagnostic laboratories and the hazardous substances/ agents in
use, the following regulations must be adhered to at all times during your visit to Pathology.
Visitors must be accompanied at all times by an experienced member of staff.
Visitors must comply with any instructions issued by their guide during the tour.
Laboratory coats must be worn at all times in laboratory areas.
Open cuts, abrasions etc. must be covered using waterproof dressings.
Visitors must not eat, drink, smoke, chew gum during the tour and must avoid hand to mouth contact in
laboratory areas.
Hands must be thoroughly washed when leaving laboratory areas.
Any accidents or incidents involving visitors must be reported immediately to the accompanying member off
staff and subsequently to the Departmental Safety Officer who will complete an accident form if necessary.
On hearing the fire alarm, visitors must stay with their laboratory guide who will escort them to safety.
Directorate of Pathology
Road Network
Hospital Site
Entry route
via Gate 3 Car Park
A&E entrance
Pay and Display Parking
Sender
The sender must ensure that the samples are in the correct container for transportation and that
the patient's confidentiality is maintained by ensuring the form is not visible to the person
transporting it.
Samples sent from Pathology department are normally taken by Transport department and it is the
senders' responsibility to organise this.
Bassetlaw District General Hospital
Weekdays 9.00am - 5.00pm
All samples should be taken to Pathology Specimen Reception.
All other times
All samples should be taken to Pathology Specimen Reception.
Please ring the bell located on the entry keypad to inform staff that samples are being delivered.
Doncaster Royal Infirmary
Weekdays 9.00am - 5.00pm
Blood Bank samples
- Take directly to Blood Bank
Histology samples
- Take directly to Histopathology department
All other samples
- All samples should be taken to Pathology Specimen Reception.
All other times
All samples should be taken to Pathology Specimen Reception.
Please ring the bell at reception to inform on call Biomedical Scientist and leave the samples in
the green basket attached to the shutter, not on the floor or just outside the Blood bank door.
Mexborough Montagu Hospital
Weekdays 9.00am - 5.00pm
All samples should be taken to the laboratory at Mexborough for transportation to DRI at 10:45,
12:45 and 15:30. There is an additional transport run at 17:00 from Barnburgh ward, so all
samples for that run should be sent there by the person requesting the tests.
All other times
All samples should be taken to Barnburgh or Adwick ward for pick up by the driver and it is the
responsibility of the person requesting the test to arrange suitable transport.
Conditions
Version 2.0 - May 2013
>
>
>
>
Do not open the box
Do not place the box in sunlight or next to the heater outlet
Ensure the box is secure and unable to move around
If there is a delay in transportation due to traffic difficulties etc, the driver must contact the
transport department immediately or as soon as it is safe to do so 01909 500990 Ext 2424. If
this defaults to an answer machine the driver must contact the BMS on call in Haematology via
switchboard immediately 01302 366666 or 01909 500990
Formalin
Specimen pots for histology samples will be in a chemical fixative solution called formalin (also
known as formaldehyde) which can be hazardous if transported inappropriately. Drivers should
have relevant health and safety guidance and instruction in what to do in the event of a spillage of
the formalin chemical.
Bassetlaw District General Hospital
Main
Reception
Pathology
Specimen
Reception
At Clinical Therapyentrance
go up stairs / lift to second floor, Pathology Laboratory
reception is slightly to the left and across from you
as you come out of the stairs.
Pathology Main Reception
QUADRANGLE
Hospital Site
Pathology
Entry route
Car Park
entrance
Pay and Display Parking
Doncaster Royal Infirmary
Main
Reception
Histopathology
RECEPTION
OFFICE
OFFICE
OFFICE
WC
OFFICE
WC
CLEANER
OFFICE
STORE
DARK
ROOM
CUT-UP
STORE
BASEMENT CORRIDOR
STORE
CYTOLOGY
TISSUE
PROCESSING
HIGH
RISK
SAMPLE
PROCESSING
Histology
Specimen
Reception
PLANT ROOM
SAMPLE
PROCESSING
QUADRANGLE
LEVEL 1 - CLINICAL CHEMISTRY
OFFICE
Pathology
Patient &
Visitor
Reception
STORE
STORE
Proceed beyond Pathology
Main Reception, turn right
and then down stairs.
At foot of stairs turn left
through doors and enter
first doors on left.
Pathology
Specimen
Reception
CORRIDOR
Enter at Accident and
Emergency Entrance.
Turn immediately right
and then left
along corridor.
OFFICE
OFFICE
CYTOLOGY
BOOKING IN
OFFICE
STAFF ROOM
OFFICE
HISTOLOGY
Hospital Site
Pay and Display Parking
Pay and Display Parking
Entry route
via Gate 3 Car Park
A&E entrance
Pathology Main Reception
Histopathology
Mexborough Montagu Hospital
Hospital Site
Version 1.0 - March 2007
Pay and Display Parking
Pathology
Reception