Welcome to the user guide handbook for Biochemistry and
Contents
1. East Lancashire Hospitals NHS Trust 01 10 14 BS M20 Rev 18 Phenobarbitone 10 40 mg L 4 hours Phenytoin 5 0 20mg L 4 hours Phosphate 0 80 1 50 mmol l 4 hours Platelets 150 450 10 9 L 4 hours Potassium 3 5 5 3 mmol l 4 Hours Progesterone Next day Mon Fri Post ovulatory gt 30 nmol L Prolactin lt 500 mu l Next day Mon Fri 40 49Yrs lt 2 5 ug L 50 59yrs lt 3 5 ug L PSA Next day Mon Fri 60 69yrs lt 4 5 ug L gt 70yrs lt 6 5 ug L Protein total 60 80 g L 4 hours Male 4 50 6 50 10 12 L Red cell count RBC 4 hours Female 3 8 5 5 10 12 L Salicylate lt 150 mg L 4 hours Male 11 71 nmol L SHBG 2 3 days Mon Fri Female 25 110 nmol L Sodium 133 146 mmol L 4 hours T3 free 3 0 7 1 pmol L Next day Mon Fri T4 free 10 4 24 5 pmol L Next day Mon Fri Male 10 37 nmol L Testosterone 2 3 days Mon Fri Female 0 3 2 6 nmol L Theophylline 10 20 mg L 4 hours TIBC Total iron binding 45 80 umol L Next day Mon Fri capacity TIBC saturation 20 0 55 0 Next day Mon Fri 24 East Lancashire Hospitals NHS Trust BS M20 Rev 18 01 10 14 TSH 0 2 6 0 mU L Next day Mon Fri Thyroid peroxidase TPO Bes at 0 351U ml 2 3 days Mon Fri antibodies Troponin lt 30 ng L PI i 4 hours High sensitivity e2. Burnley Site Telephone Transfusion Lab 14318 01282 804318 Outside core hours Bleep 020 Requesting Procedure Use red labelled BTS sample tubes Complete all the patient details on the special blood transfusion request form by ballpoint pen Blood transfusion fatalities are most often caused by clerical error double check that the information on the request form and the blood tube are complete and correct If the data supplied is incomplete Blood Transfusion staff cannot accept the blood specimen USE ONLY BLOOD TRANSFUSION TUBES The patient s full name DOB Hospital number or NHS number should be on the sample tube and form Pre printed labels must not be used on sample If pre printed label used on form passport number MUST be written on form Alternatively Requests for group and antibody screens may be made using ICE Desktop Advice for irradiated products are given on the reverse of the request form Timing of Requests Before blood can be issued a group and antibody screen needs to be undertaken This takes approximately a minimum of half an hour from the time of receipt into the laboratory If atypical antibodies are present the time required will be increased depending on the complexity of the case Requests for emergency issues of blood must be made by telephone Blood is issued for definite use only Emergency O Negative uncrossmatched blood is available for emergency use 14 East Lancashire Hospitals IN
3. Scientist Staff Blood Sciences Managers Mr I Lancaster 82490 Biochemistry and Reception Mr C Flynn 82488 Blood Sciences Manager Mr S Rigby 82458 Haematology Laboratory Enquiries Laboratory Blackburn Results amp Enquiries 84144 GP Supplies 82974 Laboratory Burnley Reception 14507 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Request forms and identification policy To ensure rapid return of results to the originating source request forms and sample containers must be fully identified This should include Key request form identifiers Forename and Surname Hospital or NHS number Date of Birth Address where possible Gender Location Requestors name Type of specimen Date and time of sample collection Tests required All relevant clinical data Key specimen container identifiers e Forename and surname e Date of Birth e Time and date of collection Points indicated in RED are mandatory requirements The laboratory will not process requests where there is insufficient information for unequivocal identification of the patient Phlebotomy Service Blackburn Site A ward phlebotomy service is available at RBH Monday to Friday A limited service is available on Saturdays and Sundays to aid patient flow If the Phlebotomist is unable to attend notice will usually be given In these circumstances and at all other times ward staff must collect the blood samples and arrange their delivery t
4. testing for a range of conditions may be available through the Regional genetics Service in Manchester Mangen However it is advisable to contact the centre directly prior to requesting such tests as access to specific counselling services may be required It is also necessary to complete a specific consent form for genetic requests available from the link below Samples will not be forwarded by this laboratory without this consent form http www mangen co uk CubeCore uploads Lab 20Documents Useful 20documents joint referral fo rm pdf East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Point Of Care Testing Point of Care Testing is defined any Clinical Laboratory Medicine test performed for a patient by a healthcare professional outside the traditional centralised laboratory by the Medicines Health Regulatory Authority MHRA Examples of POCT include Blood glucose ketone monitoring Blood gas co oximetry analysis Blood coagulation measurement Blood HbA1c analysis Urine analysis Pregnancy testing Golden Rules Do not use any Point of Care Device until you have received training from the designated Trainer Always use your own password and never share your password with anyone Always identify your patient correctly on the Point of Care Device remember to prefix RXR before 7 numerical digits for the hospital number Always follow the latest Standard Operating Procedure SOP for the device ava
