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Pathology User Guide

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1. All specimens must be labelled with the patient s identification details i e name date of birth hospital number and the date and time of specimen collection Accompanying request forms must contain the same information and the NHS number Samples for blood group and cross match must be hand written with surname first name date of birth hospital number and signed by the person taking the sample All specimens must be transported inside a sealed polythene bag The person collecting the specimen is responsible for positively identifying the patient Ideally the patient should be asked to state their name and date of birth and this should then be checked against the information on the patient s wristband If the patient is unable to speak their identity must be ascertained from their wristband The sample tubes must be labelled with ballpoint pen as soon as the samples are collected and before leaving the patient or bleeding any other patient Labelling must be clear and legible Unlabelled or mislabelled specimens cannot be accepted for the safety of patients and for the medico legal protection of hospital staff Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath f csTs King s College Hospital MES Page 11 of 85 Transport of specimens to the laboratory Hospital sites Samples should be sent to the laboratory by either the pneumatic tube system or arranging collection by a hospital
2. King s College Hospital MES Page 23 of 85 Ferritin Male 20 yrs 30 400 ug L Female 15 50 yrs 15 150 ug L 50 yrs 30 400 ug L Free light chains Kappa 3 3 19 4 mg L Lambda _ 5 7 26 3 mg L K L ratio 0 26 1 65 FSH Follicle Stimulating Male 2 0 12 0 iu L Hormone Female Follicular 2 0 12 0 iu L Luteal 3 0 9 0 iu L Levels high mid cycle Post Menopause gt 25 0 iu L Gentamicin Refer to normogram for dosage interval Antibiotic policy is available on the Trust intranet For endocarditis patients only maintain pre dose lt 1mg L and post dose 1 2 hours between 3 5 mg L Gamma Glutamyl Transferase 5 55 iu L GGT Globulin 15 35 g L Glucose sugar plasma 3 0 6 0 mmol L Serum CSF glucose 60 of plasma glucose Haematinics Serum B12 and Folate B12 gt 150 pg mL Folate gt 4 6 18 7 ng mL Haemoglobin A1c Glycated Hb lt 53 mmol mol lt 7 suggests good glycaemic control HbA1c 53 64 mmol mol 7 8 suggests fair control though improvement of glycaemic control is desirable 64 75 mmol mol 8 1 9 suggests inadequate glycaemic control gt 75 mmol mol gt 9 suggests poor glycaemic control HDL Cholesterol See lipid interpretation BHCG human chorionic Non pregnant 0 4 iu L gonadotrophin Homocystine Not increased Immunoglobulins IgA IgG and Adult IgA 0 5 4 0 g L IgM Adult IgG 5 0 14 0 g L Adult IgM 0 5 2 0 g L See Protein Electrophoresis SOP book for ch
3. TURN AROUND TIMES 10 14 days PCR 2 3 working days Antibody several weeks 10 14 days 1 2 days during working week Service not available over weekend or bank holidays 10 14 days 1 2 days during working week 3 4 days during working week 1 3 days Review August 2012 Pathology User Guide Bedford Hospital Trust Page 72 of 85 a TOXOPLASMA IgG VZV IgG VZV IgM very rarely indicated as Chicken pox is a Clinical diagnosis WEILS DISEASE Leptospira antibodies SAMPLE red and yellow top 5ml clotted blood with gel red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top ingsPath King s College Hospital MEK COMMENTS Animal transmission Particular concern in pregnancy Please state whether patient is pregnant or immunocompro mised Date of contact MUST be given Sent to Reference laboratory Rarely necessary as Chicken Pox is essentially a clinical diagnosis Reference laboratory request Full details of risk factors e g sewage worker ingested river water etc must be given Date of onset and clinical details also required TURN AROUND TIMES Positives sent to ref lab for confirmation Tested daily Positives sent to ref lab for confirmation Run daily Positive results phoned Negative results 10 14 days 10 14 days INFECTION CONTROL
4. Microalbuminuria All adults and children with known diabetes over the age of 12 years not previously diagnosed with microalbuminuria or proteinuria should be screened annually for microalbuminuria Send a clearly labelled early morning urine to the Clinical biochemistry laboratory The laboratory will measure the urinary albumin creatinine ratio ACR Reference values are Males lt 2 5mg mmol Females lt 3 5mg mmol Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ee sKingsPath la csTs King s College Hospital MES Page 31 of 85 If the urinary albumin is found to be grossly elevated gt 3800mg L then urinary total protein will be reported instead of microalbumin The patient should be investigated for gross proteinuria in the usual way to exclude urinary tract infection etc A normal microaloumin requires no further action until the next annual routine screen is performed If the microalbumin is raised then the patient should be asked to provide a further two samples preferably one week apart within the following three months which will be tested in sequence Two positive results are required to make a diagnosis of microalbuminuria If the second sample is positive result above the reference range then the third sample will not be analysed Once a patient has been diagnosed with microalbuminuria treatment should commence and the patient s condition should be monitored by submitting urine samples for
5. Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 10 of 85 e clinical diagnosis and relevant clinical signs symptoms including travel history if indicated e examination required e Consultant caring for the patient e Name and bleep or contact number of requesting doctor Adequate clinical information and current drug treatment must be given to facilitate the interpretation of results to establish the need to do further laboratory investigations on a specimen and to identify possible drug test interactions etc Drug timing and dosages are also necessary to provide reliable therapeutic drug monitoring If a test requires special collection conditions e g fasting timing it should be clearly stated that the conditions have been met Please ensure that the correct consultant GP code is used and that the destination for delivery of results is accurately and clearly stated If request forms are not correctly and legibly completed then the laboratory reserves the right to cancel requests for the safety of patients We attempt to inform and advise users of such problems as they arise but may not always be able to contact those concerned Private work All such work must be identified on the original request form With private GP outpatients and day patient requests the appropriate invoicing address must be written on the form The laboratory will advise on the procedures and charges Specimen collection
6. 2KingsPath la csTs King s College Hospital MEK Page 54 of 85 gt Screening for congenital infections gt Chlamydia trachomatis antigen detection If any tests other than the listed ones are required please contact the laboratory Urine culture Mid Stream Urine should be collected in a sterile container Clean catch urine In young children clean catch specimens are preferable to bag urines which are almost always contaminated by perineal flora Supra pubic aspirates may be necessary in children to confirm a urinary tract infection CSU send CSU only if infection is suspected colonisation of the catheter is fairly common and does not require treatment Pad Urine The limitations of pad urine are as follows e Cell count cannot be ascertained on pad urine samples e Specimen should be collected from the pad without delay or will be contaminated with perineal flora giving false positive results If the specimen cannot be sent promptly to the laboratory it can be stored overnight in a specimen fridge or in a cool place Please Note Specimens will not be examined if undated or inadequately labelled efforts will be made to determine the date but if this is not possible or there is uncertainty over the date it will be discarded as erroneous results can occur Turnaround time one to two working days Stool culture Please state if e the patient has returned from abroad food poisoning is suspected the patient is
7. All serological tests require clotted blood samples In case of any molecular investigations such as HIV HBV and HCV viral loads CMV PCR and neonatal HIV diagnosis EDTA sample is required see specimen requirements and containers section below Turnaround time for sendaway serology generally 10 14 days from receipt in laboratory Mycobacteria microscopy and culture Sputum Auramine staining for Acid Fast Bacilli AFB if urgent this test can be made available within a few hours Three sputum samples should be sent preferably the first sputum expectorated each morning for three consecutive days Urine When sterile pyuria is noted three early morning urines EMU should be collected in the containers available from the laboratory Biopsy specimens sterile fluids CSF pleural fluid etc should be sent in sterile containers to the laboratory Molecular technologies available in reference laboratories for rapid detection of genetic material of Mycobacterium tuberculosis Contact laboratory for further information Turnaround time Microscopy one working day culture up to eight weeks Positive culture and auramine film results will be telephoned immediately Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i soe skingsPath la csTs King s College Hospital MES Page 61 of 85 Antibiotic assays Assays for gentamicin and vancomycin are available on site Antibiotic assay protocol availabl
8. Minimum 2 working days Acanthamoeba 10 14 days Smear available same day if requested Culture Minimum 2 working days 1 working day 5 7 working days GSTS London Actinomyces Minimum 2 weeks 1 2 working days Review August 2012 Pathology User Guide Bedford Hospital Trust Page 65 of 85 URINE Schistosoma URINE Legionella Antigen URINE AFB URINE Pregnancy Test SPUTUM Routine bacterial culture BRONCHIAL ASPIRATE TRAP SPUTUM AFB BRONCHIAL ASPIRATE TRAP AFB NPA RSV FAECES Routine culture amp Parasitology FAECES For C DIFFICILE TOXIN A amp B PERIANAL SWAB IN SALINE For Threadworm Version 1 0 10 ml terminal urine including last few drops specimen collected around midday 10 20 ml urine in sterile universal 3 consecutive early morning samples each in a 350 ml sterile container 10 20 ml early morning urine Deep cough specimen Not saliva in 60ml wide neck sterile container Sealed trap or Sterile universal Deep cough specimen Not saliva in 60ml wide neck sterile container Sealed trap or Sterile universal Place tube containing aspirate in sterile container Sterile universal half filled container Sterile universal half filled container In preference to sellotape slide use saline moistened swab rubbed over the perianal region early morning before bathing and placed in a plastic universal containing 2mls saline s
9. UKAS Scope GSTS Pathology is a clinically led customer focused and scientifically driven full service pathology provider of accurate timely and clinically useful prognostic diagnostic and screening results blood and blood products with clinical advice to the NHS and private sector locally nationally and internationally Services include core pathology such as blood sciences tissue sciences and infection sciences typically delivered from each operational Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath GSTS King s College Hospital Pathology NHS Foundation Trust amp Page 5 of 85 site and specialised tests delivered from centres of excellence Services participate in research development and clinical trials Aims and objectives The GSTS management system supports the business vision to be the leading pathology provider of high quality cost effective pathology services and ensures that e GSTS Pathology has a business reputation based on safety quality and customer service using innovation to build a competitive advantage in chosen market sectors so that GSTS Pathology becomes the provider of choice e GSTS Pathology identifies its resource requirements through an effective management structure to ensure that risk and improvement opportunities are identified and acted on to protect or improve the health and safety of patients staff and visitors e GSTS Pathology services op
10. on site for sample production Following analysis if all values are within reference ranges then no further appointments will be issued by the laboratory If any values are outside reference ranges in the first sample then the laboratory will request a second sample and send a second information sheet and pot to the patient Once the second sample has been examined and a report issued the laboratory will not request any further samples If a patient fails to attend A letter will be sent to the requesting clinician and we would ask that contact is made with the patient to ascertain the reason for the non attendance If the test is still required please send a repeat request to the laboratory at the above address If you have any questions regarding the provision of the Andrology service please contact the appointments office GSTS Pathology on 01234 792149 Advice for patients Please ensure that adequate instruction is given to the patient on production of the semen specimen The time of specimen collection must be recorded on the request form and specimen container Semen specimens must be delivered to the laboratory within one hour of production as these samples deteriorate rapidly and results will be impaired particularly the motility assessment Please note that there are NO facilities on the Hospital site suitable for the production of semen samples Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2King
11. 0 1 5 4 0 5 5 8 5 0 2 0 8 0 7 1 5 lt 0 4 0 3 0 8 150 400 up to 2 1 7 mm 2 10 mm 3 9 mm 5 15 mm Issued August 2011 i icsts Review August 2012 Pathol User Guid i a 2KingsPath la csTs King s College Hospital MES Page 43 of 85 The International normalised Ratio INR is performed for routine Warfarin treatment control and APTT for the control of heparin therapy Normal therapeutic ranges are as follows INR Routine anticoagulation following DVT or PE 2 0 3 0 High risk patients prosthetic valves and grafts 3 0 45 recurrent thromboembolism APTT Control of Heparin therapy by iv pump 40 60 secs LMW heparin is not monitored Prothrombin Time normal 9 5 12 5 secs APTT normal 23 31 secs D Dimer normal lt 220 ng ml for PE amp DVT diagnosis Clotting factor inhibitor tests normal not present Fibrinogen normal 2 0 4 0 g l Anti Xa assay for control of LMWH Available for specific patients only Seek advice from the consultant haematologist The advice of the consultant haematologist should be requested for patients with more serious coagulation defects particularly if surgery is planned or for investigation of bruising More detailed clotting studies including factor assays e g Factor VIII Factor IX are also available but only after discussion with a consultant haematologist Tests for thrombophilia and platelet function are sent to a reference laboratory If required
12. Advice is available at all times Infection control policies are available in all wards and departments and on the intranet NOTIFIABLE DISEASES Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery amoebic or bacillary Food poisoning or suspected food poisoning Leprosy Leptospirosis Malaria Measles Meningitis viral bacterial or fungal Meningococcal septicaemia Mumps Ophthalmia neonatorum Version 1 0 Issued August 2011 Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox eradicated in 1979 Tetanus Tuberculosis Typhoid Typhus Viral haemorrhagic fever Viral hepatitis A B C D E Whooping cough Yellow fever Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 73 of 85 5 Cellular pathology Cellular pathology comprises histology and cytology The laboratory offers the following services Histopathology Histopathology provides a comprehensive tissue diagnostic service to Bedford Hospital and local general practitioners including immunocytochemistry and referral for molecular diagnostics Also provides tissue diagnosis for the Bowel Cancer Screening Programme Cervical cytology The cytology dept provides the NHSCSP cervical screening service for Bedfordshire PCT and since April 1 2010 has provided the same service for NHS Luton PCT processing and screening in excess of 39000
13. before it is sent to the histopathology department should be resisted Subsequent fixation of a partly incised specimen may cause distortion and hinder anatomical orientation In the case of excised tumours it may then be impossible to identify surgical planes of excision Containers of formalin should be securely closed and users are recommended to read the Trust policy on the transport of specimens in formalin Formaldehyde vapour is a well recognised respiratory irritant Skin contact with formalin solution should be avoided as repeated exposure may cause dermatitis in some individuals On no account should unfixed specimens be sent to the histopathology laboratory without prior consultation with one of the consultant histopathologists SAMPLES IN FORMALIN MUST NOT BE SENT VIA THE PNEUMATIC TUBE SYSTEM Turnaround times Urgent results can be available within 48 hours Biopsy reports are generally available 48 hours from receipt of the specimen Routine results are usually available within three to five working days Complex specimens and specimens requiring further investigation may take longer Most small specimens will be reported in three to five days Most larger specimens will be reported in five to seven days Specimens containing bone Bone Marrow Trephines require decalcification and the minimum turnaround time for a report is five days Other specimens which contain bone will take longer than one week Version 1 0 Issued
14. days contact the lab for bottle Homocystine EMU 7 days Metadrenalines Phaechromocytoma 24hr collection Acid preservative required 17 days screen contact the lab for bottle Microalbumin EMU 3 days Mucopolysaccharides MSU 19 days Osmolality MSU Same day Porphyrins Fresh EMU Protect from light 14 days Porphobilinogen PBG Fresh EMU Protect from light 14 days Potassium 24 hr collection Same day Albumin Creatinine Ratio ACR EMU Same day Sodium MSU Same day EMU Early morning urine MSU Midstream urine Protect from light 24 urine protein is not routinely available We recommend ACR in accordance with NICE Guidelines In non diabetic consider clinically significant proteinuria to be present if ACR is 30mg mmol or more this is approximately PCR of 50mg mmol or more or a urinary protein excretion of 0 5g 24hr or more Heavy proteinuria should be considered present when the ACR is 70mg mmol or more PCR of 100mg mmol or more or a urinary protein excretion of 1 0g 24hr or more Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 20 of 85 Test name Sample Special Requirements Expected turn around time Tests highlighted in blue denote test sent routine tests are carried away out the same day if received before midday Faeces Elastase Small plain stool Must be received in lab 15 days sample
