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Pathology User Guide - the Royal Cornwall Hospitals Trust website

1. Specimen Test or Suspected Epa a Note mix purple Turnaround Referred for Tats E volume Which testing to infection in alphabetical E pink or blue tubes Remarks Time PH order naif Lab asap to prevent see Reference Facilities blank PEOR information for details clotting ny cell counts Ascitic Pleural HAEM Plain 24h Folate 5 10ml CC Gold 4h Free T3 pmol l CC Gold up to 24 h Free T4 pmol l CC Gold up to 24 hrs Free serum light chains 5 10ml CC Gold 2 weeks Taunton Free Fatty Acids CC Grey Investigation of Hypoglycaemia 21 days Southmead Only required in some diabetic Fructosamine 5 10ml CC Gold patients where HBA1c is not 2 weeks Reading reliable FSH Follicle Stimulating Hormone 5 10ml CC Gold up to 4 hrs Full Blood Count FBC 4ml Purple Paediatric 1ml HAEM Pink top Available on request from lab en Processed by coagulation on FVIII Gene mutation HAEM 4 x purple request of Consultant 3 wks Specialist centre Haematologist only FVIII 8 FVIII inhibitor 3ml HAEM 1 blue 2 wks Fungal culture amp microscopy Microscopy 24hr See Mycology oe ee MEO Culture negative positive 2 4 weeks Fungal serology 5 10ml CMB Gold vacutainer Farmer s lung etc 7 days PHE Bristol POE Must state if for diabetes or stiff l GAD antibodies 2ml HAEM Gold person syndrome Up to 28 days Derriford Galactomanin 5 10ml CMB Gold 7 days PHE Bristol Galactose 1 Phosphate Uridyl 5 mL cc Gran If tranfused measu
2. Specimen Test or Suspected APIS Note mix purple Turnaround Referred for volume Which testing to infection in alphabetical naif Lab pink or blue tubes Remarks Time Ruane nee order blank asap to prevent information for details clotting Faecal Occult Blood cc Plain oo and Private Patients Leeds Minimum Cherry sized portion Faeces culture n a CMB Fecon container 5 10 ml if liquid Further info 3 days Faeces As above plus relevant clinical Faeces ova cysts amp parasites n a CMB Fecon container details Further info Faeces 1 day Fasting Glucose CC Grey up to 4 hrs FBC 4ml HAEM Purple 24h FBC and Hb Electrophoresis 4ml HAEM Purple 24h Please send request to Fertility testing HAEM Coagulation when appointment amp tube will be sent to patient Ferritin 5 10ml CC Gold up to 4 hrs Fibrin monomers 3ml HAEM Blue 2 hrs Fibrinogen 3ml HAEM Blue 2 hrs Filaria 4ml HAEM Purple 24h Film blood 4ml HAEM Purple 3d FK506 CC See Tacrolimus Flavirus see Arbovirus 5 10ml CMB Gold See Arbovirus 10 days PHE Porton Down Flecanide 5 10ml ICC Red Pre dose trough sample up to 28 days Penarth required UTM nose amp throat swabs PCR Test available Flu A B and other respiratory cup NPA Monday to Friday call lt 24 hrs viruses Sputum lab BAL aboratory Bronchial washings Pathology User Guide Page 28 of 137 Which tube
3. Specimen Test or Suspected EAS E Note mix purple Turnaround Referred for einer E volume Which testing to infection in alphabetical 5 pink or blue tubes Remarks Time PY order naif Lab asap to prevent see Reference Facilities blank PEOR information for details clotting Blood culture 3 sets from separate 48hrs Endocarditis 5 10mI CMB venepuncture sites preliminary Gold vacutainer Clotted blood for serology 10 days Endomysial Antibodies 2ml HAEM Gold Request TTG 11 21 days Blood culture Enteric fever CMB Consult medical microbiologist FENIS Faeces preliminary Urine typhoid Erythropoetin EPO 2ml HAEM Gold up to 28 days King s Erythrocyte sedimentation rate 4ml HAEM Purple 24h Ethosuximide im cc Green Purple SST re ou Sample 1 week NSE Taken gt 4hrs post ingestion Ethyleneglycol 1mL CC Grey Phone lab prior 2 days Penarth Extractable nuclear antigen 2ml HAEM Gold Part of autoantibody screen 11 21 days Factor V 3ml HAEM Blue 2 wks Factor V Leiden 3ml HAEM Blue Part of thrombophilia screen 3 wks Sent to Derriford Factor VII 3ml HAEM Blue 2 wks Factor VIII C assay 3ml HAEM Blue 2 wks Factor IX 3ml HAEM Blue 2 wks Factor X or XI assay 3ml HAEM Blue 2 wks Factor XI 3ml HAEM Blue 2 wks Factor XII 3ml HAEM Blue 2 wks Factor XIII 3ml HAEM Blue 2 wks Faecal Elastase CC Plain universal up to 5 w days Pathology User Guide Page 27 of 137 Which tube
4. Signature of person taking the specimen Transfusion only Sample type Clinical Microbiology Histology and Diagnostic Cytology Site and side if appropriate Clinical Microbiology Histology and Diagnostic Cytology Date and time of collection Mandatory for Transfusion Histology and Diagnostic Cytology desirable for all specimens Desirable Report destination All specimens failure to provide this information will lead to delays Hospital number All specimens Gender Transfusion 5 7 3 Poor or illegible handwriting may be misinterpreted and result in report delay Please help to minimise this by completing all sections of the appropriate request form using a ballpoint pen Printed patient addressograph labels are preferable to minimise error except in Blood Transfusion where they are not acceptable 5 7 4 It is essential that a summary of relevant clinical details and therapy is included for the correct processing of the specimen and interpretation of results 5 7 5 Clinical Microbiology Haematology RCH requests only Chemistry RCH requests only Blood Transfusion Diagnostic amp Molecular Pathology Yellow Headed Request forms with sealable bags Haematology Clinical Chemistry WCH GP Community CHA1844 CHA26 CHA101 CHA171 CHA414 CHA1140 Diagnostic amp Molecular Pathology 2 week wait Cancer Referral Orange Headed form Patholo
5. PUO There is no panel of tests for the investigating PUO Please ensure that clinical details are given to guide investigation or discuss with the laboratory Quantiferon TB Gold This assay measures the T cell response to antigens derived from Mycobacterium tuberculosis When positive it reflects either latent or active tuberculosis The main use for the test is to detect latent tuberculosis in contacts of cases or in patients starting immunosuppressive therapy in whom reactivation of tuberculosis is a risk The test is only available from Monday to Thursday The timing of collection and submission of the kits is very important Once the blood is drawn into the quantiferon tubes they must be shaken vigorously 10 times and returned to the laboratory before 1600hrs the same day To obtain the collection kits please contact the laboratory Full instructions accompany the collection kits Rashes in pregnancy Rashes presenting in pregnancy or contact by pregnant women with rashes in others raises concerns about infections which may affect the woman or fetus Testing of the pregnant woman s blood may be useful in this situation to determine susceptibility to infection For contacts of patients with vesicular rashes including chickenpox and shingles varicella immunity can be determined in contacts using a rapid blood test for VZV IgG These results will be normally available on the day the specimen is received by the laboratory
6. Specimen Type Transportation details Information special handling needs LBC Cervical Samples from GP s All LBC vials must be sent in Samples Community Clinics The a clear specimen bag samples are placed into the accompanied with a HMR courier transportation boxes 101 5 request form and delivered daily to the laboratory in accordance with Courier policies and Due to the 14 day turn procedures Samples from around time for Cervical the Plymouth GPs are samples It is vital that they placed into specific blue are sent to the laboratory on bags prior to transportation a daily basis Samples from Colposcopy excluding weekends are transported to the laboratory by porter CSF Specimen degrades quickly All specimen containers and should arrive in the laboratory within one hour of collection The sample must arrive at the lab by 4pm to allow for processing time must be placed into Cellular Pathology specimen bag with the completed request from attached prior to transportation Breast FNAC s Mermaid Centre Make sure the slide box is tightly sealed an elastic band can be used to prevent the slides from breaking during transportation in the air tube system All specimen containers must be placed into Cellular Pathology specimen bag with the completed request from attached prior to transportation Pathology User Guide Page 99 of 137 Specimen Type Transportation details
7. VB1 is tested for urethral infection or inflammation and VB2 is tested for urinary bladder infection If VB1 2 and 3 are positive this indicates acute bacterial prostatitis Flow cytometry Urine cytometry counts the number of white blood cells epithelial cells casts and bacteria This technique is approximately four times more sensitive than microscopy and can confidently identify negative urine samples without bacterial culture The only exceptions to this will be those recommended by the National guidelines i e specimens from children lt 6yrs pregnant women and where immunocompromised is clearly written in clinical details or if a specific request is made by telephone to perform culture Most samples with negative flow cytometry will be reported as negative on the day of receipt with no further investigations undertaken Those with elevated counts and those recommended in the National Guidelines will be cultured The flow cytometry result will be available the same day of receipt by accessing patient results on the computer Flow Cytometry Report White blood cells X X x 10 L Normal range 0 40 Squamous epithelial cells Y Y x 10 L Normal range 0 50 Culture Pathology User Guide Page 88 of 137 More than 40 x 10 L white blood cells is considered to be significant pyuria If a second urine specimen is received which yields sterile pyuria we will culture for fastidious micro organisms but you may wish to
8. e Combined Laboratory Biochemistry Section Derriford Hospital Plymouth Devon PL6 8DH e Clinical Biochemistry Department Freeman Hospital Freeman Road Newcastle Upon Tyne NE7 7DN e Department of Clinical Biochemistry Macewen Building Glasgow Royal Infirmary Glasgow G4 OSF e Chemical Pathology Great Ormond Street Hospital for Children Great Ormond Street London WC1N 3JH e SAS Reception Biochemical Endocrinology Hammersmith Pathology Centre Area G Hammersmith Hospital London W12 OHS e Dept of Neuroimmunology Room 917 Institute of Neurology Queen Square London WC1N 3BG e Clinical Biochemistry Department King s College Hospital Denmark Hill London SE5 9RS Pathology User Guide Page 112 of 137 e Dept of Biochemistry and Immunology Britannia House Britannia Road Morley Leeds LS27 0DQ e Molecular Genetics Laboratory Royal Devon amp Exeter Hospital Barrack Road Exeter EX2 5DW e Dept of Chemical Pathology Taunton amp Somerset Hospital Musgrove Park Somerset TA1 5DA e Specific Protein Reference Unit Immunology Dept P O BOX 894 Sheffield S5 7YT e SAS peptide section Royal Surrey County Hospital Clinical Laboratory Level B Egerton Road Guildford GU2 7XX e Department of Clinical Chemistry Sheffield Children s Hospital NHS Trust Western Bank Sheffield S10 2TH e Endocrine Unit Level D South Pathology Block Southampton University Hosp Trust Tremona Road Southampto
9. eg 2WW Fine Needle Air dried slides There are special arrangements Mermaid Aspirates in a plastic for in clinic diagnosis at some of Clinics one FNAs slide carrier the Mermaid Clinics hour from the gt Breast Label the time the gt Lymph frosted end of Syringes must NOT be sent via sample is node each slide in the ATTS received in the gt Head amp pencil with two laboratory neck patient When smearing the cell sample gt Thyroid identifiers and avoid pressing too hard as this Within 7 days FNA site If will result in crush artefact Do unless stated breast FNA not make the sample too thick otherwise label the and air dry quickly eg 2WW slides left or right as appropriate EUS BUS As required Sample adequacy is assessed at Adequacy FNAs following clinic by laboratory staff BMS assessment is sample and is case dependant immediate at adequacy clinic Final assessment result within 7 days unless stated otherwise eg 2WW Urine 5 100mlina 1 ambulatory morning sample is Within 7 days universal or best not EMU If the patient unless stated specimen has stones catheter any otherwise Urine instrumentation in place include eg 2WW Screening pot in clinical details containing fixative Joint fluids 5ml into a Analysis for the presence of gout Within 7 days universal or pseudogout crystals only unless stated container otherwise Please complete a yellow eg 2WW Cellular Pathology form and ensure thes
10. 10 1 8 3 For details of the recommended management of patients with abnormal smears follow up and referral policies contact the laboratory ext 2550 10 1 9 Time Limits for requesting additional tests Pathology User Guide Samples that have been rejected because the patient was not invited for screening will be retained by the laboratory for 21 days from receipt to allow the sender to make other arrangements if required Private testing is available on request to the laboratory Page 108 of 137 10 2 Diagnostic Cytopathology 10 2 1 For labelling of request forms and samples please refer to DDMP SPECIFIC Form amp Specimen Labelling Requirements 10 2 2 Sample requirements Turnaround Volume Special precautions and times and Specimen type required Factors affecting Performance Time limits Interpretation for additional tests Serous fluids Approx 20ml in DO NOT SEND LARGE Within 7 days Cyst fluids a screw top VOLUMES OF FLUID gt 100ml unless stated Hydrocele universal The department has no facilities otherwise fluids for disposal of gross specimens eg 2WW Sputum Screw top 3 specimens a deep cough Within 7 days universal specimen should be taken on unless stated container each of three consecutive days otherwise If visible food particles are eg 2WW present it is advisable to repeat straight away Better samples may be obtained in the morning preferably before breakfast
11. Make arrangements with local GP for specimens to be collected by RCHT courier service Specimen pots must be contained within sealed bag attached to specimen request card Pathology User Guide Page 102 of 137 Specimen Type Transportation details Information special handling needs Skin Biopsies for Immunofluorescence Transported in Michel s medium obtainable from laboratory with 24hours notice Must be kept at room temperature and NOT refrigerated Multiple bowel biopsies Acetate strips are available from the histology department strips cut 12 squares on the longer edge and 10 on the shorter The biopsies should be placed along one edge of the strip placing the first biopsy at the diagonal end of the strip Biopsies should be placed one per square and place acetate strip in labelled biopsy pot OSNA specimens Transported on ice from St Michael s theatre suite to the OSNA laboratory in St Michael s hospital as quickly as possible Must be booked in advance via the secretaries of the breast surgeons In order to preserve MRNA of potential epithelial metastatic cancer cells the specimen must be kept cold Small Biopsies Cell safes are available from the histology department Biopsies should be placed in the deeper side of a cell safe and clicked shut and then place cell safe in labelled biopsy pot Needle cores prostate breast etc Biopsy i
12. Calcium corrected Calcium Phosphate and ALP lonised Calcium is available on Pathology User Guide Page 59 of 137 request to hospital patients and requires an additional tube Gold as full as possible 1 9 4 Urate Requests for serum Urate will be automatically coupled with a measure of Creatinine since so many cases of hyperuricaemia are due to a degree of renal dysfunction 1 9 5 Lipids An initial screen can be performed by using a random total Cholesterol or Lipid profile Tests in the Lipid profile are Cholesterol Triglyceride and HDL Cholesterol and calculated LDL cholesterol Patients with combined hyperlipidaemia should be monitored using a fasting profile Further guidelines on the management of hyperlipidaemia can be obtained from Dr Fleming 1 9 6 Drugs of abuse Full screens on new patients require 50 ml of urine to perform the following tests e Amphetamines Opiates Methadone and Benzodiazepines and cocaine e Cannabinoids should be requested additionally to Drugs Screen if required and these are referred to another laboratory for analysis Under no circumstances should this screen be used for medico legal or employment screening 1 9 7 Haemoglobin Atc is used for monitoring glycaemic control and for the diagnosis of Diabetes Mellitis in adults 1 9 8 Thyroid Function Tests the front line Thyroid function test analysed is a measurement of TSH Generally the result is within the reference r
13. Clinical details must include the following criteria e Travel to Asia Africa South America Caribbean Central America and Eastern Europe e Persistent diarrhoea or loose stools for more than 2 weeks e Eosinophilia e Weight loss failure to thrive In the absence of relevant clinical details samples will not be tested for ova cysts and parasites unless the laboratory is contacted by telephone or email For parasitology please submit at least three specimens of faeces passed greater than 24hrs apart marked Ova with relevant clinical details It is recommended that specimens are collected every other day Unless the patient has severe diarrhoea or dysentery no more than one specimen should be examined within a single 24 hour period as shedding of cysts and ova tends to be intermittent Please give any clinical details especially travel abroad or importantly note duration time of symptoms If E histolytica or G lamblia are suspected and the first three specimens are negative ideally three additional specimens should be submitted at weekly intervals Pathology User Guide Page 85 of 137 Giardia Fresh unpreserved specimens should be transported immediately they will not survive if the specimen dries out Cysts will not form once the specimen has been passed If the specimen is liquid it should be examined ideally within 30 minutes from the time of collection Soft stools should preferably be examined within one hour o
14. Urgent work will be processed at any time Outside normal opening times see above the Biomedical Scientist BMS on duty or the Consultant on call for each department may be contacted through the Royal Cornwall Hospital switchboard 01872 250000 Key factors affecting the performance of tests or the interpretation of results These are given in the information related to each Department Specialty where necessary or by contacting the laboratory These include pre analytical sample handling and analytical laboratory methodology variation and biological variation within the patient Time limits for requesting additional tests This is dictated by the stability of the test concerned and specimen retention time These are given in the information related to each Department Specialty or by contacting the laboratory Haematology Tick the urgent box on the form samples will be processed as they are received in the lab 5 5 Courier Service Courier vans deliver samples to the laboratories daily times depending on location Paper reports where provided are sorted ready for the courier vans to take out the following working day see also results section below Enquiries should be made to the Courier Manager in Estates telephone 01872 25 2985 or 3813 There is no courier service at weekends A limited service collection from local Hospitals usually operates on Public Holidays 5 6 Contacting Pathology Specialty Director of L
15. a Royal Brompton Sirolimus CC Purple Trough sample up to 7 days Harefield Skin antibodies 2ml HAEM Gold Derriford Solvent screen plasma CC Green up to 28 days London Toxicology Pathology User Guide Page 45 of 137 Which tube Specimen Test or Suspected Senos Note mix purple Turnaround Referred for E TREI volume Which a testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time pS order n a i ab asap to prevent see Reference Facilities blank information for details clotting EDTA on ICE Part of Gut Somatostatin 3 mL CC EDTA hormone profile up to 28 days Hammersmith Saliva 8 postnasal secretions not suitable Specimens taken dav Soi CMB Universal or 60m before antimicrobial treatment is y P sterile container started Indicate if CF or Ciliary Dyskinesis Note if atypical infection suspected Serna Ie cue yer Streptococcus pneumoniae CMB Sterile urine NOT boric lt 24 hrs antigen container Sucroselyn HAEM Pink x 1 Red x 1 Sulhonylureas CC Red or plain urine up to 28 days Guildford Surrey Surface Immunoglobulins HAEM Purple x 4 Haem Consultant request only Within 24 hrs Surface markers acute sees Leukaemia HAEM EDTA x4 Haem Consultant request only Within 24 hrs Surface markers chronic ee leukaemia HAEM EDTA x 4 Haem Consultant request only Within 24 hrs Soak swab well in the deepest 3 days part of wound Gram
16. jb ction a PEA Pathology User Guide Page 31 of 137 Which tube Specimen Test or Suspected Senn AS E Note mix purple Turnaround Referred for gt A volume Which E testing to infection in alphabetical n aif Lab pink or blue tubes Remarks Time rada order blank asap to prevent information for details clotting Patient should fast overnight and H2 blockers should be Gut hormone profile Gastrin stopped for 72h and VIP glucagon chromogranin A amp B CC EDTA on ice omeprazole for 2 weeks before up to 28 days Hammersmith somatostatin PPP amp CART blood is taken Send sample to lab on ice ASAP Haemachromatosis Genetic Must confirm raised iron screen HFE 5 10ml CC Purple saturation and ferritin before up to 28 days Derriford requesting Haematinics lron B12 Ferritin Folate CC Gold up to 4 hrs Haemoglobin A1c CC Purple up to 24 hrs Haemoglobinopathy screen i Haemoglobin Electrophoresis 4ml HAEM Purple cie era 3 wks Torbay incl HBA2 amp HbF 9 i Haemoglobin H 4ml HAEM Purple 3 wks Haemoglobin S 4ml HAEM Purple 3 wks Torbay Haemosiderin urine HAEM MSU Within 24 hrs Haptoglobin 5 10ml CC Gold up to 4 hrs HbA1c Haemoglobin A1C CC Purple up to 24 hrs HCO3 mmol l CC Gold Part of Electrolytes U amp E up to 4 hrs HCG Human chorionic gonadotrophin 5 10ml CC Gold up to 4 hrs Heinz bodies 4ml HAEM Purple 2 wks Helicobacter antibodies Cannot be us
17. 1 1 3 0 1 1 3 gt 16 years All 0 2 0 6 0 2 0 6 Eosinophil Up to 1 day 0 1 2 0 0 1 2 0 6 count 1 3 days 0 1 0 8 0 1 0 8 un Pathology User Guide Page 128 of 137 3 days 1 year 0 1 0 9 0 1 0 9 1 6 years 0 1 1 4 0 1 1 4 6 16 years 0 1 1 0 0 1 1 0 gt 16 years 0 1 0 5 0 1 0 5 Basophil Up to 1 year 0 02 0 2 0 02 0 2 count gt 1 year 0 02 0 1 0 02 0 1 ae Platelet count All 150 400 150 400 x10 Plasma All 15 1 72 1 5 1 72 op viscosity Pathology User Guide Page 129 of 137 One all we care Royal Cornwall Hospitals NHS NHS Trust COAGULATION HAEMATOLOGY According to clinical indication see BNF INR for warfarin 2 0 2 5 Prophylaxis of DVT 2 0 3 0 Hip and Femur Surgery Treatment of DVT PE Atrial Fibrillation amp TIA Antiphospholipid syndrome Arterial grafts amp Arterial Disease including MI 3 0 4 5 Recurrent DVT amp PE in patients currently receiving warfarin with INR gt 2 Artificial heart valves Antithrombin Protein C amp S Deficiencies refer to Consultant Haematologist APTT for heparin 1 5 2 5 According to clinical indication Neonatal amp adult reference ranges for Coagulation screening Test Preterm Term 1 month 3 months Adult 19 30 30 38 weeks weeks INR 1 7 5 0 0 8 1 8 0 9 1 5 0 7 1 3 0 7 1 2 0 8 1 2 APTT ratio 2 5 5 0 0 9 2 0 0 9 1 6 0 8 1 5
18. 14 1 weeks The quad test measures AFP free B hCG unconjugated oestriol and inhibin A as explained in the Wolfson Institute leaflet Unconjugated oestriol is unstable in whole blood and free B hCG is more unstable than total hCG which we used to measure samples therefore need to be Pathology User Guide Page 62 of 137 received by our laboratory within 24 hours of being taken to be spun and separated Samples must not be taken on a Friday if they cannot be sent to the RCHT lab on the courier on the same day One full buff top tube is required as 1ml of serum needs to be sent away and a sample is also kept here in case the first gets lost in the post Samples should be taken between 14 2 and 20 0 weeks The Newcastle Royal Infirmary request form should be fully completed including maternal weight at sampling ethnicity and smoking status as all affect the DS risk If the woman has not had a scan please provide the date of future scan if known Return both the sample and form to the Clinical Chemistry No other form should be used please contact the laboratory and a form will be forwarded to the appropriate ward department if necessary Batches of quad forms are available from Clinical Chemistry on request or an electronic version is available please contact Dr Angela Mallard or Miss Anna Barton for details Samples are spun and separated on receipt and referred to the Newcastle Royal Infirmary on Mondays to Thursdays
19. 28 days BRI Cholinesterase CC Gold 2 wks Penarth Order tube from Chemistry Chromium and Cobalt CC Trace Metals Tube For MOM patients Charing Cross Clomipramine CC Red no gel up to 28 days Penarth Clonazepam CC Li Hep EDTA SST up to 28 days NSE GDH screening assay 7 days a Same day for week Toxin detection by GDH and Cytotoxin assay Monday to rapid toxin A B Clostridium difficile 5 10ml CMB Fecon container Friday and by rapid toxin A B _ test 16 24 test at weekend Also available hours for on special request at other cytotoxin times assay Clotting screen 3ml HAEM Blue Must reach the lab the same day lt 4 hrs Paediatric 1 3ml Dark Blue screw Available on request from lab Which tube profile stopped for 72h and Specimen Test or Suspected APIS Note mix purple Turnaround Referred for E TREI volume Which a testing to infection in alphabetical i pink or blue tubes Remarks Time one order naif Lab asap to prevent see Reference Facilities blank prob information for details clotting top Give reason for test e g CMV Antibody ps Cytomegalovirus IgM IgG 5 10ml CMB Gold acute CMV infection vs 5 days previous exposure CMV PCR viral load CMB Purple 5 days PHE Bristol Coagulation screen TCT Fibrinogen derived 9 HAEM Blue dd See Anti tissue Coeliac test 2ml HAEM Gold transglutaminase 11 21 days
