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Pathology User Guide

1. File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong
2. King s College Hospital IMEE Page 90 of 98 6 Patient information sheets The following patient information sheets are available on the Bedford Hospital site www bedfordhospital nhs uk clinical biochemistr 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i Bedfo rd Feel Trust aK ngsPath GSTS King s College Hospital NHS Pathology Page 91 of 98 BD Vacutainer System D BD Diagnostics Preanalytical Systems wW BD i Tube Guide including Order of Draw Please display this in your clinical areas beside your venepuncture equipment Bedford Hospital NHS Trust 28 07 2011 Blood samples should be taken in the following order an o Tne Determinations Special Instructions Blood Aerobic followed by anaerobic if insufficient blood for Culture both culture bottles use aerobic bottle only Routine Biochemistry 3607956 SST Ill B12 Folate M aemainis KFK112 3 5 m Immunology 363095 Sodium i i Ensure tube is filled KFK119 sn INR Clotting Studies above minimum fill line pee Serum Microbiology Serology RA KFK168 Gmi Latex 367883 Lithium Chromosomes Genetic l j pa i tests Specialist Bio Genetic Tests only ml che
3. 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 Stool C amp S Universal half filled Stool OCP 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 60ml pot quarter filled 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 suspected Skin scr
4. 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 Oral Glucose Tolerance Test OGTT Advise patient to fast for about 12 hours overnight following three days of unrestricted carbohydrate diet 75g of glucose in the form of Lucozade is given and blood samples taken at 0 mins and 120 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital IMEE Page 32 of 98 Glycated Haemoglobin HbA is not provided at present for the diagnosis of diabetes mellitus Glycated Haemoglobin is useful in monitoring tre
5. Reference Ranges 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 Rapid progressive Slow sluggish progressive Non progressive Non motile Dow 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 Department Uncertainty of Results in Diagnostic Semen Analysis File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEE Page 88 of 98 Uncertainty in relation to laboratory testing simply means the existence of doubt or a level of error associated with a particular measurement A degree o
6. 77 11 10 13 87 Instructions for Amend JT 18 10 13 AS patients 78 11 10 13 84 Amend Instructions Date amp Time of specimen JT 18 10 13 AS 79 11 10 13 13 Change time 9 40 5 10 LW 18 10 13 AS File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 97 of 98 King s College Hospital MES ia csTs 80 11 10 13 13 Amend add on tests LW 18 10 13 AS 81 11 10 13 13 Amend hospital add on LW 18 10 13 AS 82 11 10 13 13 Ti Urgent samples LW 18 10 13 AS 83 11 10 13 14 Add 170HP LW 18 10 13 AS 84 11 10 13 16 Amend Bicarbonate Special Bottle LW 18 10 13 AS 85 11 10 13 16 Amend Copper Special Bottle LW 18 10 13 AS 86 11 10 13 16 Amend CRP No indication to repeat LW 18 10 13 AS 87 11 10 13 17 Amend Glycated Hb Remove LW 18 10 13 AS 88 11 10 13 17 Add 17 SST not suitable LW 18 10 13 AS hydroxyprogesterone 89 11 10 13 17 Change Immunoglobulin Now done in house LW 18 10 13 AS 90 11 10 13 17 Change Immunoglobulin TAT now 7 days LW 18 10 13 AS 91 11 10 13 17 Lamotrigine Cannot be added on LW 18 10 13 AS 92 11 10 13 17 Porphyria screen Full screen requires LW 18 10 13 AS 93 11 10 13 17 RAST TAT is 21 days LW 18 10 13 AS 94 11 10 13 18 Vit D Now done in house LW 18 10 13 AS 95 11 10 13 18 Protect cells Protect from light LW 18 10 13 AS 96 11 10 13 20 NEW CSF TABLE LW 18 10 13 AS 97 11 10 13 20 GP add on tes
7. King s College Hospital IMEE ists Test name Tests highlighted in blue denote test sent away Sample SST unless otherwise stated Special Requirements Expected turn around time routine tests are carried out the same day if received before midday Folate SST or Red top only Same day Free light chains Part of serum 14 days electrophoresis profile Follicle stimulating See infertility protocol Same day hormone FSH Fructosamine 8 days Gastrin Special tube Arrange with lab 14 days available in lab Gentamicin Serum sample Please state time of Same day ONLY last dose amp regime Contact Microbiology for clinical interpretation Glucose Fluroide Oxalate State fasting random Same day Flu Ox timed or if known DM sample Glucose tolerance test GTT Flu Ox timed Arrange with 2 days samples phlebotomy SW or NW y glutamyl transferase GGT Same day Haemoglobin A1c EDTA Available only for 1 2 days known DM HDL cholesterol Same day Human chorionic Daily but not week ends gonadotrophin HCG Human Growth Hormone 8 days 17 hydroxyprogesterone SST not suitable Do not use a tube 10 days containing gel serum or lithium Heparin plasma is accpetbable Immunoglobulins IgA IgG amp 3 days IgM Immunoglobulin IgE 7 days Insulin C peptide FI Ox amp SST Arrange with lab 15 days Iron Same day Lactate FI
8. Sent to reference laboratory Antibody levels gt 10 iu ml considered as immune Please give full clinical details and date of onset of symptoms igicsts 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 74 of 98 skingsPath King s College Hospital MEE TEST SYPHILIS SEROLOGY TOXOPLASMA IgG VZV IgG VZV IgM very rarely indicated as Chicken pox is a clinical diagnosis WEILS DISEASE Leptospira antibodies SAMPLE 5ml clotted blood 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 COMMENTS TURN AROUND TIMES 1 3 days Positives sent to ref lab for confirmation Tested daily Positives sent to ref lab for confirmation Run daily Animal transmission Particular concern in pregnancy Please state whether patient is pregnant or immune compromised Date of contact MUST be given Sent to Reference laboratory Rarely necessary as Chicken Pox is essentially a Cli
9. Serum oestradiol is not recommended for investigating menopausal symptoms Menopause can be identified with certainty a year or more after the LMP File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 34 of 98 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 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 L Normal although does not absolutely exclude a localised prostatic cancer 4 10 ug L 20 25 chance of cancer 10 59 ug L 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 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
10. bronchiectasis TURN AROUND TIMES 1 working day 1 2 hours Culture 6 8 weeks 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 Do not send repeat specimens within four A amp B weeks if positive 1 2 working days DIFFICILE TOXIN half filled container File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide skingsPath Bedford Hospital Trust igicsts TURN AROUND TIMES Microscopy weekly Culture 2 4 weeks King s College Hospital IMEE Page 68 of 98 TEST SAMPLE COMMENTS MYCOLOGY Skin scrapes from Universals or brown active edge of envelopes lesion Or Dermapak Nail scrapes in sterile universal deep enough 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 3 sterile universal containers CSF for bacteriology virology All 3 specimens to Microbiology Phone laboratory to say sample is being sent Microscopy same day Bacterial Culture 2 3 days Fungal 7 days AFB 6 8 weeks Remove the centre portion of 48 hour interim the barcode and place on the report request form 5 day final Blood culture bottles sets 10 days for available from Pathology suspected BLOOD Aerobic bottles 8 CULTURES 10ml Anaerobic bot
11. effectiveness and publishes a quality account which defines our quality improvement objectives Services complete an Annual Management Review AMR to ensure objectives are monitored locally and changes or new systems processes or procedures are implemented effectively Satisfaction of Users of the service is seen as a key indicator of success in improvement of services GSTS Pathology is proactive in managing its business risks and has plans in place to ensure service continuity in all events File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i Sol ae skingsPath CSTs King s College Hospital Pathology NHS Foundation Trust Page 6 of 98 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
12. File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 83 of 98 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 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 fluid 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 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 inf
13. Guha bedfordhospital nhs uk Service Delivery Manager Guy Humphrey Direct line 01234 792611 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 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 54 of 98 Specimens and Tests Request forms for specimen labelling If a pre printed label is used please ensure that a label is also placed on all back copies of
14. Guide Bedford Hospital Trust King s College Hospital MEE ists Page 94 of 98 Amend Date Page No Details of Change Approved Date amended Amended No by electronically by Current Replaced by 26 20 9 12 17 Gastrin Special Tube Change Serum only sample MS 20 9 12 AS 27 20 9 12 17 Porphyrins Add EDTA Protect from light MS 20 9 12 AS 28 20 9 12 17 Add Vancomycin assay MS 20 9 12 AS 29 10 9 12 21 Add ACR Clinical Guidance MS 20 9 12 AS 30 10 9 12 24 Microalbumin Change Microalbumin ACR MS 20 9 12 AS 31 10 9 12 24 Add Clinical Guidance and MS 20 9 12 AS NT Pro BNP assay Units of measure 32 10 9 12 28 Unusual drug assays REMOVE MS 20 9 12 AS 33 10 9 12 28 PTH red topped Remove red topped PTH MS 20 9 12 AS 94acutainers vacutainers 34 10 9 12 28 Ammonia Lavender white Change Translucent MS 20 9 12 AS 35 10 9 12 34 Add The Department provides MS 20 9 12 AS CA125 analysis in line with ovarian care NICE guideline 122 April 2011 36 10 9 12 34 Digoxin REMOVE MS 20 9 12 AS 37 18 10 12 87 Add Blood Tube Guide GH 18 10 12 AS 38 18 10 12 81 Samples to be Change Samples to be delivered NC 18 10 12 AS delivered to the to the laboratory within laboratory within 1 30 45 minutes of hour of production production 39 07 11 12 56 Chlamydia swab Add change or urine GH 27 11 12 AS 40 07 11 12 62 Gen Probe Chlamydia Add change or urine kit GH 27 11 12 AS File Name B