15. for results as we are not authorised to give results to patients directly The laboratory examines the sample and reports it according to the latest reference ranges If any parameters are outside the reference ranges or if the laboratory is unable for technical reasons to complete all test a repeat sample will be requested by the laboratory and you will receive a pot and new documentation for this in the post kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk Copies of the above instructions for patients are available from the laboratory on request Reporting of semen samples Semen reports for the investigation of infertility include the following Sample volume pH assessment of viscosity presence of agglutination or aggregation of sperm sperm concentration total number of sperm in the sample assessment of sperm motility and of sperm morphology It is helpful to include the name of the partner and the NHS Hospital number on the request form for the correlation of results from both partners If provided this will be included on the report Recommendations for measurements and reference values for semen analysis in infertility investigation have been made by the World Health Organisation WHO whose standards are employed by most andrology laboratories WHO recommendations changed in 2010 and this laboratory reports semen samples in line with the current WHO recommendations 5 Edition Reference range
16. identification Identification of high risk specimens For the protection of laboratory workers the request form and any specimens collected from a patient with a known or suspected infection due to a Hazard Group 3 biological agents must be labelled as high risk These agents include HIV 1 and 2 Salmonella typhi amp paratyphi Hepatitis B virus Mycobacterium tuberculosis Hepatitis C virus HTLV 1 and 2 Brucella spp and the causative agents of Anthrax Creutzfeldt Jakob disease Rabies Yellow Fever Plague Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEK Page 76 of 85 Histology laboratory Surgical pathology Fixation The tissue fixative used routinely is formalin 10 neutral buffered formalin solution On request labelled specimen containers of various sizes containing formalin are provided by the laboratory to all users as required All tissue samples should be placed in fixative as soon as possible after removal from the patient With small biopsies in particular it is important not to let the specimen dry out The recommended volume of fixative is at least ten times the volume of the specimen so it is important not to squeeze a specimen into too small a container If in doubt choose a larger container Poor fixation can hinder or prevent accurate histological diagnosis The temptation to slice open or dissect an excised specimen
17. information sheets are available on the Bedford Hospital site www bedfordhospital nhs uk clinical biochemistry Appointment for a Glucose Tolerance test Patient instructions for Collecting a 24 hour urine sample Patient instructions for Collecting a 24 hour urine sample for HMMA VMA Catecholamines Metadrenalins and 5HIAA Version 1 0 Issued August 2011 Review August 2012
18. on antibiotics or has received some in the last four weeks 1 Specimens from the community will be investigated routinely for Salmonella Shigella Campylobacter spp Verotoxic Escherichia coli E coli0157 VTEC Parasites Clostridium difficile on request Extra investigations for other enteric pathogens are performed based on the age of the patient the clinical picture and travel history Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae sKingsPath ia csTs King s College Hospital MES Page 55 of 85 If parasites are of particular concern send three separate specimens as parasites may be intermittently excreted requesting a concentration for ova cysts and parasites Threadworms Enterobius vermicularis investigation A sellotape slide is the most appropriate specimen See section on Specimen requirements amp containers below Rotavirus Adenoviris investigation A test for the detection of rotavirus and adenovirus antigen is available and is routinely performed on all stools from children of five years or less in age 2 Specimens from the hospital 1 Specimens from patients will be routinely tested for Salmonella Shigella Campylobacter spp Verotoxic Escherichia coli E coli0157 VTEC Clostridium difficile And any other tests requested Samples will NOT be processed if e A previous positive result was reported within 28 days of new request If clearance of C diffici
19. phlebotomy including outpatients Blood samples received from other locations are required to take a fluoride oxalate grey white capped vacuette for glucose analysis Phlebotomy collections from small children and babies A 2 ml paediatric orange lithium heparin bottle can be used for these patients instead of an SST to yield a better volume of plasma for analysis except for the following tests where an SST is necessary Anti tissue transglutaminase Lithium C1 esterase inhibitor Protein electrophoresis CEA Vancomycin Folate Gentamicin A minimum of 1 ml of blood is required for a routine biochemistry profile A 2 ml paediatric yellow fluoride oxalate bottle can be used for glucose analysis Some of the more specialised assays may require different samples please contact laboratory before bleeding the patient See assay services table Some important notes to help us give you a good service 1 Always ensure minimum delay between venepuncture and sending samples to the laboratory Delays can cause changes in some analytes particularly artefactual increases in serum potassium phosphate and some enzymes Haemolysis lipaemia and icterus samples that may affect some analytes will be noted on the report Grossly haemolysed samples will not be analysed However if prompt delivery is not possible some tests are still valid on serum samples stored overnight see list of tests below for further information Further details of
20. place in other conditions Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 34 of 85 Subfertility investigations for males erectile dysfunction The most useful biochemical investigations are serum FSH LH Testosterone SHBG and Prolactin Tumour markers Tumour markers are non specific and are not useful as screening tests High concentrations may occur in many benign conditions and in the absence of a tumour If a tumour has not been identified it may be inappropriate to randomly request tumour markers to identify the primary tumour Generally tumour markers are valuable in monitoring treatment of patients known to have malignancies and in follow up to detect recurrence CA 125 There are a variety of conditions in which raised values are obtained e g endometriosis pelvic inflammation etc CA 125 is useful in monitoring treatment for carcinoma of the ovary If there is a family history of carcinoma of the ovary 1 or more members of the family or if ovarian mass is present then full screening procedures including assay for CA 125 need to be done Clinical utility of other tumour markers Other tumour markers useful in monitoring therapy and follow up include a fetoprotein AFP hepatocellular carinoma and testicular tumours human chrionic gonadotrophin hCG choriocarcinoma and testicular tumours carcinoembryonic antigen CEA colo
21. please refer to consultant haematologist Clinical haematology Bedford Hospital provides a clinical haematology service covering all aspects of blood disease Inpatients Inpatients are managed jointly with consultant physicians Patients are admitted for blood transfusion platelet transfusion chemotherapy for chronic leukaemias myeloma and some lymphomas treatment of some coagulation disorders treatment of thrombocytopenia management of sickle cell crises and other haemoglobinopathy problems An increasing number of patients can be managed as day cases This would include simpler chemotherapy i v immunoglobulin therapy venesection and clotting factor replacement and blood transfusion Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i eae sKingsPath la csTs King s College Hospital MES Page 44 of 85 Outpatient referrals Outpatient referrals are all seen by a consultant haematologist Advice on the suitability of a referral can be obtained by telephone throughout the working day Suitable cases might include lron deficiency Iron deficiency which is unexpected or unusual most cases will be due to bleeding which should be investigated unless obvious Most such patients may be better served by direct referral to a physician for endoscopy etc Failed iron therapy is often due to inadequate therapy two to three months may be needed to get iron stores back to normal or due to an inadequate ir
22. result maybe available earlier Wound infections Pus samples If frank pus is available always send this in a sterile universal container and not a swab with pus on it Tissue should be sent as a priority sample placed in a sterile container and sent to the laboratory Wound swabs Any chronic ulcers should be cleaned with sterile water and swabbed to avoid colonising flora Animal bite or scratch acquired outside the UK please discuss the patient with the public health doctor on call via switchboard immediately if anti rabies treatment indicated Turnaround time Result available one to two working days after receipt Eye ear throat and oral infections Eye swabs from neonates are cultured for appropriate pathogens including Neisseria gonorrhoeae and thus it is important that such specimens reach the laboratory promptly after collection Examination for Chlamydia trachomatis is also indicated in a neonate with a purulent eye discharge use the swabs designated for the detection of C trachomatis from the male genital tract Throat swabs are cultured for haemolytic streptococci and Corynebacterium diphtheriae If culture for Candida sp or other occasional pathogens is required please state this clearly on the request form Per nasal swab If whooping cough is suspected special swabs may be required Turnaround time Result available one to two working days after receipt Preliminary result maybe available earlier Ve
23. s College Hospital MEK igicsts Test name Sample Special Requirements Expected turn around time Tests highlighted in blue denote test sent SST unless otherwise routine tests are carried away stated out the same day if received before midday Follicle stimulating hormone FSH See infertility protocol Same day Fructosamine 8 days Gastrin Special tube Arrange with lab 14 days available in lab Glucose Flu Ox timed sample State fasting random or if Same day known DM Glucose tolerance test GTT FI Ox timed samples Arrange with phlebotomy 2 days SW y glutamyl transferase GGT Same day Haemoglobin Alc glycated haemoglobin EDTA Available only for known 1 2 days DM HDL cholesterol Same day Human chorionic gonadotrophin HCG Daily but not week ends Human Growth Hormone 8 days 17 hydroxyprogesterone 10 days Immunoglobulins IgA IgG amp IgM 3 days Immunoglobulin IgE amp RAST 21 days Insulin C peptide FI Ox amp SST Arrange with lab 15 days Iron Same day Lactate FI Ox Send to lab immediately Same day Lamotrigine 8 days LDH Daily weekdays Lead Li hep or EDTA 21 days Lipids cholesterol amp Triglyceride Fasting sample Same day Lithium 12 hrs post dose Same day Liver function tests LFT Bilirubin AST Same day Alk Phos amp albumin Luteinizing Hormone LH Same day Magne
24. ug L Antibiotic policy is available on the Trust intranet Version 1 0 Issued August 2011 i icsts Review August 2012 Pathology User Guide Bedford Hospital Trust Page 27 of 85 skingsPath King s College Hospital MES LIPID INTERPRETATION i icsts Cholesterol Triglyceride HDL Cholesterol LDL Cholesterol Chol HDL Ratio Fasted sample Calculated test Valid if patient fasted and Triglyceride does not exceed 4 5 mmol L In patients with personal history of occlusive vascular disease target Total Cholesterol should be less than 4 0 mmol L 0 40 1 80 mmol L Ideally greater than 1 0 mmol L In patients with personal history of occlusive vascular disease target LDL Cholesterol should be less than 2 0 mmol L Ratio of lt 5 00 reduces the risk of cardiovascular disease Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 28 of 85 On call service The following tests are available if requested Electrolytes and creatinine CRP Urea Bilirubin on paediatric samples total amp direct Glucose Calcium inc albumin Amylase Magnesium Bicarbonate Paracetamol Chloride Salicylate CSF protein LFT CSF glucose CK Vancomycin Lactate grey white topped vacuette Blood Gases amp Carboxyhaemoglobin Other routine analytes may also be resulted on the interim report which is sent
25. within 30 minutes Porphyrins Small plain stool Protect from light 14 days sample Sweat Tests Sweat chloride Collection performed by paediatric department Same day Send away tests are indicated in blue Results marked as urgent that fall within the agreed guidelines will be issued to the requesting ward via the pneumatic tub system within one hour of receipt Add on tests are generally not recommended unless the additional tests are important for immediate patient management or a repeat sample will not be relevant e g a paracetamol level on an additional sample taken much later after the overdose Laboratory staff who receive telephoned add on requests will inform the requestor to send an additional request card stating that the sample is already in the laboratory and providing clinical information to justify the request Specialist assays may be vetted for sanctioning by the consultant chemical pathologist or clinical scientist If other assays are required please contact Consultant Chemical Pathologist Dr W Wassif or Dr Louise Ward principal clinical scientist to discuss The following hospitals are routinely used to refer specialist tests for analysis GSTS Pathology London Central Middlesex Hospital London St Bartholomew s Hospital London St Mary s Hospital London Royal Free Hospital London Hammersmith Group Hospitals London Protein Reference Unit Sheffiel
26. 0 Alb 45 Corrected Ca 2 70 Invalid if albumin is lt 20 g L 2 5 7 5 mmol d 4 12 mg L Version 1 0 Issued August 2011 i icsts Review August 2012 Pathology User Guide Bedford Hospital Trust Page 22 of 85 skingsPath King s College Hospital MES Carboxyhaemaglobin Chloride Chloride sweat Cholesterol C3 complement C4 complement CA 125 CA 153 CA 199 CEA Cortisol serum Creatinine serum Creatinine Clearance Creatine Kinase CK lt 1 5 of Total Hb 95 108 mmol L Less than 40 mmol L See Lipid interpretation 0 75 1 65 g L 0 20 0 65 g L 0 35 u mL 0 28 u mL 0 34 u ml 0 4 ug L 9 am 170 700 nmol L 12mn lt 100 nmol L Random cortisol is of limited clinical use If Cushing s Syndrome is suspected we recommend overnight dexamethasone suppression test as the initial investigation If adrenal failure is suspected a short synacthen test is indicated 0 1 month 30 80 umol L im 6years 15 40 umol L 6y 12 years 25 60 umol L Over 12 years 60 110 umol L 80 120 ml min Male 40 320 iu L Female 25 200 iu L C Reactive Protein lt 5 mg L Cryoglobulins Not detected Digoxin 0 5 2 0 ugl L eGFR See interpretive information in this document Electrolytes Na K and Creatinine Serum See individual Test Urine See individual Test Version 1 0 Issued August 2011 Review August 2012 i icsts Pathol User Guid i a 2KingsPath la csTs
27. 2KingsPath la csTs King s College Hospital MES Page 13 of 85 2 Clinical biochemistry Key contacts Telephone Result Enquiries Direct Lines 01234 792148 792160 Consultant Chemical Pathologist Dr W S Wassif Tel 01234 792167 Ext 4661 Principal Clinical Scientist Dr Louise Ward Tel 01234 355122 Ext 4657 Specialty Manager Mr M Seaman Tel 01234 792165 Ext 4665 Laboratory Tel 01234 792166 Ext 4654 Out of hours Tel 01234 355122 Bleep 432 Secretary Tel 01234 355122 Ext 4625 Laboratory service Routine services Enquiries Specimens Monday to Friday 8 00 am 8 00 pm 8 00 am 5 30 pm Saturday 9 00 am 12 30 pm 9 00 am 12 30pm Urgent specimens only An out of hour s service is provided at all other times Specimens for all pathology departments should be left at specimen reception located on the 1st Floor of the pathology building Access is via the hospital main corridor A lift is available The laboratory provides a wide range of tests for the diagnosis and follow up of patients the results of most being available within 24 hrs of receipt of samples Results from samples sent to specialist laboratories will take longer Some of the in house specialised tests are done in batches and results are available within one week Turnaround times are indicated in the assay service table Additional tests may be added to previously received samples up to a maximum of two days after receipt subject to which test requeste
28. ACR assay every six months only a single sample should be sent on each occasion Estimated Glomerular Filtration Rate eGFR National Service Framework NSF on chronic kidney disease CKD recommends eGFR to monitor diagnose CKD Consider requesting eGFR as an alternative to creatinine clearance eGFR is not validated for use in children lt 18 years old acute renal failure pregnancy oedematous states muscle wasting disease states amputees or malnourished patients Reference ranges Estimated GFR eGFR ml min 1 73m gt 90 Indicates normal GFR unless there is a structural abnormality or a functional abnormality such as persistent proteinuria or microscopic haematuria 60 89 Does not indicate chronic kidney disease unless there is other existing laboratory clinical evidence of disease 30 59 Indicates moderate renal impairment Consider monitoring eGFR 6 monthly 15 29 Indicates established renal impairment Consider monitoring eGFR monthly 15 30 lt 15 Indicates established renal failure Consider monitoring eGFR 3 monthly For African Caribbean people only eGFR should be multipled by 1 212 Further information can be obtained from Department of Health National Service Framework for Renal Services Part Two Chronic Kidney Disease Acute Renal Failure and End of Life Care 2005 Available at www dh gov uk renal Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae 2KingsPath la csTs King
29. August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 77 of 85 Cytology laboratory 1 Cervical cytology Liquid Based Cytology LBC samples 2 Diagnostic Cytology Cytology of fluids and aspirates Note that NHS Luton and NHS Bedfordshire as local purchasers of the cervical screening programme determines the policy on cervical screening including interval between smears The laboratory actively manages inadequately labelled samples late deliveries of samples and out of programme samples in order to ensure patient safety and to deliver the 14 day patient pathway Out of programme samples which cannot be processed by the laboratory are 3 Patient is under 24 5 years old and not scheduled from a previous test 4 Patient on three yearly recall and sample received less than 30 months since previous routine negative test 5 Patient on five yearly recall and sample received less than 54 months since previous routine negative test 6 Patient aged 65 and over with 3 consecutive routine negative tests 2 of which were in the last 10 years 7 This sample is not clinically appropriate Liquid based cytology Procedure for submitting a liquid based cytology sample Equipment request form LBC vial with collection fluid pre filled Cervibrush The vial must be clearly labelled with the patient s surname forename date of birth and NHS number or Hospital number A