20. 53 IS E EI EI S Oo Y OB CRT EE d CASO 5077 S po E TAE eee Creatinine enzymatic 1 15 37 15 37 po 3 21 36 21 36 O FC e E E VEA o oy y y g 28 52 gt Yo 5 53 35 58 IS EI EI EI S po CEP ECC E S E e lt A EI CA VES SHE IAF CARPA VFGAIRA Pathology User Guide Page 122 of 137 iliverandBone Alkaline Phosphatase 1 80 450 100 460 iu L A pta 50 300 70 30 o Opa 50 390 50 160 A pta 60 17 _ 50 120 IS ESOO IES EE E Total protein im 45 65 45 65 po 75 50 75 a eee E es ee eee Corrected calcium_____ tm_____ 2 40 2 77 2 40 2 77 mmol L pm 288 274 238 274 pm 285 271 285 271 po tM 2s2 268 2 32 2 68 pod 280 267 230 267 pod 80 264 230 264 as 26 262 226 262 O OS 223 260 2238 260 Pod EB 222 258 po y 221 258 221 258 pd 20 257 220 257 pod EB 222 258 po ya 22 257 222 257 IS ESOS IES E lonised Calcium td 108 142 108 142 mmol L Oo y y Ody ttt 139 P lt pA 118 142 t1t8 142 pA 1t10 14 1t10 14 oo sa 114 146 114 146 o 18 146 118 146 ph 118 146 118 146 pf ttm 123 137 128 137 o OO OS ta0 134 120 134 A A A E Phosphate 1 1 80 2 22 130 222 mmol L A O pa 100 1sw 100 180 oo 00 180 00 180 os pas oso t6N 0 90 1 60 A AN o Urate im 006 027 mmol l p12 0 33 E oS S ooo 1 043 o1s 038 AA PA A Lipids
21. A O A O Total cholesterol 10 34 48 3 4 4 8 Pathology User Guide Page 123 of 137 AAA A NO LDL 7 3 157 30 mmol L 7 80 80 pK ts 30 B30 po PO Triglyceride 10 0 41 1 25 0 41 1 25 A pis 045 136 045 136 Proteins po 2 20 O Je i z 1tit a2 o o pna 7m A i a 14238 gt pes 1 20 12 20 NA AE S CATA A Caeruloplasmin_____ 4m_ 009 0 27 0 09 0 27 gk p14 0 41 ATC p14 0 47 014 047 po 0G 0 27 016 027 Oo A ETS TR ee Immunoglobulin G 2w_ 50 170 50 170 gk pow ss 180 39 180 gt gt gt gt gt gt a 2 77 24 77 pom 2488 24 88 pom so eo 30 90 o O im s0 t0s 30 109 Oo y O y aeg 34 138 EJ gt e ara J Oo y y de 49 161 J4s i6e1i gt oo 54 161 54 161 oo Oo paa 54 161 54 161 OO OPS 54 161 54 161 EE a ee PO ImmunoglobulinA 2w 0 01 0 08 0 01 0 08 gL po 002 015 0 02 0 15 pom 005 04 005 04 pm 0 05 05 pm 015 07 015 07 ptm 02 07 02 07 2 jo3 12 03 12 3 03 13 03 13 Page 124 of 137 Pathology User Guide po KO 4 200 o ass Os aa 2 o pa pO7 25 07 25 o BAB jos 28 E OS ImmunoglobulinM 2w_ 005 0 20 0 05 0 20 gk pw 008 040 0 08 0 40 pom 015 0 70 015 070 pm oz 10 02 10 pm 0414 gt tm 0 21 06 21 ooo 22 jos 22 A ja jos 282 fos a2 o CJ jos 0 05 20 SE E DHEAS Dehydroepiandroste
22. Acids CC Gold days Bilirubin CC Gold Part of Liver Function up to 4 hrs BK Virus 5 10ml CMB Urine not Boric Please discuss with laboratory 10 days PHE Bristol Bleeding time HAEM N A POr ete toatoa disci 1 day Sample will remain stable Blood Count inc film 4ml HAEM Purple overnight if refrigerated max lt 24hrs time for add on tests Usuall Pathology User Guide Page 19 of 137 Which tube Specimen Test or Suspected Senn AS a Note mix purple Turnaround Referred for einer E volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time PH order n a i ab asap to prevent see Reference Facilities blank E information for details clotting tested by 2000hrs Must be handwritten with patient s forename surname DoB gender unique identifier Blood Group 6ml BT Pink NHS or CR number date amp lt 24 hrs time of sample and sample taker s signature Blood gases acid base 2mL CC Blood gas syringe Bone Calcium Phosphate Total Protein Albumin Alkaline CC Gold up to 4 hrs Phosphatase Discuss with Consultant Microbiologist ASAP before 5 10ml Gold submission of specimens Powis OMe Faeces Fecon Toxin testing Culture and toxin testing Brucellosis culture CMB og culture sets 30ml of blood total in 3 bottles 3 weeks Brucellosis serology 5 10ml CMB Gold Give exposure travel histol 7 day
23. Fax requests are preferred Hospital users may obtain materials from the Colposcopy department at Treliske Other users should contact the laboratory NHS Shared Business Services Camberwell House Grenadier Road Exeter Devon EX1 3LQ 01392 351351 Materials provided include e A Vial containing PreservCytTM e CervexTM broom sampler green handle e HMR request form e Specimen Bags Please note Vials and brushes come as a pack Therefore brushes and vials must be ordered together in the same quantities Pre printed HMR request forms are available from the Open Exeter System Pathology User Guide Page 106 of 137 10 1 5 Prior to sampling Check the patient s age Samples not invited for screening Under 24 5 years olds Over 65 and ceased from screening will be rejected if they do not have a screening history Symptomatic patients under 24 5 years of age should be referred directly to Colposcopy Label the Vial when the patient is present For each Cervex sampler and Vial that Hologic provide there is also a filter and slide at the laboratory These are ordered as a kit Please do not misuse the clinic materials as this will also waste materials at the laboratory Labels with patient details may be used but keep the unlabeled portion of the Vial free of label so that the contents may be seen If bar coded labels are used these must be applied horizontally Please note that Vials have an expiry date
24. If results are required to assist with urgent clinical decision the laboratory must be notified by telephone even during normal working hours Without such notification the specimen will not be prioritised and will be processed routinely Please mark the request form URGENT Chemistry and Haematology requests from Primary care will be regarded as Urgent if they are received in a white envelope or in purple INR specimen bag 5 3 Results It is our aim to issue results in a timely manner Currently all results are reported electronically with additional results being sent as hard copies for some locations service users Winpath results are available via Maxims and Winpath Ward Enquiry To gain access to this please contact CITS on 1717 Hours of service Laboratory opening hours are given below Clinical Chemistry Monday to Friday 0800 to 2000 hrs Saturday 0900 to 1600 hrs Clinical Microbiology Monday to Friday 0800 to 1715 hrs Saturday 0830 to 1230 hrs Haematology and Blood Transfusion Monday to Friday 0800 to 2000 hrs Saturday 0900 to 1300 hrs Pathology User Guide Page 4 of 137 Diagnostic and Molecular Pathology DMP Monday to Friday 0830 1700hrs There are no provisions for out of hours services within DMP The Saturday Sunday Bank Holiday service offered by all departments is intended for essential work Urgent samples for CMB should be delivered to the laboratory before 1100hrs 5 4 Out of Hours
25. Leishmaniasis serology 5 10ml CMB Gold Leishmaniasis only Tissue 2 weeks Pie p required for cutaneous infection Leptospirosis 5 10ml CMB Gold Give exposure details Up to 7 days peer ae LFT Total Protein Albumin Alkaline Phosphatase ALAT 5 10ml CC Gold up to 4 hrs Bilirubin LH Luteinising Hormone 5 10ml CC Gold up to 4 hrs Lipase 5 10ml CC Gold up to 28 days Southmead Lipids Chol Trig HDL LDL 5 10ml CC Gold No longer requires fasting up to 4 hrs Blood culture r l By yara Consult Medical Microbiologist Listeriosis CMB CSF Serology not available 2 days Charcoal swab Liver Function Test Total Protein Albumin Alkaline 5 10ml CC Gold up to 4 hrs Phosphatase ALT Bilirubin Liver autoantibodies HAEM Gold Derriford LMW Heparin 3ml HAEM Gold 1 week Pathology User Guide Page 37 of 137 Which tube Specimen Test or Suspected Solin te E Note mix purple Turnaround Referred for Tats E volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time H order n a i ab asap to prevent see Reference Facilities blank information for details clotting Lower Respiratory Tract CMB Un erence eeiner Sputum Bronchoalveolar lavage 3 days Infection Lupus screen HAEM Blue x 2 Gold x2__ Part of Antiphospholipis screen 2 wks Give date of onset amp clinical Lyme disease serology g details IgG antibodies are Borrelia burgdorfe
26. Reference Facilities order blank asap to prevent information for details clotting Anti Ganglioside antibodies 2ml HAEM Within 28 days Derriford Anti Hepatitis A B C See 5 10mI CMB Gold Hepatitis Anti Intrinsic Factor antibodies 2ml HAEM Gold 11 21 days Anti Mag antibodies 2ml HAEM Gold Up to 28 days Oxford Anti Mullerian Hormone AMH 2ml CC Gold Obs amp Gynae request only Up to 21 days Derriford Anti Musk antibodies 2ml HAEM Gold Up to 28 days Oxford Anti Neuronal Antibodies 2ml HAEM Gold Up to 28 days Inst of Neurology Anti Neutrophil Antibodies 2ml HAEM Gold Special Form Immunology 11 21 days Derriford Anti Nuclear Antibodies 2ml HAEM Gold Part of Autoantibody screen 11 21 days Anti Nuclear Cytoplasmic i Antibody 2ml HAEM Gold 11 21 days Apt test BT Pink if testing blood Other fluids eg vomit accepted 24 hours Anti Phospholipid Antibody HAEM Blue x2Goldx 2 Wil include lupus anticoagulant wks Anti RO 2ml HAEM Gold Part of Autoantibody screen 11 21 days Derriford ao ee serology 540mi cmB Gold ASO ADB 10 days Exeter Antithrombin iu dl HAEM Blue Part of thrombophilia screen 14 days Coeliac test Stable for up to 7 Anti Tissue Transglutamase 2ml HAEM Gold days if refrigerated maximum 11 21 days Derriford time for add on tests Antibiotic Assays 5 10ml CC Gold Antibiotic assays up to 4 hrs Anti XA heparin assay for 3ml HAEM Blue Detail exact LMWH amp last dose 7 days APCR Pathology User Guide
27. Samples received on a Thursday to Saturday are stored separated and frozen over the weekend and posted the next working day Lower and higher risk results are reported in the same way as for the FT Combined service outlined above Higher risk results are faxed to our laboratory by the Newcastle Royal Infirmary usually within two days whereas Lower risk results are posted with an average turn around time of 10 days Results of all Quad tests can be viewed on Viewpoint and WinPath This test achieves a Down s syndrome detection rate DR of 75 with a 3 3 screen positive rate SPR using a cut off risk of 1 in 150 at term Although this doesn t comply with the current NSC requirements it is the best test possible for late bookers or women who cannot have an NT measurement performed 1 10 3 NTD service The NTD service in Cornwall is now provided via the anomaly scan at around 20 weeks No samples will be referred for NTD screening If you have any queries please contact either e Dr Angela Mallard 01872 252564 or e Miss Anna Barton 01872 252566 Pathology User Guide Page 63 of 137 2 Department of Haematology Service Details 2 1 For urgent requests tick the box on form Please phone the laboratory if results are needed immediately or for blood products that are needed urgently Out of hours do not bleep the BMS unless very urgent or for a cross match blood product issue or advice Tests available outsi
28. YY MM DD Do not use expired Vials Remove the Vial lid before taking the sample 10 1 6 Taking the sample Do Not use lubricant when inserting the speculum Lubricant will block the filter during processing resulting in the sample being inadequate for analysis The cervix must be visualized If you do not visualised the cervix fully then record this on the form It is the responsibility of the smear taker to confirm they have sampled the correct area Remove the mucous plug if present using a sterile swab The Cervex sampler is rotated 5 times clockwise The direction is important as the bristles of the sampler are bevelled Vigorously rinse the Cervex sampler into the PreservCyt fluid in the Vial by pushing it into the bottom of the Vial 10 times forcing the bristles apart As a final step swirl the Cervex vigorously to further release material Inspect the bristles to ensure no material remains attached Discard the Cervex sampler DO NOT leave the head of the sampler in the vial Use of the endocervical brush Please note Endocervical brushes are not supplied by the Cytopathology department Evidence of Transformation Zone sampling is necessary for the follow up of glandular abnormalities Sampling of the Transformation Zone may be difficult in women who have had treatment for glandular abnormalities In this circumstance it may be necessary to use an endocervical brush in addition to the Cervex broom sampler provided or
29. available from the scientific staff Due to the significant variation in individual s sperm parameters a second confirmatory testing is recommended following the observation of an abnormal result The Male fertility investigation may only be undertaken by prior arrangement with the laboratory due to the logistics of having to test samples immediately Please send a completed pathology request form to the laboratory instructions on rear The patient s full address must be noted so that we can send the appointment container amp instructions Due to the laboratories other commitments testing is usually limited to set periods within a week but if there are particular time requirements please discuss with the laboratory Samples are collected by masturbation following at least two days of abstinence Production at the patients home and delivery to the laboratory within 11 2 hours for testing is usually satisfactory Full instructions are included in the appointment letter sent to patients Pathology User Guide Page 65 of 137 If there are particular problems regarding sample production a room can be used in the Cornwall Centre for Reproduction Medicine on Wheal Unity ward by prior arrangement only Due to the distance special arrangements exist for patients in the West of the county if sample transport is required 2 6 Post vasectomy screening specimens may be sent to the laboratory without prior arrangement via the courier s
30. between Monday and Friday Pathology User Guide Page 94 of 137 Non vesicular rashes are due to many viruses including Rubella and Parvovirus B19 human erythrovirus Of these parvovirus is far more common Blood samples should be taken from pregnant women with rashes or a history of contact giving full details including the date of exposure and onset of rash Please contact the laboratory if the patient is not known to be rubella immune so that additional testing can be performed RSV Routine RSV detection is performed on nasopharyngeal aspirates NPA on weekdays using a respiratory virus PCR panel see Influenza and respiratory virus section above At other times a commercial immunochromatographic device is used to detect RSV in upper respiratory tract secretions NPA samples should be obtained by aspirating from the nasopharynx using a trachea set specimen collector Eros code FF H047 If secretions are scanty sterile saline can be sucked through the collector to ensure the specimen is collected in the trap The tubing should then be removed from the trap and replaced by the cap The capped trap may be sent to the laboratory in the usual way Syphilis Syphilis screening is performed on blood using a sensitive enzyme immunoassay EIA Patients reactive in this test are tested using a second TPPA test to confirm the result Reactive samples are referred to a specialist laboratory for further testing to determine the stage of
31. brief guide to the services we Offer Pathology User Guide Page 91 of 137 Atypical pneumonia Serology for the investigation of atypical pneumonia is referred to another laboratory Investigations will not be performed without a date of onset of symptoms and a relevant clinical history For respiratory serology paired blood samples taken in the acute phase of the illness and one 10 14 days after onset are generally required Samples are routinely investigated for Mycoplasma pneumoniae respiratory Chlamydia and Q fever A wider range of investigations is available after discussion with the laboratory Chlamydia trachomatis Genital tract ocular and other specimens are currently tested for Chlamydia trachomatis DNA using a commercial polymerase chain reaction PCR assay In certain settings GU medicine and Sexual Health clinics the same samples are also tested for Neisseria gonorrhoeae DNA In all other areas gonorrhoea testing is performed by culture using the techniques described above in the Bacteriology section Suitable specimens for the diagnosis of genital tract infection in women are vulvovaginal and cervical swabs taken using the Chlamydia collection kits Detailed instructions are included with the kits Men should send a first voided urine sample do not send a boric acid urine container ensuring that the COBAS yellow topped Chlamydia Urine sample is filled within the marked window on the container Sampling from
32. consider submitting a further specimen for Chlamydia or mycobacterium investigation if appropriate The presence of epithelial cells on flow cytometry indicates contamination and the reliability of the culture result is called into question Long term catheters are invariably colonized with one or more micro organisms Treatment with antibiotics should be reserved for those with signs of systemic infection Increased fluid intake acidification of the urine and or catheter change may be beneficial Bladder washouts with antiseptics may be of value but may increase the risk of further introduction of infection If repeat specimens yield results which indicate contamination you may wish to use instrumentation which facilitate the collection of urine avoiding contamination e g the Whiz Midstream device which has been designed specifically for women to give a mid stream specimen of urine not only with less spillage and hence greater dignity but also with a much lower risk of contaminating the sample Schistosomiasis Mid day specimens of urine should be collected for the investigation of schistosomiasis in non boric acid container Please note collection of the total urine passed during the time period 1000h and 1400h has shown that the maximum concentration of eggs are excreted Large 250ml containers are available from the laboratory Mycobacterial investigation Please submit three consecutive early morning urine specimens in 250 ml
33. culture may also be prolonged From knowledge of the likely antimicrobial sensitivities a medical microbiologist can usually advise on appropriate therapy following examination of preliminary cultures and before antimicrobial susceptibility tests are available Interpretation of results can only be attempted if adequate clinical details are given on the request form 3 3 Notes On Collection Of Samples 3 3 1 BACTERIOLOGY BLOOD CULTURES Please see the document Guidelines on Blood Culture Collection which is available on the Intranet Documents Library Pathology User Guide Page 82 of 137 THROAT SWABS Corynebacterium throat swabs will only be investigated for this organism when one or more of the following risk factors are reported e membrane or membranous pharyngitis tonsillitis e travel overseas especially former USSR Africa South America or South East Asia within the last 10 days e recent contact with someone who has travelled overseas recently anywhere travel or contact with travellers in the past 10 days is most likely to be relevant to the risk of diphtheria e recent consumption of raw milk products C ulcerans e recent contact with farms farm animals or domestic animals C ulcerans e the patient works in a clinical microbiology laboratory or similar where Corynebacterium species may be handled Diphtheria if suspected give anti toxin immediately never wait for the laboratory result before instigating the
34. dimer is required please state reason DVT PE DIC 2 8 Specimen requirements for coagulation studies Test Sample Storage Ref ranges PT INR warfarin 1 citrate Stable for 24hrs at 4 C APTT Heparin 1 citrate 4 hours 1 5 2 5 ratio Clotting screen 1 citrate 4 hours 0 8 1 2 ratio D dimer for DVT PE DIC 1 citrate 4 hours Negative Factor assays 1 citrate 4 hours Pathology User Guide Page 66 of 137 2 9 Coagulation tests pre analytical variables Variable Affect on result Sample type Trisodium citrate precipitates calcium therefore stopping clot formation other anticoagulants cannot be used due to different mechanisms of action Sample volume Blood anticoagulant 9 1 Underfilling overfilling will affect this ratio Sample production Clean venepuncture and gentle mixing needed to avoid blood frothing and activation of coagulation Sample age PT stable for 24 hours APTT ideally tested within 4 hours of sampling Sample clotted activated Activation may result in shortened time Haemolysis Excessive haemolysis may result in shortened time interferes with chromogenic immunological measurement Jaundice lipaemic Interfere with automated clot detection interfere with chromogenic immunological measurement Coagulation samples are volume critical if a patient is difficult to bleed paediatric tubes 1 3ml a
35. e Haemoglobinopathy investigation if variant haemoglobin detected or potential thalassaemia the sample is referred to Torbay Hospital 2 23 MARKERS IN THE DIAGNOSIS AND MONITORING OF INFLAMMATORY DISORDERS From Presentation to Test A Guide to Appropriate Use of Markers in Diagnosis and Monitoring of Inflammatory Disorders CRP only rises substantially in bacterial fungal infection and only very modestly in viral infection We recommend that these tests are performed once only unless there is compelling clinical evidence meriting a repeat test Clinical Suspicion First Line Second Line based on wen Diagnostic Test s Diagnostic Test s MSc uno and examination Bacterial Infection CRP CRP DNA ENA Arthritis RF CRP ANA in women lt 60yh ma net CRP with synovitis with clinical suspicion of SLE ANA CRP does not DNA ENA as ee I rise in uncomplicated ENA ACA if oo ANA MCTD SLE but rises c pregnant DNA infection Igs C3 C4 ACA C3 C4 DNA if Vasculitis PAN ANCA ANA 19S Sn OOLOBUIINS Ai SEE Arteritis C3 C4 CRP RF Clinically indicated ANCA if positive DNA ENA max every 3 weeks CRP Temporal Arteritis Polymyalgia CRP or ESR CRP or ESR Rheumatica Inflammatory CRP in Crohn s but not bowel disease uncomplicated UC Cervo ronms Hodgkin s Disease Biopsy ESR U E Ca LFT Protein Myeloma Raised U E Catt LFT f a Viscosity o
36. infection The specialist laboratory will also perform RPR tests which are used to monitor response to treatment and to detect re infection in previously infected individuals It is essential that adequate clinical details accompany all requests for syphilis serology to ensure that the correct tests are performed and properly interpreted Vesicular rashes Herpes simplex chicken pox and shingles Serology is of limited value in the diagnosis of these infections Sensitive molecular tests performed on virus containing samples are preferred Swab lesions ideally getting fluid from intact vesicle using Copan mini UTM RT collection kit available from the Microbiology Laboratory supplies order line ext 4966 PCR based detection of HSV 1 and 2 is available locally Specimens requiring investigation for chickenpox shingles will be forwarded to a reference laboratory for VZV PCR Viral load testing These tests are performed using quantitative PCR techniques HIV and Hepatitis C viral load testing is available locally for monitoring the response to antiviral treatment These tests are usually performed at the request of specialist Genito urinary medicine and hepatology clinics Other users Pathology User Guide Page 95 of 137 should contact the laboratory before requesting these assays Hepatitis B HBV and CMV viral load testing are currently performed at specialist laboratories HBV testing is mainly used to determine the infectivity of c
37. informed choices regarding participating in the screening programme and provide help for those couples identified by screening as being at higher risk For all pregnant women presenting to maternity services in England sickle cell and thalassaemia screening is an integral part of the early antenatal care offered to all women at first presentation to primary care or first booking 2 22 2 Women undergoing antenatal booking are assessed for potential Haemoglobinopathy using the family origin questionnaire FOQ and for thalassaemia using the MCH 2 22 3 The following stages are involved e Initial Haemoglobinopathy screening Please send FOQ white top copy only with FBC sample and antenatal booking request form to Haematology do not sent in same bag as Group and Save Please enter EDD on FOQ and do not make any entry in the declined box unless patient specifically declines screening e Criteria for which the woman s sample is further screened O MCH lt 27 lab will check history O C area midwife will be automatically contacted to arrange partner sample Please include female ID information on request O If FOQ positive for either woman or partner which is any ethnic descent other than pure North European Caucasian identified by ticks in the Gold boxes Laboratory will send women s sample to the referral laboratory Partner sample is not required at this stage for this screen Pathology User Guide Page 75 of 137
38. like growth factor ILGF 1 Pathology User Guide 0 16 0 36 0 18 0 53 g L mg L 0 3 2 0 0 3 2 0 g L a T E O peo oe a a T ee lt X umol L g L 40 300 13 150 ug L 197 866 197 866 ng L 46 187 46 18 7 ug L EPS IES Time 09 00 170 700 170 700 nmol L 1 77 9 99 umol L Follicular 3 5 12 5 Ovulation 4 7 21 5 Luteal 1 7 7 7 Follicular 2 4 12 6 Ovulation 14 0 95 6 Luteal 1 0 11 4 nmol L Page 120 of 137 Prolactin mU L Testosterone nmol L Frets 40 68 pmolt Thyroid Peroxidase Antibodies Vitamin E 10 2 39 10 2 39 umol L Vitamin D lt 25 Severe vitamin D deficiency nmol L 25 50 vitamin D insufficiency 50 75 Adequate vitamin D gt 75 Optimal vitamin D gt 300 May indicate toxicity E as Pe a 40 200 40 200 mmol 2 a 25 125 25 125 mmol 2 330 580 330 580 4h Potassium D Urea AAA 4h Pathology User Guide Page 121 of 137 fovemignt overnight Noradrenaline nmol m mol Creat Adrenaline nmol m mol Creat Dopamine lt 300 lt 300 nmol m mol Creat 5 HIAA 24h 5 Ma Hydroxy Indole Acetic acid Urine Free Cortisol 100 300 100 300 nmol 2 24h 4h PAEDIATRIC lt 16 YEARS REFERENCE RANGES Urea and electrolytes Creatinine 15 37 15 37 umolll o OB a a 21 38 A Js 27 42 27 42 o y 8 5 28 52 o ja 35 538 35
39. number The use of either of these numbers ensures correct patient identification and also speeds up sample processing However the NHS 10 figure number is regarded as a safer means of positive identification as the computer system automatically performs an integrity check 5 7 13 Each sample must be in the appropriate container for the analysis required 5 7 14 Samples for blood transfusion will not be accepted unless they bear the patient s family name forename NHS hospital number and date of birth not age and are signed and dated Addressograph labels or evidence of their attachment must not be used on Blood Transfusion specimens 5 7 15 Samples for Diagnostic and Molecular Pathology will not be accepted unless they bear three points of patient identification signed by the requestor have date and time of biopsy sample specimen and clinical details entered on the form The sample container must be labelled with at least two patient identifiers and specimen site details including right or left side of body Pathology User Guide Page 10 of 137 5 8 Containers and packaging 5 8 1 Specimens must be submitted in approved containers which are available from NHS Supplies for General Practice Practitioner Support Services Camberwell House Grenadier Road Exeter Business Park Exeter EX1 3LQ Telephone 01392 351351 5 8 2 Clinical Microbiology specimen containers may be obtained directly from the department order line nu