15. 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 63 of 98 Antibiotic assays Assays for gentamicin and vancomycin are available on site See Biochemistry guide Antibiotic assay protocol available on the Intranet Contact the Consultant Microbiologist for advice if necessary Turnaround time
16. 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital MEE Page 55 of 98 The pneumatic tube system may be used to transport specimens in accordance with the rule of use of the system Pneumatic Tube Policy 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 which 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 Salm
17. Ox Send to lab Same day immediately Lamotrigine 8 days LDH Due to sample integrity Daily weekdays this assay cannot be added on Lead Li hep or EDTA 21 days Lipids cholesterol amp Same day Triglyceride Lithium 12 hrs post dose Same day Liver function tests LFT Same day Bilirubin AST Alk Phos amp albumin Luteinizing Hormone LH Same day Magnesium Same day Manganese Special tube 15 days available from lab NT Pro BNP GP Only 8 days 17B Oestradiol See HRT monitoring 2 3 days Osmolality Same day Paracetamol Same day File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 19 of 98 SkingsPath King s College Hospital IMEE i icsts Test name Tests highlighted in blue denote test sent away Sample SST unless otherwise stated Special Requirements Expected turn around time routine tests are carried out the same day if received before midday Paraprotein typing 14 days Parathormone PTH Subject to in house protocol 7 days see guidance in the Clinical Services Section Phenobarbitone Prior to oral dose 3 days Phenytoin Prior to oral dose 3 days Porphyrins Full prophyria Protect all samples from 14 21 days screen light requires EDTA blood random urine and stool sample Progesterone 7 days before next cy
18. Service is pleased to receive constructive comments upon any aspect of its service Each department within the Pathology Service holds a Quality Manual describing all aspects of their department s Quality Management System This is available for inspection by users File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath a csTs King s College Hospital MEE Page 13 of 98 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 Service Delivery 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 40 am 5 10 pm 8 00 am 5 30 pm Saturday 9 00 am 12 30 pm 9 00 am 12 30pm limited profile available 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 ist 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 2
19. User Guid i oe 2KingsPath GSTS King s College Hospital IMEE Page 80 of 98 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 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 transport should be in line with 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 individu
20. User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath a csTs King s College Hospital IMEE Page 42 of 98 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 cross matching Samples must never be stored in direct sunlight carried on the parcel 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 please 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 Identi
21. 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 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital IMEE Page 49 of 98 Unexpected PE DVT in patients lt 45 yrs age DVT PE occurring in several family members DVT PE in
22. 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 9am blood sample SST tube collected after giving 1 mg of dexamethasone orally at 2300hr the previous evening If hyposecretion is suspected i e Addison s then we recommend performing a short synacthen test File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 31 of 98 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
23. control HDL Cholesterol See lipid interpretation BHCG human chorionic gonadotrophin Non pregnant 0 4 iu L Immunoglobulins IgA IgG and IgM Adult IgA 0 5 4 0 g L Adult IgG 5 0 14 0 g L Adult IgM 0 5 2 0 g L See Protein Electrophoresis SOP book for child ranges Iron Male 10 30 umol L Female 9 27 umol L Lactate 0 50 2 00 mmol L Lactate Dehydrogenase LDH 240 480 iu L LDL Cholesterol See lipid interpretation Lithium 0 50 1 20 mmol L Suggested therapeutic range Therapeutic range of 0 5 0 8 mmol L may be adequate in prophylaxis LH Luteal Hormone 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 0 7 1 0 mmol L Microalbumin ACR Male lt 2 5 Female lt 3 5 mg mmoL creatinine File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 26 of 98 skingsPath King s College Hospital IMEE Analyte Clinical Guidance NT Pro BNP Units pgl mL Interpretation Normal lt 400pg mL Heart failure unlikely consider alternative diagnosis Intermediate 400 2000pg mL Echocardiograph and clinical management plan required If heart failure confirmed refer to heart failure clinic High gt 2000pg mL refer to rapid access heart failure clinic Oestradiol Osmolality Serum U
24. 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 circumstances when the patient is unconscious or unknown a UNIQUE NUMERIC IDENTIFIER A amp E number GENDER amp DATE TIME SIGNATURE 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 is 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 guideline
25. form from Open Exeter 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 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 Cytopathology 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 April 2012 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
26. 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 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 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 translucent lavender topped tube needs to be taken on ice and received immediately to the laboratory Screening for urine drugs of abuse is part of the on call profile For any other test the Consultant Chemical Pathologist or Principal Clinical Scientist on call needs to be contacted via switchboard 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
27. production of semen samples for post vasectomy analysis The following advice is issued to patients for routine post vasectomy semen analysis Instructions to patients 9 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 9 The container must be labelled with File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital IMEE Page 89 of 98 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 Excessive cold or heat must be avoided as either will affect the test results The sample MUST arrive in the laboratory on the day that it was produced The sample must arrive by 2pm please note that if you are using the courier service the sample may arrive after 2pm in the laboratory Post vasectomy samples arriving later than 2pm will be rejected The sam
28. 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 60acutainer If culture for Candida spp 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 five to seven working days after receipt Preliminary result may be available earlier File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 61 of 98 Lower Respiratory Tract Infections Sputu
29. 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 please refer to Consultant Haematologist Clinical Haematology Bedford Hospital NHS Trust 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2Kings
30. the Accident and Emergency Department only can alert the laboratory that samples need to be processed urgently or to enquire if results are available on their patients This DECT phone is not for use outside of the A amp E Department File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath GSTS King s College Hospital IMEE Page 9 of 98 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 critical results produced out of hours will be telephoned or hard copy sent in the air tube to the requesting location All other results will be available on the ward reporting system available on all Trust computers connected to the Intranet In the event of ICE system failure an interim report will be sent to the ward 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
31. 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 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 Inadequately 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
32. 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 surgeon is essential Other patients with probable lymphoma will almost certainly need complex diagnostic procedures and should be referred to the Consultant Haematologist File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital IMEE Page 48 of 98 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 emer
33. working days Culture 6 8 weeks Minimum 5 days Minimum 2 working days Minimum 1 working day Routine 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 3 working days File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 67 of 98 TEST URINE Schistosoma URINE Legionella Antigen URINE AFB SPUTUM Routine bacterial culture BRONCHIAL ASPIRATE TRAP SPUTUM AFB BRONCHIAL ASPIRATE TRAP AFB NPA RSV FAECES Routine culture amp Parasitology FAECES For C SAMPLE 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 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 ingsPath King s College Hospital IMEE COMMENTS preferably after exercise Available from Pathology State if patient suffers from
34. 0 and 20 00 may be contacted on extensions 4833 4653 Haematology Blood Transfusion Biochemistry Microbiology 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 40 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 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 Clinical 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 BMS Clinical Biochemistry Bleep 432 Haematology Blood Transfusion Bleep 474 If no response please contact switchboard Both the Clinical Biochemistry and the Haematology Blood Transfusion BMS also carry DECT phones so that