30. F BACTERIOLOGY SAMPLES AND ASSOCIATED TURNAROUND TIMES TEST SWABS Routine bacterial culture PUS ASPIRATES TISSUE PUS ASPIRATES TISSUE AFB SWAB Whooping cough SWAB Ear MRSA SCREEN CONTACT LENS Routine and Acanthamoeba Culture CORNEAL SCRAPINGS CHLAMYDIA EYE INFECTION CHLAMYDIA OTHER SITES IUCD s Actinomyces culture URINE Routine bacterial culture Version 1 0 SAMPLE COMMENTS Swab Blue Cap Containing transport medium Sterile Universal No formalin As above No formalin Pernasal swab fine twisted wire swab with small bud Either routine swab Blue cap or fine wire swab with small bud Swab Blue Cap Notify Laboratory before sending See Infection Control MRSA Policy Acanthaboeba sent to ref lab if requested Send lens in lens fluid Please label slide and plates with patient demographics Smear scraping on clean labelled microscope slide and place in slide box Spread scraping onto Blood agar Chocolate plate and Sabouraud agar Smear on slides Special collection kits Send in sterile 60ml wide necked container 10 20 ml midstream urine in a Sterile Universal CSUs are of very limited value Issued August 2011 TURN AROUND TIMES Minimum 2 working days Minimum 2 working days Microscopy 1 2 working days Culture 6 8 weeks Minimum 5 days Minimum 2 working days Minimum 1 working day Routine
31. Keep telephone enquiries to an absolute minimum Please note Abuse of the system results in delay of other genuinely urgent work Up to midnight haematology blood transfusion biochemistry samples will be processed at regular intervals It is only necessary to contact the on call BMS if the work is considered very urgent After midnight it is ESSENTIAL to bleep the on call biomedical scientist Clinical biochemistry Bleep 432 Haematology blood transfusion Bleep 474 If no response please contact switchboard Both the clinical biochemistry and the haematology blood transfusion biomedical scientist also carry DECT phones so that the accident and emergency department can alert the laboratory that samples need to be processed urgently or to enquire if results are available on their patients Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital MES Page 9 of 85 This DECT phone is not for use outside of the A amp E department Between 17 00 and 20 00 haematology blood transfusion may be contacted on extensions 4833 4653 Microbiology Contact via switchboard The on call microbiology BMS is usually off site and should always be contacted before urgent work is sent Work sent after midnight without bleeping the relevant personnel will be processed with the next urgent batch of work ALL results produced out of hours will be telephoned and or hard copy sent in the
32. ND TIMES Amikacin tobramycin Sent to Reference Amikacin and and teicoplanin Laboratory tobramycin available next day if received before 9 30am Teicoplanin next working day Verbal results ASOT 5ml clotted blood Fairly non specific test Once per week red and yellow top of limited value Aspergillus precipitins 5ml clotted blood Reference laboratory 10 14 days red and yellow top request risk factors and date of onset must be given Atypical Respiratory Acute and If atypical pneumonia is 10 14 days Screen Legionella Convalescent suspected and sputum Chlamydia Psittacosis serum samples samples are negative Mycoplasma Influenza A required taken 10 for culture amp B Q Fever Coxiella 14 days apart Sent to Reference 5ml clotted blood laboratory red and yellow top Samples will NOT be sent unless date of onset is given and any travel history Urine sample for Legionella antigen should be sent if Legionella suspected AVIAN antibodies 5ml clotted blood Reference laboratory 10 14 days red and yellow top request risk factors must be given e g keeps birds BRUCELLA 5ml clotted blood Reference laboratory 10 14 days ANTIBODIES red and yellow top request details of travel history must be given as well as risk factors e g eating unpasteurised cheese Date of onset and clinical history must be given CAMPYLO BACTER 5ml clotted blood Reference laboratory 10 14 days SEROLOGY red
33. air tube to the requesting location and or will be available on the ward reporting system available on all Trust computers connected to the Intranet Please LOOK on the ICE system before telephoning for results CSF and antibiotic levels will be telephoned through to the requesting ward These results will not be available on the ICE system until the next working day Consultant staff may be contacted via switchboard if clinical advice is required Requesting investigations Request forms should be completed using ballpoint pen All forms must be fully completed including patient s first name and surname date of birth hospital number NHS number or address sex location for return of report e g ward GP surgery risk status consultant name and bleep number of requesting doctor date and time of specimen Request forms for specimen labelling If a pre printed label is used please ensure that a label is placed also on all back copies of the request form It is essential that specimens are correctly identified otherwise e apatient may receive the wrong treatment e apatient may not receive the treatment that they require If request forms are being handwritten please ensure that they are legible A correctly completed request form must state e the patient s name date of birth hospital number or NHS number if Known nature of the specimen date and time the sample was collected Version 1 0 Issued August 2011 Review August 2012
34. al and internal audit to monitor adequacy of operating procedures and effectiveness of the quality system Quality tools such as root cause analysis are used to ensure effective corrective actions are implemented We recognise the confidentiality of information we hold on patients donors and clients and allow accreditation and regulatory bodies appropriate access to the knowledge systems maintained to provide third party assurance to GSTS pathology and our stakeholders GSTS is registered with the Care Quality Commission CQC as an independent healthcare provider at all locations on which it operates for the provision of diagnostic and screening services and blood and transplant services Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i Bedfo aani Trust ai ngsPath GSTS King s College Hospital Pathology NHS Foundation Trust Page 7 of 85 Pathology block is located in the South Wing of Bedford Hospital see map below Pathology can only be accessed via swipe cards out of hours but during working hours personnel can access the department from the hospital main corridor by pressing the pad on the left hand side of the main doors and reporting to pathology reception using the stairs or lift to the first floor The pathology block does not have the facilities for any phlebotomy service The pathology block indicated on the map contains the mortuary and bereavement service on the ground floor clinical biochem
35. alescent sample taken 10 14 days later A serological diagnosis can be made when the following can be demonstrated gt There is an increase in antibody titre from the acute to the convalescent serum samples usually fourfold or greater gt A stationary but high antibody titre in both samples gt A fallin titre of antibodies can be regarded as evidence of recent infection gt IgM is detected The following details should be included with ALL serological requests gt Date of onset of symptoms gt Relevant clinical details including history of travel contact dates and any other appropriate information including vaccination history gt Risk factors The laboratory cannot process specimens or interpret the result without sufficient clinical information Label all specimens and request forms with HIGH RISK stickers if patient known or suspected to be high risk For investigation of Blood Borne Viruses a SIGNED request form is essential TEST SAMPLE COMMENTS TURN AROUND TIMES Amoebiasis Hyatid Schis 5ml clotted blood Reference laboratory 2 3 weeks tosomal red and yellow top request will only be sent if full travel history and risk factors are given ANTI SPERM 5ml clotted blood 3 4 weeks ANTIBODIES red and yellow top Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath a csTs King s College Hospital MEK Page 68 of 85 TEST SAMPLE COMMENTS TURN AROU
36. and yellow top request Please give full clinical details e g Guillain Barre syndrome Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 69 of 85 a TEST CAT SCRATCH FEVER Bartonella CMV IgG M Screen DENGUE FEVER RICKETTSIA HAEMORR HAGIC FEVER TYPHUS WEST NILE VIRUS SARS etc EBV Enterovirus including Coxsackie Haemophilus Pneumococal Tetanus Antibodies Helicobacter pylori IgG HEPATITIS A IgG HEPATITIS A IgM Version 1 0 SAMPLE 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top Citrated blood required for PCR DO NOT TAKE SAMPLE without contacting Consultant Microbiology 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood with gel red and yellow top 5ml clotted blood red and yellow top Issued August 2011 ingsPath King s College Hospital MEK COMMENTS Reference laboratory request Please give full clinical details and risk factors Please give date of onset and state whether patient is immunocompromi sed Infection usually only of Clinical significance in immunocompromi sed or pregnant patients CONTACT Consultant Microbiologist Suggest send sample for Monospot in the first instance If negative and EBV remains a differential diagnosis send sample
37. arcel shelf of a car or left near a radiator as these factors will directly interfere with results Samples should reach the department on the same day Where this in unavoidable contact the laboratory for specific storage instructions Completion of request forms All samples must be accompanied by a fully compliant request form Information from the request card is transferred to the laboratory computer system Illegible handwriting may lead to poor data transfer and incorrect filing of patient results Addressograph and other pre printed labels must not be used on any sample sent to the blood transfusion department They can however be used on the request form Unsatisfactory blood transfusion request forms may in some cases be returned to the ward for correction and may lead to a delay in blood issue Identification of high risk specimens For the protection of laboratory workers the request form and any specimens collected from a patient with a known or suspected infection due to a Hazard Group 3 biological agents must be labelled as high risk These agents include HIV 1 and 2 Salmonella typhi amp paratyphi typhoid Hepatitis B virus Mycobacterium tuberculosis TB Hepatitis C virus HTLV 1 and 2 Brucella spp and the causative agents of Anthrax Creutzfeldt Jakob disease and vCJD Rabies Yellow Fever Plague Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath la csTs King s Colleg
38. assay interference are available from the laboratory on request Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i eae sKingsPath la csTs King s College Hospital MES Page 15 of 85 2 Please fill Vacutainer tubes 3 5 ml even if few tests are requested economising on samples can cause processing problems and changes to some analytes In general multiple analyses can be performed on a single sample Exceptions are indicated in the list of assays Pathology laboratories will not assay samples without the following minimum data set on both request card and sample container SURNAME FIRST NAME DATE OF BIRTH HOSPITAL NUMBER OR NHS NUMBER It is also desirable and frequently essential for results interpretation to include DATE OF SAMPLE TIME OF SAMPLE ADEQUATE CLINICAL INFORMATION Inappropriately labelled or unlabelled samples will not be analysed A report will be issued stating Unlabelled sample received unsuitable for analysis Consider repeat if still needed This will also be conveyed by phone for urgent requests Specimen transport All specimens must be in blood collection tubes of approved leak proof primary containers as supplied by the laboratory Lids must be firmly affixed to prevent leakage Primary containers must be further contained within the specimen transport plastic bag with the request card kept separate in the front pocket Leaking specimens are hazardous an
39. cervical liquid based cytology specimens annually Diagnostic cytology Cytopathology also provides a comprehensive Fine Needle Aspiration FNA and diagnostic cytology service This includes evaluation of body cavity fluids and washings and brushings from various sites in the body Fine needle aspiration cytology This is a quick minimally invasive and cost effective method of reaching a cellular diagnosis on mass lesions The consultant cytopathologist offers an on demand FNA service Semen analysis This includes routine semen analysis for infertility cases as well as evaluation of post vasectomy specimens Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ee sKingsPath la csTs King s College Hospital MES Page 74 of 85 Key contacts External Internal Dr M Wilkins Consultant Histopathologist 01234 792094 4729 Dr K Adu Poku Consultant Histopathologist 01234 355122 x 4731 4731 Dr J Patel Consultant Histopathologist 01234 355122 x 4730 4730 Mr N Cully Specialty Manager Cellular Pathology 01234 792092 4694 Dr F Mutch Consultant Cytopathologist 01234 792325 4725 Hospital Based Co ordinator Cytology Advanced 01234 355122 x 4734 4734 Practitioner A amp C Office Mrs A Strong A amp C Manager 01234 792628 4658 Histology enquiries 01234 792149 4607 Cytology enquiries 01234 355122 x 4611 4611 Opening times Enquiries Specimens Monday to Friday 8 30 am 5 00 pm 8 30 am 4 30 pm During workin
40. ces when the patient is unconscious or unknown a UNIQUE NUMERIC IDENTIFIER A amp E number GENDER amp DATE TIME SIG can be accepted In the case of a suspected transfusion reaction or adverse transfusion event immediately telephone the lab Ext 4833 or bleep 474 on call for advice appropriate documents required Blood and blood product component Issue Blood transfusion risks to the patient are significantly greater during the out of hours period Therefore it essential that non urgent requests are limited during this period This is in accordance with national guidelines SHOT and local Trust policy this is available on the intranet under policies and guidelines Blood must ONLY be stored at 2 6 in a validated blood bank Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 49 of 85 Routine crossmatching takes about 65 mins but it is important to give as much notice as possible preferably 24 hrs due to possible blood shortages or the unexpected presence of atypical antibodies 48 hrs minimum may be required when the patient is known to have atypical antibodies Where the patient has had a recent group and negative antibody screen lt 72hrs blood can normally be issued safely using an abbreviated method within 5 10 mins The laboratory will automatically withdraw unused issued blood after 24 48 hrs unless an extension to this time has been requ
41. cimens for all pathology departments should be left at specimen reception located on the first floor of the pathology building Access is via the hospital main corridor A lift is available Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath la csTs King s College Hospital MES Page 52 of 85 Specimens and tests Request forms for specimen labelling If a pre printed label is used please ensure that a label is placed also on all back copies of the request form It is essential that specimens are correctly identified otherwise e apatient may receive the wrong treatment e a patient may not receive the treatment that they require If request forms are being handwritten please ensure that they are legible A correctly completed microbiology request form must state the patient s name date of birth hospital number or NHS number if Known nature of the specimen and the site from where it was taken date and time the sample was collected clinical diagnosis and relevant clinical signs symptoms including travel history if indicated date of onset of symptoms vital for serological tests sample may not be processed without this information examination required names of any recent current or intended antibiotics Consultant caring for the patient Name and bleep or contact number of requesting doctor Inadequately labelled specimens will not be examined and the report will be produced Ina
42. ctive change often parallels the ESR If the count is very high gt 1000 it may be due to a primary bone marrow disorder As with PRV there is a tendency towards TIA and stroke and these patients should be referred for investigation and therapy Anticoagulant clinics Anticoagulant clinics are held Mondays to Thursdays Patients are seen by the anticoagulant specialist nurse Referrals are usually from local clinicians or provider cardiovascular units Referrals from general practitioners are accepted if patients are being transferred from elsewhere and are already on therapy A postal system which operates every day is available for patients with busy lifestyles who cannot attend the clinic and is also suitable for many other patients Much valuable clinic time can be saved in this way A computerised system for both records and dosing has been introduced This has allowed the present resources to cope with an increasing workload Advantages are reliable record keeping improved statistical analysis and more stringent follow up of non attenders The dosing programme not used for all patients tends to be cautious and some patients may be recalled sooner than they would like In some cases this is an advantage Interactions between anticoagulants and other drugs are a common problem Safe alternatives should be chosen if possible If there is no alternative patients should be asked to seek an earlier appointment at the clinic remember that it
43. d Medical Toxicology Unit London Addenbrooke s Hospital Cambridge Great Ormond Street Hospital for Children London King s College Hospital London UCLH Hospital London Selly Oak Hospital Birmingham Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 21 of 85 skingsPath King s College Hospital MES GSTS PATHOLOGY CLINICAL BIOCHEMISTRY REFERENCE RANGES FOR ASSAYS CARRIED OUT ON SITE Albumin Alkaline Phosphatase ALP Alphafetoprotein AFP Alaninne Transferase ALT Ammonia 35 50 g L Adult 30 120 iu L 0 17 yrs 40 390 iu L lt 7 iu mL 0 40 iu L Male 15 55 mmol L Female 11 48 mmol L Amylase Serum lt 100 iu L Aspartate Transferase AST 10 50 iu L Bicarbonate serum 22 29 mmol L Bilirubin Total 3 20 umol L conjugated 0 5 umol L Beta 2 microglobulin Blood Gases PH pCOz pOz Bicarbonate CO content Base excess Standard Bicarbonate Oz saturation 0 80 2 20 mg L 7 35 7 45 4 7 6 0 kPa 10 0 13 3 kPa 22 27 mmol L 24 32 mmol L 2 mmol L 22 27 mmol L No reference range Calcium serum Corrected Calcium Calcium urine Carbamazepine gt 2 150 yrs 2 20 2 60 mmol L 0 2 yrs 2 35 2 72 mmol L 0 02 mmol L of Calcium for every g l variation from an Albumin of 40 g L eg Ca 2 80 Alb 35 Corrected Ca 2 90 Ca 2 8