5. East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Welcome to the user guide handbook for Biochemistry and Haematology The aim of this handbook is to provide key information for those wishing to use the laboratory service If you note any errors or omissions please do not hesitate to contact the department Also please feel free to contact the duty biochemist for any clinical analytical queries relating to biochemistry tests Location Blackburn The laboratory is situated on Level 0 of the Royal Blackburn hospital site During the hours of 9 00 to 17 00 Monday to Friday and Saturday 9 00 to 12 00 Laboratory Reception is open to visitors Outside these hours the outer doors will be open to Trust staff only for the collection of blood for transfusion from blood bank At all times only persons will be allowed access to the laboratory areas Out patients do not attend the department for any blood sampling Venepunctures are now performed in the out patients suite which is situated on Burnley site The laboratory is in the main hospital building close to the Surgical Day Case unit Core hours are 09 00 to 17 00 Monday Friday Patient samples should be delivered to GP Practices where they will be collected by hospital transport Out of hours there is no access to the laboratory and samples should be delivered to the laboratory at RBH Opening Hours The department provides a full 24 7 routine diagnostic service including wee
6. HS NHS Trust BS M20 Rev 18 01 10 14 Location of Blood fridges Blackburn Site In the blood bank in the Pathology Laboratory Burnley Site The Blood bank Fridge situated outside the entrance door to the blood Sciences Laboratory BGH on the ground floor of Wilson Hey Keypad access Electronic Issue Blood is only issued for definite use If the patient has a current valid blood group and antibody screen result on the laboratory system and has no antibodies group specific blood can be issued in 10 minutes Patients must have a current and valid blood group and antibody screen on the laboratory system no longer than 7 days ago before the proposed transfusion date If the patient has blood group antibodies at least 24hrs notice is required for compatible units to be issued Please note Group and antibody screen and saved plasma before surgery can considerably reduce the time to supply blood if no blood group antibodies are present Ideally out patients samples could be sent with a request form 7 days before patients are admitted to hospital or when seen at out patients by a consultant What to Request Group and Antibody Screen A hand written EDTA sample e 7 5ml sample for an adult e 2 7mlor1 2ml sample for a child baby Red Cells Leucocyte depleted Each pack contains approximately 350mls One donor pack will raise the haemoglobin in an average sized adult by about 10 g I In cases where multiple packs are issu
7. Transfusion Reactions All suspected reactions must be reported immediately to the Consultant Haematologist or senior laboratory transfusion staff If a transfusion reaction is suspected STOP the transfusion immediately and contact the laboratory The laboratory will issue a form which must be completed and returned immediately to allow full investigation Miscellaneous Requests Tissue Typing HLA Typing 7 5 ml blood transfusion tube required for HLA B27 and HLA Class and II typing also 10 ml clotted blood required if for tissue or organ transplant together with a Haematology Biochemistry combined request form Cold Agglutinins 5 ml EDTA pink sample Use a Blood Sciences request form Normal range time lt 1 in 64 at 4C Direct Coomb s Test DCT An EDTA sample is required together with a fully completed Transfusion request form Kleihauer Betke KIB Collect a 7 5ml blood transfusion sample from both cord and mother s blood after delivery and send within 12 hours of collection together with a fully completed Blood Transfusion combined request form Immunoglobulin Anti D must be administered within 72 hours of delivery One dose of 500 IU is suitable for clearance of lt 4mls of foetal red cells A kleihauer is not required for patients under 20 weeks 17 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 White Cell Antibodies Possible Cause of Some Blood Transfusion Reactions 10 ml clotted blood and a Tran