35. 29 Dr K Adu Poku Consultant Histopathologist 01234 355122 x 4731 4731 Dr J Patel Consultant Histopathologist 01234 355122 x 4730 4730 Mr N Cully Service Delivery Manager Cellular 01234 792092 4694 Pathology Dr F Mutch Consultant Cytopathologist 01234 792325 4725 Hospital Based Co ordinator Cytology Advanced Practitioner 01234 355122 x 4734 4734 Admin amp Clerical 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 working 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 Clinical Advice Clinical advice for any of the tests investigations undertaken within Cellular Pathology can be obtained by contacting the department ACCEPTANCE CRITERIA FOR CELLULAR PATHOLOGY SAMPLES The information required on the sample is essential and samples will be rejected if there is missing or discrepant information Minimum Data Set for Histology Diagnostic Cytology Fluid and Sputum Samples and Request Forms These samples MUST have 3 patient identifiers which match on the sample label and the request form or the specimen will be rejected NAME DATE OF BIRTH
36. 4 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 If you need to add a further test request to a sample which we have previously received in the laboratory please telephone the relevant department to check that the sample is still viable and an add on test can be requested Any add on requests must be made within 72 hours tests will be performed if the assay is still valid and sample integrity has not been compromised If this is possible please send an email request with patient details and tests to be added on to the following secure email address GSTS Bedford Addontest nhs net Please note that faxed requests will not be accepted Within the hospital request cards received with add on tests requested will also be accepted Requests received from Accident amp Emergency Acute Assessment Unit Neonatal Unit and Critical Care Complex are treated urgently Any other urgent requests the laboratory needs to be telephoned in normal hours and bleeped after 50m Bleep 432 Requests marked as urgent but not accompanied by a telephone call will be assayed as soon as possible Critical results which need immediate intervention will also be telephoned Results of GP requests marked urgent will be telephoned File Name BED US
37. 5 mmol L less than 2 0 mmol L Chol HDL Ratio Ratio of lt 5 00 reduces the risk of cardiovascular disease 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 vacutainer Blood Gases amp Carboxyhaemoglobin Other routine analytes may also be available on the Trust ICE system Critical results will be telephoned to the requesting physician or to the ward File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 30 of 98 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 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
38. AS 57 11 10 13 80 ThinPrep Technology used NC 18 10 13 AS 58 11 10 13 11 Acceptance criteria Cell Addition NC 18 10 13 AS Path File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 96 of 98 a ingsPath King s College Hospital MES i icsts 59 11 10 13 74 Acceptance criteria Cell Addition NC 18 10 13 AS 60 11 10 13 56 Pad Urine aa TAT Amend HG 18 10 13 AS 61 11 10 13 56 Parasites On request HG 18 10 13 AS 62 11 10 13 57 Outbreak TAT Amend HG 18 10 13 AS investigations 63 11 10 13 58 Bacterial Culture TAT Amend HG 18 10 13 AS 64 11 10 13 58 Bacterial Culture Amend processing HG 18 10 13 AS 65 11 10 13 61 Per nasal swab TAT Amend HG 18 10 13 AS 66 11 10 13 61 Mycology TAT Amend HG 18 10 13 AS 67 11 10 13 62 Serology Contact 5251 Amend 4814 HG 18 10 13 AS Number 68 11 10 13 63 Vanc amp Gent Amend See Biochem Guide HG 18 10 13 AS 69 11 10 13 64 Vanc amp Gent Remove HG 18 10 13 AS 70 11 10 13 65 Ref Labs Amend and update HG 18 10 13 AS 71 11 10 13 66 Contact Lens Amend HG 18 10 13 AS 72 11 10 13 67 Urine Cultures TAT Amend HG 18 10 13 AS 73 11 10 13 67 Perianal swab Remove HG 18 10 13 AS 74 11 10 13 68 Mycology Amend TAT Amend HG 18 10 13 AS 75 11 10 13 68 Child Abuse Amend Remove Woodlands HG 18 10 13 AS 76 11 10 13 71 Cat Scratch Fever Amend HG 18 10 13 AS
39. C4 complement CA 125 CA 153 CA 199 CEA Cortisol serum 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 80 Alb 45 Corrected Ca 2 70 Invalid if albumin is lt 20 g L 2 5 7 5 mmol d 4 12 mg L lt 1 5 of Total Hb smokers lt 6 5 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 24 of 98 skingsPath King s College Hospital MEE Analyte Creatinine serum Creatinine Clearance Creatine Kinase CK Clinical Guidance 0 1 month 30 80 umol L im 6 years 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 1 0 ugl L eGFR See interpretive information in this document Electrolytes Na K a
40. Diagnostic cytology reports are typically available twenty four to forty eight hours from receipt of the specimen unless ancillary studies are required Andrology Service In order to enable improvements to the Andrology Service the Cellular Pathology department at Bedford Hospital NHS Trust operates an appointment system for its Infertility semen sample analysis 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 30 45 minutes of production Please note that there are NO facilities on site for sample production Following analysis if all values are within r
41. ED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 95 of 98 a ingsPath King s College Hospital MEE ists Amend Date Page No Details of Change Approved Date amended Amended No by electronically by Current Replaced by 41 20 11 12 76 Add Uncertainty of Results NC 27 11 12 AS 42 20 11 12 75 Add Referral Hospitals for NC 27 11 12 AS Cellular Pathology 43 27 11 12 10 Add Add on Test Requests GF 27 11 12 AS 44 27 11 12 13 Change Add Add on Test requests GF 27 11 12 AS 45 12 12 12 As Pathology Services Divisional Manager GF 12 12 12 GF necessary Manager GSTS Pathology Bedford 46 02 09 13 3 Gillian Flack Adrian O Keeffe AOK 19 09 13 AS 47 02 09 13 14 Glycated Hb HbA1c LW 19 09 13 AS 48 02 09 13 16 Bicarbonate Cannot be added on LW 19 09 13 AS 49 02 09 13 19 Cortisol Turnaround Turnaround Time LW 19 09 13 AS Time 7 days 21days 50 02 09 13 19 Microalbumin Remove LW 19 09 13 AS 51 06 09 13 83 Uncertainty of results Amended NC 19 09 13 AS Histology 52 06 09 13 74 Clinical Advice Comment added NC 19 09 13 AS 53 06 09 13 76 Requests for Information added NC 19 09 13 AS additional tests 54 11 09 13 81 Sample storage Temperature amended NC 19 09 13 AS 55 11 10 13 82 FNA Samples Additional information NC 18 10 13 AS added 56 11 10 13 78 Add referral hospital PAH NC 18 10 13
42. ER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 14 of 98 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 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 HbAic 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 hours Therefore glucose will be analysed on clotted serum samples received from inpatients and South Wing phlebotomy including outpatients Blood samples received from other locations are required to take a fluoride oxalate grey vacutainer 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
43. HS 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 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 the Blood Safety amp Quality Regulations BSQR as regulated by the 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 sy
44. Meningococcal PCR and antibodies MUMPS antibodies NEEDLESTICK INJURIES HUMAN BITES etc PARVOVIRUS IgG IgM RUBELLA IgG RUBELLA IgM SAMPLE 5ml clotted blood red and yellow 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 ingsPath King s College Hospital IMEE 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 are 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
45. NHS NUMBER or HOSPITAL REFERENCE NUMBER Additional Information To allow the efficient processing of the sample the following additional information should also be present on either the sample or the request form REQUESTING CLINICIAN File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEE Page 77 of 98 SPECIMEN TYPE AND CLINICAL DETAILS COLLECTION TIME AND DATE PATIENT ADDRESS where applicable Minimum Data Set for Diagnostic Cytology FNA Samples and Request Forms These samples MUST have 2 patient identifiers which match on the slide and the request form or the specimen will be rejected This can be 2 out of the following 3 identifiers NAME DATE OF BIRTH NHS NUMBER or HOSPITAL REFERENCE NUMBER Additional Information To allow the efficient processing of the sample the following additional information should also be present on either the sample or the request form REQUESTING CLINICIAN SPECIMEN TYPE AND CLINICAL DETAILS COLLECTION TIME AND DATE PATIENT ADDRESS where applicable Minimum Data Set for Cervical Cytology Samples and Request Forms These samples MUST have 2 patient identifiers which match on the specimen and the request form or the specimen will be rejected This can be 2 out of the following 3 identifiers NAME DATE OF BIRTH NHS NUMBER or HOSPITAL REFERENCE NUMBER Additional Information To all
46. Number and the date and time of specimen collection Accompanying request forms must contain the same information 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i o skingsPath GSTS King s College Hospital MEE Page 11 of 98 Please also see Acceptance Criteria for Cellular Pathology Samples Page 74 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 porter High risk samples b
47. Path a csTs King s College Hospital IMEE Page 46 of 98 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 Many 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 iron 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
48. S 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 operate 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
49. Unit Microbiology County Hospital Hereford HR1 2ER Meningococcal Reference Unit Public Health England 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 Microbiology County Hospital Hereford HR1 2ER Antimicrobial Reference Laboratory Department of Medical Microbiology North Bristol NHS Trust Southmead Hospital Bristol BS10 5NB Mycology Ref Lab SouthWest Public Health England Myrtle Road Kingsdown Bristol BS2 8EL Mycology Reference Laboratory Public Health England General Infirmary Leeds LS1 3EX NPHS Microbiology Cardiff University Hospital of Wales Heath Park Cardiff CF14 4XW Public Health England Porton Down Salisbury SP4 0JG Respiratory amp Systemic Infection Laboratory Public Health England 61 Colindale Ave London NW9 5HT Sexually Transmitted amp Blood Borne Virus Laboratory Public Health England 61 Colindale Ave London NW9 5HT Southampton Laboratory Level B South Laboratory Block Southampton General Hospital Southampton SO16 6YD SouthWest Public Health England 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 File Name BED USER 14 GSTS Pa
50. Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 38 of 98 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 refrigerator 4 C 6 C for 24 hours perhaps without significant change to routine analytes Centrifugation of blood samples in SST tubes Take blood sample from patient using normal Vacutainer procedure Mix blood by gentle inversion 6 times Allow sample to clot for 15 30 minutes Centrifuge for ten minutes at 3000 rpm PONS 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 tu
51. a EDTA on ice Ring lab first On receipt Amylase Same day Aspartate Transaminase Same day AST Beta 2 microglobulin 14 days Bicarbonate Cannot be added on 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 10 days Obtainable from lab Calcium Same day Carbamazepine Prior to oral dose 3 days Carboxyhaemoglobin Li Hep On receipt Carcino embryonic antigen 3 days CEA CA 125 3 days CA 199 3 days CA 153 3 days C1 esterase inhibitor 10 days Cholesterol Same day Cholinesterase amp phenotyping 21 days Complement C3 amp C4 3 days Copper Special bottle 10 days Obtainable from lab Cortisol Timed sample See adrenocortical 3 days function protocol Creatine kinase CK Same day C reactive protein CRP No indication to Same day repeat within 24hrs these requests will be blocked 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 18 of 98 SkingsPath
52. ailable 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital IMEE Page 62 of 98 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 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
53. als Formalin spillage kits should be available to each department that stores formalin 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 samples are prioritised Routine results are usually available within 3 7 working days but every effort is made to make the results available sooner Complex specimens requiring further investigation may take longer Specimens containing bone Specimens that contain bone will take longer than one week File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 81 of 98 Cytology Laboratory Cervical Cytology Liquid Based Cytology LBC samples 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 Date Vials Dates on all vials must be checked before taking an LBC sample as this will prevent a woman receiving an inval
54. ange 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 37C 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 30 45 minutes 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath a csTs King s College Hospital MEE Page 86 of 98 Pathology Specimen Reception Floor 1 GSTS Pathology South Wing Bedford Hospital Kempston Road Bedford MK42 9DJ Tel 01234 792149 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 department 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 for results as we are not authorised to give results to patients directly The laboratory exami
55. apings for Dermapak if available or Universal Send as much material mycology as possible Aspirates body fluids Universal 20ml maximum pus etc File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital MEE Page 64 of 98 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 2ml CSF for glucose estimation and 1 fluoride oxalate bottle blood for blood glucose estimation 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 64acutaine swab or urine kit available from infections Microbiolog Chlamydia eye Corneal smear slide infections 1 2ml blood in EDTA Pneumococcal PCR Legionella amp Universal 10 20ml clean catch pneumococcal urinary antigen Microbiology difficile toxin transmission For 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 tests and groups of tests and the number of different reference laboratories to which they are sent it is not po
56. at the process used to achieve the result is of the highest standard e Plays a large part in controlling internal control materials and variable factors such as supplies and reagents e May look at a series or sequence of results over short or long periods to show consistency or improvement and provide certainty of results e Will enable staff to probe and analyse any reasons for uncertainty Internal Quality Assurance implies that the whole examination process should be assessed The following hospitals are routinely used to refer specialist tests for analysis GSTS Pathology London Addenbrooke s Hospital Cambridge King s College Hospital London UCLH Hospital London Luton amp Dunstable Hospital Moorfields Hospital London North West Thames Regional Genetics Services London Royal Marsden Hospital London Princess Alexandra Hospital PAH Harlow Requesting Additional Tests Additional tests can be requested by contacting the department Here are the timeframes for each test type Andrology before the test is reported Cervical Cytology 2 weeks after the specimen has been collected Diagnostic Cytology 1 week after the result has been issued Histology is dependent on the test that is being requested please contact the department for further details File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol
57. ate for prostate cancer Parathryoid Hormone PTH PTH assay is available to investigate 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 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 place in other conditions 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 inflamma
58. atient s illness is lt 10 days then an acute serum sample should be collected at this time and a convalescent 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorise
59. atment 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 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 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 microalobumin 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 tw
60. 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 IQC and assurance with External Quality Assurance EAQ is used as part of the overall assurance mechanism along with clinical and internal audit to monitor adequacy of operating procedures and effectiveness of the quality system Quality tools such as Root Cause Analysis RCA 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i soe skingsPath GSTS King s College Hospital NHS Pathology NHS Foundation Trust Page 7 of 98 Pathology Block is located in the South Wing of Bedford Hospital See map below Pathology can only be accessed via security swipe cards out of hours but du
61. be 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 39 of 98 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 Service Delivery 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 Outpatient Department 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 o
62. cle Same day is due day 21 Prolactin Same day Prostate specific antigen Same day PSA Proteins Total protein Same day albumin amp globulin Protein electrophoresis 14 days RAST Specific IgE 21 days Renal profile Na K amp Same day creatinine Salicylate Same day Testosterone 2 3 days Theophylline Prior to oral dose 3 days Thyroglobulin 15 days Thyroid stimulating hormone Same day TSH 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 Vancomycin Serum sample Please state time of last Same day ONLY dose amp regime Contact Microbiology for Clinical Interpretation Vitamin B12 Same day Vitamin D Subject to in house protocol 7 days see guidance in the Clinical Service section 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 Protect from light Please send both cells and separated plasma it is not necessary to wash the cells Not available as part of standard liver test profile Send away tests are indicated in blue File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 20 of 98 skingsPath King
63. ctions for collection of 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 Errors amendments and suggestions for the next edition should be brought to the attention of the Divisional Manager GSTS Pathology Bedford This handbook is also available on Bedford Hospital website www bedfordhospital nhs uk Key Contacts Clinical Director GSTS Pathology Bedford Dr Fraser Mutch fraser mutch bedfordhospital nhs uk 01234 792325 Ext 4725 Divisional Manager GSTS Pathology Bedford Adrian O Keeffe Adrian o keeffe 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i Sete skingsPath GSTS King s College Hospital NHS Pathology Page 4 of 98 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 N
64. d A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 70 of 98 TEST SAMPLE COMMENTS TURN AROUND 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 chee
65. d 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 20 24 C and kept gently agitated Collect from Lab immediately before use together with a platelet giving set One unit of A RhD positive platelets is stocked for emergency purposes and will be issued dependent upon the clinical circumstances age and gender of the patient In all other cases platelets will be ordered from the National Health Blood and Transplant Service at Colindale North London 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 haematologist 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 Laboratory 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 immunoglobuli
66. e 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 Available for suspected overdose 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 urine osmolality and serum sodium Testosterone Male 9 29 nmol L Testosterone SHBG ratio Free Testosterone Index FTI 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 a csTs Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital MEE Page 28 of 98 Analyte Clinical Guidance Theophyline Adult 8 20 mg L Neonate 5 10 mg L Thyroxine FT4 12 22 pmol L Tri iodothyronine FT3 3 1 6 8 pmol L TSH Thyroid stimulating hormone 0 25 4 00 mu L Transferrin 23 43 umol L Troponin T The following interpr