44. d Dermapak if available or Universal Send as much material mycology as possible Universal 20m maximum pus etc Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath la csTs King s College Hospital MEK Page 62 of 85 Cerebrospinal fluid Sterile universals X 3 Ist and 3 to Microbiology MC amp S 2 universal to Biochemistry approximately 0 3mI CSF for protein estimation PLUS 1 fluoride oxalate bottle approximately 0 2m CSF for glucose estimation and 1 fluoride oxalate bottle blood for blood glucose estimation General viral 5ml clotted blood in plain tube serology 5ml clotted blood in plain tube 5ml blood in EDTA Viral swabs for culture Green topped MW amp E swab from Microbiology Issued only on authorisation of Consultant Microbiologist Chlamydia genital GenProbe chlamydia swab available from Microbiology infections Chlamydia eye Corneal smear slide infections vancomycin assay Monitoring Gentamicin and Vancomycin levels 7 8ml blood in EDTA Meningococcal amp 1 2ml blood in EDTA Pneumococcal PCR Legionella amp Universal 10 20ml clean catch pneumococcal urinary antigen Microbiolog difficile toxin HIV maternal 1 2ml blood in EDTA transmission Eor most viral serology paired sera are required an acute as early during the illness as possible and a convalescent 10 days afterwards Because of the large number of serological te
45. d and sample integrity by the requesting physician phoning the laboratory Results of inpatient requests marked urgent will have a hard copy sent in the air tube and will be available on the ward reporting system as soon as processed Critical results which need immediate intervention will still be telephoned Results of GP requests marked urgent will be telephoned The consultant chemical pathologist or principal clinical scientist is available on site during working hours and by mobile phone at other times when on call Doctors are encouraged to discuss the investigation and management of individual patients with the consultant chemical pathologist Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae sKingsPath la csTs King s College Hospital MES Page 14 of 85 Sample requirements Becton Dickinson BD Vacutainer System Most routine tests can be performed on 3 5ml Serum Separating Tube SST sand cap Except Glucose 2 ml Fluoride Oxalate grey cap Glycated Hb 2 ml EDTA translucent lavender cap Fluoride Oxalate preservative grey capped vacutainer enables stable and accurate glucose measurements to be performed Glucose measurements on unpreserved clotted serum samples can also produce accurate measurements if the sample is received and processed in the laboratory promptly within two hrs Therefore glucose will be analysed on clotted serum samples received from inpatients and South Wing
46. d may be destroyed The pneumatic tube system may be used to transport specimens in accordance with the rule of use of the system Air tube guide is available on the hospital intranet online facilities Specimens transported by road are classified as dangerous goods and must be packaged and labelled in accordance with the Carriage of Dangerous Goods regulations Specimen transport bags and request forms which are supplied to the GPs have an absorbent pad which will immobilise the entire leakage of a liquid specimen These used in combination with the hospital courier service will ensure compliance with the regulations Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 16 of 85 SkingsPath King s College Hospital MEK igicsts ASSAY SERVICES OFFERED BY CLINICAL BIOCHEMISTRY DEPARTMENT Test name Sample Special Expected turn around time routine tests Tests highlighted in blue denote SST unless Requirements are carried out the same day if received test sent away otherwise stated before midday ACE 15 days ACTH EDTA on ice Send to lab 21 days immediately Albumin Same day Alkaline Phosphatase ALP Same day Alpha fetoprotein AFP 3 days Alpha 1 antitrypsin 10 days Amino acid chromatography Li Hep 10 days Amiodarone Pre dos
47. d to transport specimens in accordance with the rule of use of the system Air tube guide is available on the hospital intranet online facilities Specimens transported by road are classified as dangerous goods and must be packaged and labelled in accordance with the Carriage of Dangerous Goods regulations Haematology transport bags which are supplied to GPs have an absorbent pad These used in combination with the hospital courier service will ensure compliance with the regulations Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 42 of 85 Kings Normal ranges Version 1 0 HAEMOGLOBIN g dl MCV fl MCHC g dl MCH pg RDW WHITE CELLS TOTAL Neutrophils Lymphocytes Monocytes Eosinophils PLATELETS RETICS E S R Men Women Child 3 months Child 1 year Child 3 6 yrs Child 10 12 yrs Adult Child Child Child Child 3 months 1 year 3 6 yrs 10 12 yrs Adult and Child Adult Child Adult and Child Adult Child Child Child Adult Child Adult Child Adult Child Adult Child 1 year 4 7 yrs 10 12 yrs 6 yrs 6 yrs 6 yrs 8 yrs Men lt 50 yrs gt 50 yrs Women lt 50 yrs gt 50 yrs Path pital WEA 13 0 18 0 11 5 165 9 5 13 5 10 5 13 5 12 0 14 0 11 5 14 5 76 96 95 mean 70 86 73 89 77 91 31 36 27 32 24 31 11 5 14 5 4 0 11 0 6 0 18 0 5 0 15 0 4 5 13 5 2 0 7 5 2 0 6
48. dequately labelled specimen received Not processed Please repeat Unrepeatable specimens In the case of unlabelled unrepeatable specimens such as CSF blood cultures pleural fluids etc the requesting doctor will be given the opportunity to identify the specimen The doctor will be asked to sign to accept responsibility for identification Specimen transport All specimens must be in blood collection tubes of approved leak proof primary containers as supplied by the laboratory Lids must be firmly affixed to prevent leakage Primary containers must be further contained within the specimen transport plastic bag with the request card kept separate in the front pocket Leaking specimens are hazardous and may be destroyed Please ensure that the outside of the container is not contaminated by the specimen at the time of collection Contaminated containers are hazardous and may be destroyed Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 53 of 85 The pneumatic tube system may be used to transport specimens in accordance with the rule of use of the system Air tube Guide is available on the hospital intranet online facilities Specimens transported by road are classified as dangerous goods and must be packaged and labelled in accordance with the Carriage of Dangerous Goods regulations Microbiology transport bags attached to the request forms wh
49. e Hospital MES Page 41 of 85 Sample labelling It is essential that specimens are correctly identified otherwise e a patient may receive the wrong treatment e apatient may not receive the treatment that they require All specimens must be labelled with e The patient s first name Surname Date of birth Hospital or NHS number The date time of specimen Inadequately labelled specimens will not be examined and a report will be produced Inadequately labelled specimen received Not processed Please repeat Where there are clerical errors omissions or quality issues with the sample this will lead to immediate rejection by the laboratory Unrepeatable specimens It is unlikely that samples for haematology are genuinely unrepeatable In the unlikely case of unlabelled unrepeatable specimens the requesting doctor will be given the opportunity to identify the specimen The doctor will be asked to sign to accept responsibility for identification Re Labelling of samples for blood transfusion is not permitted Sample transport All specimens must be in blood collection tubes of approved leak proof primary containers as supplied by the laboratory Lids must be firmly affixed to prevent leakage Primary containers must be further contained within the specimen transport plastic bag with the request card kept separate in the front pocket Leaking specimens are hazardous and may be destroyed The pneumatic tube system may be use
50. e on the Intranet Contact the consultant microbiologist for advice if necessary Turnaround time within a working day Preliminary results will be phoned to the doctor or a senior staff member as soon as the tests are completed Procurement of consumables From Stores Directly from Microbiology Swabs for bacterial culture blue caps EMU pots for AFB Blood culture bottles Per nasal swabs Universal containers MSU pots Chlamydia trachomatis detection swabs Sputum containers Herpes simplex detection swabs Faeces containers Viral culture swabs Hospital Request forms no absorbent pad Dermapak GP Request forms with absorbent pad Specimen requirements and containers Urine MC amp S Universal 10 20ml clean catch Urine AFB Special 500ml plastic pot with instructions from Microbiology Entire EMU Universal half filled Enterobius microscopy Sellotape slide Enterobius vermicularis the pin worm lay its eggs around the anus at night The eggs are invisible to the naked eye Dab the sticky side of a length of sellotape onto the anus early in the morning Stick the tape to one side of a glass microscope slide keeping the tape as flat as possible Slides and slide boxes available on request Mucus Specimen Set Remove tube assembly replace with aspirate C amp S cap provided and send the Universal only Swabs C amp S Wound Sterilin plain transport swab Throat Nose Vaginal if gonorrhoea Sterilin charcoal swab suspecte
51. e sample 10 days Ammonia EDTA on ice Ring lab first On receipt Amylase Same day Aspartate Transaminase AST Same day Beta 2 microglobulin 14 days Bicarbonate Same day Bile Acids 8 days Bilirubin total amp conjugated Same day Blood Gases Heparin syringe Send on ice not via On receipt pneumatic tube Caeruloplasmin Special bottle Obtainable from lab_ 10 days Calcium Same day Carbamazepine Prior to oral dose 3 days Carboxyhaemoglobin EDTA or Li Hep On receipt Carcino embryonic antigen 3 days CEA CA 125 3 days CA 199 3 days CA 153 3 days Cl esterase inhibitor 10 days Cholesterol Same day Cholinesterase amp phenotyping 21 days Complement C3 amp C4 3 days Copper Special bottle Obtainable from lab 10 days Cortisol Timed sample See adrenocortical 3 days function protocol Creatine kinase CK Same day C reactive protein CRP Same day Cryoglobulins Plain bottle Arrange with lab 7 days Cyclosporin EDTA or Li Hep 3 days DHEAS 14 days Digoxin 6 8 hours post dose 3 days Electrolytes See renal function Same day Estimated GFR eGFR See guidance notes Same day Ethanol Li Hep Arrange with Same day Consultant Chemical Pathologist Ethosuximide Prior to oral dose 7 days Ferritin Same day Folate SST or Red top Same day only Free light chains Part of serum 14 days electrophoresis profile Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 17 of 85 SkingsPath King
52. enerate unnecessary additional tests and delay the issue of results In the event of an unexpected abnormal result the laboratory will usually carry out further relevant haematological tests e g Direct Coombs test when the blood film suggests possible haemolysis The consultant haematologists are available for advice or interpretation of results Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide skingsPath Bedford Hospital Trust a GSTS King s College Hospital MES Page 39 of 85 The following tests are performed and the results will normally be available within one working day Test FBC ESR M screen Reticulocytes Sickle cell screen R A test Rhesus immunisation tests incl Kleinauer Malaria identification Direct Antiglobulin test Coombs Test G6PD screening test sample required EDTA 1 X 3ml mauve top EDTA EDTA EDTA EDTA Serum 1x 6ml red top EDTA 1 X 3ml mauve top EDTA 1 X 3ml mauve top EDTA 1 X 3ml mauve top EDTA 1 X 3ml mauve top 1 X 3ml mauve top 1 X 3ml mauve top _ a a a 1 X 3ml mauve top 1 X 3ml mauve top Coagulation Screening CITRATE 1 X 3ml blue top INR CITRATE 1 x 3ml blue top Atypical Blood Group antibody ID EDTA 4 X 6 ML pink top The following tests are batched and performed on a batch basis and results are normally available within one week Haemoglobinopathy screening Serum plus 2 EDTA samples for thalassaem
53. ent for prostatic disease A PSA should not be carried out without a DRE and all patients with abnormal DREs should be referred to a urologist Changes in PSA usually take place fairly slowly and steadily and it is usually unnecessary to repeat PSA more frequently than every three months A sudden rise in PSA to unexpectedly high levels should be confirmed before any action is taken as coincidental conditions such as prostatitis can occur in men with prostate cancer Finasteride a 5 a reductase inhibitor used in the treatment of BPH reduces PSA by 50 after 12 months of therapy If a patient has a PSA level determined before starting finasteride and a subsequent level after 12 months does not fall below 75 of the pre treatment level it would be prudent to re evaluate for prostate cancer Rhabdomyolysis Request a serum Creatine Kinase CK and a renal profile In acute rhabdomyolysis there is severe muscle destruction and serum CK activities may exceed 50 times the upper limit of the reference range Subfertility investigations for females First line biochemical investigations include FSH LH Prolactin Testosterone and Sex Hormone Binding Globulin SHBG and Progesterone if the patient is menstruating Blood for FSH LH should be taken during the follicular phase days 1 5 Progesterone assays are useful in detecting ovulation or anovulatory cycles Best done during mid luteal phase 7 days before the next cycle is due It has no
54. erate above the minimum level of quality and compliance set by legislation and professional standards in the environment we operate e GSTS Pathology integrates its organisational structure processes and procedures required to fulfil this policy and demonstrate improved quality outcomes e GSTS Pathology has an effective governance system that ensures accountability and provides internal and external assurance through reliable and relevant evidence e GSTS Pathology engages stakeholders to understand meet and exceed their needs and requirements for patient safety clinical effectiveness and operational performance e GSTS Pathology maintains an ethical culture and environment to underpin the business values High standards of behaviour staff engagement and empowerment with accountability are maintained to allow excellence in our services to flourish Quality improvement GSTS has established continuous quality improvement as a business philosophy for all processes and services to support safe and effective patient care GSTS Pathology continually monitors its activity annually reviews this policy for its suitability and effectiveness and publishes a quality account which defines our quality improvement objectives Services complete an annual management review to ensure objectives are monitored locally and changes or new systems processes or procedures are implemented effectively Satisfaction of users is seen as a key indicator of success i
55. ested by the doctor Anyone collecting or transporting blood or blood products must only do so if they have attended the mandatory Trust transfusion session within the last year In order to enter p pathology an access card will be required and all persons collecting should only do so if given three points of patient ID porter s collection slip the product required and the number of units required Full and unambiguous traceability of blood and blood products is a legal requirement in accordance with the Blood Safety amp Quality regulations 2005 The tear off section of the bag label must be completed as required and returned to the laboratory after transfusion Where the label has not been returned it will be the responsibility of senior ward staff to provide documented evidence Failure to comply is a criminal offence and may be subject to disciplinary action Platelets must be stored 18 24 C and kept gently agitated Collect from Lab immediately before use together with a platelet giving set Platelets are not stocked in the laboratory and any request must normally be made through the Clinical Haematologist As all platelets are collected from the NHSBT at Colindale North London they are not immediately available The journey takes at least 90 mins In cases of massive bleeding or trauma laboratory staff can order up to two units directly If quantities greater than this are thought to be required contact the consultant haematologis
56. for EBV testing Reference laboratory request Please give full clinical details only available if diagnosis is pericarditis Sent to reference lab Cannot distinguish between current and past infection Immunity check Transmission usually occurs enterically through Person to Person contact Ingestion of contaminated food or water TURN AROUND TIMES 10 14 days Tested once per 10 14 days 1 2 weeks 2 weeks Once per week 1 3 days 1 2 days during working week Confirmation from ref lab usually 10 14 days Review August 2012 Pathology User Guide Bedford Hospital Trust skingsPath Page 70 of 85 TEST HEPATITIS B Surface Antibody HEPATITIS B Core Antibody HEPATITIS B Surface Antigen HEPATITIS C antibodies HERPES SIMPLEX antibodies HERPES SIMPLEX PCR HIV 1 amp 2 Ag Ab HIV REQUEST NEONATE BORN TO HIV POSITIVE MOTHER Version 1 0 SAMPLE 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top CSF Swabs 5ml clotted blood red and yellow top Confirmatory sample should be taken in EDTA EDTA Sample within 24 hours of birth Repeat at 6 weeks 3 months and 6 months Issued August 2011 King s College Hospital MEK COMMENTS Post vaccine Indicator of current or previous HBV
57. fter taking the sample with the Cervibrush place brush in vial and agitate to ensure all the cervical material is released into the fluid Remove brush and send vial to laboratory Vials are transported to the laboratory in transport boxes provide by the hospital courier Sample takers are requested to submit the sample with an A5 size HMR101 request form generated by the Open Exeter computer system Instructions for printing the correct format of HMR101 5 form from Open Exteter are available on request from the cytology department If senders are unable to print the HMR101 form then request forms are available from the cytology dept Request forms must be completed in full This includes name and previous names address date of birth NHS number reason for the smear sender and source details time and date of test and any relevant clinical information Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath a csTs King s College Hospital MES Page 78 of 85 Relevant clinical information includes any history of CIN and previous biopsy results If the patient has had a hysterectomy please indicate the reason as this will determine the need for further vault samples The laboratory works to all guidance and protocols issued by the NHS Cancer Screening Programmes including those found in the following publications Achievable Standards Benchmarks for Reporting and Criteria for Evaluating Cervical Cytopatho
58. g hours specimens are to be delivered to the 2 floor laboratory Specimens can be left at the Specimen Reception Desk situated on the First Floor of the Pathology Block off the main corridor of the Hospital when the Cellular Pathology Department is closed User satisfaction and complaints Cellular pathology is pleased to receive constructive comments upon any aspect of its services A quality manual describing all aspects of the department s quality management system is available for inspection by users Completion of histology and cytology request forms All sections of the request form must be completed Without this information appropriate examination may not be instituted and interpretation of results may be impossible or misleading Specimen and request card labelling It is essential that specimens are correctly identified A minimum of three points of ID is mandatory All specimens must be labelled with e The patient s full name Date of birth Hospital or NHS number The date of specimen Type of specimen Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 75 of 85 Inadequately labelled specimens will not be examined In the case of unlabelled unrepeatable specimens such as most histology samples CSF etc the requesting doctor will be given the opportunity to identify the specimen and asked to sign to accept responsibility for