40. only Within 24 hrs Direct film 24h Liquid Culture 6 weeks Tuberculosis Sputum CMB nO a Slope Culture 8 weeks container Early morning sputum taken on three consecutive days 250ml non boric Early morning urine taken on Piberculosis Unna CNB acid container three consecutive days wees Electrolytes Sodium Na U amp E 5 10ml CC Gold Potassium K Urea up to 4 hrs Creatinine Unconjugated Bilirubin 5 10ml CC Gold Extra part of Liver function up to 4 hrs Urethral swab Gonorrhoea CMB Orange topped Link to Further info interim repar charcoal swab 48 hrs Pathology User Guide Page 49 of 137 Which tube Specimen Test or Suspected men ple Which Note mix purple Turnaround Referred for infection in alphabetical Macey S pink or blue tubes Remarks Time testing to Jaif Lab see Reference Facilities der n asap to prevent E or blank information for details clotting Uric Acid Urate 5 10ml CC Gold up to 4 hrs Specimen container MUST be 30ml red topped filled to within 1cm of the fill line FC lt 24hrs Urine culture and sensitivity CMB 7ml for small marked on the container to flow cytometry volume boric acid ensure correct concentration of container boric acid urine hyperlink Culture 2 days Do not refridgerate 60ml sterile Urine Albumin CC container Do not use Red capped pot Up to 4 hrs Urinary Adrenaline Dopamine Un to 5
41. refer for colposcopic assessment If using two samplers both samples should be rinsed into the same vial i e only send one Vial per patient Pathology User Guide Page 107 of 137 10 1 7 Patients with two cervices e These require a vial for each cervix x2 vials Label 1 and 2 or left and right e Tighten the cap so the black torque line on the cap meets the black torque line on the Vial e All details requested on the HMR request form must be completed e Also ensure that the specimen transport bag is securely sealed before sending to the laboratory 10 1 8 Interpretation of Results 10 1 8 1 The Screening Programme For an effective Programme the frequency of Cervical cancer screening must follow the National Standards e Screening should not start until a woman is 24 5 years of age age of first invitation Screening under the age of 24 5 years may do more harm than good From 25 to 49 years of age routine screening should be 3 yearly e From 50 to 64 years of age routine screening should be 5 yearly e From 65 onwards only those who have not been screened since age 50 or those who have had recent abnormal tests should be screened e Colposcopy and Programme Management NHSCSP April 2004 10 1 8 2 For more information about the Screening Programme in Cornwall see the Cornwall and Isles of Scilly Cervical Screening Programme Policy Document found on the Cornwall NHS net document library on the Intranet
42. services offered Suggested Keywords Pathology tests specimen collection biochemistry microbiology haematology blood transfusion histology cytology Target Audience RCHT PCH CFT KCCG Y Executive Director responsible for Policy Medical Director Date revised 01 11 2014 This document replaces exact title of previous version Pathology User Guide V9 0 Approval route names of committees consultation Pathology Departmental Leads CSSC Governance DMB Divisional Manager confirming approval processes Sally Rowe Divisional Director CSSC Name and Post Title of additional signatories Janet Gardner Governance Lead CSSC Signature of Executive Director giving approval Original Copy Signed Publication Location refer to Policy on Policies Approvals and Ratification Internet 8 Intranet Y Intranet Only Document Library Folder Sub Folder Clinical Pathology Pathology User Guide Page 133 of 137 Links to key external standards Clinical Pathology Accreditation UK Ltd Standards for the Medical Laboratory Standard E1 Information for users and patients Related Documents Pathology Specimen Acceptance Policy Guidelines on Blood Culture Collection Training Need Identified No Version Control Table Version Changes Made by Date No Summary of Changes Name and J
43. stain Swabs various CMB Charcoal swabs Deep seated wounds 1hr of receipt abscesses and urgent requests if urgent will also get a gram stain Link otherwise da Pathology User Guide Page 46 of 137 Which tube Sample z Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround testing to infection in alphabetical naif Lab pink or blue tubes Remarks Time Ee order blank Senin prevent information for details to further Info of receipt Synovial fluid white cell count HAEM Sterile container Syphilis Antibody studies 5 10ml CMB Gold 4 days T Cell count CD4 HAEM or GU Haem or GU Consultant ae Consultant only en EDTA request only ER Haematology and GU sii T cell subsets HAEM Purple Consultant request only Within 24 hrs TSH is front line with fT4 added T4 Free T4 fT4 5 10ml CC Gold if outside limits or lt 17yrs old up to 4 hrs Tacrolimus FK506 Adult CC Purple a sample refrigerate upto 14days Derriford Tacrolimus Paediatrics CC Purple ae sampile amyeraie Up to 14 days BRI Tau protein name no longer used please see Beta 2 Transferrin T Cell gene rearrangement Consultatant Haematologist PCR HAEM Purple x 4 request only TCK creatine kinase 5 10ml CC Gold up to 4 hrs Tegretol same as Carbamazepine 5 10ml CC Gold up to 4 hrs Microbiology Teicoplanin 5 10ml CC Gold Trough sample up t
44. sterile containers with no preservatives Pathology User Guide Page 89 of 137 CSF Ideally a minimum volume of 1ml will be provided For Mycobacterium species as large a volume as possible this is particularly important if tuberculosis infection is suspected where small numbers of organisms may be present Indicate if cryptococcal investigation required Common practice is to send the first and last specimens taken for microbiological examination and the second specimen to chemistry for investigation If subarachnoid haemorrhage is suspected send the first and third samples clearly labelled so that differential red cell counts may be attempted Specimens should be transported in the ATTS allowing rapid investigation Do not refrigerate specimen as cells disintegrate and a delay may produce a cell count that does not reflect the clinical situation of the patient The results of microscopy are available within one hour on Winpath Ward Enquiry and any positive cultures are always telephoned routine neurological specimens are not telephoned Normal CSF values ucocytes bonates lt 4 weeks old BO cells x 105 weeks 4yr old PO cells x 10 r puberty 10 cells x 10 Jults 5 cells x 10 throcytes bwborn 575 cells x 105 1 Jults 10 cells x 10 CSF samples taken after routine neurological examination or from leukaemic patients without symptoms do not have a Gram film or culture performed un
45. thrombosis recurrent foetal loss thrombocytopaenia The antiphospholipid syndrome can be primary or secondary to a CTD such as SLE If the antiphospholipid syndrome is suspected a lupus anticoagulant screen should always be performed regardless of the cardiolipin result Haematology section of Combined Laboratories Coeliac disease Tissue transglutaminase is used as the screening test for Coeliac disease if this is positive the laboratory will automatically perform an endomysial antibody test for confirmation Connective tissue diseases Antinuclear antibodies are present at high titre in SLE and other connective tissue diseases and at lower titre in rheumatoid arthritis other autoimmune diseases and in 10 of normal elderly A homogenous pattern is associated with dsDNA antibodies while a speckled pattern is associated with antibodies to extractable nuclear antigens ENA The laboratory will automatically perform dsDNA and ENA antibodies where appropriate Antibodies Disease associations dsDNA antibodies SLE ENA antibodies Ro SSA Sjogren s SLE neonatal lupus LA SSB Sjogren s SLE neonatal lupus sm SLE RNP MCTD SLE Jo 1 Dermatomyositis polymyositis Scl 70 systemic sclerosis Pathology User Guide Page 78 of 137 Goodpasture s syndrome GBM antibodies are present in 75 of patients with biopsy proven anti GBM disease Hereditary angioedema This condition is very rare is associated with recurrent angioedema bu
46. 0 8 1 3 0 8 1 2 TCT ratio 1 7 3 1 0 8 1 7 0 8 1 5 0 8 1 2 0 8 1 2 0 8 1 2 Fibrinogen 0 6 3 0 1 3 3 5 0 6 3 8 1 5 3 8 1 5 3 8 1 5 4 0 Male Fertility Testing Ranges Parameter Normal Ranges Sample Age 0 2 hrs pH 7 2 8 1 Volume 1 5 10ml Motility 40 100 Normal sperm gt 4 Abnormal sperm lt 96 MAR Antibody negative screen Count gt 15 million per ml Film see comments Viability gt 58 Lo i 07 1 fea se j e eles Normal CSF values Leucocytes Neonates lt 4 weeks 0 30 cells x 10 old 4 weeks 4yr old 0 20 cells x 10 5yr puberty 0 10 cells x 10 Adults 0 5 cells x 10 Erythrocytes Newborn 0 675 cells x 10 Adults 0 10 cells x 10 Pathology User Guide Page 131 of 137 APPENDIX 7 VACUTAINER TUBE GUIDE BD Vacutainer BD Diagnostics Preanalytical Systems Royal Cornwall NHS Trust l April 2012 version Aerobic followed by anaerobic if insufficient blood for both culture bottles use aerobic bottle only INR APTT Coagulation Screens Must be first tube taken after Factor Assay and Thrombophilla Screen by Somi ae alee line and arrangement only ext 2502 three tubes are m oag screen must required be tested on the same day Paediatric Imi size from iab Routine Chemistry and immunology Routine Clinical Microbiology Request form gives advice on the Ante natal infection soeen need for additional tubes PCR assays fo
47. Assistance from a physiotherapist will also produce a better sample quality for cytological analysis Deliver the sample to the lab the same day as the sample is taken The quality of cells suspended within sputum degrade fairly rapidly Bronchial 20ml of fluid Collected at Endoscopy into Within 7 days suckings suspended in universal containers DO NO unless stated washings saline solution SEND THE TRAP TOPPED otherwise CONTAINERS eg 2WW Vigorously shake the brush end Cells are in the vial Remove the brush Within 7 days Brushings suspended in from the vial with foeps and unless stated Liquid Based 20ml of discard the brush head DO otherwise Cytology Preservcyt NOT LEAVE THE BRUSH IN eg 2WW solution vials THE VIAL Once the brush has can be been washed in Preservcyt obtained from solution DO NOT put the brush the Cytology back into the patient Department Complete two separate forms if both Histology biopsies and Cytology suckings washings and brushings are requested Pathology User Guide Page 109 of 137 Turnaround Volume Special precautions and times and Specimen type required Factors affecting Performance Time limits Interpretation for additional tests Cerebrospinal Minimum Specimens degrade quickly and Within 7 days fluid 0 5ml in a should arrive at the laboratory unless stated sterile within 1 hour of collection NB otherwise universal must arrive at the lab by 1600hrs
48. CT team in Clinical Chemistry or on the POCT area on the RCHT Pathology website 1 6 Comments about or experience of problems with the service should be addressed to the Lead BMS Consultant Head of Department or to the Specialty Directors 1 7 This version supersedes any previous versions of this document 2 Purpose of this Guidance 2 1 This guidance is to provide service users with information of sample types specimens tests repertoire reference ranges and more specific guidance related to the four Pathology disciplines 3 Scope 3 1 This guidance is provided for all users of the services provided by Laboratory Medicine and Diagnostic amp Molecular Pathology RCHT Pathology User Guide Page 3 of 137 4 Ownership and Responsibilities 4 1 Role of the Managers Line managers are responsible for ensuring staff are aware of this User Guide 5 General Standards and Practice 5 1 Clinical Advice and Interpretation Clinical advice is available from medical and senior scientific staff throughout normal working hours using the departmental numbers listed below Information on specimen collection and test selection is given in the Appendix 1 Further details of Specialty specific services are described in Appendices 2 Laboratory Medicine and 3 DDMP Out of hours clinical advice may be accessed via the RCHT switchboard and asking for the member of medical staff on call for the relevant department 5 2 Urgent requests
49. Derriford Cold Agglutinins 6ml BT Red Keep at 37 C 24 hours Complement C3 and C4 CC Gold up to 4 hrs Charcoal swab Bacteriology 2 days Conjunctivitis n a CMB UTM swab viruses Virology if etiology suspected 3 days Coombs test direct antiglobulin Can be performed on purple test 6ml BT Pink EDTA 24 hrs Copper CC Gold up to 28 days Derriford Always contact laboratory to Gram 1 hour Pomeal scrape SUB provide a sample collection kit Culture 2 days Cortisol CC Gold Preferable 9am up to 4 hrs Corynebacterium diphtheriae Give clinical details including ulcerans a one CNArEOAVSWAN contact exposure Further Info oe Cystic fibrosis or ciliary 3 days Routine Cough swab n a CMB Charcoal swab dyskinesis patients only Creatine Kinase CK TCK CC Gold Muscle or Heart Muscle up to 4 hrs Chromogranin A amp B Patient should fast overnight also part of the gut hormone 1 mL CC EDTA on ice and H2 blockers should be aha Hammersmith Pathology User Guide Page 23 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for T volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time ae order n a i ab asap to prevent see Reference Facilities blank E information for details clotting omeprazole for 2 weeks before blood is taken Send sample to lab on ice ASAP Must be handwritten with patient s forename sur
50. Duty Microbiologist for Clinical queries Laboratory Administrator Kathy Pollard Lead BMS Bacteriology Julian Rogers Haematology Results and Enquiries Consultant Dr M D Creagh Consultant Dr A R Kruger Consultant Dr R S Noble Consultant Dr J Blundell Consultant Dr E Parkins Consultant Dr B Pottinger Consultant Transfusion Scientist amp Lead BMS Haematology amp Blood Transfusion Mr S Bassey Lead Transfusion Practitioner Ms D Thomas Pathology User Guide Page 6 of 137 01872 25 4974 01872 25 4946 01872 25 2548 01872 25 2524 01872 25 2506 01872 25 2765 01872 25 3048 01872 25 2765 01872 25 3048 01872 25 2508 01872 25 3093 cornwall nhs uk Clinical Scientist Coagulation Mr P Carson 01872 25 2502 Lead BMS Immunology Mr N Oakes 01872 25 3040 Directorate of Diagnostic amp Molecular Pathology Results and Enquiries 01872 25 2550 Speciality Director Consultant Dr H Jones Consultant Dr R Hohle Consultant Lead Cytopathologist Dr H Jones Consultant Dr M Jenkins Consultant Dr Hopkins Consultant Dr H B Smethurst Consultant Dr R Marshall Consultant Dr R Jenkins Consultant Dr J Stolte Lead BMS DDMP Mr P Helliwell BMS Consultant Cervical Cytology Specialist Mrs C Wilson Lead BMS Histopathology Mrs V Rodd Lead BMS Cytology Mrs C Winn Mortuary Manager Mr K Hammett 01872 25 2555 Pathology Information Tech
51. GUIDE cooooococccccononoccnccononnccnnnnnnnnnnncnnnnnncnnnnnnnnccnncnnns 132 Appendix 8 Governance Information coccccccnncocccccnncccccnnnnnnnnnnncnnnnnnncnnnnnnnnnnncnnnnnnnnnnnnnns 133 Appendix 9 Initial Equality Impact Assessment Form ccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 135 Pathology User Guide Page 2 of 137 1 Introduction 1 1 The analysis of Pathology specimens provides important information concerning the diagnosis and treatment of diseases This user guide is intended to provide general information in support of this aim 1 2 The Pathology mission statement To continue to provide and develop quality cost effective Pathology services and staffing relevant to local clinical practice and within a changing technological functional and organisational environment 1 3 This guide is designed to help you make the best use of Pathology services 1 4 There are two specialities within Pathology in Cornwall Laboratory Medicine comprising Clinical Chemistry Haematology Blood Transfusion and Clinical Microbiology Diagnostic and Molecular Pathology comprising Histopathology Cytopathology Molecular and Cellular Pathology Mortuary and Bereavement services All departments are based at the Royal Cornwall Hospital in Truro where there are consultants in all specialities who can be contacted for advice 1 5 Information and assistance regarding Point Of Care Testing may be obtained from the PO
52. HAEM Blue Factor V Leiden screen Page 17 of 137 21 days Derriford erformed instead Which tube Specimen Test or Suspected ue ES Which Note mix purple Turnaround Referred for infection in alphabetical n a if Lab pink or blue tubes Remarks Time a AN order blank F prevent information for details Apolipoprotein B ApoB100 CC Gold Green top 14 days In house Apolipoprotein E Genotyping 5 10ml CC Purple Send whole up to 28 days Bolton APTT for monitoring UF 3ml HAEM Blue Must reach the lab the same Dre Heparin day Performed if APTT prolonged APTT correction 3ml HAEM Blue armo identifiable reason 2 hrs Aquaporin 4 antibodies 2ml HAEM Gold Up to 28 days Give travel exposure history amp Arbovirus serology 5 10ml CMB Gold discuss with laboratory 10 days PHE Porton Down Urine preferred see Urine Arsenic CC Purple Arsenic Stop eating up to 28 days Guildford Surrey fish shellfish 5 days prior Aspartate Amino Transferase AST or ASAT 6ml CC Gold up to 4 hrs Aspergillus serology 5 10ml CMB Gold 7 days PHE Bristol AST Aspartate Amino Transferase CC Gold up to 4 hrs Give clinical details onset date Atypical Respiratory Serology 5 10ml CMB Gold Acute amp convalescent sera 7 days Exeter Bristol recommended Atypical Serology CMB Gold 24 hours Auto Immune Profile AIP HAEM Gold Heriata 11 21 days Paediatric TBC Blood C
53. Immunoglobulins up to 4 hrs A Must list likely allergens i IgE and Rast 7ml HAEM Gold for up to 6 allergens 11 21 days IgG g l CC Gold Part of Immunoglobulins up to 4 hrs Only by prior arrangement with IgG4 2ml HAEM Gold Haem Lab IgM g l CC Gold Part of Immunoglobulins up to 4 hrs ILGF1 Insulin Like Growth Pathology User Guide 5 10ml CC Gold Page 34 of 137 up to 28 days Derriford Factor Which tube Specimen Test or Suspected ate Pe Which _ Note mix purple Turnaround Referred for infection in alphabetical naif Lab pink or blue tubes Remarks Time rene TR order blank sia prevent information for details Imipramine CC Red Trough level up to 28 days Penarth eF Mononuclepsis 4ml HAEM Purple Up to four days if refrigerated lt 24h pes oe oo 4x4ml HAEM Purple x 4 Haem consultant request only Within 24 hrs Immunoglobulins includes Ig A G and M plus protein Protein electrophoresis g l eR me electrophoresis Peele Infectious disease serology 5 10ml CMB Gold See individual targets Same day Influenza A amp B See Flu A amp B CMB See Flu A amp B See Flu A amp B Monday to Friday Inhibitor Factor V111 or IX 3ml HAEM Blue 2 wks Inhibitor screen 3ml HAEM Blue x 2 2 wks INR Prothrombin Time 3ml HAEM Blue Stable overnight if refrigerated lt 24 hrs Must be accompanied by a lab Insulin 5 10
54. Information special handling needs Bronchoscopy Samples Transported via Porter to the laboratory The laboratory is sent a patient list for each clinic Tuesday s samples should arrive in the laboratory by 16 30 Thursday s samples should arrive in the laboratory by 14 00 If samples have not been transported to the lab within the time frame then a member of cytology staff contacts Endoscopy To allow for processing time prior to MDT Histology samples taken in RCHT ultra sound department on a Thursday afternoon will be collected by member of histology staff Please ensure histology department are contacted for this collection on ext 2576 Clinic times Tuesday PM Thursday AM If Cytology and Histology samples are taken then samples should be placed into separate specimen bags with a completed request form for each department Diagnostic Cytology samples RCHT Transported via porter or tube to the laboratory Labelled Glass slides must be placed into a slide carried box All specimen containers must be placed into Cellular Pathology specimen bag with the completed request from attached prior to transportation Diagnostic Cytology samples External Including Synovial Fluids for Crystal analysis Via Courier service All specimen containers must be placed into Cellular Pathology specimen bag with the completed request from attached prior to transportation Pathology
55. James University Hospital Leeds LS9 7TF e Immunology Dept Churchill Hospital Headington Oxford OX3 7LJ e Neuroimmunology Room 917 Institute of Neurology Queens Square London WC1N 3AR e Neuroimmunology Southern General Hospital 1345 Govan Road Glasgow GS1 4TF Pathology User Guide Page 116 of 137 e Protein Reference Unit Dept of Immunology PO Box 894 Sheffield S5 7YT e Regional Molecular Genetics Unit The Lewis Laboratories Southmead Hospital Bristol BS10 5NB Coagulation e Haemoglobinopathy section Haematology Laboratory Pathology Level 3 Torbay Hospital Lawes Bridge Torquay TQ2 7AA e Oxford Haemophilia amp Thrombosis Centre Churchill hospital Headington Oxford OX3 7LJ e Membrane Biochemistry International Blood Group Reference Lab NHS Blood amp Transplant 500 North Bristol Park Northway Filton Bristol BS34 7QH e Institute of Molecular Medicine John Radcliffe Hospital Headington Oxford OX3 9DS e Haemostasis Research Unit Haematology Dept University College London 1st Floor 51 chennies Mews London WC1E 6HX Pathology User Guide Page 117 of 137 APPENDIX 6 TEST REFERENCE RANGES Please note For all tests done in the Clinical Chemistry Laboratory reference ranges are either from the manufacturers literature or agreed in line with the National Pathology Harmonisation project www pathologyharmony co uk For tests referred to other laboratories the quoted referen
56. NO dave ARS BI BISIG request Request form must be HIV Antibody status 5 10ml CMB Gold completed and signed by 3 day requestor HIV RNA detection Adults in house 7 days Viral Load ONB Purple Paediatrics referred 10 days PRE COMAG HLA ABC DR only by 4x4ml HAEM EDTA x 4 Must only take if Lab approves 7 10 days Pathology User Guide Page 33 of 137 Which tube Specimen Test or Suspected Senn AS E Note mix purple Turnaround Referred for Ea volume Which E testing to aeaea eh esL n aif Lab Bose o CS mme see Reference Facilities order blank COEIRE prevent information for details contacting lab Gold x 2 HLA B27 Monday to Thursday 2x4ml HAEM EDTA x2 Only Monday Thursday 7 10 days Spin and freeze plasma in Homocystine CC Purple on ice nder 30 minute up to 28 days BRI Hormones See individual listings Ce a HTLV 1 and 2 Antibody 5 10ml CMB Gold 14 days Derriford Plymouth fee chorionic gonadotrophin 5 10ml CC Gold 4h Hydatid diseae 3 Discuss with Medical Hosp for Tropical Echinococcus serology 20m OMB eo Microbiologist ie aeys Diseases London Hydroxycalciferol CC See Vitamin D up to 28 days See 17 OH Hydroxyprogesterone 5 10ml CC progesterone Hypochromia rbc 4ml HAEM Purple 24h IG antibodies Haemophilus and HAEM Gold 11 21 days Pneumococcus Ig Sub class 2ml HAEM Gold 11 21 days IgA g l CC Gold Part of
57. Noradrenaline etc ie CC Overnight Order bottle from Chemistry p19 working days catecholamines Urinary Amino Acids CC Random Freeze on day of collection up to 28 days Southmead Urinary Amphetamine CC Random Must be positive DOA screen 1 2 weeks Plain urine container not red Urinary Amylase CC Random topped 24 hours Stop eating fish shellfish 5 days Urinary Arsenic CC Random or 24 hour prio collection Up to 28 days Guildford Surrey Urinary Buprenorphine screen CC Random pes ame Ber Up to 28 days Penarth ee anno Pale CC 24 hour Order bottle from Chemistry 24 hours Urinary Calcium and Phosphate Random CC Random up to 4 hours Urinary Cannabis CC Random up to 28 days Torbay Urine C Peptide cc Random Boric Endocrinologist request only Exeter acid red topped Required special protocol Pathology User Guide Page 50 of 137 Which tube Specimen Test or Suspected ae ple Which _ Note mix purple Turnaround Referred for infection in alphabetical lake IE pink or blue tubes Remarks Time testing to ne order n a i ab asap to prevent see Reference Facilities blank clotting information for details up to 5 Urinary Catecholamines CC Overnight Order bottle from Chemistry working days Urinary Citrate CC 24 hour S desta IEA up to 28 days Order bottle from Chemistry To Urinary Copper CC 24 hour investigate disorders of copper up to 28
58. One all we care Royal Cornwall Hospitals NHS NHS Trust RCHT PATHOLOGY USER GUIDE V 10 0 January 2015 Table of Contents Wi is A easter doc secede say daucec ee cay see cedar eeavt cds ten ghceemeach tenets 3 25 PURPOSE ONIS QUINCE A A AA 3 A A 3 4 Ownership and ResponsibilitieS oo o noococccnnnndnnnnnncconccccccnncncnnnnnnnanancnnnnnnnnnnnnnnnnnnos 4 5 General Standards and Practice it AA nnee 4 6 Dissemination and Implementation ccccceeeeeseeeeeceeeeeeeeeeeeeeeeaeeeeeeeeeeeeeeeeesaaeees 11 7 Monitoring compliance and effectivenesS ooooccccnncccccccccnncccconannnenancncnnnnncnannnnnnnnnnnos 12 8 Updating MA a RS cats 12 9 BQuality amg Diversity nooo 12 APPENDIX 1 PATHOLOGY REPERTOIRE by test specimen or suspected infection 13 APPENDIX 2 LABORATORY MEDICINE ccccceceeeceeeeeeeeeeeeeeeeeeeeeeeecnaeeeeeeeeneeeeeeeseaes 56 1 Department of Clinical Chemistry i an 56 2 Department of Haematology essa 64 3 Department of Clinical MicrObi0lOgy ccocococccccnnnnnicinnnoncnonccnnnncnnnnnnnnnnnncnnnnncnnnnnnnes 82 APPENDIX 3 DIAGNOSTIC AND MOLECULAR PATHOLOGY DEPARTMENT 97 APPENDIX 4 WEST CORNWALL HOSPITAL 00 2 cceeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 111 APPENDIX 5 REFERENCE FACILITIES wiinccccievesevacevessvavevevesvevavevecsvavevacevaveneutvnsevarecavene 112 APPENDIX 6 TEST REFERENCE RANGES ansia oie 118 APPENDIX 7 VACUTAINER TUBE