67. e top 1 X 3ml mauve top a a 1 X 3ml mauve top 1 X 3ml mauve top Malaria identification EDTA 1 X 3ml mauve top EDTA 1 X 3ml mauve top EDTA 1 X 3ml mauve top Coagulation Screening CITRATE 1 X 3ml blue top INR CITRATE 1 x 3ml blue top EDTA 4 X 6 ML pink top Direct Antiglobulin test Coombs Test G 6 P D screening test Atypical Blood Group antibody ID The following tests are batched and performed on a batch basis and results are normally available within one week Haemoglobinopathy screening for thalassaemia and abnormal haemoglobins Serum plus 2 EDTA samples 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 Service Delivery 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 File Name BED USER 14 GSTS Pathology
68. ection Hepatitis B or C should be identified clearly on both the sample and request form FNA Samples Direct Slides Microscope slides should be labelled clearly at the frosted end Please label in PENCIL as ink is dissolved by the laboratory staining techniques The preparations can either be air dried or alcohol wet fixed When air drying slides they must be air dried quickly and placed in a plastic slide carrier The slide carrier and request form see Request Form Acceptance Criteria should be promptly transported in a plastic sample bag pouch pocket to the laboratory For discussion on alcohol fixed FNA slide preparations please contact the laboratory who will be able to give up to date advice on how to fix them and where to obtain fixative Needle Washings Needle washings should be collected in saline injection type The needle can be flushed through with saline The washings should be sent in a universal container labelled with the patient s forename surname date of birth and NHS number or Hospital number The universal container and request form see Request Form Acceptance Criteria should be promptly transported in a plastic sample bag pouch pocket to the laboratory Direct slides and needle washing samples should be sent together File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 84 of 98 Results
69. eference 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 85 of 98 Please ensure that adequate instruction is given to the patient on production of the semen specimen The date amp 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 t
70. ein Reference Unit Sheffield Addenbrooke s Hospital Cambridge Great Ormond Street Hospital for Children London King s College Hospital London UCLH Hospital London GSTS PATHOLOGY CLINICAL BIOCHEMISTRY REFERENCE RANGES FOR ASSAYS CARRIED OUT ON SITE Analyte Clinical Guidance Albumin 35 50 g L Urine Albumin Creatinine Ratio ACR Male lt 2 5mg mmol creatinine Female lt 3 5mg mmol creatinine Alkaline Phosphatase ALP Adult 30 120 iu L 0 17 yrs 40 390 iu L Alphafetoprotein AFP lt 7 iu mL Alaninne Transferase ALT O 40 iu L Ammonia 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 0 80 2 20 mg L File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 23 of 98 Wer Analyte Blood Gases PH pCO pOz Bicarbonate CO content Base excess Standard Bicarbonate Ov saturation Clinical Guidance 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 Carboxyhaemaglobin Chloride Chloride sweat Cholesterol C3 complement
71. erate 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 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
72. etive 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 0 1 0 4 mmol L Urine 1 5 4 5 mmol d Urea Serum 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 ug L Antibiotic policy is available on the Trust intranet File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEE Page 29 of 98 LIPID INTERPRETATION Cholesterol In patients with personal history of occlusive vascular disease target Total Cholesterol should be less than 4 0 mmol L Triglyceride Fasted sample 0 40 1 80 mmol L HDL Cholesterol Ideally greater than 1 0 mmol L In patients with personal LDL Cholesterol Calculated test history of occlusive Valid if patient fasted and vascular disease target Triglyceride does not exceed LDL Cholesterol should be 4
73. f biological uncertainty exists when only a single semen sample is tested Procedural uncertainty also exists from errors associated with specimen collection to sample testing method bias sampling error and operator error through to final reporting The steps taken by the laboratory to 88acutain uncertainty include e Semen analysis methodologies are based on WHO fifth edition recommendations e There is robust confirmation of the patient s identity and details on the specimen container s request and report forms are matched e Strict specimen acceptance criteria are applied with samples accepted in appropriate specimen containers e The period of abstinence is defined The interval between collection and analysis is defined and semen analysis is commenced within an appropriate timeframe All laboratory equipment is appropriate and regularly serviced and maintained Samples are well mixed prior to analysis Measurement of motility is carried out at 37 C Sampling error is 88acutaine by assessing large numbers of sperm wherever possible Staff are trained and their competency is assessed at intervals e Robust Internal and External Quality Control measure are in place 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 Advice for patients for the
74. fication 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital MEE Page 43 of 98 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 u
75. ficult 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 up 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 labora
76. for the following tests where an SST is necessary Anti tissue transglutaminase Lithium C1 esterase inhibitor Protein electrophoresis CEA Vancomycin Folate Gentamicin For a 17hydroxyprogesterone 17OHP a sample collected into a tube without gel is required Serum or lithium heparin plasma is acceptable 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 15 of 98 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 assay interference are available from the laboratory on req
77. gency 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 reactive 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
78. gnostics Also provides tissue diagnosis for the Bowel Cancer Screening Programme Cervical Cytology The cytology department 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 39 000 cervical liquid based cytology specimens annually HPV Testing Since April 2012 the department has offered HPV testing on samples in line with the NHSCSP Cervical Screening Programme Guidelines Testing is routinely performed at the laboratory in The Princess Alexandra Hospital Harlow 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 76 of 98 Key Contacts External Internal Dr M Wilkins Consultant Histopathologist ClinicalLead 01234 792094 47
79. h Repeat at 6 weeks 3 months and 6 months ingsPath King s College Hospital IMEE COMMENTS Post vaccine Indicator of current or previous HBV 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 73 of 98 a TEST LYMES DISEASE Borrelia burgdorferi
80. he production of semen samples Please ensure patients are reminded of the importance of writing the date amp 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 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 entire sample is collected in the specimen pot If any of the sample is lost please telephone the laboratory on the number provided to arr
81. id cytology result and if necessary an invalid HPV result and having an unnecessary repeat test Out of programme samples which cannot be processed by the laboratory are 1 Patient is under 24 5 years old and not scheduled from a previous test 2 Patient on three yearly recall and sample received less than 30 months since previous routine negative test 3 Patient on five yearly recall and sample received less than 54 months since previous routine negative test 4 Patient aged 65 and over with 3 consecutive routine negative tests 2 of which were in the last 10 years 5 This sample is not clinically appropriate Liquid Based Cytology LBC Procedure for submitting a liquid based cytology sample Equipment request form LBC vial with collection fluid pre filled Thinprep Cervex brush After taking the sample with the Cervex brush place brush in vial and agitate to ensure all the cervical material is released into the fluid Dispose of brush and send vial to laboratory File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital IMEE Page 82 of 98 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
82. idence 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 or urine which may be stored in the fridge overnight after collection Bacterial Culture Ideally swabs should be cultured immediately If processing is delayed refrigeration is preferable to storage at ambient temperature Where a sexually transmitted disease is suspected it is recommended that the patients are referred to the department of Genito Urinary Medicine GUM for follow up and contact tracing Turnaround time two to three working days Blood Culture Blood Cultures must be transported by porter to microbiology 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 cultu
83. ingsPath GSTS King s College Hospital NHS Pathology NHS Foundation Trust PATHOLOGY USER GUIDE BEDFORD HOSPITAL NHS TRUST Effective from August 2011 updates will be available on the electronic version available on Bedford Hospital website Version 4 2 February 2014 Review February 2015 Pathology User Guide i Bedford Hospital Trust aii ngsPath King s College Hospital MEE Page 2 of 98 3a 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 Pathology GSTS Page 39 50 53 75 90 Patient instructions for Collecting a 24 hour urine sample for HMMA VMA Catecholamines Metadrenalins and 5HIAA Guide for the Vacutainer System Tube Guide Amendments to Version 1 of the User Guide 91 92 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology Pathol User Guid i T 2KingsPath GSTS King s College Hospital i Page 3 of 98 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 and specimen requirements and instru
84. logist Suggest send sample for Monospot in the first instance If negative and EBV remains a differential diagnosis send sample 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 2 weeks Once per week 1 3 days 1 2 days during working week Confirmation from ref lab usually 10 14 days File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 72 of 98 a 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 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 birt