59. gy within an hour of collection This may be done 24 hours a day General practice blood culture is available to general practitioners although rarely indicated in the community Please discuss the case with the laboratory and request the appropriate culture bottles To collect blood for culture using the BACTEC automated blood culture system gt Wash your hands gt Clean the venepuncture site with an alcohol wipe and allow to dry Do not touch the venepuncture site again Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i eae sKingsPath la csTs King s College Hospital MEK Page 57 of 85 gt Remove the flip off tops from an aerobic blue silver top and an anaerobic mauve deep pink top bottle gt Clean the rubber diaphragm on each bottle with an alcohol wipe and allow to dry gt Collect blood aseptically and inoculate 10 mls into the aerobic bottle and then 10 mls into the anaerobic bottle Please note 8 to 10 mls is the optimum amount for each bottle If blood is being collected for other tests always inoculate the blood culture bottles first gt Label each bottle with the patient s name ward date and time of collection Do not use a patient identification label gt Remove the detachable bar code labels from the bottles and stick onto the request form gt Fill in the microbiology request form giving full clinical details including antibiotics and place both bottles in the accompanying
60. hs 1 2 2 1 mmol L 6 mth 1 yr 1 2 1 9 mmol L 1 7 yrs 1 3 1 8 mmol L gt 7 yrs 0 8 1 5 mmol L Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 25 of 85 skingsPath King s College Hospital MES i icsts Primidone Porphobilinogen Porphyrins Prolactin Macroprolactin Protein Serum Urine CSF Protein Electrophoresis Potassium Serum Urine PSA Progesterone Assayed as phenobarbitone Customised Porphyria report Customised Porphyria report Male lt 450 mu L Female lt 550 mu L Customised report 60 80 g L lt 0 15 g d lt 0 4 g L Normal Pattern 3 5 5 3 mmol L 25 125 mmol d 0 5 4 0 ug L Normal although does not absolutely exclude a localised prostatic cancer PSA is also raised in other conditions e g BPH prostatitis prostatic infarction UTI transuretheralresection of prostate TURP and prostate biopsy A rise of gt 20 year refer for further investigation Levels of lt 20 nmol L probably non ovulatory Ovulation likely if level gt 30 nmol L These interpretations apply only for samples taken 7 days before the next cycle Rheumatoid Factor lt 30 iu ml Salicylate Sex hormone binding globulin Not detected Male 15 55 nmol L Female 20 120 nmol L Sodium Serum 133 146 mmol L Sweat lt 60 mmol L Urine Interpret in the light of clinical features plasma and ur
61. ia and abnormal haemoglobins Blood Group amp Antibody screen EDTA 1 X 6 ml pink top The following tests are normally available only after arrangement with the haematologist Bone marrow aspiration and related cytochemistry Trephine biopsy Requests for other tests should be directed to either the clinical haematologists or specialty manager Thrombophilia screening HLA identification and cytogenetic studies are sent to specialist centres Information regarding turnaround times and specific sample requirements can be obtained from the laboratory Immunology testing is performed at another centre samples are received in haematology for onward travel Most immunology testing is performed from SST tube gold top Further details regarding Immunology may be obtained from the referral department in haematology Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae sKingsPath la csTs King s College Hospital MES Page 40 of 85 Limitations and special precautions Coagulation screens must be tested within four hours of being taken Additional tests such as d dimer may only be added within two hours from phlebotomy ESR may be added to a sample taken the same day Blood film requests may be added to samples taken the same day I M screening may be added to samples taken the same day Group and Save samples are kept for six days for crossmatching Samples must never be stored in direct sunlight carried on the p
62. ich are supplied to GPs have an absorbent pad These used in combination with the Hospital courier service will ensure compliance with the regulations Identification of high risk specimens For the protection of laboratory workers the request form and any specimens collected from a patient with a known or suspected infection due to a Hazard Group 3 biological agents must be labelled as high risk These agents include HIV 1 and 2 Salmonella typhi amp paratyphi Hepatitis B virus Mycobacterium tuberculosis Hepatitis C virus HTLV 1 and 2 Brucella spp and the causative agents of Anthrax Creutzfeldt Jakob disease Rabies Yellow Fever Plague Hazard group 4 biological agents Specimens known or suspected to contain biological agents in Hazard Group 4 MUST NOT be sent to the laboratory without discussion with and the permission of the consultant microbiologist This includes the causative agents of Viral Haemorrhagic Fevers Lassa Fever Ebola Fever and Marburg Disease Test repertiore Microbiology test repertoire Urine culture Stool culture Investigations for genital tract infections Blood culture CSF examination Specimens from other normally sterile sites Wound infections Eye ear throat and oral Infections Lower respiratory tract Infections Fungal infections Culture for Mycobacteria spp Antibiotic assays Serology VVVVVVVVVVVVV V Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A
63. ild ranges Iron Male 10 30 umol L Female 9 27 umol L Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 24 of 85 skingsPath King s College Hospital MES i icsts Lactate Lactate Dehydrogenase LDH LDL Cholesterol Lithium LH Luteal Hormone 0 50 2 00 mmol L 240 480 iu L See lipid interpretation 0 50 1 20 mmol L Suggested therapeutic range Therapeutic range of 0 5 0 8 mmol L may be adequate in prophylaxis Male 2 0 9 0 iu L Female Follicular 2 0 12 0 iu L Luteal 1 0 11 0 iu L Post menopause gt 12 0 iu L Levels high at mid cycle Magnesium Microalbumin 0 7 1 0 mmol L Male lt 2 5 Female lt 3 5 mg mmoL creatinine Oestradiol Osmolality Serum Urine Premenopausal female 110 1450 pmol L depending on stage of cycle Untreated post menopausal female less than 110 pmol L Although the test is of limited clinical value in the diagnosis of menopause Male less than 160 pmol L 275 295 mOsmol kKg Interpret in light of clinical features serum osmolity and random urine sodium Parathyroid hormone PTH Calcium albumin phosphate amp total protein also to be assayed Paracetamol Serum Urine Phenobarbitone Phenytoin Phosphate Version 1 0 15 65 pg ml Not Detected Not Detected 15 40 mg L Adult 10 20 mg L 0 1 mth 1 2 2 8 mmol L 1 6 mt
64. ine osmolality and serum sodium Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 26 of 85 skingsPath King s College Hospital MES Testosterone Testosterone SHBG ratio Free Testosterone Index FTI Theophyline Thyroxine FT4 Tri iodothyronine FT3 TSH Thyroid stimulating hormone Transferrin Troponin T Male 9 29 nmol L Female 0 2 1 8 nmol L Male 25 90 Female 0 2 5 6 In males low FTI indicates androgen insufficiency In females high FTI indicates androgen excess Adult 8 20 mg L Neonate 5 10 mg L 12 22 pmol L 3 1 6 8 pmol L 0 25 4 00 mu L 23 43 ug L The following interpretive comments only apply if the sample is taken at least 6 hours after the onset of chest pain lt 14 ng L Myocardial damage may be ruled out gt 50 ng L Myocardial damage present Consider cardiology opinion 14 49ng L Borderline Troponin T concentration It would be prudent to repeat test after a further 6 hours If the clinical picture is that of acute coronary syndrome consider cardiology opinion Urate Serum Urine Urea Serum 0 1 0 4 mmol L 1 5 4 5 mmol d 2 5 7 8 mmol L Urine 250 600 mmol d Valproate 50 100 mg L Some patients are effectively controlled with concentrations below 50 mg L and others require concentrations far in excess of 100 mg L Vancomycin Maintain dose between 5 15
65. infection Should be requested in cases of household contact Automatically performed on non responders to Hepatitis B vaccine Transmission routes Percutaneous Permucosal sexual Transmission routes Percutaneos Permucosal PLEASE NOTE incubation period is 2 26 weeks Herpes simplex antibodies of little value in diagnosing current infection VIRAL SWAB of lesion preferred Reference laboratory request Sent to reference laboratory CSF must demonstrate appropriate cellular features to justify test Transmission routes Percutaneous Permucosal Sexual EDTA sample must also be taken from mother at time of birth so that primers can be checked TURN AROUND TIMES 1 2 days during working week 1 2 days during working week Confirmation from ref lab usually 10 14 days 1 2 days during working week Confirmation from ref lab usually 10 14 days 1 2 days during working week Confirmation from ref lab usually 1 4 weeks 2 4 working days 1 2 days working days Confirmation from ref lab usually 10 14 days 10 14 days Review August 2012 Pathology User Guide Bedford Hospital Trust Page 71 of 85 a TEST LYMES DISEASE Borrelia burgdorferi Meningococcal PCR and antibodies MUMPS antibodies NEEDLESTICK INJURIES HUMAN BITES etc PARVOVIRUS IgG IgM RUBELLA IgG RUBELLA IgM SYPHILIS SEROLOGY Version 1 0 SAMPLE 5ml clotted blood red and ye
66. ingsPath GSTS King s College Hospital MEA cia mn Pathology PATHOLOGY USER GUIDE BEDFORD HOSPITAL Effective from August 2011 updates will be available on the electronic version available on Bedford Hospital website Version 1 0 Pathology User Guide i Bedford Hospital Trust sg ngsPath King s College Hospital MES Page 2 of 85 3a Version 1 0 INDEX TO USER GUIDE General Information Biochemistry Haematology Blood Transfusion Microbiology Cellular Pathology Histology Cytology Andrology Patient Information Sheets Appointment for a Glucose Tolerance test Patient instructions for Collecting a 24 hour urine sample GSTS Patholog Page 37 48 51 73 85 Patient instructions for Collecting a 24 hour urine sample for HMMA VMA Catecholamines Metadrenalins and 5HIAA Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath CSTs King s College Hospital thology Page 3 of 85 General information Handbook preface This manual outlines the pathology service offered by GSTS Pathology at Bedford Hospital NHS Trust The information provided includes reference values or interpretative data where relevant specimen requirements and instructions for collecting specimens to comply with health and safety requirements Should you have queries in connection with any aspect of the pathology service our staff will be pleased to discuss these with you E
67. istry haematology and blood transfusion on the first floor cellular pathology on the second floor and microbiology is located on the third floor en fom we ove smun umcomnos E com rowsr p ows 5 mr fa E waoe fs ne CO peu msmo E am cannes E NG men Pa MERA Ee m Ema B mw p a Weta can Entrance Bhasma Road LLE I Main Entrare Entrance com Werreston Pod Gram Wieg Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide skingsPath Bedford Hospital Trust King s College Hospital MES Page 8 of 85 Pathology opening hours Please refer to individual departments Out of hour s service Haematology Biochemistry Microbiology Blood Transfusion Monday to Friday 20 00 08 00 20 00 08 00 17 00 08 45 Friday to Saturday 20 00 09 00 20 00 08 00 17 00 08 45 Saturday to Sunday 12 30 07 00 12 30 08 00 12 00 08 45 Sunday to Monday 07 00 08 00 08 00 08 40 08 45 08 45 Bank Holidays 08 00 08 00 08 00 08 00 17 00 08 45 next day next day Please be aware that there is only one member of staff for each discipline working during the hours listed above and that only a limited range of tests are available You are respectfully asked to e Restrict requests to tests which are ESSENTIAL FOR THE IMMEDIATE CLINICAL MANAGEMENT OF THE PATIENT e Non urgent work should only be sent during normal working hours e
68. ith another 4 Ensure that urine collections are timed correctly and kept cool 5 Fill in clearly what tests are required Only ask for what you really need 6 Avoid sending samples outside the routine working hours unless they are urgent and laboratory staff are expecting them Do not contaminate request forms with sample Special tests Patients requiring phlebotomy for tests with special requirements see individual discipline section Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i soe skingsPath i csTs King s College Hospital IMEE Page 12 of 85 Reporting of results Printed reports Printed reports are sent out to hospital wards hospital clinics and GPs daily Electronic reporting Access to completed pathology results is available on all wards departments and GP surgeries via the hospital electronic reporting system Sunquest Anglia ICE Critical results These will always be telephoned GP requests marked urgent will be telephoned NB Cytology and histology results do not get reported over the telephone Other services complaints Pathology is able to provide a range of services and information to wards departments and GP practices If you wish to discuss any service developments or require information relating to or derived from the pathology service then please contact the pathology services manager Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao
69. kingsPath King s College Hospital MEK preferably after exercise Available from Pathology State if patient suffers from bronchiectasis Do not send repeat specimens within four weeks if positive Kits available from Client Services Issued August 2011 1 working day 1 2 hours Culture 6 8 weeks Same day testing Minimum 2 working days Minimum 2 working days Microscopy 1 2 working days Culture 6 8 weeks As above 1 working day 2 3 working days 1 2 working days 1 working day Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MEK Page 66 of 85 MYCOLOGY Skin scrapes from Universals or brown Microscopy active edge of lesion envelopes weekly Nail scrapes in sterile Or Dermapak Culture 2 3 universal deep enough weeks to include invaded tissue ideally base of nail Hair should be plucked to include scalp scales and placed in a sterile universal or 60 ml container CSF for 3 sterile universal All 3 specimens to Microscopy bacteriology containers Microbiology same day virology Phone laboratory to say Bacterial Culture sample is being sent 2 3 days Fungal 7 days AFB 6 8 weeks BLOOD Aerobic bottles 8 10ml Remove the centre 48 hour interim CULTURES Anaerobic bottles 8 portion of the barcode and report 10ml place on the request form 5 day final Paediatric bottles 1 Blood culture bottles sets 10 days for 3
70. le toxin is requested If additional investigations are required they MUST be requested on the laboratory form Outbreak investigations Outbreaks from the community should be reported to the Health Protection Unit on 01462 705 300 who will organise samples after liaison with the laboratory Hospital outbreaks must be reported as soon as possible to the infection control team who will give advice on specimen submission Bleep 422 030 or 301 Turnaround time one to two working days Preliminary result maybe available earlier Faecal occult blood To avoid false positive results in this test it is important that an appropriate diet is followed prior to collection of the specimens Copies of the instructions are available to patients from the department of microbiology or at pathology reception Instructions for collecting stool samples for testing for faecal occult blood 1 For three consecutive days and whilst collecting the specimens of stools eat no red meat red meat extracts or green vegetables On second day take a mild purgative 2 On fourth day collect a small portion of stool and place in a specimen pot Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 56 of 85 3 Label with name and date and mark bottle Specimen 1 4 Collect specimens from next two stools and label as above marking them Specimen 2 and Specimen 3 respective
71. le twenty four to forty eight hours from receipt of the specimen Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 80 of 85 Andrology service In order to enable improvements to the andrology service the cellular pathology department at Bedford Hospital NHS Trust introduced an appointment system for its Infertility semen sample analysis on August 1 2011 From this date the Infertility semen analysis service runs between the hours of 09 00 and 13 00 Monday to Wednesday by appointment only How to book an appointment Send a pathology request form clearly stating semen analysis for infertility to Appointments Office Administration and Clerical Office GSTS Pathology Bedford Hospital Kempston Rd Bedford MK42 9DJ Please ensure the correct and full patient address is included on the request form On receipt of the form the laboratory will post a patient information sheet and sample pot to the patient and will allocate the next available appointment date but allowing a fortnight for delivery of the information A contact telephone number will be provided to allow the patient to rearrange the appointment date if it is inconvenient The patient may bring the sample to the laboratory at any time between 09 00 and 13 00 on the appointed date The sample should be delivered within one hour of production Please note that there are NO facilities
72. llow top CSF and PLASMA i e EDTA sample for PCR 5ml clotted blood red and yellow top If current infection is suspected Saliva testing kit should be requested from Colindale 020 8200 6868 ext 4412 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood red and yellow top 5ml clotted blood ingsPath King s College Hospital MEK COMMENTS Reference laboratory request risk factors such as insect bites and travel history must be given as well as onset and nature of symptoms PCR request sent to Ref lab if findings indicate risk of infection Antibody sample should be collected 3 weeks after onset of infection is only of value for retrospective diagnosis Reference laboratory request suitable for at risk contacts of confirmed cases only Post vaccination antibody levels will not be tested as not appropriate MUST state whether donor or recipient of injury Should discuss such cases with Consultant Microbiologist and or CCDC Hepatitis B antibodies and serum save will be run on recipient s serum Tests on donor blood will only be run if permission is given Please give full clinical details and date of onset Sent to reference laboratory Antibody levels gt 10 iu ml considered as immune Please give full clinical details and date of onset of symptoms Issued August 2011