59. Public Taxi s Only to be transported through NHS Couriers Pathology User Guide Page 101 of 137 Specimen Type Transportation details Information special handling needs Renal specimens Lab staff will deliver the Hanks Medium ready for use on request They will retrieve the specimen on phone call from the renal physicians Un used specimen pots must be collected by laboratory staff and NOT used Must be booked in advance by phoning ext 2576 Samples transported in Hanks medium obtained from laboratory Products of Conception Termination of Pregnancy These specimens must be received in 10 buffered formalin Tissue samples before 24 weeks gestation containing products of conception which are for histology must be accompanied by a Consent Form for funeral arrangements after pregnancy loss anda Cornwall Council Penmount Crematorium Form Certificate of Medical Practitioner or Midwife in Respect of Foetal Remains These forms on completion indicate what funeral arrangements are required once the histology has been performed Such specimen types are will not be accepted processed unless the correct documentation accompanies the specimens These requirements are in line with the Human Tissue Authority The forms are available on the RCHT document library as appendices of the Policy Procedure for the Sensitive Disposal of Pre 24 week Fetal Tissue Dental specimens
60. Smaller numbers may be seen in iron deficiency megaloblastic anaemia myelodysplasia and myelofibrosis Less elliptical cells are sometimes called ovalocytes Long thin cells are called pencil cells and are typically associated with iron deficiency Howell Jolly bodies Fragments of nucleus remaining in a red cell These are a normal feature that should be removed by the spleen An excess is therefore seen post splenectomy and in hyposplenic states They can also be seen in patients receiving antimetabolite therapy e g Methotrexate or megaloblastosis Hypochromia A red cell that is pale in colour Can be caused by any of the conditions that cause microcytosis Often reported together Iron deficiency is a hypochromic microcytic anaemia Can also be present in anaemia of chronic disorders Macrocytosis Increase in red cell size An increase in the size of all of the red cells will cause a rise in MCV but some macrocytes can be present in the absence of a raised MCV Will be present in liver disease some tumours as a result of chronic excessive ethanol consumption B12 or folate deficiency myelodysplastic syndrome and other marrow disorders such as myeloma antifolate drugs e g methotrexate or those that interfere with DNA metabolism e g azathioprine Reticulocytes are larger than mature red cells so can raise the MCV if present in exceptional numbers Oval macrocytes are characteristic of megaloblastic anaemia Microcytosis Decre
61. To ensure the correct concentration of boric acid is achieved 1 9 the container must be filled to within 1cm of the fill line marked on the label If this is not achieved the specimen will not be tested Boric acid containers are only suitable for URINE specimens requiring routine bacterial investigation For paediatric patients or other patients where obtaining sufficient volume is a problem smaller 5ml boric acid containers are available from the laboratory Bag urine Used commonly for infants and young children The sterile bags are taped over the genitalia and the collected urine is transferred to a sterile leak proof container There are frequent problems of contamination with this method of collection Bag urine samples will not have flow cytometry result as fibres can interfere with the analyser Pathology User Guide Page 87 of 137 lleal conduit urostomy urine Results from this type of specimen may be difficult to interpret Ureteric urine Paired urine samples are obtained from each ureter during cystoscopy via ureteric catheters inserted from the bladder Urines may also be sent following nephrostomy surgery or bladder washout Localisation culture for diagnosis of prostatitis The following specimens are collected the initial 5 8ml voided urethral urine VB1 MSU bladder urine VB2 expressed prostatic secretions following prostatic massage EPS the first 2 3ml voided urine following prostatic massage VB3
62. User Guide Page 100 of 137 Specimen Type Transportation details Information special handling needs Head and Neck Clinic FNAC Transported via porter or tube to the laboratory please make sure the slide box is tightly sealed an elastic band can be used to prevent the slides from breaking during transportation in the air tube system Labelled slides must be placed into plastic slide boxes placed into a specimen bag accompanied with a completed request form EUS EBUS FNA BMS attendance at the clinic specimens transported to the laboratory by these staff As directed by staff in attendance at clinic Routine Histology All histology specimens should be transported in 10 neutral buffered formalin DO NOT use Saline 60ml pre filled biopsy pots are available from either EROS GP can request pots from Practitioner Support Services NHS Shared Business Services Camberwell House Grenadier Road Exeter Business Park Exeter Devon EX1 3LQ Hospital theatres RAF St Mawgan RNAS Culdrose and Bodmin Treatment Centre BTC can obtain a range of empty pots in various sizes from the histology department Volume of 10 formalin must be 5 x the volume of the specimen Under no circumstances must specimens containing formalin be sent by the air transport tube or Royal Mail Postal Service Histopathology samples must never be delivered from GP s or hospitals via
63. a of Unknown Origin CMB econ Paeces 3 days neg Gold Clotted blood acute amp 7 days convalescent Pathology User Guide Page 43 of 137 Which tube Sample 7 Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround testing to infection in alphabetical z pink or blue tubes Remarks Time ae d naif Lab t t see Reference Facilities order blank a preven information for details Pyruvate Kinase PK screen 4ml HAEM Purple 1 week l Discuss with Laboratory Not Quantiferon testing TB CMB Quantiferon kit available Friday to Sunday Exeter See Atypical Respiratory l serology Please indicate if f Q Fever Coxiella Infections CMB Gold Andoearditigichranic mecla 7 days Exeter Bristol PHE suspected Rabies CMB a Must list likely allergens i Rast and IgE 7ml HAEM Gold for up to 6 allergens 11 21 days Must be taken to Clin Chem immediately Renin 1 mL CC Purple If aldosterone ratio required up to 28 days Southampton Refer to Aldosterone for drug requirements Reptilase time 3ml HAEM Blue 2 hrs Retics Reticulocytes 4ml HAEM Purple ee Ona 24h Must be handwritten with patient s forename surname ee DoB gender unique identifier Rh antibodies 6m BT Pink NHS or CR number date amp 24 hr time of sample and sample taker s signature Rheumatoid factor 5 10ml CC Gold up to 4 hrs Rickettsia Patholo
64. aboratory Medicine Dr S Fleming 01872 25 2541 Specialty Director of Directorate of Diagnostic amp Molecular Pathology Dr H Jones 01872 25 2550 Lead BMS Laboratory Medicine Malcolm Owen 01872 25 2508 Lead BMS Diagnostic and Molecular Pathology Peter Helliwell 01872 25 2550 Pathology User Guide Page 5 of 137 Clinical Chemistry Results and Enquiries Generic email address 01872 25 2540 48 clinchem rcht cornwall nhs uk Duty Biochemist Consultant Dr S C Fleming Consultant Biochemist Dr A Patterson Principal Biochemists Lead BMS Alan Bromley Point of care testing Downs screening Dr Angela Mallard Joint Reception Manager Jo Walsh Urgent Requests Point of Care testing Generic email address Clinical Chemistry Helen Hobba Clinical Chemistry Kate Tregunna Coagulation Phil Carson Clinical Microbiology All Enquiries Generic email address Consultant Head of Dept Dr R P Bendall Consultant Dr S Jog Consultant Dr P Chakrabarti Consultant Dr A Evans RCHT CMBEnquir 01872 25 3047 01872 25 2541 01872 25 2546 01872 25 2564 2566 01872 25 2556 01872 25 2564 01872 25 2554 01872 25 2542 01872 25 2547 POCT POCT RCHT cornwall nhs uk 01872 25 2556 01872 25 2540 01872 25 2502 01872 25 4900 01872 25 4900 01872 25 4900 01872 25 4900 01872 25 4900 On weekday afternoons the on call Medical Microbiologist acts as a
65. age 97 of 137 5 DDMP SPECIFIC Form amp Specimen Labelling Requirements FORM LABELLING REQUIREMENTS Both Form amp Specimen Mandatory i e will be rejected if not given Surname Forename or coded identifier All specimens NHS Hospital number or Date of birth All specimens Signature of the requester All specimens Date of collection All specimens Time specimen taken Histology only Sample type All Specimens Site and side All specimens Description of Biopsy Histology only Consultant or patient s GP All specimens Patient location or address Cervical Cytology desirable for diagnostic cytology Report destination All specimens Complete all boxes of HMR 101 5 Cervical Cytology SAMPLE LABELLING REQUIREMENTS Surname Forename All specimens coded identifier for GUM clinic cervical samples All specimens except unknown NHS Hospital number or Date of birth patients Label frosted slide end Full Name and Hospital No or NHS number or DOB and Diagnostic Cytology Sample type and Site side Sample type All specimens Site and side if appropriate All specimens Pathology User Guide Page 98 of 137 6 Transportation of samples and special handling needs Histopathology samples must never be delivered from GP s or hospitals via Public Taxi s Only to be transported through NHS Couriers
66. agnostic Cytology CMB HIV testing all requests except unknown patients NHS Hospital number and date of birth are mandatory for Transfusion Signature of the requester Transfusion Histology and Diagnostic Cytology CMB HIV testing Sample type Mandatory Microbiology Histology and Diagnostic Cytology DesirableTransfusion Chemistry desirable for all other specimens Site and side if appropriate Microbiology Histology and Diagnostic Cytology Chemistry Test s required All requests Desirable Patient home address including All requests post code Patient location and Report All requests destination Consultant or GP code All requests Clinical details including All requests relevant medication Gender All requests Complete all boxes of HMR 101 5b Cervical cytology Tests required All requests Age if DoB not given approximate age for unknown All requests patients Practioner s contact no bleep All requests or extension Pathology User Guide Page 8 of 137 SPECIMEN LABELLING REQUIREMENTS Mandatory i e will be rejected if not given Please see section 4 of the Specimen Acceptance Policy Surname Forename or coded identifier All specimens NHS Hospital number or Date of birth NHS Hospital number and Date of birth are mandatory for Transfusion Histology and Diagnostic Cytology Desirable for all other specimens
67. ange no further tests are performed There are a number of exceptions if the patient is lt 17 years old pregnant or under endocrinology or oncology Further tests Free T4 amp Free T3 are added to assist in diagnosis and monitoring as appropriate Therefore full clinical details and the dose s of any treatment employed are essential 1 9 9 Therapeutic drug monitoring Drug levels are only useful after the patient has been on the therapy for sufficient time to achieve steady state conditions and samples must be taken at appropriate times See table below Pathology User Guide Page 60 of 137 SAMPLE TIME OF THERAPEUTIC DRUG TYPE SAMPLING RANGE UNIITS AKA SERUM TROUGH CARBEMAZEPINE TEGRETOL HEPARIN PRE DOSE 4to 12 SERUM TROUGH PHeNopararTal HEPARIN PREDOSE 10040 TROUGH PHENYTOIN SERUM EPANUTIN HEPARIN PRE DOSE 10 to 20 SODIUM SERUM TROUGH REFERRED VALPROATE EPICIM HEPARIN PRE DOSE ANALYSIS i PEAK 2 HOURS SERUM 6 8 HOURS FOR mg L THEOPHYLLINE AMINOPHYLLINE HEPARIN SLOW RELEASE 10 TO 20 DIGOXIN SERUM 6 8 HOURS Meann Post oose 0St020 2 PRIADEL SERUM 12 HOURS POST LITHIUM CAMCOLIT DOSE 0 4 TO 1 0 mmol L SERUM gt 4 HOURS POST PARACETAMOL ACETAMINOPHEN HEPARIN INGESTION SERUM If raised bolus SALICYLATE ASPIRIN HEPARIN check 274 sample 1 9 10 AntibioticTesting Vancomycin Gentamicin and Tobramycin are measured in Clinical Chemistry at RCH and other antibiotics are referred to Southmead Hosp
68. arriers and the response to antiviral treatment CMV PCR is mainly used to monitor transplant recipients and other immunocompromised patients for active CMV infection Specialist reference tests Many unusual or infrequently requested tests are available from reference laboratories eg tests for tropical diseases CUD Whipple s disease endemic mycoses polyoma viruses and can be arranged by the laboratory Specialist molecular tests such as viral genotyping and resistance testing are also available Please discuss with the laboratory before sending samples for any of these investigations Pathology User Guide Page 96 of 137 APPENDIX 3 DIAGNOSTIC AND MOLECULAR PATHOLOGY DEPARTMENT The Diagnostic and Molecular Pathology Department is divided into the following specialities 1 Cytopathology provides the following e National Health Service Cervical Screening Programme NHSCSP e Diagnostic Cytopathology services includes e Head and Neck Fine Needle Aspiration Cytology FNAC e Liquid Based Cytology LBC Bronchial Oesophageal and Common Bile Duct Samples e Breast Fine Needle Aspiration Cytology FNAC e Body fluid and aspirate cytology e EUS EBUS Endoscopic and endobronchial ultrasound FNA service Adequacy of the sample is assessed within the clinical setting Samples include Mediastinal lymph node FNA s transbronchial EBUS and transesophageal EUS and Pancreatic FNAs 2 Histopathology provides a diagnostic ser
69. ars 4 3 5 7 3 9 5 0 Up to 1 day 0 47 0 59 0 47 0 59 1 day 3 months 0 26 0 7 0 26 0 7 Haematocrit 3 months 6 years 0 27 0 44 0 27 0 44 1 1 6 12 years 0 34 0 42 0 34 0 42 gt 12 years 0 39 0 50 0 36 0 44 Mean cell Up to 1 day 90 118 90 118 fi Pathology User Guide Page 127 of 137 1 day 3 months 75 125 75 125 3 months 1 year 68 103 68 103 1 6 years 71 86 71 86 6 12 years 75 91 75 91 gt 12 years 77 98 77 98 Up to 3 months 26 0 40 0 26 0 40 0 Mean cell 3 months 6 years 23 0 35 0 23 0 35 0 Haemoglobin 6 12 years 25 0 33 0 25 0 33 0 Pg gt 12 years 27 3 32 6 27 3 32 6 Mean cell Haemoglobin All 316 349 316 349 g l Concentration Up to 8 days 5 0 23 0 5 0 23 0 8 days 1 year 5 0 19 5 5 0 19 5 1 3 years 5 6 17 0 5 6 17 0 WBC count 3 6 years 4 9 12 9 4 9 12 9 x10 l 6 8 years 4 4 10 6 4 4 10 6 8 16 years 3 9 9 9 3 9 9 9 gt 16 years 3 7 9 5 3 9 11 1 Up to 1 day 1 7 23 0 1 7 23 0 1 3 days 3 8 17 1 3 8 17 1 Neutrophil 3 days 1 year 1 3 9 4 1 3 9 4 6 count 1 6 years 1 5 7 7 1 5 7 7 me 6 16 years 1 4 5 9 1 4 5 9 gt 16 years 1 7 7 5 1 7 7 5 Up to 1 day 1 0 11 0 1 0 11 0 1 3 days 2 0 7 3 2 0 7 3 Lymphocyte 3 days 1 year 1 9 13 5 1 9 13 5 A count 1 6 years 1 6 8 6 1 6 8 6 nl 6 16 years 1 4 4 3 1 4 4 3 gt 16 years 1 0 3 2 1 0 3 2 Up to 1 day 0 1 3 7 0 1 3 7 1 3 days 0 1 1 9 0 1 1 9 ee 3 days 1 year 0 1 1 8 0 1 1 8 x10 1 16 years 0
70. ase in red cell size Most often seen in iron deficiency and the anaemia of chronic disease More rarely in the haemoglobinopathies and thalassaemia Normochromic A red cell that is normal in colour and therefore contains a normal concentration of haemoglobin Red cells with normal appearance are present in the absence of a haematological abnormality If the patient is anaemic then it can be associated with acute blood loss or renal failure Normocytic A red cell of normal size and shape Pappenheimer bodies Red cell inclusions that contain iron Often seen post splenectomy Pathology User Guide Page 72 of 137 Poikilocytes Red cells of abnormal shape A common non specific finding in many haematological abnormalities Usually caused by the production of abnormal cells or damage to the cells in vivo Teardrop poikilocytes are characteristic of marrow fibrosis Polychromasia Red cells that stain pinkish blue These are early reticulocytes associated with an increase in erythropoiesis as in the successful treatment of or response to anaemia or as a response to bleeding or haemolysis Rouleaux Stacking of red cells Excess rouleaux is caused by an increased plasma protein concentration May indicate a paraprotein or inflammation Schistocytes Fragments of red cell These are caused by mechanical damage to red cells Most common causes are microangiopathic haemolytic anaemia or mechanical haemolytic anaemia Sickle Cells Red ce
71. cal HAEM Universal 24h investigation Cyanide CC Purple Send whole sample up to 28 days Penarth g up to 5 Cyclosporin Adult CC Purple Whole blood Trough working days Derriford cited up to 5 Cyclosporin Paediatrics CC Purple Whole blood Trough working days BRI Various dependant Only haematology patients ni ENIOgengies I on sample type referred by Haematology lab a Lab will post Preferably on genetics form Cytogenetics Cimamosama CC Li Hep with consent forms Samples pur Bristol Genetics analysis does not handle results a E ar pu known cystinuria see urine Cystine Cystinuria Screening CC Plain urine random collection section Southmead DAG DAGT Direct Antiglobulin Can be performed on purple Test Coombs Test ol ie EDTA sen D Dimer 3ml HAEM Blue Reason DVT PE DIC 2 hrs 7 Dehydrocholesterol CC Green up to 28 days _ Sheffield Childrens Dengue Fever 5 10ml CMB Gold 10 days PHE Porton Down 11 Deoxycortisol 5 10ml CC Gold up to 28 days St Thomas London Desipramine 1mL CC Red a rough Sample up to 28 days Penarth Diazepam CC Green Purple SST 1 week NSE Differential White Blood count 4ml HAEM Purple 3d Digoxin 5 10ml CC Gold At least 6hr post dose up to 4 hrs 1 25 Dihydroxycholecalciferol CC See 1 25 dihydroxy vitamin D Diphtheria CMB Charcoal Further info Throat swabs 3 days Pathology User Guide Page 25 of 137 Which tube Specimen Test
72. ce ranges are those issued by that laboratory ANTIBIOTICS Test Range Comment Gentamicin assay Trough 0 5 2 0 For once daily Gentamicin a Peak 6 0 10 0 lower trough is expected amp peak measurement is not usually performed as is always high Please contact Pharmacy if in doubt Vancomycin assay Trough 5 0 10 0 Peak 25 0 40 0 Tobramycin assay Trough 0 5 2 0 Peak 6 0 10 0 These ranges only apply for multiple daily dosing For once daily Gentamicin a lower trough is expected and a peak measurement is not usually performed as it is always high Please contact the Pharmacy department if in doubt ADULT REFERENCE RANGES Urea and electrolytes mos A CSC or mmo Beason Jeo eo fo ceaim fec ao uma we eere eers rron Pathology User Guide Page 118 of 137 E a SE s h ur mm fo a 7 E o a et Glucose fasting 3 0 6 0 3 0 6 0 Armonia aa 0 5 2 2 0 5 2 2 Proteins Pathology User Guide 135 225 135 214 iu L 3 5 5 2 3 5 5 2 1 4 4 0 1 4 4 0 mmol L 05 186 05 186 mmol L Page 119 of 137 313 3 s 3 cis 3 3 3 2 3 3 3 3 3 HEIE o a o a jafja jaja 2 2 ANA Beta 2 microglobulin Caeruloplasmin CRP Haptoglobin Immunoglobulin G Immunoglobulin A Immunoglobulin M Iron studies and haematinics Iron Transferrin Ferritin Vitamin B12 Folate Cortisol Dehydroepiandrosteron e sulphate Insulin
73. chloric Acid CS E UN AE Urinary free 24 hour Plain Cortisol Albumin Overnight Nil Creatinine ratio 1 6 Specimen collection and storage ES EN mM E i E El ES ES pees ln eee random o E Delay in separation of the cells from the serum can lead to inaccuracies in the results The date and time the specimen was taken must be clearly recorded on the tube and the request form If sample transport considerations mean the transit time from venepuncture to receipt in the laboratory is great than 4 hours the surgery should consider obtaining a centrifuge and spinning them locally Unspun blood tubes for chemistry requests should never be stored in the fridge Once spun the samples can be safely stored in a refrigerator for up to 48 hours Angle head centrifuges are not idea and may produce poor quality separation resulting in rejection of the sample To obtain advice and information on suitable centrifuges or on any aspect of centrifuging samples contact Alan Bromley Lead BMS Clinical Chemistry Tel 01872 25 2542 Pathology User Guide Page 58 of 137 1 7 Retrospective testing Specimens are retained in Clinical Chemistry under appropriate storage for up to 3 days It is possible to ask for tests to be added to samples already received provided the analyte required is sufficiently stable It may not be possible to add certain tests which are known to deteriorate after a short time e g Troponin may only be added within 24 h
74. cts if patient Culture 2 dave Throat swab has had treatment prior to y admission Herpes simplex Varicella a ie Enterovirus Enterovirus Microbiology mening Us Eneepiralils Mira SMB par performed routinely Otherwise raays Addenbrookes discuss with Laboratory EDTA Pink paeds A Meningococcal Pneumococcal Meningo Ref Unit PCR CMB ae Purple 7 days Manchester Mercury CC Purple up to 28 days Guildford Surrey Only in patients with equivocal Metanephrines CC Purple on ice urinary catecholamines Up to 28 days T Contact lab before sending Inform laboratory prior to Methanol CC Grey sending Penarth Arrange with Derriford at Methotrexate HAEM 0500hrs Microfilaria 4ml HAEM Purple 24h Hospital patients MRSA screening CMB Red GP Community patients Ai 188 State if patient receiving 3 days pos suppression therapy Pathology User Guide Page 39 of 137 Which tube Specimen Test or Suspected EAS E Note mix purple Turnaround Referred for gt T volume Which E testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time PH order n a i ab asap to prevent see Reference Facilities blank information for details clotting Mumps diagnostic CMB Salivary kit Feo Waa ol 10 days VRD PHE Colindale May be used diagnostically Not Mumps serology 5 10ml CMB Gold recommended for determining 10 days VRD PHE Colindale immunity to M
75. days metabolism l up to 5 Urinary Creatine CC 24 hour Order bottle from Chemistry working days Urinary Drugs of abuse cc Random Amphetamine benzodiazepine up to 5 cocaine methadone Opiates working days Urinary Electrolytes CC 24 hour Order pame MON CNEMISIY 24 hours Urinary Electrolytes Random CC Random up to 4 hours up to 5 Urinary Free Cortisol UFC CC 24 hour Order bottle from Chemistry working days Urinary Galactitol CC Random meen 119828 Spec imenapon Up to 28 days Urinary HVA VMA CC Random es Up to 28 days BRI Urinary Indole Acetic Acid l up to 5 5 HIAA CC 24 hour Order bottle from Chemistry working days Urinary Intestinal Permeability CC e a 1 2 weeks Urinary Ketones CC Random Dipsticks available on the wards 24 hours Urinary Magnesium CC 24 hour Order bottle from Chemistry Up to 28 days Derriford Urinary Mercury CC Plain EMU Up to 28 days Guildford Surrey Urinary Microalbumin initial cc Rad 24 h rs screen Pathology User Guide Page 51 of 137 Which tube E Sample z Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround TERG to adsan ehes n aif Lab Prik Or IU lees CS us see Reference Facilities order blank asap to prevent information for details clotting Urinary Mucopolysaccharides CC Random up te a Bristol working days Urinary N Methyl Histamine CC 24 hour Up to 28 days Urinary Organic ac
76. de Page 83 of 137 Placental swab Placental swab taken post delivery Rectal swabs Taken via a proctoscope Fluids and pus These are taken from the fallopian tubes tubo ovarian and Bartholin s abscesses etc during surgery INTRAUTERINE CONTRACEPTIVE DEVICES IUCDS The presence of an IUCD may be associated with Pelvic Inflammatory Disease PID or salpingitis Infections of the upper genital tract are commonly referred to as pelvic inflammatory disease PID and are often accompanied by fever leucocytosis dyspareunia intra menstrual bleeding and chronic pelvic pain National Guidelines recommend that lUCDs are only cultured when supported by relevant clinical details i e PID or other inflammatory conditions If this information is not provided the specimen will be rejected and not investigated Health Protection Agency The investigation of genital tract specimens BSOP 28i4 1 Issue 4 1 Issue date 03 05 2005 SPUTUM BRONCHOALVEOLAR LAVAGE BAL COUGH SWABS Do not collect shortly after the patient has been drinking eating or cleaning the teeth Remember that prior antimicrobial therapy may prevent the isolation of respiratory pathogens Importantly please indicate if the patient has bronchiectasis cystic fibrosis ciliary dyskinesis is immunocompromised or on steroids The material required is soutum from the lower respiratory tract expectorated by deep coughing When the cough is dry physiotherapy postural d
77. de Page 81 of 137 3 Department of Clinical Microbiology 3 1 Taking Specimens Specimens must where possible be obtained before antimicrobial agents have been administered If administered please ensure they are stated in the Clinical details section of the request form An adequate quantity of material should be obtained for complete examination Always send pus rather than a swab of the pus volume allowing The specimen selected should be representative of the disease process e g material swabbed from the opening of a sinus tract is more diagnostic than material obtained by curettage or biopsy of the base of the tract Scrupulous care must be taken to avoid contamination of the specimen by the micro organisms normally found on the skin and mucous membranes Sterile equipment and aseptic technique must be used for collecting specimens particularly those from normally sterile sites Material must be forwarded promptly to the laboratory Swabs for culture and sensitivity must be placed in transport medium and swabs for MRSA screening should be submitted using the red topped Transwabs no transport medium Please contact the laboratory if there is any doubt about the best specimen to take or concerning the availability of a test 3 2 Cultures Microbes take time to grow The final results of cultures and antimicrobial susceptibility tests may take from 24 hours for urine specimens to many weeks for mycobacterial culture Viral
78. de normal laboratory hours are FBC film in exceptional cases eg Malaria ESR IM Screen Sickle Screen Retics Basic Coagulation screen reason for D Dimer must be stated DVT PE amp DIC Group amp screen Crossmatch and blood product component issue Additional tests eg Factor VIII assay available by arrangement A few tests are only available by agreement with a Consultant e g cell markers Available tests are listed in the Pathology repertoire table with additional advice 2 2 Reporting Telephoning Results which are markedly abnormal will always be telephoned Most standard GP test results are available on the next working day Certain tests are done in weekly batches and others are referred to other centres and will therefore take longer to report see Pathology repertoire table Inpatient results for standard tests e g FBC amp Coagulation will usually be available within two hours of laboratory receipt INR results are reported to GPs via GP link by 1830 on the day of receipt provided the request is received by 1630 As a safeguard all INRs over 5 are automatically telephoned and verbally communicated by laboratory staff to the relevant surgery or Serco Kernow Urgent Care Services as appropriate Telephone requests for results should be avoided whenever possible Surgeries are asked to check their IT systems before telephoning the lab Where an urgent telephone request for an essential individual