8. arin 24 hour urine collection procedure Please do not discard any liquid or powder which may be in the bottles provided This acts as a preservative for the sample Please ensure that the urine bottles are fully labelled with patient identifiers name and date of birth After getting up in the morning empty your bladder and discard that urine Note the time For the next 24 hours save all urine passed in the container provided When you wake up the following morning empty your bladder and ADD this urine to the container and note the time Bring all the urine collected to the lab or doctor s surgery East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Sample type required will vary depending on test Please see A to Z of urine tests for information regarding correct specimen container to use Allergy testing Below is a list of allergens tested at the Royal Blackburn site A wider range of allergens are available on request Careful history taking should be able to identify a likely cause and specific tests should only be requested if exclusion is not possible Please do not blanket request specific RAST a maximum of 5 should be adequate Include all relevant clinical details on the form as failure to do so may result in the relevant request not being processed Mixed nuts panel Peanut hazelnut Brazil nut almond and coconut Mixed foods panel Egg white milk cod wheat peanut and soya Mixed tree panel M
9. ase see separate protoco male 200 430umol l Urate serum 4 hours Female 140 360 mol l Urea 2 5 7 8 mmol L 4 hours Valproate non quoted 4 hours Vitamin D thresholds in respect to adult bone health i lt 30nmol I is deficient Vitamin D i 30 50nmol I may be inadequate Next day Mon Fri 250H Vit D in some people gt 50nmol l sufficient for almost all the population White cell count WBC 4 0 11 0 10 9 L 4 hours Zinc 10 24 umol L 2 3 days Mon Fri 25 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 A to Z of urine tests Analysis of the following tests requires a 24 hour urine collection Please see the earlier section regarding the correct method to collect a 24 hour urine sample 2 5 7 5 mmol 24hr Acid bottle Calcium on a normal diet 24 hour collection 8 8 17 6 mmol 24hr Thymol Preservative 2 4 6 5mmol 24hr Thymol Preservative Phosphate 15 50mmol 24hr Thymol Preservative 25 0 100 0 mmol 24hr Thymol Preservative lt 0 1 g 24hr Thymol Preservative 40 220 mmol 24hr Thymol Preservative 1 5 4 5 mmol 24hr Thymol Preservative Acid bottle Metadrenaline 24hr 0 2 umol 24hrs 24 hour collection Male 0 5 3 umol 24hrs Acid bottle Normetadrenaline 24hr Female 0 4 3 umol 24 hrs 24 hour collection 5 hydroxyindole acetic acid Acid bottle 1 45 umol 24 hrs SHIAA 24hr 24 hour collection 26 East Lancashi
10. bel must be placed on the request form specimen and plastic bag Pins staples etc must not be used to seal bags Please indicate the nature of the risk on the request form To retain confidentiality yet ensure safe handling and analysis the phrase Blood Borne Virus Infection can be used for proven or suspected cases of HIV or Hepatitis B or C infection East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Biochemistry The following routine biochemical profiles are available using brown top serum tubes Profile Tests in profile Renal Sodium Potassium Urea Creatinine Liver Total Bilirubin ALT Alkaline phosphatase ALP Albumin Bone Calcium Adjusted calcium Alkaline phosphatase ALP Albumin Lipid Cholesterol Triglycerides HDL LDL HDL total cholesterol ratio In cases where a previous potassium result is suspected to be falsely raised due to the patient having a high concentration of platelets or white cells a lithium heparin tube orange top may be used Please note however that this sample type may be unsuitable for other tests and a brown topped serum tube should accompany the lithium heparin sample if further testing is required Common sample types The vast majority of tests can be performed on serum gel tubes brown top with the exception of the following tests Glucose Yellow top fluoride EDTA PTH Pink top EDTA HbA1c Purple top EDTA BNP Orange top lithium hep
11. ces may arise whereby tests are referred to a non accredited laboratory The referral decision in these instances will be made based on personal knowledge national international reputation of the laboratory and their record of publications in peer reviewed journals This decision will be made at the discretion of the Head of Department or their deputy 27
12. d directly from Blood Transfusion Laboratory Platelets are never to be stored in the fridge Anti D Anti D is available as follows 2501U for sensitizing events less than 12 weeks in cases of Surgical intervention termination of pregnancy medical or surgical unusually heavy bleeding unusually severe pain and where uncertainty exists with regards to gestation 250lU for sensitizing events between 12 and 20weeks No kleihauer test required 5001U for sensitizing events over 20 weeks and for post delivery use where the infant is Rh Positive Rhophylac 150010 For prophylactic use at 28 weeks This is normally issued on a clinic basis for named patients due to attend the Anti D Clinic Though it can be requested individually Albumin Human Albumin solution NB patient s blood group Sample is not required units will be available from the site specific laboratory Albumin is stored at room temperature Albumin is to be requested on a named patient basis only It is also to be requested for definite use not for standby purposes It is not to be stored on the wards Any albumin that is unused must be returned to the laboratory 16 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Albumin is available in the following concentrations and sizes 4 5 500ml or 250m 20 100ml Beriplex Available in 500IU doses Dosage is dependent on patient s weight and INR See package insert for calculation Suspected