73. logy NHSCSP Publication No 1 Second edition including revised performance indicators May 2000 Guidelines on Failsafe Actions for the Follow up of Cervical Cytology Reports NHSCSP Publication No 21 December 2004 Audit of Invasive Cervical Cancers NHSCSP Publication No 28 Dec 2006 Please Note Copies of NHS Cervical Screening Publications can be obtained from The Department of Health Publications Orderline Tel 08701 555 455 Fax 01623 724 524 Email doh prolog uk com Copies are also available as PDF files on the NHS Cancer Screening Programme website www cancerscreening nhs uk Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae sKingsPath la csTs King s College Hospital MES Page 79 of 85 2 Diagnostic cytology The laboratory processes a wide variety of specimens much of which is unfixed and requires processing promptly to prevent deterioration of the cells Specimens should therefore be sent to the laboratory without delay All specimens must be labelled with the patient s full name and date of birth and accompanied by a request form that has been completed in full Request form and specimen should be delivered to the cytology laboratory in plastic transport bags High risk specimens must be labelled as such to ensure that laboratory staff when handling these specimens take appropriate precautions Body fluids e g pleural fluid ascites synovial fluid hydrocoele fluid breast cyst fl
74. ly 5 Send the specimens all together to the Microbiology Department or Pathology reception at South Wing with an accompanying completed microbiology request form Copies of these instructions for patients are available from the Department of Microbiology or at Pathology Reception There is no evidence to show that iron salts such as ferrous gluconate or ferrous fumarate interfere with the test by producing false positives but it is recommended that patients be kept off oral iron for at least two days prior to collecting the specimens Turnaround time one working day Investigations for genital tract infections Vaginal discharge Adult High vaginal swab Child Low vaginal swab Suspected PID Cervical and Chlamydia swab Urethritis Urethral swab and Chlamydia swab Chlamydia Samples Full instructions on the correct sampling technique are given with the Chlamydial swab which may be stored in the fridge overnight after collection Bacterial culture Where Neisseria gonorrhoeae is a possibility soecimens must never be refrigerated as this organism will die and the diagnosis be missed Ideally such swabs should be cultured immediately Where a sexually transmitted disease is suspected it is recommended that the patients are referred to the department of genito urinary medicine for follow up and contact tracing Turnaround time one to two working days Blood culture Blood cultures must be transported by porter to microbiolo
75. ml available from Pathology suspected Fungal 8 10ml Put in Pathology incubator bacterial ASAP after collection endocarditis BACTERIAL POSITIVE CSF Performed only in ANTIGEN TEST conjunction with a positive finding it is a confirmation test NOT a diagnostic test Carried out during the next working day if indicated CHILD ABUSE Specimen collection For legal reasons each The laboratory protocol available from person involved in must be informed Woodlands Clinic collection amp prior to receipt transportation of the specimens must sign the request form stating their role and date and time CHAIN OF EVIDENCE Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath ia csTs King s College Hospital MES Page 67 of 85 3 Serology requests The department offers a range of serological screening tests and a referral service for investigations not performed in house Serology tests can be used to diagnose infections by assessing the patient s antibody response to a particular infective agent IgM is the first to rise and presence is indicative of a present or recently acquired infection Some IgM tests are available but for other infections tests for IgG are used The IgG antibody response will usually take 10 14 days to occur but may sometimes be longer If the duration of a patient s illness is lt 10 days then an acute serum sample should be collected at this time and a conv
76. monitor TFT every two to three months Patients on replacement therapy TSH will be performed in all patients FT4 will be organised in patients on thyroxine replacement with abnormal TSH FT3 will be organised in patients on T3 replacement with abnormal TSH It is usually unnecessary to monitor TFT more frequently than every two to three months Less frequent long term monitoring is needed in patients who are clinically and biochemically euthyroid Patients on suppressive therapy TSH and FT4 will be assayed in all patients on suppressive therapy Thyroid Function Tests may be misleading when requested in patients who are ill from non thyroidal illness It is usually unnecessary to screen for thyroidal illness in these situations and TFT should be organised when patient is well High risk samples All high risk samples should be clearly identified with a tick V in the high risk box on the request card The card sample and bag in which the sample is transported in should have a high risk sticker or a label clearly identifying high risk sample on them to alert the user for additional precautions that need to be taken when handling the sample Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ae 2KingsPath la csTs King s College Hospital MES Page 36 of 85 Overnight storage of blood samples Every effort should be made to send the sample to the laboratory on the same day Howeve
77. n improvement of services GSTS Pathology is proactive in managing its business risks and has plans in place to ensure service continuity in all events Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath GSTS King s College Hospital Pathology NHS Foundation Trust amp Page 6 of 85 Workforce GSTS Pathology will maintain a high quality flexible workforce that are committed engaged trained and supported to provide the highest level of service to our users in accordance with relevant good professional guidance Through recruitment induction and training staff will be made familiar with this policy and relevant content and procedures of the management system Each staff member holds a personal responsibility for the quality of the work that they perform Competency assessment and appraisal is used to ensure ongoing capability and identify individual personal development Managers and supervisors provide effective leadership and create a culture and working environment that allows operational performance and change management to be achieved by staff that are empowered to make suggestions and take decisions Assessment and monitoring Key performance and quality indicators are used to enhance operational performance and remove variation from laboratory processes Internal quality control and assurance with external quality assurance is used as part of the overall assurance mechanism along with clinic
78. nd any risk factors are stated on the request form Samples will be processed according to the details stated on the form or in line with laboratory protocol The following tests are available on site Syphilis serology Treponema pallidum antibodies Helicobacter pylori serology ASO titre Toxoplasma gondii Total antibody IgM lgG screening assay Hepatitis B virus surface antigen and antibody HBcore Total IgM IgG Hepatitis A virus IgM and Hepatitis A Total antibody IgM IgG CMV IgM amp IgG Hepatitis C virus antibody HIV 1 amp 2 antigen antibody Rubella virus IgG Rubella virus IgM Varicella zoster virus IgG to check for immunity to chicken pox Measles IgG Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 60 of 85 In house assays are generally available three to four days from receipt Many other serological tests are referred to specialist laboratories e g Colindale HPA The following are some of the commonly requested specialist investigation Amoebic serology Aspergillus serology Atypical pneumonia screen Avian precipitins Borrelia serology Bartonella serology Cryptococcal serology Hydatid serology Leptospira serology Mumps serology Parvovirus B19 serology Schistosoma serology Staphylococcal serology Toxocara serology Any enquiries regarding specialist investigations please contact the laboratory on ext 5251
79. ntire sample is collected in the specimen pot If any of the sample is lost please telephone the laboratory on the number provided to arrange a repeat test on a convenient date Ensure the lid is tightly secured and record your surname forename date of birth and date time of sample collection on the pot Keep the sample warm for example in an inside pocket during delivery to the department Excessive heat greater than 40C or excessive cold below 20C will seriously affect the test result The sample must be delivered to the laboratory as soon as possible but within one hour of production to ensure the sample is received at its best Please note there are no suitable facilities at Bedford Hospital in which to produce the sample Please deliver the sample pot and this form to Pathology specimen reception Floor 1 GSTS Pathology South Wing Bedford Hospital Kempston Road Bedford MK42 9DJ Tel 01234 792149 Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MEK Page 82 of 85 On delivering the sample we would appreciate if you could wait a short time at the specimen reception to ensure the information on your paperwork and pot are completed before leaving the laboratory The sample will be examined immediately on receipt by the laboratory and the result will be sent to the requesting doctor within seven days Please do not telephone the laboratory
80. on is essential Other patients with probable lymphoma will almost certainly need complex diagnostic procedures and should be referred to the haematologist Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i He 2KingsPath la csTs King s College Hospital MES Page 46 of 85 Myeloma Myeloma may present with bone pain symptoms which suggest a high calcium level nausea constipation thirst confusion or just a high ESR usually gt 100 Protein electrophoresis urine analysis for protein or X ray of the painful bone will often suggest the diagnosis Bone marrow aspiration is mostly needed Most patients can be treated in the OPD but hypercalcaemia is a medical emergency Radiotherapy is often useful for bone pain Polycythaemia Polycythaemia may be secondary to cyanotic heart disease COPD or diuretic therapy Occasionally it will be due to a renal tumour Heavy smoking and alcohol consumption may lead to a high haematocrit but the level is not usually more than 0 55 HB 18 0 Patients with levels significantly higher than this may have a myeloproliferative disorder PRV and should be referred They will also often have high neutrophil and platelet counts and uric acid level The spleen may be enlarged Some will appear to have iron deficiency and the high Hb will not become apparent until iron therapy is given Thrombocythaemia Thrombocythaemia may be secondary to a number of unrelated conditions This rea
81. on preparation slow release types e g Feospan and Ferrogradumet Unexplained macrocytosis Unexplained macrocytosis MCV gt 100 or persistently low B12 or Folate levels Patients with severe macrocytic anaemia Hb lt 8 0 should be referred immediately Mild macrocytosis is quite common and is often due to excessive alcohol consumption a high urate and GGT will confirm this in most However in the elderly dietary folate deficiency seems to be common and macrocytosis is also a feature of the Myelodysplastic Syndrome MDS see below Other causes of a high MCV include liver disease myeloma COPD hypothyroidism and treatment with cytotoxic drugs Unexplained anaemias Other unexplained anaemias Note that many chronic conditions and diseases lead to a mild to moderate anaemia which may be normochromic or mildly hypo chromic and needs no investigation Patients leading sedentary lives can often cope very adequately with moderate anaemia Hb 8 10 Neutropenia Neutropenia in young patients may be due to a recent virus infection but if persistent or severe further investigation is essential SLE can present in this way and tests for ANF may be appropriate Low platelet counts Low platelet counts are increasingly common Immediate referral is advised if very low lt 20 Counts below 100 may require further investigation Counts between 50 and 100 are unlikely to cause any bleeding bruising but may be a problem for surgeons Usually sp
82. ontaneous bleeding does not occur until the count is significantly less than 20 Possible causes are ITP alcoholic and other liver disease drug therapy diuretics may be an important cause in the elderly Incipient leukaemia and MDS are important causes but usually there will be other indications neutropenia anaemia blasts Pregnancy is often accompanied by mild thrombocytopenia in the last trimester the principles already indicated apply Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ee sKingsPath la csTs King s College Hospital MES Page 45 of 85 The cause of a high WBC will usually be obvious but consider the following if in doubt Neutrophilia early stage of Glandular Fever steroid therapy previous splenectomy Monocytosis often occurs in recovering phase of infection may be CMML MDS Lymphocytosis viral infection previous splenectomy Lymphocytosis Lymphocytosis may be the first indication of underlying CLL however unless there is marked lymphadenopathy or splenomegaly anaemia and or low platelets only observation is necessary A FBC every two to three months will be adequate in most cases Treatment is rarely needed in the early stage and many patients will not require intervention for many years particularly if the lymphocytosis was discovered by chance Confirmation of C L L requires Immunophenotyping Now that differential counts are carried out routinely it is clear tha
83. ospital Hereford HR1 2ER Meningococcal Reference Unit Health Protection Agency PO Box 209 Manchester Royal Infirmary Clinical Sciences Building Manchester M13 9WZ Microbiology Laboratory Royal Preston Hospital Sharoe Green Lane North Fulwood Preston Lancashire PR2 9HT Antimicrobial Reference Laboratory Department of Medical Microbiology North Bristol NHS Trust Southmead Hospital Bristol BS10 5NB Mycology Ref Lab SouthWest HPA Laboratory Myrtle Road Kingsdown Bristol BS2 8EL Mycology Reference Laboratory Health Protection Agency General Infirmary Leeds LS1 3EX NPHS Microbiology Cardiff University Hospital of Wales Heath Park Cardiff CF14 4XW Respiratory amp Systemic Infection Laboratory Health Protection Agency 61 Colindale Ave London NW9 5HT Sexually Transmitted amp Blood Borne Virus Laboratory Health Protection Agency 61 Colindale Ave London NW9 5HT Southampton Laboratory Level B South Laboratory Block Southampton General Hospital Southampton SO16 6YD SouthWest HPA Laboratory Myrtle Road Kingsdown Bristol BS2 8EL The Hospital for Tropical Diseases Mortimer Market Building Capper Street Tottenham Court Road London WC1E 6AU Toxoplasma Reference Laboratory TRL Singleton Hospital Sketty Swansea SA2 8QA Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 64 of 85 SkingsPath King s College Hospital MES i icsts SUMMARY O
84. ours of 9am and 2pm Monday to Friday 3 Please note there are no facilities at the hospital site to produce semen samples If you have any questions please telephone pathology 01234 792149 between 9am and 5pm Copies of the above instruction sheet are available from the histology dept on request Fresh post vasectomy samples If a patient has four or more post vasectomy semen samples showing the persistence of sperm then it is recommended that a full analysis of a fresh post vasectomy sample including an accurate assessment of sperm concentration and motility is undertaken and the above appointment system should be used for this If a fresh post vasectomy analysis is required please send a request form to the above address clearly requesting fresh post vasectomy analysis following which an appointment will be sent by the laboratory in the same way Post vasectomy reversal samples Patients requiring testing of semen following a post vasectomy reversal procedure should submit a sample via the appointment system to allow full analysis of a fresh sample A request form should be sent to the appointments office indicating post vasectomy reversal semen analysis following which an appointment will be made for submission of a sample Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid j Se as skingsPath GSTS King s College Hospital MES Page 85 of 85 6 Patient information sheets The following patient
85. p to three weeks Any positive results telephoned immediately including at weekends A negative report will be issued at 48hours after receipt into the laboratory Cerebro spinal fluid CSF CSF is always treated as an urgent specimen The CSF should be sent immediately to the Microbiology laboratory for a cell count gram stain and culture together with a blood culture Stains for mycobacteria cryptococcus etc will be performed as necessary or if requested Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i eae sKingsPath la csTs King s College Hospital MES Page 58 of 85 The following specimens should also be sent to the chemical pathology laboratory 1 sterile universal approximately 0 3mI CSF for protein estimation 1 fluoride oxalate bottle approximately 0 2ml CSF for glucose estimation 1 fluoride oxalate bottle blood for blood glucose estimation In suspected meningitis please send Blood in EDTA bottle to microbiology for PCR test for meningococcus and pneumococcus Blood culture set Throat swab for MC amp S Urine for pneumococcal antigen test In suspected viral meningitis encephalitis send CSF for viral PCR for VZV HSV and enteroviruses at least 1ml is required by the reference lab Turnaround time The cell count and gram stain will be telephoned to the clinician as soon as they are available Culture result available one to two working days after receipt Preliminary
86. plastic bag before sending it immediately to pathology reception for incubation gt Do not worry about the bits in the aerobic bottle this is resin designed to increase the yield of pathogens by absorbing antibiotics that may be present in the blood In paediatric practice where it may be difficult to obtain up to 20mls of blood the silver topped PEDS PLUS F single bottle system can be used These bottles take between 1 and 3 mls of blood In older children it is preferable to use the two bottle system as above to increase the potential yield of significant pathogens Blood cultures must be taken immediately to pathology reception on the first floor They MUST be incubated as soon as possible Out of hours the blood cultures MUST be put in the blood culture incubator situated in the lift lobby on the third floor as soon as possible after collection Please note All blood cultures should be collected at the time the patient is ill and about to commence antibiotics to maximise the chance of isolating the pathogen involved For investigation of Sub acute Bacterial Endocarditis SBE 3 sets of blood cultures collected 20 minutes apart should be sent Please include arrangements for contacting the out of hours GP service should the blood cultures become positive at the weekend or during the evening i e telephone number of the GP out of hours service Turnaround time Incubated for minimum five days or when indicated u