79. e Thrombophilia screening should be performed when a patient is stable unless Clinically urgent even if on Warfarin as results can be unsatisfactory if performed close to an event due to the acute phase response Investigation at the time of thrombosis may be invalidated by the acute phase reaction and also anticoagulants Rarely does this information affect acute management but if essential screening can be done after 2 3 months even on warfarin Completion and submission of a Thrombophilia Investigation Sheet and sent with accompanying samples will soeed appropriate testing and return of results please contact lab directly on 01872 25 2502 if a copy is required All thrombophilia results outside normal ranges are referred to Consultant Haematologist for review 2 11 Screening for Lupus Anticoagulant Current guidance recommends testing for lupus anticoagulant only in patients e Vascular thrombosis arterial thrombosis venous thrombosis or vasculitis e Unexplained pregnancy morbidity e Investigation of raised APTT Thrombosis Prevention Investigation And Management Of Anticoagulation Guidance Pathology User Guide Page 68 of 137 2 12 Anticoagulant Control Most routine anticoagulant care is undertaken by general practitioners There is a medically supervised anticoagulant clinic operating from 0900 hrs to 1130 hrs each Wednesday which is run by the DVT clinic 01872 253597 Complex cases or patients whose anticoa
80. e are clearly labelled for Cytology Pathology User Guide Page 110 of 137 APPENDIX 4 WEST CORNWALL HOSPITAL 1 RCH Pathology supports Point of Care testing POCT services at WCH hospital for the testing and management of patients where on site analysis is required Pathology staff regularly visit to check the performance of the POCT analysers and to provide back up stock control training and trouble shooting services to the on site users 2 POCT tests available at WCH TnT D dimer CRP Blood gases Creatinine Urea FBC Glucose 3 Regular 24 7 routine transport is available to support the analysis of a full range of testing on the RCH site There is also a transport facility for urgent analytical requirements outside of the routine transport times Pathology User Guide Page 111 of 137 APPENDIX 5 REFERENCE FACILITIES All departments refer some specimens for primary or secondary testing to reference facilities This list whilst not comprehensive gives details of the primary facilities used 1 CLINICAL CHEMISTRY e Analytical Toxicology Lab The Academic Centre Llandough Hospital Penarth CF64 2XX e Clinical Biochemistry Dept Bristol Royal Infirmary Marlborough Street Bristol BS2 8HW e Clinical Chemistry Medical Oncology Ground Floor Assay Laboratory Charing Cross Hospital Fulham Palace Road London W6 8RF e Clinical Biochemistry Dept City Hospital Dudley Road Birmingham B18 7QH
81. e laboratory working hours must be made to the Consultant on call for Clinical Chemistry 1 3 Results by Telephone The phoning 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 issued by the Royal College of Pathologists document number G025 Nov 2010 Other results such as those of tumour markers and endocrine requests are reviewed by Clinical Biochemists and phoned at their discretion Without knowing the full clinical picture or relevant clinical details the significance of the results is often difficult to judge The Clinical Biochemists use their clinical judgement and the information available to decide whether to ring a result to the requesting physician but cannot guarantee or be held responsible for ringing all clinically significant results If results are requested by phone it is important to only use extension 2540 or 2548 Direct dial is available by prefixing these numbers with 01872 25 1 4 Clinical Liaison and Test Protocols Specialised tests including dynamic test procedures require the specimens to be collected in the correct manner Test protocols for most diagnost
82. ed by Un to 5 Calprotectin CC Faecal Sample Gastroenterology and pio ae working days Paediatrics Carbamazepine same as Anti epileptic Trough pre Tegretol Re Gold dose sample required AES Carcinoembryonic Antigen CEA CC Gold up to 4 hrs Cardiolipin See Anti Cardiolipin 2ml HAEM Gold 11 21 days Derriford Carnitine CC Li Hep up to 28 days Sheffield Childrens Catecholamines Blood CC See metanephrines up to 28 days Des 5 10mI CMB Gold 10 days PHE Bristol Bartonella Pathology User Guide Page 21 of 137 Which tube Pathology User Guide Page 22 of 137 Specimen Test or Suspected Seine E Note mix purple Turnaround Referred for E volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time H order n a i ab asap to prevent see Reference Facilities blank information for details clotting Only on Consultant RA An PABM purple Haematologist referral CD 59 2x4ml HAEM Purple x2 Only on Consultant Within 24 hrs Haematologist referral Only on Consultant Cell Markers 4x4ml HAEM Purple x 4 Haematologist referral Within 24 hrs Chlamydia trachomatis CMB Heng male See Virology section for more avs detection Swab female details y Chlamydia trachomatis serology 5 10ml CMB Gold Only used for Fertility testing 1 week PHE Bristol Chitotriosidase CC EDTA Only on known Gaucher cases up to
83. ed to monitor H Pylori antibodies arth MB cor response to treatment odave Hepatitis A serology 5 10ml CMB Gold Indicate whether immunity 5 days Pathology User Guide Page 32 of 137 Which tube Specimen Test or Suspected EAS E Note mix purple Turnaround Referred for gt A volume Which E testing to infection in alphabetical n aif Lab pink or blue tubes Remarks Time ra order blank asap to prevent information for details clotting screen or diagnostic test is required Screening test for HBV 4 days Hepatitis B surface antigen 5 10ml CMB Gold infection Urgent testing same day for available contact laboratory urgent tests Hepatitis B immunity 5 10ml CMB Gold Give vaccination details 9 days ae P DNA detection viral 5 10ml CMB Gold At request of Hepatologist 10 days Micropathology Antibodies not normally Hepatitis C Antibody status 5 10ml CMB Gold detectable for up to 3 months 4 days after date of onset Hepatitis C RNA detection viral load 5 10ml CMB Gold 7 days Hepatitis C Genotype 5 10ml CMB Gold At request of Hepatologist 10 days TREA E a Performed routinely in acute Hepatitis E IgM 5 10ml CMB Gold hepatitis ALT gt 400iu ml 5 days Swab from base of lesion or Herpes simplex virus PCR CMB UTM swab vesicle id neas 3 days Check with Haematology Lab Special NHSBT form required 3 zi HAEN prior to sending available from lab qe S
84. entrifuged up to 28 days Kings Pathology User Guide Page 55 of 137 APPENDIX 2 LABORATORY MEDICINE 1 Department of Clinical Chemistry Service details 1 1 Routine Requests Monday to Friday most biochemical investigations are completed and reported on the day of receipt A limited service is available on Saturday mornings and Bank holidays An out of hours service for emergency cases operates at all other times 1 2 Urgent requests During normal laboratory hours Contact a member of the laboratory staff on extension 2547 to arrange for the analysis to be performed urgently Requests for urgent tests cannot be handled on other telephone lines Writing urgent on the request form will not guarantee that the specimen will be handled as an emergency Outside normal laboratory hours including Sundays The service operates for EMERGENCY requests only The on call BMS must be contacted through the Hospital switchboard Results breaching our phone limits for urgent tests will be telephoned to the ward when they are available Out of hours test repertoire e Electrolytes Creatinine Urea CRP LFTs Serum and Urine Osmolality Calcium Blood gases and acid base status Glucose CSF Protein and Glucose Amylase Salicylate Paracetamol Magnesium Ethanol TnT HCG from Obs and Gynae CSF Xanthachromia 10 00 15 00 Sat Sun Pathology User Guide Page 56 of 137 Requests for other tests outsid
85. ervice The British Andrology Society recommends that patients should be instructed to ensure that they have had at least 24 ejaculations and preferably wait at least 16 weeks before submitting a first semen sample for examination This will reduce the number of false positive samples and thus minimise both patient inconvenience and repeat laboratory assessment Patients should be given a further collection container and instructed to produce a second ejaculate for examination at an interval of two to four weeks after the initial assessment A patient is usually considered clear after two following negative results Reference British Andrology Society Guidelines for the assessment of post vasectomy semen samples 2002 J Clin Pathol 55 9812 816 Results will be reported as positive sperm seen or negative We have been advised that qualitative assessments of spermatozoa should not be used as they are not based on published data However a comment will still highlight if normal numbers or any motile ones are present 2 7 Coagulation Screening Appropriate requesting of Coagulation screening includes e Monitoring coagulopathy associated with massive blood transfusion Investigation of DIC Haematemesis significant Liver disease Patients having renal and liver biopsies and ERCP Investigation of a patient with a significant history of bleeding bruising When there is a significant family history of a congenital bleeding disorder If D
86. etails clotting 1200hrs Requested via Friday Infection Control Teams or HPU only Up to 8 days i Please state which form of HRT unless Oestradiol 5 10ml CC Gold patient is on requested urgently Oligoclonal bands see CSF cc Oligoclonal bands Ovarian antibodies 5ml HAEM Gold Up to 28 days Derriford Paraneoplastic antibodies 2ml HAEM Gold Up to 28 days Derriford Parasites Microscopy CMB Fecon container Minimum Cherry sized portion 24h Further information FAECES Parathyroid Hormone PTH nmoll CC Gold ea processed within 4 In to 4 hrs Slapped Cheek Must state date of onset and Parvovirus B19 Antibody studies CMB Gold Clinical details supporting 7 days PHE Bristol diagnosis e g rash arthritis hydrops foetalis Paul Bunnell Glandular fever test IMS Infectious 4ml HAEM Purple 24h Mononucleosis screen Peptide Histidinemethionine CC Special Li Hep containing Trasylol up to 28 days Phenylalanine CC Green a o up to 28 days Southmead Philadelphia Chromosome HAEM 2 x EDTA Haem consultants only 11 21 days Derriford Phlebovirus 5 10ml CMB Gold 10 days PHE Porton Down Pathology User Guide Page 41 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for a volume Which testing to infection in alphabetical naif Lab pink or blue tubes Remarks Time RB e Ee order blank asap to prevent informati
87. f Wales Heath Park Cardiff CF14 4XW e Micropathology Ltd University of Warwick Science Park Barclays Venture Centre Sir William Lyons Road Coventry CV4 7EZ e Microbiology Royal Devon amp Exeter Hospital Wonford Church Lane Heavitree Exeter EX2 5AD e Microbiology Derriford Hospital Derriford Plymouth PL6 8DH e Leptospira Reference Unit Dept of Microbiology amp Immunology The County Hospital Hereford HR1 2ER e Leeds and Bradford Microbiology Bridle Path York Road Leeds TS157TR e Microbiology Aintree Hospital Foundation Trust Lower Lane Liverpool L9 7AL e Meningococcal Reference Unit Manchester Medical Microbiology Partnership 2nd amp 3rd Floors Pathology User Guide Page 114 of 137 e Clinical Sciences Buildings Central Manchester and Manchester Children s University Hospital Trust Manchester Royal Infirmary Oxford Road Manchester M13 9WL e Public Health England Special Pathogens Reference Unit Porton Down Salisbury Wilts SP4 0JG e Preston Microbiology Services Royal Preston Hospital PO BOX 202 Preston PR2 9HG e Public Health England Southampton Laboratory Level B South Laboratory Block Southampton General Hospital Southampton S016 6YD e Microbiology Department Singleton Hospital Swansea Wales SA2 8QA e Department of Parasitology The Hospital for Tropical Diseases Mortimer Market Tottenham Court Road London WC1E 6JB e Mycobacterium Reference Unit amp Regional Ce
88. f passage Hot stools should be examined within 30 minutes for the presence of trophozoites to confirm a diagnosis of Amoebic dysentery After 30 minutes cysts will form and this diagnosis cannot be confirmed Unformed semi formed and liquid faecal specimens submitted from General Practice will undergo a direct examination for Giardia and Entamoeba Clostridium difficile Testing for Cl difficile will only be undertaken on the following groups of patients All in patients gt 2yrs GP patients gt 2yrs with e Pseudomembranous colitis Ulcerative colitis Antibiotic associated diarrhoea On antibiotics Neutropenia with semi formed unformed liquid faeces e As part of an outbreak e Semi formed unformed liquid specimens from patients gt 65yrs of age e When requested Vibrio species Tested if clinical details state e Travel to a specified country from one of the following continents Asia Africa South America Caribbean Central America and Eastern Europe in three weeks prior to specimen submission e Amention of seafood consumption e Or if a specific request is made by telephone to perform this test Enteric clearance of pathogens The microbiological screening of faeces specimens for clearance of pathogens is considered unnecessary except in infections with Salmonella typhi paratyphi amoebic dysentery and Shigella dysenteriae serotype 1 and Vero toxin producing E coli 0157 All but the last of these organisms are very rare in Co
89. g event Must be handwritten with patient s Kleihauer 6ml BT Pink forename surname DoB 24 hrs gender unique identifier NHS or CR number date amp time of sample and sample taker s signature Taken to lab immediately on Lactate CC Grey ICE lt 10 minutes up to 4 hrs Lactate Dehydrogenase LD Samples stored at 4c are LDH a os Gola unsuitable for analysis U A Consult medical microbiologist Lassa fever CMB E and inform CCDC immediately upon diagnosis LD Lactate Dehydrogenase 5 10mi CC Gold ae om y up to 5 w LD isoenzymes 5 10ml CC Gold days Lamotrigine CC Green SST EDTA Trough sample up to 28 days NSE Pathology User Guide Page 36 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for a a volume Which A testing to A lo ella reveal n aif Lab IS MME see Reference Facilities order blank asap to prevent information for details clotting Lead CC Purple up to 28 days Derriford Leg ulcer swab CMB Charcoal swab Further ulcer swab information 3 days Legionella sputum lung biops Culture may still be successful ae erie e a y CMB Universal container after antimicrobial therapy up to 7 days gS P commenced ieaionela Urinary Antigen Sterile urine Positive for up to 10 days ida y g CMB container NOT This test replaces blood 1 days boric serology Positive in visceral Hospital for Tropical
90. gulant care is difficult to control may be overseen by Dr Creagh arrangements made by telephone ext 2501 2506 2524 or by writing or faxing his secretary fax on 01872 253237 Thereafter follow up anticoagulant control is generally offered via a postal service INRStar computerised dosing system for warfarin treated patients or the DOH Gold card scheme for non warfarin treated patients The INR sample is obtained by the surgery and sent in with the INRStar dosing sheet or the DOH Gold Anticoagulant Therapy Record Adjustments to dosage are made and the new INRStar dosing sheet or Gold card returned directly to the patient Please note that for samples on Friday the patient may only receive the returned dose schedule on the following Tuesday Those surgeries wishing to undertake performing their own INRs should contact the coagulation laboratory who will be pleased to offer an INR Point of Care advisory and monitoring service Therapeutic ranges for anticoagulation BCSH Guidelines on oral anticoagulation warfarin third edition 2005 update 2 13 Advice on Results For medical opinion on results or advice on patient management it is usually possible to speak to one of the Consultant Haematologists during working hours via the medical secretaries For urgent consultation out of hours please contact the switchboard 2 14 Outpatient Referrals Please write directly to the consultant for new outpatient appointments Waiting times a
91. gy User Guide 5 10ml CMB Gold Give clinical Page 44 of 137 10 days PHE Porton Down details travel exposure history Which tube Specimen Test or Suspected Senn AS a Note mix purple Turnaround Referred for einer E volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time PH order n a i ab asap to prevent see Reference Facilities blank A information for details clotting Rivotril Clonazepam CC Se up to 28 days NSE Ross River 5 10ml CMB Gold 10 days PHE Porton Down Paediatric patients lt 5yrs l outbreaks and other groups Rotavirus CMB Fecon container after discussion with 24 hrs Laboratory Respiratory ear to Friday tested by RSV Respiratory syncitial virus CMB secretions NPA Weakend lt 24 hrs preferred immunochromatographic strips Indicate whether immunity Rubella Antibody studies i 3 German measles 5 10ml CMB Gold screen or diagnostic test is 3 days required SS 4ml HAEM Purple 48 hrs Urine steril If infection suspected send 3 x Schistosomiasis CMB bore ioe urine samples tia di Sent ec Faeces Fecon Schistome serology may be seas p container helpful discuss with 2 weeks Serum Gold laboratory Discuss with Consultant Schuum s test 4ml HAEM Purple Haematologist Selenium CC Gold up to 28 days Sheffield Sickle cell test Sickle screen 4ml HAEM Purple 24h
92. gy User Guide CHA2590 Page 9 of 137 5 7 6 Cervical Cytology NHSCSP HMR 101 5 forms are available from Cytopathology department or printable versions are available from the Open Exeter system If printing choose the A5 format If using A4 paper select portrait printing format prior to printing 5 7 7 Routine Diagnostic Cytology and Histology Routine Diagnostic Cytology and Histology samples can be requested using a yellow headed Diagnostic and Molecular Pathology Request Form 5 7 8 Urgent Diagnostic Cytology and Histology For Urgent diagnostic Cytology or Histology these can be stated on the request form by ticking the appropriate box in the bottom left hand corner of the request form 5 7 9 Samples for 2 week wait Samples for 2 week wait Cancer patients can be requested using 2 week wait orange headed forms 5 7 10 NHS request forms are available from RCHT Supplies for hospital bases Histopathology Department for Bodmin Treatment Centre Histopathology Department for Dental Surgeries 5 7 11 Blood samples should be sealed in the attached bag and stored according to instructions on the reverse of the form also see advice on A Z of Services webpage Please keep urine specimens Liquid Base Cytology Specimens and anything containing Formalin separate from bloods in order to avoid contamination issues 5 7 12 The laboratory computer uses the patient s hospital number or the NHS number as the file accession
93. ic procedures are obtainable from the laboratory The Clincial biochemists are available for discussion on the choice of tests and the interpretation of results For specialist clinical advice contact the Consultant Chemical Pathologist Some tests require special analysis which is only available at reference laboratories Many of these analytes are unstable and it is vital that specimens be collected in the appropriate manner Such tests should always be arranged in advance with the laboratory to avoid the unnecessary repetition of invasive procedures If the services of the department are required in a research project or a drug trial it is essential that the protocol is discussed with the head of department Dr SC Fleming before the project is started 1 5 Urine specimen requirements and preservatives Please Note some of the preservatives used are hazardous Please ensure patients adhere to the instructions on collection bottles Adding specimens directly to containers is not acceptable Pathology User Guide Page 57 of 137 Phosphate 20 ml M Hydrochloric Acid Oxalate or Citrate 24 hour 20 ml 5M Hydrochloric Acid or Cystine 5 HIAA 20 ml 5M Hydrochloric Acid 24 hour or random Creatinine 10 ml Thymol in Isopropanol 24 hour or random Urea 10 ml Thymol in Isopropanol 24 hour or Protein 10 ml Thymol in Isopropanol random Catecholamines Overnight 2g EDTA Metabisulphite Metanephrines 24 hour 20 ml 2M Hydro
94. ids CC Random Freeze same day Up to 28 days Southmead Urinary Osmolality CC Random With a paired blood sample Up to 4 hours Urinary Oxalate CC 24 hour Order bottle from Chemistry Up to 28 days UCL Urinary pH CC Random Up to 4 hours Urinary Porphyrin amp or cc andoni a a a E Up to 5 Local PBG screen 8 Porphobilinogen PBG asap Give full clinical details working days Cardiff Pophyria Lab Urinary Protein CC 24 hour Order bottle from Chemistry 24 hrs Urinary Protein Creatinine ratio Random CC Random Up to 4 hours Urinary Reducing Substances CC Random Up Ue gt working days aed ne Binding protein CC Random Freeze same day 1 2 weeks GOSH reatinine ratio Random Urinary Sodium CC Random Up to 4 hours Full steroid profile for Paediatric or complicated Endocrine cases E Plain a hour oror only Order bottle from Urinary Steroids Full profile CC children plain Chamisir 4 weeks random SY If Cortisol only wanted see Urinary Free Cortisol UFC Urinary Urate CC 24 hour Order bottle from Chemistry 24 hours Random Urinary Urate CC Random up to 4 hrs Pathology User Guide Page 52 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for a a volume Which testing to A login ree naif Lab IS AGI MME see Reference Facilities order blank asap to prevent information for details clotting Urinary Urea and Creatini
95. information for details clotting 1 25 Dihydroxy Vitamin D CC Li Hep or Red Top send immediately to laboratory up to 28 days Southampton 25 Hydroxy Vitamin D 250ul CC Gold up to 14 days Derriford 5 HIAA Plasma CC e EL Hep Contact lab up to 28 days Leeds i Early morning sample adult 17 OH Progesterone 250ul CC Gold female follicular phase up to 28 days Southampton l a Must pre arrange with Abacavir sensitivity HAEM EDTA Immunology Up to 28 days Acanthamoeba CMB 7 days Tropical Medicine Acetyl Choline Receptor 2mI HAEM Gold 11 21 days Derriford antibody Actinomyces culture CMB IUCD Clinical details must state PID 10 days Pathology User Guide Page 13 of 137 Which tube Specimen Test or Suspected EAS E Note mix purple Turnaround Referred for gt A volume Which E testing to infection in alphabetical pink or blue tubes Remarks Time PY order naif Lab asap to prevent see Reference Facilities blank PIOR information for details clotting or other inflammatory conditions a Blood spots on Acyl Carnitine CC Guthrie card up to 28 days Southmead Paediatric patients lt 5yrs Adenovirus enteric CMB Fecon guibreaka and other groups 24hours after discussion with Laboratory Adverse reactions 2m HAEM Gold up to 28 days anaphylactoid Adrenocorticotrophic hormone Preferably 9am sample with a ACTH CC Purple cortisol request up to 28 days Southa
96. is The specificity of a positive c or p ANCA is determined by measuring proteinase 3 PR3 and myeloperoxidase MPO antibodies which are the major target antigens respectively In the case of a c ANCA occasionally a MPO specificity can be found These tests are automatically performed by the laboratory when a c or p ANCA is detected Further information on the Immunology service can be obtained by contacting e Nigel Oakes on extension 3040 RCH e Dr Claire Bethune Consultant Clinical Immunologist for Clinical advice Tel Ext 52406 Derriford Hospital e Paul Cooper for Laboratory advice results Tel Ext 52293 Derriford Hospital Histocompatibility testing Tissue Typin The Immunology laboratory at Derriford Hospital performs molecular typing for HLA A B C DR and DQ genes HLA allo antibody screening and indentification together with lymphocytotoxic and flow cytometric crossmatching are available for the renal transplant programme Contact the laboratory for further information Tel Ext 52390 2 29 Molecular Biology Tests The molecular biology section at Derriford Hospital offers a range of tests useful in the diagnosis and monitoring of disease progression in patients with various haematological malignancies as well as some genotyping tests for coagulopathies and hereditary haemochromatosis These are all polymerase chain reaction PCR based tests that require purified DNA or RNA The table below shows the tests curre
97. is essential that the reference laboratory receive the specimen no later than 3 hours from the time the specimen was taken The biopsy must be placed in sterile gauze soaked with normal sterile saline The gauze must then be placed in a sterile universal pot and transported to the RCHT Histopathology laboratory immediately with a covering letter for the reference laboratory containing full patient details soecimen details and tests requested The histology lab will then package the specimen to wait for collection by the arranged courier It is important that the histology laboratory has at least 24 hours notice to arrange correct packaging for any biopsy that is to be sent to another hospital 9 3 Additional Immunohistochemistry not available at RCHT is referred to UCL The slides are returned and interpreted by RCH histopathologists 9 4 Her2 requests The Her2 service is provided by the Molecular Cell Biology Unit MCBU to the five hospital sites within the South West Peninsular network RCHT Derriford Exeter Torbay and Barnstaple A Her2 request form must be filled in by a secretary within one of these five sites upon request by a consultant pathologist The forms are available as an electronic document from the RCHT Diagnostic and Molecular Pathology Office The request form should then be sent with the appropriate paraffin wax block to the Histopathology secretaries within the RCHT site Diagnostic and Molecular Patholog