85. lood 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 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 Itis 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 needs 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 Page 90 for order of drawing samples 2 Avoid contamination of sample with i v fluids 3 Do not mix blood from one specimen container with another 4 Ens
86. m 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 antibody 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 two working days 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 and 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 av
87. mistry Assays on Tuesday mornings KFK281 368860 EDTA FBC ESR Cyclosporin HLAB27 needs 4 tubes Ammonia Assay send to KFK042 4ml Lead Ammonia eo ca y 367836 a EDTA HbA Tc FBC difficult 2ml to blee KFK279 mre PRA a 367941 PPN a Cross Match Group 4 tubes required for KFK277 f emi and Screen antibody investigation oe 367934 mane Glucose Alcohol and KFK250 2ml Lactate Grey 368380 Trace Element Trace Elements KFK359 6 ml RECOMMENDED ORDER OF DRAW BD Diagnostics Preanalytical Systems 1 Blood culture bottles The Danby Building Edmund Halley Road Oxford Science Park Oxford OX4 4DQ 2 COAGULATION TUBES Tel No 01865 781603 Fax 01865 781528 3 Tubes with NO ADDITIVES BD BD logo and all other trademarks are property of Becton Dickinson and Company 2010 4 OTHER Tubes with ADDITIVES Clinical and Laboratory Standards Institute Formerly NCCLS Guidelines H3 A6 6th Edition File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 92 of 98 King s College Hospital MEE i icsts Amendments to the Pathology User Guide Amend Date Page No Details of Change Approved Date amended Amended No by electronically by Current Replaced by 1 23 8 65 FAECES Routine Sterile 60 ml FAECES Routine Sterile universal half filled GH 23 8 AS culture amp Pa
88. 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 assessment for prostatic disease A PSA should not be carried out without a DRE and all patients with abnormal DREs should be referred to an 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 35 of 98 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 evalu
89. n Samples for full blood counts are normally analysed on the day of receipt and results returned via electronic link Anglia Sunquest ICE and or by paper result Samples taken after the Courier collection can be stored overnight at room temperature with no significant deterioration in quality 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 generate 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide skingsPath Bedford Hospital Trust a GSTS King s College Hospital IMEE Page 41 of 98 The following tests are performed and the results will normally be available within one working day except where indicated Test FBC ESR M screen 3 working days Reticulocytes Sickle cell screen R A test 3 working days Rhesus immunisation tests incl Kleinauer Sample required EDTA 1 X 3ml mauve top EDTA EDTA EDTA EDTA Serum 1x 6ml red top EDTA 1 X 3ml mauve top 1 X 3ml mauv
90. n 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i Se an skingsPath GSTS King s College Hospital MEE Page 52 of 98 All Anti D removed for use must be entered in the Anti D register next to the Blood Bank 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 register 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i Se as skingsPath GSTS King s College Hospital IMEE Page 53 of 98 4 Microbiology Key Contacts Consultant Microbiologist Dr Simantee Guha Direct line 01234 795845 Internal extension 4603 e mail Simantee
91. n the first floor of the pathology building Access is via the hospital main corridor A lift is available Services available out of hours A 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 cross matching 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath a csTs King s College Hospital MEE Page 40 of 98 Turnaround times and sample requirements 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 those GP Practises that provide phlebotomy services is in operatio
92. nd Creatinine Serum See individual Test Urine See individual Test Ferritin Male 20 yrs 30 400 ug L Free light chains FSH Follicle Stimulating Hormone Female 15 50 yrs 15 150 ug L 50 yrs 30 400 ug L Kappa 3 3 19 4 mg L Lambda _ 5 7 26 3 mg L K L ratio 0 26 1 65 Male 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 2 0 12 0 iu L Gentamicin Gamma Glutamyl Transferase GGT Globulin calculated Glucose sugar plasma Serum CSF glucose 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 5 55 iu L 15 35 g L 3 0 6 0 mmol L normally 60 of plasma glucose File Name BED USER 14 GSTS Pathology User Guide Version 4 2 a csTs Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital IMEE Page 25 of 98 Analyte Clinical Guidance Haematinics Serum B12 and Folate B12 gt 150 ng L Folate gt 4 6 18 7 ug L Haemoglobin A1c Glycated Hb lt 53 mmol mol lt 7 suggests good glycaemic HbA1c control 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
93. nd Date Page No Details of Change Approved Date amended Amended No by electronically by Current Replaced by 13 10 9 12 74 Dr M Wilkins Consultant Dr M Wilkins Consultant NC 10 9 12 AS Histopathologist Histopathologist Clinical Lead 14 10 9 12 76 users are transport should be in NC 10 9 12 AS recommended to read line with the the 15 10 9 12 76 Formalin Spillage NC 10 9 12 AS Instructions 16 10 9 12 76 Turnaround times of Amended NC 10 9 12 AS samples 17 10 9 12 76 Bone Marrow Removed Specimens which NC 10 9 12 AS Trephines require contain bone will take decalcification and longer than one week the minimum turnaround time for a report is five days 18 10 9 12 77 Out of Date Vials Information added NC 10 9 12 AS 19 10 9 12 77 Remove brush Dispose of brush NC 10 9 12 AS 20 10 9 12 79 Urine Samples REMOVE NC 10 9 12 AS 21 10 9 12 79 ADD RESULTS unless NC 10 9 12 AS ancillary studies are required 22 10 9 12 80 Amendment to Operates an appointment NC 10 9 12 AS paragraph system 23 20 9 12 13 Additional Tests May be added by Change the receipt of an add MS 20 9 12 AS the requesting on request card or fax physician phoning the lab 24 20 9 12 16 Alpha1 Change Not available as part of MS 20 9 12 AS Antitrypsin standard liver test profile 25 20 9 12 16 Caeroplasmin Change Not available as part of MS 20 9 12 AS standard liver test profile File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User
94. nes 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 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital IMEE Page 87 of 98
95. nical 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 Positive results phoned Negative results 10 14 days 10 14 days INFECTION CONTROL Advice is available at all times Infection Control policies are available in all wards and departments and on the Trust Intranet NOTIFIABLE DISEASES Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery amoebic or bacillary Food poisoning or suspected food poisoning Smallpox eradicated in 1979 Leprosy Leptospirosis Malaria Measles Meningitis viral bacterial or fungal Meningococcal septicaemia Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Tetanus Tuberculosis Typhoid Typhus Viral haemorrhagic fever Viral hepatitis A B C D E Mumps Whooping cough Ophthalmia neonatorum Yellow fever File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 75 of 98 9 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 dia
96. nlabelled 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 used to transport specimens in accordance with the rule of use of the system Pneumatic Tube Policy 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 44 of 98 skingsPath King s College Hospital IMEE Normal ranges i icsts HAEMOGLOBIN g dl Men 130 180 Women 115 165 Child 3 mo
97. nths 95 135 Child 1 year 105 135 Child 3 6 yrs 120 140 Child 10 12 yrs 115 145 MCV fi Adult 76 96 Child 3 months 95 mean Child 1 year 70 86 Child 3 6 yrs 73 89 Child 10 12 yrs 77 91 MCHC g dl Adult and Child 310 360 MCH pg Adult 27 32 Child 24 31 RDW Adult and Child 11 5 14 5 WHITE CELLS TOTAL Adult 4 0 11 0 Child 1 year 6 0 18 0 Child 4 7 yrs 5 0 15 0 Child 10 12 yrs 45 135 Neutrophils Adult 2 0 7 5 Child 6 yrs 2 0 6 0 Lymphocytes Adult 1 5 40 Child 6 yrs 5 5 8 5 Monocytes Adult 0 2 0 8 Child 6 yrs 0 7 1 5 Eosinophils Adult lt 0 4 Child 8 yrs 0 3 0 8 PLATELETS 150 400 RETICS up to 2 E S R Men lt 50 yrs 1 7 mm gt 50 yrs 2 10 mm Women lt 50 yrs 3 9 mm gt 50 yrs 5 15 mm File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 45 of 98 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 4 5 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 up to 0 55FEU mg L for PE amp DVT diagnosis Clotting factor inhibitor
98. o 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 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 33 of 98 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 mod
99. o the infection control team who will give advice on specimen submission Bleep 422 030 or 301 Turnaround time two to three working days Preliminary result may be 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 9 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 9 On fourth day collect a small portion of stool and place in a specimen pot File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 58 of 98 9 Label with name and date and mark bottle Specimen 1 9 Collect specimens from next two stools and label as above marking them Specimen 2 and Specimen 3 respectively 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 ev
100. odothyronine 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 monitor TFT every two to three months File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i a 2KingsPath la csTs King s College Hospital IMEE Page 37 of 98 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 pa
101. onella 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 Repertoire 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 VVVVVVVVVVV VV File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital MEE Page 56 of 98 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