87. porter High risk samples blood gas samples blood culture samples and any samples in formalin must not be sent through the pneumatic tube system General practitioner surgeries Pathology samples are collected from surgeries by our courier service High risk specimens Separate procedures are used in the laboratory for the safe handling and examination of some samples from patients known or suspected to have infections caused by certain pathogens see below that pose a risk to laboratory workers and others if handled incorrectly It is the responsibility of the person taking such a specimen from a patient and sending it to the laboratory to ensure that the request forms and specimen container are labelled to indicate a danger of infection The request forms should be flagged with a self adhesive high risk label The request form must give sufficient clinical information to enable experienced laboratory staff to know what special precautions are necessary In the interests of confidentiality only the warning label need be clearly visible to others Specimens from V R E and M R S A positive patients do NOT require flagging Please see individual departmental guidelines for high risk specimen types To ensure valid results are obtained 1 Avoid prolonged venous stasis when collecting blood Consult tube guide for order of drawing samples 2 Avoid contamination of sample with i v fluids 3 Do not mix blood from one specimen container w
88. quirements Turnaround time for haematology and blood transfusion specimens may depend on the tests required It is the responsibility of the doctor to arrange for blood samples to be taken into the correct sample tube and arrive at the pathology department in good time to be analysed GPs may send their patients to be bled by the phlebotomists Monday to Friday during normal working hours Please note that after 12 30 pm waiting times will be considerably shorter At present a satellite phlebotomy station is available at North Wing where arrangements are similar except on Fridays when the station is closed A collection service for some GP practises who provide phlebotomy services is in operation Samples for full blood counts are normally analysed on the day of arrival and results returned to the requesting doctor the next morning following the evening computer print run Results from work arriving on Friday will usually be delivered on Monday Some Bedford practices will have their results delivered by hospital van whilst others will be posted Samples taken after the van collection can be stored overnight at room temperature with no significant deterioration in quality Results can also be sent electronically to GP practices via Anglia Sunquest ICE Urgent or very abnormal results will be telephoned as soon as possible Relevant clinical information is of value in interpreting results e g in patients on chemotherapy Failure to give this may g
89. r in exceptional circumstances some useful information may be obtained after overnight storage of blood sample if the following are observed 1 Fluoride Oxalate tubes grey cap for glucose or EDTA translucent lavender cap for HbA1c may be unaffected by overnight storage at room temperature 2 Serum Separation Tube samples sand cap stored upright at room temperature i e 20 C overnight may well be suitable for some routine tests However artefactual elevation of serum potassium phosphate and some liver enzymes are expected and make these assays unreliable 3 However if Serum Separation Tube samples are stored in a a refrigerator which may be close to 0 C b a hot place e g near a radiator or on a sunny window sill c acar boot which may be either hot or cold Considerable changes to some analytes will occur e g high potassium high phosphate low sodium and low calcium etc etc In short results will be unreliable 4 As storage conditions are beyond laboratory control and any changes to analytes cannot be quantified the laboratory will merely comment as follows 1 Date of specimen collection if known and date received will be documented 2 Haemolysed this can be caused by poor or prolonged storage or difficulty with venepuncture and will cause increase in potassium phosphate and some enzymes 5 If your surgery has a centrifuge the following procedure will enable SST samples to be stored in a refrige
90. rator 4 C 6 C for 24 hours perhaps without significant change to routine analytes Centrifugation of blood samples in SST tubes 1 Take blood sample from patient using normal Vacutainer procedure 2 Mix blood by gentle inversion 6 times 3 Allow sample to clot for 15 30 minutes 4 Centrifuge for ten minutes at 3000 rpm Time and speed may vary for different capacity centrifuges The laboratory would be happy to advise please telephone Mr M Seaman 01234 792165 NOTE The gel in the tube has now formed a barrier between cells and serum 5 Store the sample upright in a refrigerator at 4 C 6 C NB Never centrifuge an SST more than once for any reason Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i a 2KingsPath la csTs King s College Hospital MES Page 37 of 85 3 Haematology Key contacts Direct line 01234 Internal Ext Haematology Results and General Enquiries 792150 4811 Consultant Haematologist 792145 2446 Bleep 264 Consultant Haematologist 2385 Consultant secretary 792145 2445 Mr A F Northern Specialty Manager 792158 4662 Mr P Laundon Blood Transfusion Manager 795764 4726 Bleep 331 Referral Laboratory 01234 355122 4668 Location The haematology and blood transfusion laboratories are located on the first floor of the pathology building on the South Wing site Access is via the hospital main corridor Phlebotomy services are only available in the out patient depa
91. ratory Haemastasis Department of Clinical Haematology and Blood Transfusion Addenbrooke s Hospital Hills Road Cambridge Immunology Laboratory Addenbrooke s Hopsital Hills Road Cambridge Haemoglobinopathy Ref Lab Oxford Radcliffe Hospitals NHS Trust Oxford Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 48 of 85 3a Blood transfusion Specific Information for blood transfusion requests Telephone requests always require confirmation by a valid form plus sample where necessary Samples must include the following mandatory information e SURNAME e FIRST NAME e HOSPITAL NUMBER or EMERGENCY NUMBER or FULL ADDRESS or NHS No e DATE OF BIRTH not age e GENDER e DATE TIME OF SAMPLE COLLECTION SIGNATURE person taking sample Request forms must include the following mandatory information THREE POINTS OF ID As per sample labelling GENDER WARD CONSULTANT DRS SIGNATURE DATE TIME OF BLOOD OR BLOOD COMPONENT PRODUCT REQUIRED REASON FOR REQUEST SPECIAL REQUIREMENTS where applicable HIGH RISK STICKER where applicable Failing to disclose special requirements such as CMV neg or Irradiated products may result in major morbidity A bleep number and notification when a patient has atypical blood group antibodies is important Failure to supply this information may delay blood issue In emergency circumstan
92. rectal cancer CA19 9 adenocarcinoma of pancreas and CA15 3 carcinoma of breast Therapeutic drug monitoring Usual blood sampling times for oral preparations Anti Epileptics Collect just prior to the oral dose Digoxin Collect at least six hours post dose Lithium Collected approximately 12 hrs post dose Theophylline Peak 2 hours after rapid release preparations 4 hours after sustained release preparations Trough Immediately before oral dose Digoxin Change of therapeutic range and units of reporting in line with National Pathology Harmonisation Introduced on 06 05 09 Digoxin now measured in ug L Therapeutic range 0 9 2 2 ug L Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ee sKingsPath la csTs King s College Hospital MES Page 35 of 85 Thyroid function tests Reference range TSH Thyroid Stimulating Hormone 0 25 4 00 mU L FT4 Free Thyroxine 12 22 pmol L FT3 Free Triodothyronine 3 1 6 8 pmol L Screening TSH is the first line of investigation If TSH is less than 0 60 mU I a FT4 will be organised If TSH is high greater than 4 0 mU L but less than 50 0 mU L a FT4 will be organised T3 toxicosis will be excluded where appropriate by assaying FT3 in those patients with suppressed TSH but normal FT4 In patients with compensated borderline hypothyroidism who are not on thyroxine replacement and are being monitored it is prudent to check thyroid antibodies and
93. requires immediate receipt by the laboratory for freezing ASAP An ACTH request must be accompanied by a cortisol request sand topped vacutainer Ammonia on call staff in the laboratory need to be contacted sample lavender white topped needs to be taken on ice and received immediately to the laboratory For any other test the consultant chemical pathologist or principal clinical scientist on call needs to be contacted via switchboard Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i He 2KingsPath la csTs King s College Hospital MES Page 29 of 85 Clinical Service The department runs a metabolic clinic and has an active role in the management of patients with dyslipidaemias porphyrias and other metabolic disorders Further information Additional information useful suggestions and guidelines of services provided by the clinical biochemistry department are described in the following section This is by no means a comprehensive list but if there are any specific problems please phone the laboratory or consultant chemical pathologist to discuss Adrenocortical function Random cortisol measurement is of limited clinical value If hypersecretion is suspected i e Cushing s syndrome then we recommend that cortisol should be measured in a Yam blood sample SST tube collected after giving 1 mg of dexamethasone orally at 2300hr the previous evening If hyposecretion is suspected i e Addison
94. rrors amendments and suggestions for the next edition should be brought to the attention of the pathology service manager This handbook is also available on Bedford Hospital website www bedfordhospital nhs uk Key contacts GSTS Clinical Director Bedford Dr Fraser Mutch fraser mutch bedfordhospital nhs uk 01234 792325 Ext 4725 GSTS Pathology Services Manager Bedford Mrs Gillian Flack gillian flack bedfordhospital nhs uk 01234 792156 Ext 4617 Customer Service Contact Anne Strong anne strong bedfordhospital nhs uk 01234 792628 Ext 4658 Results Hotline 01234 355122 Ext 4811 Further pathology contacts can be found within discipline specific sections Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath GSTS King s College Hospital IMEE Page 4 of 85 Services The pathology laboratories offer a comprehensive range of pathology services fully supported by consultant grade staff Service objectives GSTS Pathology LLP the Uk s leading independent provider of pathology services is a unique and innovative joint venture between Kings College Hospital Guy s and Thomas Hospitals NHS Foundation Trust and Serco plc Bedford Hospital joined this partnership in December 2009 GSTS is an exemplar of public private partnership in the health sector The result is a unique clinically led customer focused and scientifically driven pathology service GSTS is
95. rsion 1 0 Issued August 2011 Review August 2012 Pathol User Guid i A 2KingsPath la csTs King s College Hospital MES Page 59 of 85 Lower respiratory tract infections Sputum Salivary specimens will not be cultured Do not forget the possibility of tuberculosis see Mycobacteria Microscopy amp culture below If atypical pneumonia is suspected please send Sputum for Microscopy Culture amp Sensitivity MC amp S and Legionella culture Blood in a plain tube for atypical pneumonia serology will be sent to the reference lab for a baseline respiratory virus screen including mycoplasma but specific requests must be made with clinical details for legionella mycoplasma and Q fever serology A second sample may be indicated in convalescence to detect a 4 fold rise in antibiody and or a rise in IgM to be diagnostic Urine sample for legionella antigen is a quick diagnostic test in acute legionnaires disease Broncho alveolar specimens Will be cultured for routine pathogens Mycobacterium tuberculosis and fungus Turnaround time Result available one to two working days after receipt Mycology In suspected dermatophyte infections send skin scrapings hair or nail clippings Turnaround time Microscopy one working day culture up to four weeks Serology bacterial viral parasite and fungal For all serological procedures it is important that all relevant clinical details including the date of onset of symptoms a
96. rtment South Wing and Gilbert Hitchcock House at North Wing Paediatric phlebotomy services are available from Riverbank children s ward The laboratory is unable to offer phlebotomy services Opening times Routine services Enquiries Specimens Monday to Friday 8 00 am 8 00 pm 8 00 am 5 30 pm Saturday 9 00 am 12 30 pm 9 00 am 12 30pm Urgent specimens only Specimens for all pathology departments should be left at specimen reception located on the first floor of the pathology building Access is via the hospital main corridor A lift is available Services available out of hours The consultant haematologist is available via hospital switchboard for clinical advice and interpretation Urgent samples will always be processed by the department Only contact the on call staff for any work after midnight or for any crossmatching request All other specimens will be processed as timely as possible The on call biomedical scientist may be contacted via switchboard or on bleep 474 Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i He 2KingsPath la csTs King s College Hospital MES Page 38 of 85 User satisfaction and complaints The haematology department is pleased to receive constructive comments upon any aspect of its services A quality manual describing all aspects of the department s quality management system is available for inspection by users Turnaround times and sample re
97. s then we recommend performing a short synacthen test Please note that prednisolone and hydrocortisone suppress the adrenal gland and interfere with cortisol assays Please contact the laboratory or seek an endocrinological opinion if you need to investigate these patients Diabetes Mellitus DM Random Blood Glucose Capillary Blood mmol L Venous Plasma mmol L Diabetes likely gt 11 1 gt 11 1 Fasting Plasma Glucose Diabetes likely gt 7 0 Impaired Fasting Glycaemia IFG 6 1 6 9 If random plasma or blood glucose gt 11 1 or fasting plasma glucose gt 7 0 and the patient has symptoms polyuria polydipsia or unexplained weight loss then further tests are unnecessary and DM is confirmed If symptoms are not present another raised fasting or random plasma glucose concentration is needed to diagnose DM Individuals with IFG should have their fasting plasma glucose checked annually All those with a repeat non diagnostic fasting plasma glucose in the IFG range should have oral glucose tolerance test OGTT to exclude diagnose DM If in doubt an oral glucose tolerance test should be performed A fasting glucose alone may not be diagnostic Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i Set oe sKingsPath la csTs King s College Hospital MES Page 30 of 85 Oral Glucose Tolerance Test OGTT Advise patient to fast for about 12 hours overnight following three days of unrestricted carbohydra
98. s College Hospital MES Page 32 of 85 HRT monitoring Oestradiol assays are useful to monitor patients on implants They are of little or no value in patients on oral preparations as these are first conjugated in the liver and hence may give a false indication of serum oestradiol levels Furthermore conjugated oestrogen preparation produce metabolites which interfere with oestradiol assays Serum oestradiol assay is available to investigate postmenopausal bleeding suspected gonadal hypothalamic pituitary disorders and to monitor oestradiol implants Human Chorionic Gonadotrophin hCG We do NOT provide this test for the routine diagnosis of pregnancy If ectopic pregnancy is suspected then we recommend urgent referral of the patient to the accident and emergency department hCG is a useful marker to monitor molar pregnancies Menopause We recommend only FSH as the appropriate test to monitor ovarian oestrogen secretion around the time of menopause Serum oestradiol is not recommended for investigating menopausal symptoms Menopause can be identified with certainty a year or more after the LMP A wide variety of hormonal patterns of LH FSH and oestradiol can occur in the serum during peri menopause with raised FSH being the most consistent feature However post menopausal biochemical parameters are no guarantee of post menopausal state Prostatic Specific Antigen PSA Serum PSA values tend to increase gradually
99. s for human semen samples The following normal reference ranges are used for human semen 1 Motility Sperm motility is assessed in four categories and the percentage falling into each category calculated The categories of motility are A Rapid progressive B Slow sluggish progressive C Non progressive D Non motile Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 83 of 85 The normal reference ranges are Progressive sperm motility A B gt 32 Total sperm motility A B C gt 40 2 Morphology Sperm morphology is assessed against published WHO criteria and the percentage of normal forms reported WHO guidelines recommend a lower reference range of 4 normal forms 3 Other values Semen volume gt 1 5ml Total number of sperm in ejaculate gt 39 Million Sperm concentration gt 15 Million per ml Sperm vitality live sperm gt 58 pH gt 7 2 ref WHO laboratory manual for the examination and processing of human semen 5 Ed If you have any queries regarding semen analysis for infertility investigation please contact the andrology service manager histology dept Post vasectomy sample analysis The introduction of the appointment system does not affect the service for routine post vasectomy samples These can be delivered to the laboratory at any time between 09 00 and 14 00 Monday to Friday Version 1 0 Issued A
100. sPath la csTs King s College Hospital MES Page 81 of 85 Please ensure patients are reminded of the importance of writing the time of specimen production on the request card and specimen container before delivery to the laboratory in addition to general information required for labelling specimen containers and request cards The patients are asked to remain in the pathology specimen reception area for a short while after delivering the sample pot and form to ensure all information required has been provided Instructions to patients The following information is provided by the laboratory to patients FRR KI KIRK KKK IK IR KIKI RIK IIR KIKI KIKI IKK IK IR KAKI IK IAI IR IARI KIA IKK KIKI KIKI e ke IKI AAR KIRK Patient instructions and helpful information Please produce the sample at home carefully following the instructions provided below You should abstain from sexual intercourse or masturbation for a minimum of two days and a maximum of seven days before producing the sample for examination this will ensure the sperm are at their best for testing The specimen must be produced by masturbation stimulation by hand directly into the specimen container provided It is very important that only the container provided is used as this has been confirmed as being suitable for the test Do not use an ordinary condom to collect the sample or use lubrication as either will seriously affect the test results It is important that the e