98. ised plate which has a very short shelf life Providing us with relevant information will allow us to eliminate these bacteria from our investigations If no travel information is noted from these specimen types we will assume that these agents are not responsible for infection and will not culture for them 3 3 2 MYCOLOGY The laboratory offers a mycology service in addition to serological tests listed in the table at the end of the handbook Collection of samples for mycology culture Skin Send enough material for both microscopy and culture At least 5mm of skin flakes are required Swabs are of no value for the investigation of dermatophyte infections Nails and hair Nail clippings should include the full thickness of the nail and extend as far back from the edge as possible Hair should be plucked from affected areas together with skin scrapings from associated scalp lesions please note cut hair shafts are inappropriate Hair Hair should be plucked from affected areas together with skin scrapings from associated scalp lesions please note cut hair shafts are inappropriate 3 3 3 VIROLOGY The Virology department performs serology detection of viral and bacterial antigens and an increasing menu of molecular tests Virus culture has been replaced by these non culture methods and is no longer available Details of specimen selection test modality and turnaround times are given in Table 1 of this guide The following is a
99. ital Bristol Vancomycin and Gentamicin analyses are available daily with a turnaround time of approximately 2 hours during normal working hours Monday to Friday and within 4 hours on weekends and Bank Holidays Tobramycin analyses are also performed on site This is test is performed on demand All other antibiotic requests will be referred to Southmead Hospital for analysis It is important that the guidelines found in the Antibiotic Policy and on the Intranet are followed with regard to dosing and sampling times 1 10 Down s Syndrome DS Screening Service 1 10 1 DS Screening First Trimester Combined Test Pathology User Guide Page 61 of 137 All pregnant women booking before 12 weeks are offered screening in the first trimester of pregnancy using the Combined test this involves nuchal translucency NT measurement fluid present in all fetuses at the back of the neck at the time of the dating scan and blood taken for free B hCG and PAPP A measurement Written information is sent to women in advance of the booking appointment The booking midwife requests an early dating scan At the Early Dating Scan appointment the patient is asked if she wants to have the blood test for DS screening If she does she is scanned and the NT measurement is taken N B women not requiring DS screening just have the early dating scan The woman then has blood taken 1x SST buff top tube by the phlebotomist and is weighed The te
100. iu ml are investigated for Hepatitis A and E in addition Please contact the laboratory directly to discuss the need for any additional tests Positive hepatitis serology will normally be confirmed with additional tests which may delay the issuing of a final report Chronic hepatitis B or C may be treated with antiviral drugs The response to therapy is monitored using quantitative molecular techniques see viral load section Please contact the laboratory to arrange these studies Immunity to hepatitis B following vaccination is determined by measuring anti HBs antibody Details of vaccination history are required to interpret the results of this test and should accompany all requests We routinely test non responders to hepatitis B vaccine for evidence of previous hepatitis B infection using an anti HBc assay HIV Serum from patients at risk or with suspected HIV infection is tested using a 4th generation ELISA for HIV 1 and 2 antibodies and p24 antigen A same day testing service is available after discussion with the laboratory Reactive samples are referred to a specialist laboratory for confirmation which may take a week Note that antibodies may not be present in recently acquired infection the window period and re testing 3 months post exposure is required to conclusively exclude infection Further advice on HIV testing is available from the laboratory or Department of Genitourinary Medicine Influenza and other re
101. ld up to 4 hrs Stable for up to 7 days if Cases aie Anibodies 2ml HAEM Gold refrigerated maximum time for 1 2 wks Derriford ytop add on tests Androstenidione 500m ICC Gold Take in morning 1 2 wks Southampton Must stop ACE inhibitors 24 36 Angiotensin Converting enzyme 250ul CC Gold hours prior to blood sampling 2 weeks Torquay Must be handwritten with patient s forename surname Antenatal group amp antibody DoB gender unique identifier screen onl a fs NHS or CR number date amp eevee time of sample and sample taker s signature Antenatal Haemoglobinopathy To be sent in with DH Family a cerca 3ml HAEM Pink Origin Questionaire 3 days Torbay if positive Stable for up to 7 days if Anti Cardiolipin antibodies 2ml HAEM Gold refrigerated maximum time for 11 21 days Derriford add on tests Anti Cholinesterase antibodies 2ml HAEM Gold Up to 28 days Derriford Anti Cyclic Citrullinated Protein Done ACCP 5 10ml CC Gold Rheumatology request only fortnightly Anti DNA 2ml HAEM Gold 11 21 days Anti DS Double stranded DNA 2m HAEM Gold Not directly requestable added 14 54 gays Derritord on at lab s discretion Pathology User Guide Page 16 of 137 Which tube LMWH Specimen Test or Suspected EPS Note mix purple Turnaround Referred for a a volume Which A testing to A velar ea naif Lab PS YAGI MME see
102. less the leucocyte count is raised gt 5wbc x 10 6 L SKIN WOUND AND VENOUS LEG ULCERS SWABS Always state the site and nature of the wound on the request form This is essential as it dictates method of investigation and interpretation of results If a collection of pus is present aspirate this material with a sterile syringe and needle and transfer to a sterile universal container Do not send specimens from the same wound on consecutive days as this is a waste of valuable resources Routine processing of superficial swabs of ulcers should be discouraged Swabbing dry crusted areas are unlikely to be helpful Royal College of Nursing guidelines The management of patients with venous leg ulcers Clinical Practice Guidelines 1998 indicate that processing leg ulcers should only occur if supported by relevant clinical details as indicated on Pathology User Guide Page 90 of 137 the form as evidence of clinical infection i e inflammation redness cellulitis increased pain purulent exudates foul odour rapid deterioration of the ulcer or pyrexia Corynebacterium If submitting a wound swab from a patient who has travelled abroad where they may have obtained an insect bite please include details of this in the clinical details section of the request form The bacteria Corynebacterium diphtheriae and Corynebacterium ulcerans can cause cutaneous diphtheria by colonising these bite sites These are cultured on a special
103. lls with a typical curved shape like a sickle and found in sickle cell anaemia Spherocytes Red cells that are more spherical than biconcave These cells have lost some membrane without losing any of the cell content Present in most forms of haemolysis in hyposplenism and in hereditary spherocytosis Target cells Appear as the name suggests Target cells are most often associated with liver disease iron deficiency and the haemoglobinopathies 2 19 2 White cell morphology Abnormal Lymphocytes Lymphocytes with morphology that is not normal and the cause is likely to be malignant If the cell line can be clearly identified these may be quantified as part of the white cell differential lymphoma cells hairy cells Hypersegmented Neutrophils Increased neutrophil lobulation This is often associated with megaloblastosis B12 or Folate Deficiency or drug induced and may be seen in reactive states Left shift to the Neutrophils This refers to a reduced number of lobes and is associated with immaturity In infection is often seen together with toxic granulation Pelger Huet Anomaly A form of reduced neutrophil lobularity Reduced lobulation of the neutrophils not associated with immaturity May be Pathology User Guide Page 73 of 137 inherited or seen as a consequence of myelodysplasia or after treatment with cytotoxic drugs Plasmacytoid Lymphocytes These lymphocytes are intermediate between the lymphocyte stage and the an
104. mber 01872 25 4966 Specimens should be placed inside the bag attached to the request form Bulky specimens should be placed inside a large polythene bag tied at the neck with the form attached to the outside 5 8 3 If samples are not transported by the hospital courier service it is the responsibility of the requesting doctor to ensure that appropriate packaging is used to contain spillage in the event of an accident and that samples requests are taken directly to the laboratory concerned under conditions which protect their integrity 5 8 4 Occasionally patients deliver their own samples under direction from the requesting clinician in which case all due care and attention must be given to the safe containment of the specimen and also protection of sensitive data Data Protection Act 5 8 5 Infectious samples Due to the introduction of universal precautions in Pathology it is no longer a requirement to use Danger of Infection labels However the nature of any infectious or potential infectious agent must be given in the clinical details 5 9 Reference Facilities All departments refer some specimens for primary or secondary testing to reference facilities The lists at Appendix 5 whilst not comprehensive give details of the primary facilities used 6 Dissemination and Implementation 6 1 All users of the Laboratory Service will be informed by email that the policy has been updated and where it can be located via the Docume
105. ml CC Gold glucose result lt 2 5mmol L up to 28 days Southampton Insulin Antibodies HAEM Contact Lab up to 28 days Insulin like growth factor ILGF1 CC Gold or LiHep up to 28 days Southampton Insulin like growth factor binding Red no gel Paeds protein 3 ILGF BP3 o9 clear top Up 10 25 Gaye UNIONS Intrinsic factor 2ml HAEM Gold lonised Calcium 5 10ml CC Gold up to 4 hrs Iron Transferrin and Iron Sawiralion 5 10ml CC Gold up to 4 hrs Routinely measure ferritin Iron stain HAEM Purple unless clinical details support Within 24 hrs request Iron Studies Ferritin 5 10ml CC Gold If require Iron amp Iron Saturation up to 4 hrs Pathology User Guide Page 35 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for T volume Which testing to infection in alphabetical pink or blue tubes Remarks Time ae order naif Lab asap to prevent see Reference Facilities blank ROR information for details clotting please specifically request Islet cell antibodies HAEM Gold Up to 28 days Itraconazole 5 10ml_ CC Gold Red up to 28 days Royal Brompton Only by Consultant oe am PAE rne Haematologist referral JC Virus 5 10ml CMB Gold and CSF Discuss with Laboratory 10 days VRD Colindale Kaolin clot time 3ml HAEM Blue Specialist lupus screen test 2 wks The maternal sample should be taken 30 45 minutes after the sensitisin
106. mpton Adrenal antibodies 2ml HAEM Gold Up to 28 days Alanine Amino Transferase l ALT or ALAT 5 10ml CC Gold Part of Liver Profile up to 4 hrs R Par over ana Bone 5 10ml CC Gold Part of Liver and Bone profiles up to 4 hrs Must record time of collection Alcohol Ethanol CC Grey or Gold Gold top received in lab asap up to 4 hrs Take to lab asap Diurectics B blockers ACEi amp f Calcium channel blockers A if aldosterone discontinued for 2 weeks before only sampling treatment with aleoprerone TOOU ae EDTA if require aldosterone antagonists e g up to 28 days Southampton renin too spironolactone oestrogens must be discontinued for at least 6 weeks Adequate sodium potassium in diet Alkaline Phosphatase 250ul CC Gold Part of Liver and Bone profile up to 4 hrs Pathology User Guide Page 14 of 137 Which tube Sample Sat Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround esa to O IE naif Lab Bose o CS us see Reference Facilities order blank asap to prevent information for details clotting Alkaline Phosphatase ae up to 5 isoenzyme 250ul CC Gold Measured if ALK Phos is high working days Alpha 1 Antitrypsin Phenotype 2 mL CC Gold up to 28 days BRI Alpha 1 Antitrypsin Genotype CC Purple Send whole blood up to 28 days Sheffield PRU Alpha 1 Antitrypsin in Faeces CC Fresh and freeze up to 28 days St George
107. n SO16 6YD e Department of Clinical Chemistry Southmead Hospital Westbury on Trym Bristol BS10 5NB e Analytical Unit Cardiac amp Vascular Sciences St George s Hospital Medical School Cranmer Terrace London SW17 ORE e National Society for Epilepsy Chalfont Centre for Epilepsy Chesham Lane Chalfont St Peter Bucks SL9 ORJ e Chemical Pathology Dept Torbay Hospital Torquay TQ2 7AA e Trace Element Reference Centre Department Clinical Biochemistry Robens Institute University of Surrey Guildford GU2 5XH e Dept Clinical Chemistry UCL Hospital 60 Whitfield Street London W1T 4EU e Maternal Serum Screening Laboratory Department of Clinical Biochemistry New Medical School Royal Victoria Infirmary Newcastle Upon Tyne NE1 4LP Pathology User Guide Page 113 of 137 2 CLINICAL MICROBIOLOGY e Public Health England Centre for Infections 61 Colindale Avenue London NW9 5ht e Antibiotic Resistance Monitoring Laboratory e Laboratory of Gastrointestinal Pathogens e Laboratory of Hospital Associated Infection e Gonococcal Reference Unit e Haemophilus Reference Laboratory e Streptococcus amp Diphtheria Reference Unit e Atypical Pneumonia Unit e Virus Reference Department e Public Health England Myrtle Road Kingsdown Bristol BS2 8EL Public Health England East of England Clinical Microbiology Addenbrookes Hospital Hills Road Cambridge CB2 2QW e Anaerobe Reference Unit University Hospital o
108. n terms 2 19 1 Red cell morphology Acanthocytes Red cells with a smaller number of irregular spicules Acanthocytosis may be inherited but is more commonly seen in liver disease myelodysplasia and post splenectomy Anisocytosis Increase in the variability of red cell size A non specific abnormality found in many haematological abnormalities suggestive of altered haematopoiesis Auto agglutination Red cells that are sticking together because of antibodies When reported on a blood film this normally refers to cold antibodies and is an in vitro effect Often seen in Cold Haemagglutinin disease Dimorphic Two distinct populations of red cells Most often seen when a haematological abnormality has been corrected as in the successful treatment of iron deficiency when a new population of normochromic normocytic cells will exist alongside the older hypochromic microcytic population Basophilic Stippling Red cell inclusions that contain RNA Generally seen in dyserythropoiesis and haemoglobinopathies Pathology User Guide Page 71 of 137 Echinocytes Red cells covered in short blunt spicules Echinocytes are a reversible change in red cells Most often occur as a result of storage of blood before a film is made Other causes are liver disease renal disease and haemolytic uraemic syndrome Elliptocytes Red cells that are elliptical instead of round Hereditary elliptocytosis is a result of a defect in the red cell cytoskeleton
109. name DoB gender unique identifier Cross Match 6ml BT Pink NHS or CR number date amp time of sample and sample taker s signature CRP CC Gold up to 4 hrs l Do not take on a Friday Keep lup to 5w Cryoglobulin for Cryoprotein CC Gold at 37 degrees C days Clinical details essential Cryptosporidum oocysts CMB Fecon container Further info crypto 2 days AI POLIO Sl Requires blood sample and CSF Oligoclonal Bands 0 5mL CC with paired blood csp P 10 days Derriford sample Gold CSF Microbiology CMB Universal container Phone if micro required urgently 1 hr CSF Microbiology Culture CMB Universal container Further info CSF link 48h CSF Microbiology Viral PCR CMB 7 days PHE Bristol CSF Chemistry for Protein and se Glucose 1ml CC Plain sterilin pot up to 4 hrs CSF Tumour Markers ai HCG AFP CC Plain sterilin pot For Pineal Tumours 28 days Charing Cross Should be 4 Sample delivered CSF Xanthochromia 1mL CC Plain 1o AD Dy ane Prorecren fom up to 24 hrs light asap Please state timing since onset of symptoms Pathology User Guide Page 24 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for a a volume Which testing to A E naif Lab IS IS MME see Reference Facilities order blank asap to prevent information for details clotting CSF Haematologi
110. ndice e Evidence of lymphoproliferative or myeloproliferative disease especially splenomegaly or lymphadenopathy Pathology User Guide Page 70 of 137 Evidence of haemoglobinopathy Evidence of thrombocytopenia Suspicion of disseminated intravascular coagulation Acute renal failure Retinal haemorrhage or evidence of hyperviscosity Bacterial viral or parasitic infection Disseminated cancer The decision to look at a blood film is dependent on age sex any relevant medical history previous FBC results or if a previous blood film has been reviewed If there is a clinical need for blood film review alert the laboratory by clearly stating the reason on the request form In the event of a request for blood film review arising after FBC analysis contact the laboratory directly up to 24hours after the sample was taken and it will be added to the request After this a fresh sample is required Correct storage of the sample prior to delivery to the laboratory is important as blood cells will start to deteriorate in just a few hours if exposed to heat Further tests are sometimes indicated as a result of blood film review Where possible the laboratory will instigate these directly otherwise advice for further testing may be included in the report To aid in interpretation a list of the more common technical terms used in the blood film report is included with explanation of the term and the most common causes 2 19 Morphological descriptio
111. ne CC 24 hour Order bottle from Chemistry 24 hours Only measured in cased of Valproate Sodium Valproate 5 10ml CC Gold suspected OD or non up to 2 weeks Torbay compliance Trough is immediately prior to l next dose Vancomycin 5 10ml CC Gold Peak t hauratierihednder IU to 4 hrs infusion Varicella Zoster diagnosis CMB UTM swab Swab lesion for VZV PCR 5 days PHE Bristol Varicella Zoster immunit 5 10ml CMB Gold pregnantor pee E if unity immunocompromised Give E A urgent contact date where appropriate Vasectomy post screen HAEM Universal 4 days VIP Vasoactive intestinal EDTA on ICE Part of Gut peptide 3mL CC EDTA hormone profile up to 28 days Hammersmith EDTA on ice Part of Gut Vasopressin CC EDTA hormone profile up to 28 days Purple Li Hep Very long chain fatty acids CC Paed clear top up to 28 days Southmead Clinical details essential Vibrio species CMB Fecon container country and dates of travel link 3 days to Further info Vitamin A CC Gold up to 14 days Derriford Vitamin D 25 OH Vitamin D CC Gold up to 28 days Derriford Vitamin E CC Gold up to 14 days Derriford Vitamin B12 CC Gold up to 4 hrs Pathology User Guide Page 53 of 137 Which tube Pathology User Guide Page 54 of 137 Specimen Test or Suspected ate Pe Which Note mix purple Turnaround Referred for infection in alphabetical a pink or blue tubes Remarks Time tes
112. ng test for myeloma is total serum immunoglobulins and electrophoresis and urinary Bence Jones protein The laboratory will automatically characterise and quantify any paraprotein found Differential diagnosis monoclonal gammopathy of undetermined significance Contact consultant haematologists for advice Rheumatoid arthritis Rheumatoid factors are found in 70 of patients with rheumatoid arthritis seropositive RA Another 30 of patients have rheumatoid arthritis but do not have rheumatoid factors seronegative RA Rheumatoid factors can also be found in patients with other connective tissue disorders Skin autoimmunity Pathology User Guide Page 79 of 137 Circulating basement membrane antibodies are found in pemphigoid and intercellular cement antibodies in pemphigus Thyroid autoimmunity Thyroid peroxidase antibodies are found in patients with autoimmune thyroiditis Hashimoto s 95 and Grave s 70 Thyroid stimulating hormones TSH receptor antibodies are found in 90 of patients with Grave s thyrotoxicosis Vasculitis Anti neutrophil cytoplasmic antibodies ANCA are found in patients with vasculitis but can be non specific The c ANCA pattern is associated with Wegener s granulomatosis and microscopic polyarteritis 85 while the p ANCA pattern is found less commonly in Wegener s and microscopic polyarteritis 10 but mainly in other vasculitides such as Churg Strauss syndrome SLE and rheumatoid vasculit
113. nly if Electrophoresis total protein Protein Electrophoresis Giinicaily indicated Beta 2 Paraproteinaemia Urinary Bence Jones microglobulin BJP Pathology User Guide Page 76 of 137 2 24 Immunology Please note that all Immunology requests must be accompanied by full and relevant clinical details or the request will be rejected 2 25 Diagnostic flow cytometry The department is equipped with a state of the art multiparametric flow cytometer and sample preparation module for the diagnosis and monitoring of Haematological malignancies and Immune surveillance 2 26 Immunophenotyping and flow cytometry Requests for Immunophenotyping of suspected Haematological malignancy are only accepted from the Consultant Haematologists who should be consulted in all instances where such a diagnosis is being considered 2 27 CD4 counts on HIV Immune deficient patients 2 27 1 Requests for CD4 counting and immune surveillance are only accepted from the Consultants in GU medicine or the Consultant Haematologists The department will not process any requests received without referral from either of these sources 2 27 2 The Derriford Combined Laboratory currently offers a sub regional immunology diagnostic service to South amp West Devon and Cornwall The repertoire offered includes immunochemistry autoantibodies cellular immunology and allergy tests The majority of the tests are performed in house but a number are sent
114. nology Pathology IM amp T Manager Gwyn Bennett 01872 25 3839 Cornwall IT Services CITS 01872 25 1717 CITS Servicedesk Cornwall nhs uk Please contact CITS initially for all queries regarding the setup of new Clinician Requester codes or for messaging result reporting issues involving mapping issues or multiple missing results 5 7 Request forms and specimen labelling requirements 5 7 1 Please refer to the current version of the Pathology Specimen Acceptance Policy which can be accessed via the Documents Library on the Cornwall and loS NHS intranet The full policy includes details of specimen integrity and Health and Safety This policy is strictly adhered to by all departments 5 7 2 Please see separate table for Diagnostic amp Molecular Pathology specific requirements DDMP Specific Form amp Specimen Labelling Requirements Pathology User Guide Page 7 of 137 FORM LABELLING REQUIREMENTS Please see Section 2 of the Specimen Acceptance Policy Mandatory i e will be rejected if not given Surname Forename or coded identifier All requests correctly spelt for Transfusion Unique identifier e g NHS number NHS Hospital number and date of birth are mandatory for Transfusion Histology and Diagnostic Cytology Desirable for all other specimens All requests except unknown patients Hospital number or Date of birth if NHS number not given Mandatory all Transfusion Histology and Di
115. nsert papers are available from the Histology department Needle cores to be placed directly onto cassette insert paper and then place paper in labelled biopsy pot Frozen sections Must be booked in advance with histology department Specimen Must be received dry not in formalin Must be delivered immediately to the histology department and handed to a member of staff Portering or Theatre staff delivering specimens must hand the sample to a member of staff in Histology Specimens must not be left in reception areas Telephone Pager number must be on request form to enable immediate reporting of results by telephone Pathology User Guide Page 103 of 137 7 Key Factors affecting Performance or interpretation of histology e Insufficient volume of fixative e Inappropriate fixation time 24 48hrs optimal e Specimen for frozen section direct immunofluorescence being placed in formalin e Dry specimens left in reception areas e Renal specimens being placed in formalin or incorrectly stored Hanks e Extreme hot cold temperatures of formalin 8 Availability of Clinical Advice and Interpretation 8 1 For all enquiries please contact the Diagnostic and Molecular Pathology Laboratory on 01872 252550 8 2 All results are typed into the Laboratory Information Management System LIMS Winpath and made available for all individuals registered with CITS to access Winpath Ward Enquiry once
116. nt Library and A Z intranet page 6 2 The previous version will be kept within the Document Library archives and Pathology controlled document archives Pathology User Guide Page 11 of 137 7 Monitoring compliance and effectiveness 7 1 This document is intended as a guide and therefore does not require direct monitoring for compliance Within Pathology there are mechanisms in place to monitor the quality of samples received testing reporting etc 8 Updating and Review 8 1 The document will be reviewed every three years by the author or sooner if developments require changes to the policy 9 Equality and Diversity 9 1 This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the Equality Diversity amp Human Rights Policy or the Equality and Diversity website 9 2 The Initial Equality Impact Assessment Screening Form is at Appendix 9 Pathology User Guide Page 12 of 137 APPENDIX 1 PATHOLOGY REPERTOIRE by test specimen or suspected infection Abbreviations in table CC HAEM Clinical Chemistry Haematology CMB BT Clinical Microbiology Blood Transfusion Sample Which tube Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround testing ta Vee Monn gie ehali n aif Lab Pin or TAME ERS REEL Time see Reference Facilities order blank asap to prevent