102. ous 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 that 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 Consultant Haematologist Myelodysplasia Myelodysplasia or the Myelodysplastic Syndrome MDS seems to be increasing possibly due
103. ow the efficient processing of the sample the following additional information should also be present on either the sample or the request form REQUESTING CLINICIAN SPECIMEN TYPE AND CLINICAL DETAILS COLLECTION TIME AND DATE PATIENT ADDRESS where applicable Gynae LBC samples will be accepted with 2 of the 3 patient identifiers in accordance NHSCSP guidelines Gynae LBC samples should be submitted on pre populated A5 Open Exeter HMR101 2009 forms Other versions of the HMR 101 form will be accepted File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 78 of 98 Minimum Data Set for Andrology Samples and Request Forms These samples MUST have 3 patient identifiers which match on the specimen and the request form or the specimen will be rejected This can be 2 out of the following 3 identifiers NAME DATE OF BIRTH NHS NUMBER or HOSPITAL REFERENCE NUMBER Additional Information To allow the efficient processing of the sample the following additional information should also be present on either the sample or the request form Patient Address where applicable Sex Purpose of investigation Sub fertility or post vasectomy Clinicians name in capitals and signature on the bottom of the form Date of production Time of production Complete days since last ejaculation infertilities If entire sample was collec
104. ples are accepted between the hours of 9am and 2pm Monday to Friday The request form should be fully completed 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i E 2KingsPath GSTS
105. rasitology container culture amp Parasitology container 2 23 8 65 FAECES For C Sterile 60 ml FAECES For C Sterile universal half filled GH 23 8 AS DIFFICILE TOXIN container DIFFICILE TOXIN A amp B container A amp B 3 7 9 11 74 Cyto Enquiries 01234 792623 Cyto Enquiries 01234 355122 X4611 AS 19 10 AS 4 2 7 12 51 GH Phone No 01234 792208 GH Phone No 01234 792611 GH 2 7 12 AS 5 2 7 12 65 Urine Pregnancy Test Remove GH 2 7 12 AS 6 2 7 12 38 Return of FBC results Now returned on same AN 2 7 12 AS day by electronic link 7 2 7 12 39 Results available in Exceptions to IM AN 2 7 12 AS one working day Screen and RA Screen 8 2 7 12 42 Haematoology ref Changes to AN 2 7 12 AS Ranges Haemoglobin 9 2 7 12 42 As above Changes to MCHC ref AN 2 7 12 AS ranges 10 2 7 12 47 Referral Laboratories Immunology Referral Labs Immunology St Thomas AN 2 7 12 AS Addenbrookes 11 2 7 12 47 Referral Laboratories Haemoglobinopathy Referral Labs Haemoglobinopathy St AN 2 7 12 AS Oxford Thomas 12 10 9 12 73 HPV Testing INSERTED Since April 2012 the NC 10 9 12 AS HPV Testing department has offered HPV testing on samples in line with the NHSCSP Cervical Screening Programme Guidelines File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust King s College Hospital MEE ists Page 93 of 98 Ame
106. re 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 59 of 98 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 patients 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 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 dif
107. rine Premenopausal female 110 1450 pmol L depending on stage of cycle Untreated post menopausal female less than 100 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 osmolality and random urine sodium Parathyroid hormone PTH Calcium albumin phosphate amp total protein also to be assayed Paracetamol Serum Phenobarbitone Phenytoin Phosphate Primidone Porphobilinogen Porphyrins 15 65 pg ml Available for suspected overdose 15 40 mg L Adult 10 20 mg L 0 1 mth 1 2 2 8 mmol L 1 6 mths 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 Assayed as phenobarbitone Customised Porphyria report Customised Porphyria report File Name BED USER 14 GSTS Pathology User Guide Version 4 2 igicsts Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 27 of 98 skingsPath King s College Hospital MEE Analyte Prolactin Macroprolactin Protein Serum CSF Protein Electrophoresis Potassium Serum Urine PSA Progesterone Clinical Guidance Male lt 450 mu L Female lt 550 mu L Customised report 60 80 g L 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 exclud
108. ring the hours of 8 00am 6 00pm 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 Biochemistry Haematology and Blood Transfusion on the first floor Cellular Pathology on the second floor and Microbiology on the third floor B ma a O u F om 6 wmo D wr 6 nen Warehouse A inl Q smun wasi a fn fo 5 7 caption 7 5 ner fi us x E mr Ea aetema et fP Warehouse 8 T rrume K eam cawene P canw C KARETA es CORFE POE SU Cer FAFS AAD PEG ORMES CEABLED P PO RAA OR RING Sou College k j wate ee _ Main Nursing rane Ward Block r y Theatres 2 F eaa y q gt Restaurant Entrance ey Bhaaria Road lal J Recaption G A Racoption K Pathology bloc Main Entramce Entrance comp Kampin Road awig File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust SkingsPath King s College Hospital IMEE O gt TS Page 8 of 98 Pathology Opening Hours Please refer to individual departments Out of Hour s Service Haematology Blood Transfusion Between 17 0
109. rsal CSF Subject to in house 16 days serum also required vetting procedure within 5 days of CSF Minimum volume 1ml collection CSF 2 ml serum Send away tests are indicated in blue Add on tests for inpatients within the Trust 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 Add on test requests from General Practice should be requested via the secure email address GSTS Bedford Addontest nhs net If other assays are required please contact Consultant Chemical Pathologist Dr W Wassif or Dr Louise Ward Principal Clinical Scientist to discuss File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 22 of 98 The following hospitals are routinely used to refer specialist tests for analysis GSTS Pathology London Royal Free Hospital London Imperial College Hospitals London Prot
110. s Blood must ONLY be stored at 2 6 in a validated blood bank File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath GSTS King s College Hospital IMEE Page 51 of 98 Routine cross matching 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 requested by the doctor Anyone collecting or transporting blood or blood products must only do so if they have attended the mandatory Trust Transfusion training session within the last year In order to enter 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 returne
111. s 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 Laboratory Haemastasis Department of Clinical Haematology and Blood Transfusion Addenbrooke s Hospital Hills Road Cambridge Immunology Laboratory St Thomas Hospital London Haemoglobinopathy Ref Lab St Thomas Hospital London File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i E 2KingsPath GSTS King s College Hospital IMEE Page 50 of 98 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
112. s Colleg al DEA GSTS Patholc Test name Sample Special Requirements Expected turn around Tests highlighted in blue denote test time routine tests are sent away carried out the same day if received before midday Urine Albumin Creatinine Ratio ACR EMU Same day Amino acid chromatography Fresh MSU 10 days Bilirubin MSU 3 days Calcium 24hr collection Same day Copper 24 hr collection Special container 12 days required Cortisol 24 hr collection 21 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 15 days required contact the lab for bottle Homocystine EMU 7 days Metadrenalines Phaechromocytoma 24hr collection Acid preservative 17 days screen required contact the lab for bottle 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 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 significan
113. se Date of onset and clinical history must be given CAMPYLOBACTER 5ml clotted blood Reference laboratory 10 14 days SEROLOGY red and yellow top request Please give full clinical details e g Guillain Barre syndrome File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 71 of 98 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 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 ingsPath King s College Hospital IMEE COMMENTS Reference laboratory request Please give full clinical details and risk factors Please give date of onset and state whether patient is immunocompromised Infection usually only of Clinical significance in immunocompromised or pregnant patients CONTACT Consultant Microbio
114. ssary 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 Add on Test Requests If you need to add a further test request to a sample that we have previously received in the laboratory please telephone the relevant department to check that the sample is still viable and an add on test can be requested If this is possible please send an email request with patient details and tests to be added on to the following secure email address GSTS Bedford Addontest nhs net Please note that faxed requests will not be accepted 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 All specimens must be labelled with the patient s identification details i e name date of birth hospital number or NHS
115. ssible to state exactly the volume of serum required Please telephone ext 4814 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 65 of 98 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 Antimicrobial Resistance of Healthcare Associated Infections Reference Unit AMRHA Public Health England Colindale 61 Colindale Avenue London NW9 5EQ Clinical Microbiology and HPA Collaborating Laboratory Brucella Reference Unit BRU University Hospital Aintree Lower Lane Liverpool L9 7AL Enteric Respiratory amp Neurological Virus Laboratory Public Health England 61 Colindale Ave London NW9 5HT GSTS Guys amp St Thomas Pathology Great Maze Pond London SE1 9RT Laboratory of Enteric Pathogens Public Health England 61 Colindale Ave London NW9 5HT Public Health England Addenbrookes Hospital Cambridge CB2 2QW Public Health England Bowthorpe Rd Norwich Public Health England 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 Leptospira Reference