101. sium Same day Manganese Special tube available 15 days from lab 17B Oestradiol See HRT monitoring 2 3 days Osmolality Same day Paracetamol Same day Paraprotein typing 14 days Parathormone PTH 7 days Phenobarbitone Prior to oral dose 3 days Phenytoin Prior to oral dose 3 days Porphyrins EDTA 14 21 days Progesterone 7 days before next cycle is Same day due day 21 Prolactin Same day Prostate specific antigen PSA Same day Proteins Total protein albumin amp Same day globulin Protein electrophoresis 14 days Renal profile Na K amp creatinine Same day Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 18 of 85 SkingsPath King s College Hospital MES i icsts Test name Sample Special Requirements Expected turn around time Tests highlighted in blue denote test sent SST unless otherwise routine tests are carried away stated out the same day if received before midday Salicylate Same day Sex Hormone binding globulin SHBG 2 3 days Testosterone 2 3 days Theophylline Prior to oral dose 3 days Thyroglobulin 15 days Thyroid stimulating hormone TSH Same day Thyroxine Free T4 2 days Transferrin Same day Tri iodothyronine Free T3 3 days Troponin T 6 hrs after onset of chest Same day pain Urate Same day Urea Same day Valproate Prior to oral dose 3 days Vitamin B12 Same day Vi
102. sts and groups of tests and the number of different reference laboratories to which they are sent it is not possible to state exactly the volume of serum required Please telephone ext 4814 Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i Bedford Hospital Trust skingsPath a GSTS King s College Hospital MES Page 63 of 85 Reference laboratories Reference laboratories to which work is routinely referred Anaerobe Reference Laboratory NPHS Microbiology Cardiff University Hospital of Wales Heath Park Cardiff CF14 4XW CAMR Porton Down Salisbury Wiltshire SP4 0JG Clinical Microbiology and HPA Collaborating Laboratory Brucella Reference Unit BRU University Hospital Aintree Lower Lane Liverpool L9 7AL Enteric Respiratory amp Neurological Virus Laboratory Health Protection Agency 61 Colindale Ave London NW9 5HT Laboratory of Enteric Pathogens Health Protection Agency 61 Colindale Ave London NW9 5HT Health Protection Agency Addenbrookes Hospital Cambridge CB2 2QW Health Protection Agency PO Box 209 Manchester Royal Infirmary Clinical Sciences Building Manchester M13 9WZ HPA Mycobacterium Reference Unit Clinical Sciences Research Centre Barts and The London Queen Mary s School of Medicine and Dentistry 2 Newark Street London E1 2AT Laboratory of Hospital Infection Health Protection Agency 61 Colindale Ave London NW9 5HT Leptospira Reference Unit Microbiology County H
103. t Fresh Frozen Plasma FFP and Cryoprecipitate are stored at 40 C and will be thawed in quantities of one unit at a time except for massive bleeding or trauma where two may be issued In cases where multiple units are being transfused telephone the Transfusion Lab Ext 4833 15 mins before the next unit is required to allow time for defrost Transfusion of these packs must ideally be completed within 4 hours for maximum therapeutic effectiveness Where there are unavoidable delays FFP may be given up to 24 hours after thawing if kept in a validated blood bank at 2 6 C Anti D immunoglobulin 1500iu amp 250iu is kept in the delivery suite blood bank A small contingency stock is retained in the lab This product is for eligible RhD NEGATIVE patients only and must not be given unless indicated by appropriate laboratory tests All anti D removed for use must be entered in the Anti D register next to the blood bank Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath CSTs King s College Hospital MES Page 50 of 85 200 g L Human Albumin Solution H A S is only available on request laboratory staff can issue up to 400ml per patient Where a greater volume is anticipated contact the consultant haematologist 50 g L H A S is stocked in minor quantities in some satellite blood banks Large volumes can be collected directly from the laboratory Details must be written in the appropriate regis
104. t transient lymphocytosis occurs in many traumatic situations and does not indicate bone marrow disease If in doubt repeat Lymphopenia Lymphopenia is common in the elderly and also occurs after chemotherapy sometimes persisting for many months and in patients with chronic renal failure It is often seen in HIV ve people Chronic Myeloid and Acute Leukaemias will usually be easy to diagnose often by the laboratory first but if in doubt please refer Chronic and acute myeloid leukaemia Chronic and acute myeloid leukaemias will usually be identified first by the laboratory but if in doubt please refer to the haematologist Myelodysplasia Myelodysplasia or the Myelodysplastic Syndrome MDS seems to be increasing possibly due to an increasingly aged population but also an increasing awareness of its subtleties Characteristic changes are often seen on the blood film but many patients will have only anaemia neutropenia low platelets in varying degree A bone marrow will often be diagnostic but in view of the limited therapy options at present it may be sensible to delay this until intervention is necessary usually this will be the need for transfusion The outlook in MDS is very variable All patients with Hodgkin s Disease or Non Hodgkin s Lymphoma NHL require specialist attention however a tissue diagnosis will usually be necessary Isolated enlarged lymph nodes will require excision and referral without delay to a surge
105. tamin D 14 days Zinc Special bottle obtained 15 days from lab Must be a fasting sample Can be carried out urgently if agreed with consultant chemical pathologist principal Clinical scientist kk wash the cells Send away tests are indicated in blue Protect from light Please send both cells and separated plasma it is not necessary to Results marked as urgent that fall within the agreed guidelines will be issued to the requesting ward via the pneumatic tub system within one hour of receipt Version 1 0 Issued August 2011 Review August 2012 Pathology User Guide Bedford Hospital Trust Page 19 of 85 ingsPath King s College Hospital MES igicsts Test name Sample Special Requirements Expected turn around time Tests highlighted in blue denote test sent routine tests are carried away out the same day if received before midday Urine Amino acid chromatography Fresh MSU 10 days Bilirubin MSU 3 days Calcium 24hr collection Same day Copper 24 hr collection Special container required 12 days Cortisol 24 hr collection 7 days Creatinine clearance 24 hr collection Requires 4ml SST blood Same day Cystine 24 hr collection no preservative 15 days Drugs of addiction In house screen MSU Same day Drugs of addiction Confirmation MSU 7 days 5 HIAA 24 hr collection Acid preservative required 15
106. te diet 75g of glucose in the form of Lucozade is given and blood samples taken at 0 mins and 120 mins Pregnant patients will have an additional sample taken at 60 mins Glucose meters should not be used for glucose assay during OGTT and a reliable laboratory glucose assay should be used to exclude diagnose Diabetes Mellitus DM with confidence The phlebotomy department at South Wing Tel 01234 792160 will make appointments for OGTTs within one week if required Diabetes Mellitus is diagnosed if 0 min plasma glucose gt 7 0 mmol l 120 min plasma glucose gt 11 1 mmol l Impaired Glucose Tolerance is diagnosed if 0 min plasma glucose lt 7 0 mmol l 120 min plasma glucose gt 7 8 lt 11 1 mmol l Glycated Haemoglobin HbA has no place in the diagnostic process nor in screening for DM Glycated Haemoglobin is useful in monitoring treatment As the life span of red cells is usually about 3 months we would like Glycated Haemoglobin assays requested not less than 10 weeks apart except in pregnancy or under special circumstances Ante natal Random plasma glucose is checked between 26 28 weeks gestation Glucose tolerance test is required for diagnosis exclusion of gestational diabetes if random plasma glucose gt 6 5 mmol L Pregnancy It is advisable to refer all patients with pre existing diabetes to the antenatal clinic at the hospital where adequate measures will be taken to monitor the patient during her pregnancy
107. ter Beriplex PCC is only available after discussion with the consultant haematologist It is available in 500iu amp 250iu packs A fully compliant request card is required and details must be recorded in the blood bank register Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEK Page 51 of 85 4 Microbiology Key contacts Consultant Microbiologist Dr Simantee Guha Direct line 01234 795845 Internal extension 4603 e mail Simantee Guha bedfordhospital nhs uk Specialty Manager Guy Humphrey Direct line 01234 792208 Internal extension 4610 e mail guy humphrey bedfordhospital nhs uk Bacteriology results and general enquiries Direct line 01234 795913 Internal extension 4703 4708 Serology results and enquiries Direct line 01234 795913 Internal extension 4814 These notes are provided for clinical staff using the microbiology laboratory they are not intended to be a complete or authoritative document but merely a guide to some of the services available If you need further information about specimens availability or suitability of tests interpretation of results or any other matter relating to the microbiology service please phone the department Laboratory staff will be pleased to help Opening hours Enquiries Specimens Monday Friday 8 45am 5pm 8 45am 4 30pm Saturday 9 00am 12 00pm 9 00am 11 00 am Spe
108. to the ward Critical results will be telephoned to the requesting physician or to the ward Iron and Lithium for overdose cases Gentamicin will be analysed if the sample is between six to fourteen hours post dose and the patient is on an extended interval regimen or they are on an alternative regimen Anti epileptic drugs theophylline and digoxin are not routinely available on call Unusual drug assays not available for information contact Medical Toxicology Unit St Thomas Hospital Lambeth Palace Rd London SE1 5EH Telephone 0207 7188 8686 8690 8783 Ethanol dark green topped lithium heparin vacutainer sample analysed by arrangement with the consultant chemical pathologist Osmolality needs to be specifically requested by a doctor ICU requests will be analysed on a Sunday between 08 00 and 19 00hrs Insulin and C Peptide red topped vacutainer will not be processed out of hours send away tests but will be stored appropriately requires immediate receipt by the laboratory for freezing ASAP an insulin request MUST be accompanied by a glucose request PTH red topped vacutainer will not be analysed out of hours but it will be stored appropriately requires immediate receipt by the laboratory for freezing ASAP A PTH request must be accompanied by a calcium request ACTH 2 x translucent lavender topped vacutainer will not be processed out of hours send away test but it will be stored appropriately
109. transforming the way pathology is delivered providing an end to end service that draws upon innovative processes and technology to improve outcomes for patients Customers have access to one of the most extensive ranges of tests and support services The company is a leading national diagnostic referral service providing a wide range of specialist tests and routine services to support all healthcare organisations GSTS customers include GPs referring clinicians the NHS and the private sector both domestically and internationally Commitment to quality All GSTS Pathology laboratories are currently registered or working towards registration with Clinical Pathology Accreditation CPA Ltd The blood transfusion service is compliant with Medicine and Healthcare Products Regulatory Agency MHRA The cytology department within cellular pathology is compliant with Cytology External Quality Assurance Quality policy This statement of purpose constitutes the quality policy for GSTS Pathology LLP which is an independent pathology provider registered with the Care Quality Commission The management system incorporates the requirements of the Health and Social Care Act health and safety and environmental legislation and blood safety quality regulations amongst others The appropriate ISO standards are the underlying standard of operation for the medical laboratory services accredited by CPA UK Ltd and the United Kingdom Accreditation Service
110. ugust 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 84 of 85 Advice for patients for the production of semen samples for post vasectomy analysis The following advice is issued to patients for routine post vasectomy semen analysis Instructions to patients 1 The sample should be produced by masturbation into the container provided No other container is suitable for this test It is important not to use either a condom or any type of lubricant as these will seriously affect test results It is important the whole sample is collected in the pot If any sample is lost then it will not be suitable for assessment and a further sample will be required on another occasion If this is the case please contact the laboratory on the telephone number below The container must be labelled with Your full name Your date of birth Your NHS number and or Hospital number The Date and Time of production of sample Please ensure the lid is properly secured to stop leakage of sample from the pot The specimen pot should be kept warm i e in an inside pocket whilst in transit to the hospital Excessive cold or heat must be avoided as either will affect the test results The form and pot should be brought to the Pathology Specimen Reception on Floor 1 of GSTS Pathology Pathology Building Bedford Hospital South Wing within one hour of production The samples are accepted between the h
111. uid should be put in a dry 60ml plastic specimen container Please provide at least 25ml of fluid from body cavity fluids to enable full analysis to take place including immunocytochemistry when appropriate Urine samples need to be fixed as the cells deteriorate very quickly in urine The specimen should be put in a plastic specimen container a small amount of preservative formalin Pre prepared urine pots are available from the cytology laboratory or pathology laboratory reception South Wing GSTS Pathology building floor 1 Three specimens of urine should be collected on three consecutive days A mid morning urine rather than the first urine of the day is the best specimen to send for cytological investigation Patient instruction sheets are available from the cytology department on request Sputum Specimens of early morning deep cough sputum should be submitted on three consecutive days The specimens should be put in a 60ml plastic specimen container Further advice on any aspect of specimen collection transport or suitability for examination can be obtained from the cytology laboratory 01234 792623 gt Please note Cells degenerate rapidly Samples for cytological examination must be sent to the laboratory as soon as possible gt Any high risk specimens e g HIV infection Hepatitis B or C should be identified clearly on both the sample and request form Results Diagnostic cytology reports are typically availab
112. will usually take several days for any change in the INR to occur after introducing a conflicting drug Generally patients with Thrombophilia a thromboembolic tendency will be referred by physicians or surgeons However it is now possible to identify some at risk individuals using blood tests Many of these will already be seen in other hospital departments but the following should be referred if not otherwise tested Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MES Page 47 of 85 Unexpected PE DVT in patients lt 45 yrs age DVT PE occurring in several family members DVT PE in young women on the Pill Women with a clear history of recurrent miscarriage The identification of the Factor V Leiden genetic defect has led to a great deal of public interest in thrombophilia Much anxiety can be generated if inappropriate tests are carried out In general the guidelines described above should be followed If in doubt telephone the consultant haematologists Easy brusing Patients with a serious defect of clotting will normally have been identified early in life Easy bruising in later years however is common but in most patients no clear diagnosis emerges Many will have taken aspirin or other drugs or preparations which affect platelet function and this possibility should be excluded Others with a clear history of bruising or bleeding should be referred preferabl
113. with age It is not unusual to find values of up to 6 5 pg litre in those over 70 years PSA values Interpretation 0 5 4 ug litre Normal although does not absolutely exclude a localised prostatic cancer 4 10 ug litre 20 25 chance of cancer 10 59 pg litre overall 66 of patients will have prostatic cancer gt 60 ug l Usually indicates metastatic prostatic cancer A rise of gt 20 year Refer for further investigation Version 1 0 Issued August 2011 Review August 2012 Pathol User Guid i ee sKingsPath la csTs King s College Hospital MES Page 33 of 85 PSA is also raised in other conditions e g BPH prostatitis prostatic infarction urinary tract infection urethral catheterisation retention of urine transuretheral resection of prostate TURP and prostate biopsy Despite the lack of specificity of PSA for prostate cancer at present it is the best tumour marker for the disease Follow up PSA tests are valuable to monitor the management of prostate cancer and to monitor men with equivocal results It is normally recommended to wait at least 6 weeks after prostate biopsy or TURP before obtaining a serum PSA level Prostate cancer can progress very slowly and it is often said that more elderly men die with prostate cancer than from it Perhaps PSA testing should only be considered for men with a life expectancy of 10 years or more Digital rectal examination DRE provides the cornerstone of the physical assessm
114. y after the following have been carried out FBC including platelet count Clotting screen Urea and liver function tests Patients with Haemophilia and other clotting disorders will usually know where to obtain help An advice service for Haemophilia is available for local patients and visitors The consultant Haematologist is willing to discuss clinical problems related to haematology throughout the working day telephone numbers at top of section Refer to the hospital switchboard for advice on urgent clinical matters out of hours Referral laboratories Where testing is not available on site samples are referred to the following CPA accredited laboratories Laboratory address Red Cell Immunohaematology North London BTS Colindale Ave London Department of Clinical Biochemistry Kings College Hospital Denmark Street London Department of Haematological Medicine Kings College Hospital Denmark Street London Histocompatibility amp Immunogenetics NHS Blood and Transplant 500 North Bristol Park Northway Filton Bristol Institute of Neurology Queen Square London Cytogenetic department Kennedy Galton Centre Northwick Park Hospital Watford Molecular Genetics Department Kennedy Galton Centre Northwick Park Hospital Watford East Anglian Medical Genetics Service Level 6 Addenbrooke s Treatment Centre Cambridge University Hospitals NHS Foundation Trust Hills Road Cambridge Blood Coagulation Labo

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