117. ntly offered and which nucleic acids are used in each test This is important for RNA based tests as RNA is very labile and these samples must be received for processing by the laboratory within 12 24 hours of removal from the patient Pathology User Guide Page 80 of 137 Samples that can be tested include peripheral blood bone marrow CSF ascitic fluid fresh and paraffin embedded tissue bone marrow trephines if decalcified with EDTA The appropriateness of samples and their sending can be discussed with the laboratory Tel Ext 2408 DNA TESTS RNA TESTS Factor V G1691A Leiden TCR Beta PCR for T cell clonality G20210A prothrombin variant Cyclin D1 over expression in MCL Hereditary haemochromatosis t 9 22 translocation Ph chromosome IgH PCR for B cell clonality t 4 11 translocation of childhood ALL TCR Gamma PCR for T cell t 8 21 translocation of AML M2 clonality t 11 14 translocation of mantle t 15 17 translocation of AML M3 cell lymphoma t 14 18 translocation of follicular lymphoma The laboratory also offers Quantitative Real Time PCR testing for haematological malignancies such as CML Contact the Immunology lab at RCH ext 3040 in the first instance for advice Results are normally available within 1 2 weeks but can take longer Please note If sending samples for other tests ensure a separate sample is included for molecular biology tests Pathology User Gui
118. ntre for Mycobacteriology Bart s and the London e Queen Mary School of Medicine and Dentistry Clinical Research Centre 2 Newark Street Whitechapel London E1 2AT 3 DEPARTMENT OF DIAGNOSTIC AND MOLECULAR PATHOLOGY e Roy Moate Plymouth Electron Microscopy Centre University of Plymouth Drake Circus Plymouth PL4 8AA e Histopathology Department Derriford Hospital Plymouth PL6 8DH e UCL Advanced Diagnostics Dept of Pathology Rm 112 1st Floor Rockefeller Building 21 University Street London WC1E 6JJ Pathology User Guide Page 115 of 137 4 DEPARTMENT OF HAEMATOLOGY Haematology e HPA Malaria Reference Laboratory London School of Hygiene and Tropical Medicine Keppel Street Gower Street London WC1E 7HT Blood Transfusion e NHS Blood and Translant Filton FAO Red Cell Immunohaematology 500 North Bristol Park Northway Filton Bristol BS34 7QH Immunology e LRF Leukaemia Unit Dept of Haematology Royal Postgraduate Medical School Ducane Road London W12 ONN e Immunology Dept Derriford Hospital Plymouth PL6 8DH e Pathology Sciences Blood Sciences and Bristol Genetics Southmead Hospital Westbury on Trym Bristol BS10 5NB e Dept of Immunology Southmead Hospital Westbury on Trym Bristol BS10 5NB e National Amyloidosis Centre Royal Free Hospital Roland Hill Street London NW3 2PF e NBS Bristol 500 North Bristol Park Northrway Filton Bristol BS34 7QH e HMDS Level 3 Bexley Wing St
119. o 28 days Seullimead Testosterone 5 10ml CC Gold Preferably 9 am up to 4 hrs Theophylline 5 10ml CC Gold up to 4 hrs Thiopurine methyl transferase Done prior to starting l TPMT CC Purple Azathiopurine up to 28 days City Hospital B ham Thiopurine metabolites 6 TGN CC Purple Requested by Gastro team only In hospital Pathology User Guide Page 47 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for a a volume Which A testing to A lo elde naif Lab PS YAGI MME see Reference Facilities order blank asap to prevent information for details clotting and 6 MMP Thread worms CMB Plain perianal swab Moistened and sent in saline lt 1 day Corynebacterium only if Throat swabs CMB Charcoal swab PPO ane oe eae factors Link to further info 3 k Throat swabs y Thrombin Time 3ml HAEM Blue Bliss Gold eas Send form to Coagulation Thrombophilia screen 15ml HAEM FBC j Discuss with Cons 7 days Haematologist Thyroglobulin amp antibodies 5 10ml CC Gold Ca Thyroid patients up to 28 days Derriford Thyroid Function initial test is TSH only 5 10ml CC Gold up to 4 hrs Thyroid peroxidase antibodies 5 10ml CC Gold weekly Tiagabine Gagitril 5 10ml CC Gold Hep EDTA Trough sample 1 2 wks NSE TIBC Transferrin and Iron CC Gold Request Iron Saturation up to 4 hrs Large enough to carry out all Sl aaa Ti
120. ob Title V6 0 Previous changes not known Transferred to Trust template for Corporate K J Pollard 19 Sep 11 V7 0 Documents Lab Administrator Changes to contact details Addition of CMB Minor changes updates Contact details K J Pollard 17 01 13 V8 0 Test Specimen guide Changes to Lab Administrator departmental specific sections CMB Minor changes updates Contact details K J Pollard 15 04 14 V9 0 Test Specimen guide Changes to Lab Administrator departmental specific sections Ditto CMB Minor changes updates Contact details S Pointon 1 11 14 V10 0 Test Specimen guide Changes to Pathology Quality and departmental specific sections Improvement All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production It should not be altered in any way without the express permission of the author or their Line Manager Pathology User Guide Page 134 of 137 Appendix 9 Initial Equality Impact Assessment Form Name of the strategy policy proposal service function to be assessed hereafter referred to as policy Provide brief description Pathology User Guide Directorate and service area CSSC Pathology Is this a new o
121. on for details clotting Phosphate Normally Part of l Bone profile 5 10ml CC Gold Part of Bone profile up to 4 hrs Further information PID PID Pelvic Inflammatory ae ar anpiraig Send endocervial or vulvo 2 days E nage CMB from fallopian disease salpingitis tube TOA vaginal swabs for Chlamydia PCR in addition Placental swab CMB Charcoal swab Taken post delivery 2 days Plasma Osmolality 5 10ml CC Gold up to 4 hrs Plasma Viscosity 4ml HAEM Purple el a KEEP ALOON 7 days Derriford ek See NHSBT form Contact lab for special NHSBT Platelet autoantibodies HAEM for details farm Up to 28 days NHSBT Bristol Platelet aggregation By 12ml HAEM Blue x 4 By arrangement with lab only arrangement with Lab only Platelet antibodies special form HAEM See toni Contact lab for special NHSBT 11 21 days NHSBT Bristol from lab form By arrangement amp immediate Platelet function 12ml HAEM Blue x 4 processing 2 wks By arrangement amp immediate Platelet nucleotides 12ml HAEM processing Platelet neutralysation 12ml HAEM Blue Specialist Lupus screen test Pleural fluid white cell count HAEM feier topped or PNH screen by arrangement ini with Lab only 4ml HAEM Purple By arrangement with lab only Within 24 hrs PO4 Phosphate and is f mmol l CC Gold Part of Bone profile up to 4 hrs normally part of Bone profile Porphyria screen CC Purple MSU Protect from light give FULL Local Screen and Faeces clinical details If Ac
122. or Suspected EAS E Note mix purple Turnaround Referred for volume Which testing to JASE MN oy Eee Tes naif Lab o CS us see Reference Facilities order blank asap to prevent information for details clotting Direct Antiglobulin Test emi IBT Pink cee IS eo Direct Coombs test 6ml BT Pink Can beperormed on purple 24 hours EDTA Dothiepin CC Red Trough Sample up to 28 days Penarth l UR Sample taken in Fetal Medicine Down s Screening 1 Trimester 5 10ml CC Gold Hee hua measure meni 15 0 to 20 0 weeks gestation dd f Sample MUST be received by Down s Screening 2 Trimester 5 10ml CC Gold our laboratory within 24 hours Newcastle of being collected Lab will post Preferably on genetics form samples but Exeter and Bristol DNA analysis MGSHCIES ge Purple with consent forms does not Genetics handle results Dual esterase HAEM Haem Consultant request only 7 10 days Gold Serolegy days PHE Bristol 5 10ml CMB EBV Epstein Barr Virus PCR viral load discuss first CHR with laboratory 5 days PAE RRO Ear swab CMB Charcoal swab 3 days Electrolytes Sodium Na Potassium K Urea Creatinine SOM ee Gale EPO ENS ENA aml HAEM Gold Part of Autoantibody screen 144 54 days Derriford Encephalitis 5 10ml CMB Gold vacutainer Discuss with Medical PHE Bristol CSF Microbiologist Pathology User Guide Page 26 of 137 Which tube
123. other sites e g rectum throat etc should preferably be performed by experienced staff at the GUM clinic Eye swabs should be taken before any fluorescent dye is added to the eyes Use a separate COBAS yellow topped female Chlamydia swab to sample each affected eyelid conjunctiva Do not use Copan mini UTM RT collection kits for this type of specimen Specimen storage and transportation Chlamydia swabs should be transported to the laboratory as soon as possible Where immediate transport is not possible or samples are posted to the laboratory the samples can be stored at room temperature without affecting the test result Glandular fever Investigation of typical glandular fever in adolescents and young adults is performed using a Paul Bunnell test For other age groups complicated illness or where greater diagnostic certainty is required EBV specific serology can be performed in the laboratory Hepatitis Pathology User Guide Page 92 of 137 Diagnostic hepatitis testing is guided in the laboratory by clinical details and liver function tests Blood will not normally be tested for most viruses unless LFTs have been performed Unless clinical details dictate otherwise ALT levels are used to determine which tests to perform according to the following schedule e ALT levels lt 100 iu ml are investigated for Hepatitis B and C e ALT levels 100 400 iu ml are investigated for EBV and CMV in addition e ALT levels gt 400
124. ours of obtaining the sample If further tests are required please telephone the laboratory to make the request and seek advice on lability Within RCH please send a request form according to the Add on protocol 1 8 Blood Plasma Glucose Specimens for GLUCOSE from primary care should always be placed in special tubes containing Fluoride EDTA Glucose samples must be inverted 8 10 times to mix the preservative and blood It is important to ensure that the glucose tube is adequately filled as shown on the tube guide Please note When sampling into a range of different tubes follow the order shown on the tube guide This avoids contamination of tubes with anticoagulants which may interfere with subsequent samples For some tests If in doubt please contact the laboratory 1 9 Test profiles Please note Multiple tests may require several specimen tubes 1 9 1 Electrolytes The routine profile for electrolytes Primary Care Sodium Potassium Creatinine Urea must be requested separately In patients Sodium Potassium urea and Creatinine Chloride and Bicarbonate are available but need to be specifically requested 1 9 2 Liver This group routinely includes Total Protein Albumin Globulins Alanine Amino Transferase ALT Alkaline Phosphatase ALP and Total Bilirubin Conjugated Bilirubin and Alkaline Phosphatase isoenzymes can be requested separately 1 9 3 Bone Tests included are Total Protein Aloumin
125. priate follow up tests and their timing All Rh D negative mothers who do not have immune anti D should be offered anti D prophylaxis This is an essential part of the management of Rh D negative women A standard dose of 1500iu should be administered at 28 weeks gestation after the samples for the routine screen have been taken and after any potentially sensitising event Wherever possible the cause of anaemia should be investigated and where a reversible cause is identified this should be corrected before resorting to transfusion 2 17 RCHT Maximum Surgical Blood Ordering Schedule MSBOS The MSBOS is a guide to help ensure that blood is available at elective surgery This guidance is not absolute and factors other than the type of surgery e g low Hb antiplatelet drugs bleeding tendency previous surgery co morbidities etc should be considered with respect to both the choice of hospital site and the availability of cross match LINK TO MSBOS ON DOCS LIBRARY CURRENTLY BEING AUTHORISED UPLOADED 2 18 Blood film examination A blood film is examined either if specially requested with appropriate clinical details or if the full blood count results are significantly abnormal and film examination is likely to further refine the diagnosis For this reason the inclusion of clear and accurate clinical information on the request form is very important Important clinical features to include are e Evidence of anaemia or jau
126. r Hepatitis B and C Alternative for Electrolytes if advised by laboratory Contact lab first if special tests are required Full Blood Count Film Reticulocytes Haemoglobin electrophoresis Sickle test IM screen Malarial parasites Haemoglobin Alc Lead Porphyrin PCR assays ESA BLOOD TRANSFUSION LAB ONLY Labels MUST be handwritten forename surname unique Ante natal group and screen DAT number NHS or CR DoB gender Kletiauer Also used for Paediatric Samples Signed dated amp timed by taker Mixing essential for preservation Glucose Alcohol other tests on advice Not required for in patients at from Lab RCH if received within 3 hours of BD have given their permission for this table to be reproduced Pathology User Guide Page 132 of 137 Appendix 8 Governance Information Document Title Pathology User Guide Date Issued Approved January 2015 Date Valid From January 2015 Date Valid To January 2018 Directorate Department responsible author owner Laboratory Medicine amp Dept of Diagnostic and Molecular Pathology Sarah Pointon Pathology Quality and Improvement Manager Contact details 01872 252549 Email sarah pointon rcht corwall nhs uk Brief summary of contents Guidance to users on contacting Pathology staff information on specimen types specimen containers and tests available with turnaround times Reference ranges and more detailed information on the
127. r existing Policy Existing Name of individual completing assessment Sarah Pointon Telephone 01872 252549 1 Policy Aim Who is the strategy policy proposal service function aimed at To provide guidance on Pathology Laboratory Services 2 Policy Objectives To advise service users of who to contact within Pathology with enquiries and to provide contact details To advise users of services tests provided To advise users of specimen acceptance criteria To provide basic guidance no result interpretation 3 Policy intended Outcomes Effective use of and understanding services provided by Pathology services to Healthcare staff in Cornwall 4 How will you measure the outcome Feedback from users via User Questionnaires Maintenance of the quality and appropriateness of specimen received 5 Who is intended to benefit from the policy Health care staff within Cornwall employed by RCHT Cornwall Foundation Trust and Cornwall 8 loS Primary Care Trust 6a Is consultation required with the workforce equality groups local interest groups etc around this policy b If yes have these groups been consulted C Please list any groups who have been consulted about this procedure No 7 The Impact Please complete the following table Are there concerns that the policy could have differential impact on Equality Strands Yes No Rationale for Asses
128. rainage or inhalation of an aerosol before expectoration may be helpful Saliva and postnasal secretions are not suitable BAL it is difficult to be specific on volume required in principle as large a volume as possible is preferred If Allergic bronchopulmonary aspergillosis ABPA is noted in clinical details we will perform fungal microscopy and culture Legionella culture and fungal culture will be performed if atypical pneumonia suspected Pathology User Guide Page 84 of 137 For mycobacterial investigation submit three soutum samples on consecutive days requesting mycobacterial AAFB investigation For other sites please contact medical microbiologist to discuss testing FAECES Do not send more than one specimen from the same patient on the same day If more than one specimen is taken on the same day the specimens are pooled as shedding of faecal pathogens tends to be intermittent Other specimens are of little value for the isolation of faecal pathogens Cryptosporidium oocysts Clinical details must include the following criteria All general practice patients lt 45 years old Paediatric patients Neutropaenia as indicated in clinical details Travel abroad Unconfirmed outbreaks HIV positive patients as indicated in clinical details Contact with confirmed cases or animals as indicated in clinical details Or if a specific request is made by telephone to perform this test Faecal ova cysts amp parasites
129. rapy In addition inform a medical microbiologist and report to the Consultant for Communicable Disease Control CCDC Tel No 0844 225 3557 without delay Please note if it is stated in the clinical details section of the request form that the patient has had recurrent infections and or failed treatment especially for those patients under the age of 25years we will examine the specimen for Arcanobacterium haemolyticum GENITAL TRACT SWABS Genital tract swabs Separate samples should be collected into appropriate transport media for detection of viruses or C trachomatis If Herpes simplex infection is suspected send an additional UTM from the lesion Give complete clinical details on the form state in particular if the patient has an IUCD in situ suspected pelvic infection and or discharge State on the label and form which site has been swabbed Urethral swabs Urethral swabs may be useful for the diagnosis of gonorrhoea They must be taken with care avoid contamination with flora from the vulva or the foreskin Thin swabs are available for this purpose and should be sent to the laboratory as soon as possible in charcoal transport medium The patient should not have passed urine for at least one hour For males if a discharge is not apparent attempts should be made to milk exudate from the penis The swab is gently passed through the urethral meatus and rotated Place the swab in charcoal transport medium Pathology User Gui
130. re Seeks Seiniead Transferase Galactose 1 phosphate Li Hep Pathology User Guide Page 29 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for T volume Which testing to infection in alphabetical laif Lab pink or blue tubes Remarks Time ae order n a i ab asap to prevent see Reference Facilities blank E information for details clotting whole blood or do GPUTR with mother Gamma GT CC Gold up to 4 hrs Gastric Parietal cells 2ml HAEM Gold Request intrinsic factor antibody 11 21 days Derriford Patient should fast overnight and H2 blockers should be stopped for 72h and Gastrin 1 mL CC EDTA on ice omeprazole for 2 weeks before Hammersmith 2 weeks blood is taken Send sample to lab on ice ASAP Bristol Royal Gaucher Disease screen CC EDTA up to 28 days Infirmary GBM antibodies 2ml HAEM Gold Up to 28 days Derriford ai Sample must be trough in once Gentamicin 5 10ml CC Gold daily regime up to 4 hrs Genital tract swabs see l separate section for Chlamydia n a CMB Charcoal swab High low vaginal cervical 3 days vulval and Herpes Simples German Measles Rubella 5 10ml CMB Gold 3 days GGT Gamma G T 5 10ml CC Gold up to 4 hrs Giardia trophozoites CMB Fecon container Devel o lab as ihe possible 1 day Further information Faeces Glandular fever see also under CMB Gold Paul Bunnell test in t
131. re available on request Some patients with a grossly raised Haematocrit HCT gt 0 57 may give errorneous coagulation test results individual patient adjusted volume coagulation tubes are available on request from the laboratory 2 10 Thrombophilia The current NICE guidance on thrombophilia investigation strongly recommends against blind testing Where a familial thrombophilia anomaly has been identified screening may be undertaken though it may not alter that individual s management with respect to at risk situations Generally patients with an inherent tendency to thrombosis present by 50 years of age accepted clinical reasons Recurrent unexplained thrombosis Spontaneous thrombosis before 45 years of age Thrombosis at atypical sites such as axillary cerebral or mesenteric veins Arterial disease before 30 years of age Skin necrosis with the use of warfarin Family history of thrombophilia first degree relative Relatives of patients with thrombophilic abnormalities Women considering the oral contraceptive pill or hormone replacement therapy with a family history of thrombosis first degree relative Repeated foetal loss IUD Thrombosis Prevention Investigation And Management Of Anticoaqulation Guidance Pathology User Guide Page 67 of 137 Thrombophilia screening should start with an affected relative Current guidelines advise screening other family members only if a defect is identified in a first degree relativ
132. re generally short 1 4 weeks Urgent cases will be seen earlier by prior arrangement with a Consultant Haematologist 2 15 Reference ranges Reference ranges age and sex related where appropriate are included in reports Results which exceed these ranges are emboldened Ranges for some common tests are given below Information on reference ranges is given in Appendix 6 2 16 Transfusion All patients requiring transfusion in the Haematology out patient department should be referred through a consultant Haematologist with full documentation of medical and drug histories The patient will only be seen by the Haematologists if this is requested within the referral Any patient who is bed Pathology User Guide Page 69 of 137 bound or unable to attend to their own toileting should be referred as an in patient Samples for group amp save crossmatch are valid for a maximum of 7 days however this is affected by the patient s transfusion and obstetric history Regularly transfused patients may need samples taken more frequently please contact the laboratory on extn 2500 if you are unsure Advice is also available on the reverse of the request form Antenatal testing Screening should test all mothers twice in pregnancy at booking and a second time in the 28th week of gestation for ABO and Rh D groups and antibody screening If any further testing is required as a result of these tests a report will be issued suggesting appro
133. result is received from a source without computer access to results the INR will be communicated Pathology User Guide Page 64 of 137 on the basis of patient ID using three points of reference Name Date of Birth Address after verification of the patients NHS number Telephone requests for multiple results will be advised to await transmission of results by GP link as the risk of a transcription error is raised A delay in notification to the patient in most cases of 1 2 days is satisfactory BCSH guidelines We appreciate that there may be a need to telephone for results but would ask that this is kept to a minimum using the Pathology Joint Reception number 01872 25 2548 or 2540 Please try to telephone in the morning whenever possible 2 3 Retrospective testing Samples are retained in the Haematology laboratory under appropriate storage It is possible to ask for tests to be added to samples already received provided the additional analyte is sufficiently stable This may be done by telephoning the laboratory Refer to the Pathology repertoire table for specimen requirements 2 4 Semen Analysis The Coagulation laboratory provides the semen testing service in Cornwall 2 5 Male Fertility Investigation This includes volume pH motility viability and normality assessments count a direct antibody screen and identification of any cells in a sample closely following WHO guidelines A basic interpretation of the results is
134. ri TELOM EME ua detectable from 6 weeks after A gaye onset of symptoms Gold for serology Lymphogranuloma venereum CMB Chlamydia swab of LGV specific PCR is the most 7 days PHE Colindale LGV reliable test lesion for PCR Magnesium CC Gold Note time of collection up to 4 hrs Malarial Parasites 4ml HAEM Purple 24h Take one tube and discard Manganese CC Purple Use 2 tube for manganese up to 28 days Birmingham request only Marrow staining MGG HAEM EDTA Haem patients only Within 24 hrs 2 samples required 1 hour apart 1 sample must be taken within 1 hour of acute Mast cell tryptase 2ml HAEM Gold event 2 sample to be taken 1 Derriford hour after 1 Note time of collection and event Salivary kit Request salivary kits from Measles diagnostic CMB Supplied by HPU Public Health England Pathology User Guide St Austell 01726 627880 Page 38 of 137 Which tube Sample ear Referred for Specimen Test or Suspected volume Which Note mix purple Turnaround testing to A eldade naif Lab PI ES TIRE ETI ime see Reference Facilities order blank EF prevent information for details 5 10ml Gold serology Give clinical details date of onset 10 days PHE Bristol Measles immunity 5 10ml CMB Gold Please discuss with Laboratory 5 days Discuss with Cons Med CSF Microbiologist Notify CCDC Micro 4 hour Meningitis bacterial CMB Blood culture Swabs from conta
135. rnwall Pathology User Guide Page 86 of 137 In patient faecal samples The bacteriological screening of stool specimens from in patients is not required unless admitted with diarrhoea However locally we will continue to investigate for Salmonella spp as well as Clostridium difficile with the exception of the following circumstances e Those in patients suffering diarrhoea within three days of admission ascertained from CORE e Patients who are HIV positive as indicated in clinical details e Patients with neutropaenia as indicated in clinical details If any of the three criteria above apply full investigation will be performed Please do NOT submit specimens for Clostridium difficile toxin testing within four weeks of a previous positive they will NOT be tested Please contact a medical microbiologist to discuss if repeat symptoms appear within 28 days Viral gastroenteritis Paediatric patients under 5 years are routinely investigated for rotavirus and adenovirus Faecal samples from outbreaks of vomiting and or diarrhoea may be tested for viral pathogens but these tests are not usually performed unless requested by the Infection Prevention and Control teams URINE Clean voided midstream urine is preferred for bacterial culture The use of boric acid containers allows specimens to be processed up to four days post collection as long as the correct volume is taken It is not necessary to refrigerate the sample