116. stem incorporates the requirements of the Health and Social Care Act Health and Safety and Environmental legislation and BSQR 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 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i T skingsPath CSTs King s College Hospital Pathology Page 5 of 98 Sciences Tissue Sciences and Infection Sciences typically delivered from each operational 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 GST
117. 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 If a pre printed patient label is used please ensure that a label is also placed on all back copies of the request form 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 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 clinical diagnosis and relevant clinical signs symptoms including travel history if indicated examination required e Consultant caring for the patient e Name and bleep or contact number of requesting doctor File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 10 of 98 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 nece
118. t 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 21 of 98 skingsPath King s Colleg al DEA GSTS Patholc Test name Sample Special Requirements Expected turn around Tests highlighted in blue denote test time routine tests are sent away carried out the same day if received before midday Faeces Elastase Small plain stool Must be received in lab 15 days sample within 30 minutes Porphyrins Small plain stool Protect from light 14 days sample Sweat Tests Sweat chloride Collection performed by paediatric department Same day Cerebrospinal Fluid CSF Protein Plain universal Bottle 2 Glucose Fluoride Oxalate Lactate Fluoride Oxalate plain Paediatric patients acceptable only send to the laboratory promptly Xanthochromia Plain universal CSF Only for SAH if CT 2 working days SST for serum head negative and LP gt 12 hours post onset of symptoms Protect from light Minimum 0 5ml CSF Serum sample also required Oligoclonal Bands Plain unive
119. ted infertilities Request Forms with missing Information After a reasonable attempt has been made to ascertain missing information a decision based on risk will be recorded on the request form as to whether the sample can be accepted Request forms with missing information may not necessarily be rejected however it may delay the diagnosis if further enquiries are necessary 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 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 JUakob disease Rabies Yellow Fever Plague File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 79 of 98 Uncertainty of Results Internal Quality Assessments IQA will minimise the risk of erroneous results on a daily basis IQA e Will help to ensure th
120. thology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 66 of 98 skingsPath King s College Hospital IMEE i icsts SUMMARY OF 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 SAMPLE Swab Blue Cap Containing transport medium Sterile Universal As above Pernasal swab fine twisted wire swab with small bud Either routine swab Blue cap or fine wire swab with small bud Swab Blue Cap Send lens in lens fluid 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 COMMENTS No formalin No formalin Notify Laboratory before sending See Infection Control MRSA Policy Please label slide and plates with patient demographics CSUs are of very limited value TURN AROUND TIMES Minimum 2 working days Minimum 2 working days Microscopy 1 2
121. tient is well Vitamin D Vitamin D assay is available if corrected calcium is lt 2 5mmol L ref range 2 2 2 6mmol L and is not recommended to monitor patients on Vitamin S replacement In this situation monitoring serum calcium is recommended 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 Overnight storage of blood samples Every effort should be made to send the sample to the laboratory on the same day However 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 File Name BED USER 14 GSTS Pathology User Guide
122. ties File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath GSTS King s College Hospital IMEE Page 16 of 98 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 17 of 98 GSTS ASSAY SERVICES OFFERED BY CLINICAL BIOCHEMISTRY DEPARTMENT Test Name Tests highlighted in blue denote test sent away Sample SST unless otherwise stated Special Requirements Expected turn around time routine tests are carried out the same day if received 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 Me 10 days Amino acid chromatography Li Hep 10 days Amiodarone Pre dose sample 10 days Ammoni
123. tion 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 36 of 98 ovarian mass is present then full screening procedures including assay for CA 125 need to be done The Department provides CA125 analysis in line with ovarian care NICE guideline 122 April 201 1 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 colorectal 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 Thyroid function tests Reference range TSH Thyroid Stimulating Hormone 0 25 4 00 mU L FT4 Free Thyroxine 12 22 pmol L FT3 Free Tri
124. tles 8 10ml Paediatric bottles 1 BACTERIAL 3ml Fungal 8 10ml POSITIVE CSF Put in Pathology incubator ASAP after collection Performed only in bacterial endocarditis 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 Genital swabs blue For legal reasons each cap for bacterial person involved in collection culture Chlamydia amp transportation of the collection kit specimens must sign the available from the request form stating their role laboratory and date and time CHAIN OF EVIDENCE CHILD ABUSE The laboratory must be informed prior to receipt File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath a csTs King s College Hospital IMEE Page 69 of 98 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 p
125. tory File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath ia csTs King s College Hospital IMEE Page 57 of 98 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 Adenovirus 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 9 Specimens from patients will be routinely tested for Salmonella Shigella Campylobacter spp Verotoxic Escherichia coli E coli0157 VTEC e Clostridium difficile And any other tests requested Samples will NOT be processed for C difficile if e A previous positive result was reported within 28 days of new request If clearance of C difficile 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 t
126. tory for a cell count Gram stain and culture together with a Blood Culture Stains for mycobacteria 59acutainers59 etc will be performed as necessary or if requested The following specimens should also be sent to the Clinical Biochemistry laboratory File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 60 of 98 9 sterile universal approximately 0 3ml CSF for protein estimation 9 fluoride oxalate bottle approximately 0 2m CSF for glucose estimation 9 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 Microscopy Culture amp Sensitivity 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 result may be 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
127. ts Request through secure LW 18 10 13 AS email address 98 11 10 13 33 PTH Additional information LW 18 10 13 AS 99 11 10 13 35 Vitamin D Additional information LW 18 10 13 AS 100 11 10 13 87 Post Vascectomy Samples Courier information KW 18 10 13 AS File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathology User Guide Bedford Hospital Trust Page 98 of 98 a ingsPath King s College Hospital MES i icsts 101 13 12 13 80 Cellular Pathology Specimen acceptance NC 13 12 13 AS criteria 102 13 12 13 81 Cellular Pathology Specimen acceptance NC 13 12 13 AS criteria 103 13 12 13 83 Cellular Pathology Specimen acceptance NC 13 12 13 AS criteria 104 24 02 14 51 Platelets are not stocked Blood Transfusion One unit of A RhD positive PL in the laboratory and any platelets is stocked for request must normally emergency purposes and be made through the will be issued dependent Clinical Haematologist upon the clinical As all platelets are circumstances age and collected from the gender of the patient NHSBT at Colindale In all other cases platelets North London they are will be ordered from the not immediately National Health Blood and available The journey Transplant Service at takes at least 90 mins Colindale North London 105 24 02 14 51 Platelets should be Blood Transfusion Platelets should be stored at stored at 20 24
128. uest 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 and may be destroyed The Pneumatic Tube system may be used to transport specimens in accordance with the rule of use of the system Pneumatic Tube Policy is available on the Hospital Intranet online facili
129. ure 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 File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath GSTS King s College Hospital IMEE Pathology Page 12 of 98 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 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 Divisional Manager GSTS Pathology Bedford User Satisfaction and Complaints The Pathology
130. 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 two to three working days Stool Culture Please state if e the patient has returned from abroad e food poisoning is suspected e the patient is on antibiotics or has received some in the last four weeks 9 Specimens from the community will be investigated routinely for Salmonella Shigella Campylobacter spp Verotoxic Escherichia coli E coli0157 VTEC Parasites on request Clostridium difficile on request Extra investigations for other enteric pathogens are performed based on the age of the patient the clinical picture and travel his
131. 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 spontaneous 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 The cause of a High WBC will usually be obvious but consider the following if in doubt File Name BED USER 14 GSTS Pathology User Guide Version 4 2 Authorised A Strong Pathol User Guid i ao 2KingsPath la csTs King s College Hospital IMEE Page 47 of 98 Neutrophilia early stage of Glandular Fever steroid therapy previ
132. 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 bruising 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 preferably 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 laboratorie

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