13. e Failure to include this information will result in the test being rejected Faecal Elastase Please collect the sample in a blue top stool collection bottle Interpretation of results is provided by the referral laboratory 10 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Haematology Investigations Routine Test sample tupe Turnaround Time Comments required Urgent 1 hour FBC EDTA pink In patient 4 hours GP OPD 12 hours Urgent 1 hour Can b lysed Reticulocytes EDTA pink In patient 4 hours ASE aT GP OPD 12 hours p Urgent 2 Hours Can be analysed era ELHA RINK Other 12 hours on FBC sample Malarial EDTA pink screening Test 2 Hours Can be analysed Parasites Confirmation Test 24 Hours on FBC sample Can be analysed on FBC sample For antenatal requests Hb opath cee EDTA pink 72 hours please use the family Screen et F Origin Questionnaire FOQ For other requests use the standard blood science request form Other than for urgent Hb S Test EDTA pink 2 hours urgent cases request a Haemoglobinopathy screen This will be reflexed WBC by the laboratory Differential TE kour depending on the FBC results Urgent 2 Hours IHESA sampak ESR Citrate Purple 6 must not be Other 12 Hours under filled 11 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Coagulation Test sample tipe Turnar
14. ed for urgent use i e trauma these can be issued in a specially insulated transport container for local storage up to 2 hours before transfusion Fresh Frozen Plasma FFP The patient s blood group is required This product is stored at below minus 30 C and requires about 40 minutes to thaw out before use The volume is about 180 mls per pack and should be transfused as soon as possible after thawing Coagulation results are usually required before decision on number of units required is taken The ward will be informed when the FFP is ready for collection from the appropriate location 15 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Patients born after 1 1 1996 should receive Methylene Blue Treated FFP Factor VIII and IX Freeze dried product is available via the haemophilia centre on a case by case basis Some other single or combined clotting factor freeze dried concentrates may be available from Regional Blood Transfusion Centres NOVO SEVEN Activated Factor VII is not held in stock but is available in cases of massive blood replacement after discussion with the Consultant Haematologist on call Platelet Concentrates The blood bank on the RBH site routinely holds one adult therapeutic dose of group A RhD Positive and group O RhD Positive platelets Specially selected platelets are available on request and are ordered in from the NHSBT The patient s blood group is required Units must be collecte
15. f collection and storage e g venous stasis on calcium delayed separation of serum on potassium can also affect the interpretation Analytical and biological variation must always be taken into account especially when determining whether a change over time is significant The laboratory can provide advice on the uncertainty of measurement of the tests appearing in the list below upon request Critical results will be telephoned to service users in accordance with RCPath guidelines Supplementary Requests Blood Sciences can only accept supplementary requests on samples previously referred to the laboratory up to 3 days after receipt of the original request and providing the request is appropriate This will depend on sample stability tube type and for some tests including therapeutic drug measurement there will be timing restrictions To order supplementary requests send a supplementary request form a supplementary request form is available on ICE and must be sent to the laboratory Please note that supplementary requests will be treated as routine If the request is urgent it is recommended that another sample is taken Dynamic function testing A Separate guide is available for dynamic function testing and is available on request from the duty biochemist Amongst others this protocol includes guidance on carrying out and interpreting tests such as the short Synacthen and dexamethasone suppression tests Genetic testing Genetic