136. rone Sulphate 2 93 16 5 2 93 16 5 umol L o wa ovs 2381 0 08 2 31 Oo o 6 70 0 92 7 60 CO oo VA TA Scene l Insulin like growth factor nmol L rr AP ao 40 40 o y y do p1t2 50 12 50 pt 7 60 17 60 o Opa 85 85 SS lt gt ja 90 23 ew PE 3a0 e w 30 9 Coo CEA NO SA Iron Studies RA Ion Sm 85 15 35 15 umollL po C t 55 20 55 20 o y jeB 65 23 65 233 A O A AE BES Vitamins AA A A 0 5 1 6 0 5 1 6 Pathology User Guide Page 125 of 137 pd AB yrs 0 8 2 2 08 22 ee 0 8 3 0 po NS TAS TA TOS Pathology User Guide Page 126 of 137 HAEMATOLOGY lt 25 2 6 2 16 25 34 2 9 2 15 35 44 2 10 2 15 45 54 2 13 2 20 For 55 64 2 20 2 25 mca 65 67 2 25 2 27 68 71 2 30 2 30 gt 72 2 50 2 36 Up to 3 days 100 450 100 450 Reticulocytes 3 7 days 10 150 10 150 x10 gt 1 week 25 125 25 125 Up to 1 day 137 201 137 201 1 day 1 week 142 240 142 240 1 2 weeks 128 218 128 218 2 4 weeks 101 183 101 183 1 2 months 90 140 90 140 Haemoglobin 2 6 months 89 141 89 141 g l 6 months 2 years 97 151 97 151 2 6 years 96 148 96 148 6 12 years 107 154 107 154 12 18 years 115 170 117 154 gt 18 years 133 167 118 148 Up to 1 day 3 5 6 7 3 5 6 7 1 day 1 month 2 8 6 5 2 8 6 5 RBC count 1 month 1 year 2 6 5 5 2 6 5 5 x10 7 1 10 years 4 1 5 3 4 1 5 3 gt 10 ye
137. s Alpha feto protein Tumour 2ml cc Gold up to 4 hrs marker Alpha Galactosidase FABRY Contact laboratory for a dried St Marys Hospital Disease re at blood spot Fabry Kit apra 28 days Manchester Alpha Sub units 1ml CC Red no gel up to 28 days Birmingham Alphavirus 5 10 ml CMB Gold 10 days PHE Porton Down ALT Alanine Amino Transferase 5 10ml CC Gold Part of Liver profile 4h Aluminium CC Navy blue Usually on Renal Dialysis up to 28 days Charing Cross patients Amikacin 5 10ml ICC Gold 1 2 wks Southmead micro Amino Acids Blood 25ul CC Lith Hep up to 28 days Southmead IBEM investigation requires a Amino Acids CSF 25ul CC Plain paired blood sample up to 28 days Southmead Amino Acids Urine CC Plain Freeze on day of collection Up to 28 days Southmead Aminophyline 5 10ml CC Gold As Theophylline up to 4 hrs Amiodorone CC Red no gel 2 weeks Penarth Amitriptyline CC Red no gel 2 weeks Penarth Pathology User Guide Page 15 of 137 Which tube Specimen Test or Suspected me BS Which Note mix purple Turnaround Referred for infection in alphabetical Macey S pink or blue tubes Remarks Time testing to n aif Lab see Reference Facilities order blank asap to prevent information for details clotting Three stool samples takenon 1 day Amoebiasis 5 10ml CMB Gold Blood if liver abscess suspected 10 days A Mop lcs Amylase 5 10ml CC Go
138. s PHE Bristol C1 Esterase 2ml HAEM Gold 11 21 days Derriford C Peptide CC Gold Send immediately to lab up to 28 days Southampton CA125 1ml CC Gold up to 4 hrs CA15 3 1ml CC Gold up to 28 days Sheffield PRU CA19 9 1ml CC Gold up to 28 days Derriford Cadmium CC Purple Send whole blood or urine 1 2 wks Charing Cross Calcitonin CC Gold Contact lap prior to co ection up to 28 days Charing Cross Sample on ice ASAP to lab Pathology User Guide Page 20 of 137 Which tube Specimen Test or Suspected Seine E Note mix purple Turnaround Referred for E volume Which testing to infection in alphabetical z 5 pink or blue tubes Remarks Time PH order n a if Lab asap to prevent see Reference Facilities blank p p information for details clotting City Hospital Calculi CC Please state location of calculi up to 28 days Birmingham l l TER Preston Indicated in the investigation of Campylobacter serology 5 10mI CMB Gold Guillain Barre syndrome 10 days kde ta di ervices Carboxyhaemoglobin 1 mL CC rece Carbohydrate Deficient Transferrin Alcohol Use ES ole up lores Gays KINJ pus Institute of Carbohydrate Deficient re Transferrin Paediatric CC Paediatric clear top Neurology Queen s Square C Reactive protein CC Gold up to 4 hrs C3 and C4 CC Gold up to 4 hrs Sarin anormal paler Bong CC Gold Part of Bone profile up to 4 hrs Only request
139. s a response to severe thrombocytopenia or in disease such as essential thrombocytosis 2 20 Malaria Routine Malaria The diagnosis of malaria requires the careful examination for 20 minutes of blood films stained at an alkaline pH An additional test using a monoclonal antibody directed against a Falciparum malaria protein may also be used The blood films are best made in the laboratory from an FBC sample less than two hours old The parasites will start to deteriorate after a few hours and a sample over 24 hours old will not be tested Pathology User Guide Page 74 of 137 2 21 Haemoglobinopathy Screening Haematology offers a full haemoglobinopathy screening service in association with The Department of Haematology Torbay Hospital A basic screen using High Performance Liquid Chromatography HPLC is used to give Hb A HbA2 and HbF levels with identification of abnormal haemoglobins such as sickle cell or Hb C This technique is also used in the diagnosis of alpha and beta thalassaemias A full DNA analysis of globin chains is available for sub typing haemoglobinopathies such as in alpha thalassaemia This is performed at the discretion of the Consultant Haematologist 2 22 Antenatal Haemoglobinopathy screening 2 22 1 The overall aim of the National Antenatal Screening Programme is to offer sickle cell and thalassaemia screening to all eligible women and couples in a timely manner in pregnancy The screening programme facilitates
140. sment Existing Evidence Age y Pathology User Guide Page 135 of 137 Sex male female trans gender gender reassignment Race Ethnic communities groups This may have an impact on employees who do not speak good English however staff employed in healthcare roles in which they would need to consult the handbook would be required to have a reasonable level of English Contact details are given at the beginning of the handbook should problems arise Disability Learning disability physical disability sensory impairment There is a potential for impact upon partially sighted blind individuals working within healthcare It is likely that provision will have been made by the d mental health probl e iS departmental practice managers to adapt working conditions but in the event that this is not the case contact details are given within the handbook to enable managers to contact the departments to ask for direct advice by telephone for the employee or to arrange to have a hard copy of the handbook produced in Braille Religion y other beliefs Marriage and civil y partnership Pregnancy and maternity V Sexual Orientation y Bisexual Gay heterosexual Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted e You have ticked Yes in any column above and e No consultation or evidence of
141. spiratory viruses A same day PCR service is offered for influenza A and B RSV adenovirus parainfluenza and human metapneumovirus in normal working hours Monday to Friday To ensure same day testing the laboratory should be informed and the specimens must be delivered to the laboratory by 1100hrs Acceptable samples for this assay are nose and throat swabs collected using Copan UTM RT collection kits sputum tracheal aspirates and nasopharyngeal aspirates see RSV section for NPA collection guide Pathology User Guide Page 93 of 137 Inoculation injuries needlesticks Samples should be collected from the source patient and the injured person according to local inoculation injuries protocol It is important to indicate clearly which are the source patient and the recipient of the needlestick injury The source patient must be counselled and will be routinely tested for Hepatitis B C and HIV if requested Blood from recipients will be stored without testing for two years Individual cases should be discussed with the Occupational Health Department Meningitis Encephalitis In addition to bacterial culture of CSF and blood molecular tests are available from specialist laboratories for detection of bacterial Neisseria meningitidis and Streptococcus pneumoniae and viral usually HSV VZV and enterovirus pathogens in blood bacterial only or CSF These tests are only referred when supported by relevant clinical information
142. ssue inf cti n CMB microscopical preparations and Multiple cultures tissues 14days Tissue Typing 4x4ml HAEM Purple x 4 A Por amane ESN 11 21 days TnT Troponin T 5 10ml CC Gold 4h P Sample must be trough in once Tobramycin Amikacin etc mg l CC Gold daily regime up to 4 hrs Toxocariasis 5 10ml CMB Gold Give exposure clinical details 14 days Panpi tor Topical Diseases London Pathology User Guide Page 48 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for T volume Which testing to infection in alphabetical naif Lab pink or blue tubes Remarks Time A e he order blank asap to prevent information for details clotting Indicate whether patient is Microbiolo Toxoplasma gondii serology 5 10ml CMB Gold pregnant or 5 days s 9Y wansea immunocompromised Transferrin Glycoforms See CDT Transferrin receptors Soluble CC Gold up to 28 days Kings Pink purple amp Transfusion reaction See le Sees Discuss with Blood Transfusion investigation form En o Impresi n Dept who will supply a form onus TERS Charcoal swab in Swab posterial fornix including Jiichomonas vaginals Emb Trichomonas broth any apparent candidal plaques 2 Gays TSH 5 10ml CC Gold up to 4 hrs TSH receptor antibodies 5 10ml CC Gold up to 28 days Glasgow Haematology and GU ags T subsets FACS HAEM EDTA Consultant request
143. st is performed between 11 2 and 14 1 weeks gestation The phlebotomist puts a barcode label on the sample and all the information including smoking status and ethnicity is entered into the Viewpoint fetal medicine system and the request exported to the Kryptor analyser in the Clinical Chemistry department Batches of samples are delivered to the laboratory for analysis Following analysis the results are imported back to Viewpoint by a Clinical Scientist and the risk calculated Risks are usually available within one working day of the samples being received in the laboratory All lower risk results are reported to the women via a letter sent from the Clinical Chemistry department and should have been received within 7 days All higher risk results are phoned and faxed to the Screening Coordinator or her deputy the woman is then contacted and offered a counselling appointment followed by CVS chorionic villus sampling or amniocentesis if required The results are reported on Viewpoint and WinPath The test achieves a Down s syndrome detection rate DR of gt 75 with a lt 3 screen positive rate SPR using a cut off risk of 1 in 150 at term as required by the National Screening Committee NSC current working standards 1 10 2 DS Screening Second Trimester Quadruple test The quadruple test is for all those women booking too late for the new first trimester combined test i e cannot have a nuchal translucency NT scan by
144. t not urticaria and there is usually a positive family history Complement C4 levels are invariably low and C3 levels normal in patients with this condition The diagnostic test C1 esterase inhibitor will only be performed on patients with a low C4 or a family history of this condition Immune deficiency Humoral immunodeficiencies usually present with recurrent bacterial infections The basic screening test for this condition is total serum immunoglobulins IgG subclasses and specific antibodies to pneumococcus and H influenzae b may sometimes be necessary Cellular immunodeficiencies usually present with recurrent viral or opportunistic infections The basic screening test for this condition is FBC and differential Lymphocyte phenotyping and T cell functional studies may sometimes be necessary but these should be discussed with the laboratory beforehand Liver autoimmunity Smooth muscle antibodies are present in 95 of patients with type chronic active hepatitis CAH but are relatively non specific Liver kidney microsomal antibodies are present in patients with type II CAH Mitochondrial antibodies are present in 95 patients with primary biliary cirrhosis PBC M2 antibodies are even more specific for PBC and are automatically performed by the laboratory when a positive mitochondrial antibody is detected Myasthenia Gravis Acetylcholine antibodies are present in 85 of patients with myasthenia gravis Myeloma The basic screeni
145. the report has been authorised and released Printed reports are sent to all requestors in the post once the reports have been authorised 8 3 Urgent reports are usually available between 48 hrs and 7 working days from time of receipt 8 4 Routine Reports are usually available within 2 weeks from time of receipt as per guidelines Delays may occur due to additional test techniques undertaken this may be in our department or a more specialised hospital laboratory out of Cornwall to aid in an accurate diagnosis but a preliminary report is normally issued stating this A supplementary report will be issued once a report from the referred laboratory is received 8 5 EUS EBUS FNA an assessment of specimen adequacy only is provided immediately at clinic by BMS in attendance The final report is usually available between 48 hrs and 7 working days from time of receipt 8 6 Routine Cervical Cytology In accordance with NHSCSP and Governmental guidelines 9 Laboratories to which work is routinely referred 9 1 Renal biopsies Tissue for electron microscopy is sent to Plymouth University for processing however the micrographs are interpreted by RCH histopathologists 9 2 Muscle nerve biopsies The requester taking the biopsy must make arrangements for transport to ensure that the specimen is delivered to the correct reference laboratory Pathology User Guide Page 104 of 137 10 Biopsies are sent dry and kept around 4 C It
146. there being consultation this excludes any policies which have been identified as not requiring consultation or e Major service redesign or development 8 Please indicate if a full equality analysis is recommended Yes No 9 If you are not recommending a Full Impact assessment please explain why Signature of policy developer lead manager director Date of completion and submission Names and signatures of 1 Sarah Pointon members carrying out the 2 Screening Assessment Keep one copy and send a copy to the Human Rights Equality and Inclusion Lead c o Royal Cornwall Hospitals NHS Trust Human Resources Department Knowledge Spa Truro Cornwall TR1 3HD Pathology User Guide Page 136 of 137 A summary of the results will be published on the Trust s web site Signed Date Pathology User Guide Page 137 of 137
147. tibody producing plasma cell They are most often reactive in nature and seen in acute infections Reactive lymphocytes Lymphocytes with morphology that is not normal but with a likely non malignant cause shock viral infection Smear Cells Abnormal lymphocytes which are very fragile and break up when a blood film is made Found in Chronic Lymphocytic Leukaemia Toxic Granulation Increased neutrophil granulation Usually seen as a response to infection 2 19 3 Platelet morphology Clumped Platelets Platelets are sticky by nature and have a tendency to stick to each other in vitro Sometimes this can be a one off event which is the first stage of the sample clotting With some individuals this will happen on every occasion Because the platelets are stuck together they can not be accurately counted A CPT bottle can be obtained from the laboratory which will usually reverse the clumping process Hypogranular Agranular platelets Normal platelets contain granules that are necessary for the normal function of the cell The presence of platelets with reduced or absent granules is therefore significant This can be caused by the sample starting to clot by disease such as myelodysplasia by treatment particularly chemotherapy or rarely as an inherited disorder Giant platelets Platelets normally vary considerably in size but occasionally platelets as big or bigger than red cells can be seen These giant platelets can be seen a
148. ting to ee d n a if Lab t t see Reference Facilities order blank asap al information for details clotting Voltage gate antibodies HAEM Gold Oxford VW Factor VWF ag amp activity emi HAEM 2x Blue ore Al EOS 3 weeks VWF VWF Collagen binding Send form details to i VWF multimers 6ml HAEM 2 x Blue coagulation 2 4 wks Oxford Receive sample in lab prior White cell enzymes CC Purple midday Mon to Thursday Give up to 28 days BRI full clinical details Bu Wie pomada Sample anterior nares by P rotating the swab on the surface swab Serology can be used Whooping cough CMB ses sirum a discuss with 7 day PHE Colindale 5 10ml Nasopharyngeal NPA is the Gold Standard aspirate sample Minimum 3 specimens of Worms faeces on different days Roundworm Hookworm OME Feconconialner whole worm or segment if tday available Fecon container Min 3 specimens of faeces 5 days Worms Liver fluke Trichuris CMB Strongyloides Gold For strongyloides 5 days al X1 Assay HAEM Blue 3 specimens Yersinia must be 2 days Yersinia CMB Fecon container requested specifically and clinical details given Which tube Specimen Test or Suspected ate Pe Which _ Note mix purple Turnaround Referred for infection in alphabetical naif Lab pink or blue tubes Remarks Time rane T order blank asap to prevent information for details clotting Zinc Zn l CC Gold up to 14 days Derriford Zinc protoporhyrin CC Purple Not c
149. to specialist reference centres In addition a clinical immunology service is available for patients with primary immune deficiencies and allergies including skin prick testing 2 28 IMMUNOLOGY DIAGNOSTIC SCREENING TESTS AND ASSOCIATED CLINICAL CONDITIONS Addison s Disease Adrenal antibodies are present in 50 of patients with Addison s disease At least 40 of patients have at least one other autoimmune endocrinopathy Pathology User Guide Page 77 of 137 Allergy IgE is raised in patients with atopy eczema gt asthmasrhinitis Allergen specific IgE antibodies RASTs are present in patients with type hypersensitivity reactions but not pseudoallergic reactions The request for allergen specific IgE must be based on the clinical history Anaphylaxis Serum tryptase levels are elevated following mast cell degranulation due to anaphylaxis type hypersensitivity or pseudoallergic reactions or mast cell syndromes rare Blood should be collected within 3 hours of the event Urinary n methyl histamine levels are elevated following mast cell degranulation as for serum tryptase above Urine should be collected between 1 and 4 hours of the event If the patient was in contact with latex rubber a specific IgE to latex should be requested Contact lab for specific advice on sampling and timing of sampling Antiphospholipid syndrome Anticardiolipin antibodies are present in the antiphospholipid syndrome arterial amp venous
150. ultures Bacteraemia Refer to Refer to Blood Culture Guide on 48h Septicaemia guide DE PA AB DOURS the Intranet Documents Library Preliminary Bacterial vaginosis CMB Air dried smear aes lt 24 hrs transported in a slide box Pathology User Guide Page 18 of 137 Which tube Specimen Test or Suspected EPS Note mix purple Turnaround Referred for T volume Which testing to uation lo ell dae naif Lab BELT OUTS Tea IS MME see Reference Facilities order blank asap to prevent information for details clotting Basement membrane antibodies 2ml HAEM Gold 11 21 days B12 Vitamin B12 CC Gold up to 4 hrs Only available on Consultant BCR Abl 2x4ml HAEM 2 x purple Haematologist referral Up to 28 days 7 10 days Bence Jones Protein BJP HAEM Urine container up to 14 days if immunofixation is necessary Beta Carotene 500 uL CC Red up to 28 days Birmingham Beta Hydroxybutryric acid CC Grey For Hypoglycaemia 1 wk Southmead Up to 5 Beta 2 Microglobulin CC Gold working days Only requested by EPU for Beta HCG Beta Human ecopie Pregnancy Chorionic Gonadotrophin 26 sola 2d i up to 4 hrs Used as Tumour Marker with AFP Bicarbonate CC Gold Part of Electrolytes U amp E up to 4 hrs Beta 2 Transferrin Few CSF cause for rhinorrhea or Asialo transferrin Drops 5 Mope Ear decharge otorrhe 21 days uci up to 5 w Bile
151. umps Microscopy 24h Mycology skin nails hair CMB Dermapak Culture negative positive O M veoks VIYCOPNENOIG aC CC Purple Take gt 12 hours post dose up to 28 days Kings Mycophenylate Mycoplasma 5 10ml CMB Gold 7 days Exeter 2 days Nasal swabs CMB Charcoal swab 24 hrs nasal screens Must be handwritten with patient s forename surname l DoB gender unique identifier NHSBT referrals 2x6ml BT pink NHS or CR number date amp Up to 7 days NHSBT Bristol time of sample and sample taker s signature Neonatal Allo neutropenia See NHSBT form Contact Lab for special NHSBT antibodies HAEM for details form tine aye NASE PENSIGI Neonatal Allo See NHSBT form Contact Lab for special NHSBT Thrombocytopenia antibodies RAEM for details form ie bays APSE T Brisiol rae See NHSBT form Contact lab for special NHSBT Neutrophil antibodies HAEM for details forh 11 21 days NHSBT Bristol Neuron specific enolase NSE 5 10mI HAEM Gold up to 28 days PRU Sheffield For same day testing must lt 24 hours Morovis OME Pecon pAmiAmS arrive at the laboratory by Monday to Pathology User Guide Page 40 of 137 Which tube Specimen Test or Suspected APIS Note mix purple Turnaround Referred for T volume Which testing to infection in alphabetical naif Lab pink or blue tubes Remarks Time e e Ee order blank asap to prevent information for d
152. ute Cardiff Porphyria Pathology User Guide Page 42 of 137 Which tube Specimen Test or Suspected om H Which Note mix purple Turnaround Referred for infection in alphabetical EE iS pink or blue tubes Remarks Time testing to n aif Lab see Reference Facilities order blank asap to prevent information for details clotting Porphyria take urine when Lab symptomatic Pregnancy test urine CC Plain Early morning urine 24h Separated within 3 4 hours of pire mepiide Type CC ae As collection Dermatology request up to 28 days Southampton only Progesterone nmol l CC Gold 7 days prior onset of menses up to 4 hrs Prolactin miu l CC Gold up to 4 hrs Prostate specific antigen PSA ug l CC Gold up to 4 hrs Protein C functional 3ml HAEM Blue Part of thrombophilia screen Stable for up to four days if Protein Electrophoresis HAEM Gold refrigerated 24h Protein S 3ml HAEM Blue Part of thrombophilia screen Part of thrombophilia screen Prothrombin mutation 3ml HAEM Blue Tube to remain unopened as 3 wks Derriford molecular test PTH Parathyroid Hormone umol l CC Gold ad processed within e up to 4 hrs PTH related Protein or Peptide CC Special Contact lab Charcoal swabs Puerperal Fever CMB Blood cultures Nose throat amp HVS 2 days Urines Blood culture set Blood cultures min 2 2 days Charcoal swab Throat swab 1 day neg mm Boric acid Urine 1 day neg Pyrexi
153. vice for surgically excised and post mortem specimens and a frozen section service to the theatres Histopathology also provides the technical support for the MOHS service in the Dermatology department of the Royal Cornwall Hospital MOHS is microscopically controlled surgery used to treat common types of skin cancer involving complete circumferential peripheral and deep margin assessment using frozen section histology MOHS surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate 3 Molecular Cell biology Unit MCBU utilises an extensive range of antibodies used in Immunology techniques for routine diagnosis and prognosis It also provides the South West Peninsular Network with a Her2 referral service The OSNA one step nucleic acid amplification technique is an intra operative technique which is used to identifiy MRNA of cytokeratin 19 which is expressed by epithelial cells within metastatic cells The lymph node is removed from the patient processed and analysed by molecular technique at the site of the breast surgery in St Michael s hospital This allows appropriate surgery to be undertaken in cases where patients are positive and thus prevents a future second operation 4 Post Mortem suite at RCHT and body storage facility at WCH As well as hospital cases autopsies are carried out on behalf of HM Coroner Facilities are available for Home Office forensic autopsies Pathology User Guide P
154. y Department Royal Cornwall Hospital Trust Truro Cornwall TR1 3LJ The request form MUST contain ALL the following information Patient forename surname DOB patient address NHS number patient s GP requesting consultant For requests where there is a private patient the form MUST include the name of the private insurer and the private policy number If the patient is paying for the test to be carried out privately without insurance then this must be specified on the Her2 request form Cytopathology Repertoire 10 1 Cervical Liquid Based Cytology LBC samples Pathology User Guide Page 105 of 137 10 1 1 The Cervical Screening Programme throughout the Peninsula uses Hologic Cytyc ThinPrep LBC technology 10 1 2 All LBC sample takers must be trained in ThinPrep LBC sampling A register of trained sample takers within the Primary Care Trusts is kept at the PCSA Primary Care Support Agency A similar RCHT register is kept in Colposcopy 10 1 3 Every slide is primary screened by NHSCSP certified and state registered Biomedical Scientists or NHSCSP certified Cytoscreeners Samples displaying abnormalities are subject to further checking by Senior Biomedical Scientists Abnormal samples are referred and reported by Consultant Cytopathologists or Consultant Biomedical Scientist 10 1 4 Consumables Materials required for taking LBC samples are on the GPs monthly ordering lists from the contact details below Email and
155. ypical Infectious mononucleosis 5 10ml cases otherwise see EBV 5 days HAEM Gold Purple Pathology User Guide Page 30 of 137 Which tube Specimen Test or Suspected Senos Note mix purple Turnaround Referred for E TREI volume Which a testing to infection in alphabetical i pink or blue tubes Remarks Time ae rder n a if Lab to prevent see Reference Facilities orde blank Heung PIES information for details Gold lt 3 hours E Glucose CC Grey if longer Record time of collection up to 4 hrs Glucose 6 Phosphate 3ml or Purple Pink l Dehydrogenase G6PD 0 5ml HARM Paeds Mark irungan unto a paye Glycosylated Haemoglobin HbA10 CC Purple up to 24 hrs Charcoal swab male urethral orange top PCR testing Genital info gonomhgga CMB available to Sexual HVS NOT cultured for GC days Health Services see Virology section for details Must be handwritten with patient s forename surname DoB gender unique identifier Group and save 6ml BT Pink NHS or CR number date amp 24 hrs time of sample and sample taker s signature Must be handwritten with patient s forename surname DoB gender unique identifier Group and antibody screen 6ml BT Pink NHS or CR number date amp 24 hrs time of sample and sample taker s signature Random growth hormone Growth Hormone 5 10mI CC Gold Anita Sao oniy De Hi swoelk Derriford done as part of dynamic

Pathology User Guide - the Royal Cornwall Hospitals Trust website

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