16. g l post stimulation see DFT protocol handbook 2 3 days Mon Fri Target range for good control HbA1c 2 3 days Mon Fri 48 59 mmol mmol HCG lt 10 IU L 4 hours Haemoglobin sagen ee 4 hours IgE 0 50kU I 2 3 days Mon Fri Immunoglobulin A 0 8 4 0 g L Next Day Mon Fri Immunoglobulin G 6 0 16 0 g L Next Day Mon Fri Immunoglobulin M 0 4 2 3 g L Next Day Mon Fri 22 NHS Trust 01 10 14 Purple ESR Tube Random growth hormone measurements are rarely indicated East Lancashire Hospitals BS M20 Rev 18 INR 0 9 1 2 seconds 4 hours Male 9 32 umol L Iron 24 hours Female 7 30 umol L Lactate 0 7 2 4 mmol L 2 hours LDH 313 618 IU L 4 hours Lithium 0 4 1 0 mmol L 4 hours Follicular phase 1 0 12 0 IU L Cycle peak 17 0 77 0 IU L LH Luteal phase 0 15 0 IU L Next day Mon Fri Male 1 0 8 0 IU L MCH 27 0 32 0 pg 4 hours MCHC 310 360 g L 4 hours MCV 76 100 FL 4 hours Magnesium 0 70 1 0 mmol L 4 hours Follicular phase 80 200 pmol L Mid cycle peak 440 1375 pmol L i Luteal phase 220 950 pmol L Oestradiol Next day Mon Fri Male 22 162 pmol L Osmolality serum 275 295 mmol kg 12 hours PTH 1 5 7 6 pmol L Next day Mon Fri parathyroid hormone pH 7 35 7 45 4 hours pco2 4 67 6 00 kPa 4 hours pO2 11 3 14 0 kPa 4 hours 23 Blood Gas tube
17. ilable from the hospital intranet Do not use any Point of Care testing device which has failed its Quality Control checks Report any device breakdowns or problems to the ELHT Point of Care Team All Patient results are confidential and must be kept securely Any incidents related to Point of Care testing must be recorded on the ELHT incident management system Any new Point of Care Device must be approved by ELHT Point of Care Testing Governance Committee and follow procedure in policy ELHT CO15 Policy for Introducing New Clinical Techniques or Procedures and new Point of Care testing Devices Please refer to ELHT Policy ELHT POLICY CP28 Point of Care Testing POCT Policy available on the Trust intranet Contact Details Samantha Kelsall Point of Care Team Coordinator 01254 732870 Ext 82870 E mail samantha kelsall elht nhs uk Saraj Ull Din Point of Care Team Associate Practitioner 01254 732870 Ext 82870 E mail saraj ull din elht nhs uk Claire Yates Point of Care Team Associate Practitioner 01254 732870 Ext 82870 E mail claire yates elht nhs uk East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 During office Hours Mon Fri Out of Hours contact Biochemistry Ext 84156 Miscellaneous tests Faecal tests Reducing substances Please collect the stool sample in a blue top stool collection bottle Samples must arrive at the laboratory within 2 hours of collection with clear indication of collection tim
18. ixed mould panel House dust mite Timothy grass Egg white Egg yolk Milk Codfish Soybean Wheat Aspergillus fumigatus Cat Dog Peanut Latex Drugs of Abuse The Laboratory offers a comprehensive screen for drugs of abuse in known or suspected abusers and those on detoxification programmes A random sample of urine is required approximately 50mls do not use boric acid preservatives Information about likely exposure where known is useful The initial screen includes opiates cocaine methadone amphetamines and benzodiazepines Cannabis must be requested specifically Methadone metabolite and buprenorphine testing is also available depending on treatment regime please indicate this on the request This is a screening test only Positives require confirmation and negatives do not exclude the presence of small quantities of drugs All paediatric samples are sent for confirmatory testing at Salford Royal SRFT East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Interpretation of Results Reference ranges are displayed together with the result on every report It is important to always refer to ranges provided by the reporting laboratory In addition please note that on statistical grounds 5 of the normal population will have results which lie outside the quoted reference range A variety of factors such as age sex race exercise diurnal rhythm and drugs can affect biochemical results The method o
19. k ends and all statutory holidays All samples will be analysed for the common tests as soon as possible on arrival to the Laboratory irrespective of the time of day or night Core hours for Blood Sciences are 9am to 5pm The out of hours service is manned by a limited number of staff between 5pm and 9am Please keep use of the service to a minimum between these times to enable us to provide the most efficient urgent and emergency service in these periods For results and general enquiries please contact the laboratory on Blackburn 84144 Burnley 14507 For clinical enquiries relating to biochemistry please contact a clinical biochemist Dr K Brownbill 84153 Dr M Pickersgill 82176 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Key Personnel amp Contact Information Replace leading 8 with 73 for external telephone number Clinical Staff Clinical Director amp Consultant Dr K Brownbill 84153 Clinical Biochemist Consultant Clinical Biochemist Dr M Pickersgill 82176 Consultant Haematologists Dr M Rokicka 82141 Out of hours the consultant Haematologists and Biochemists are contactable via switchboard Transfusion Practitioners Mrs L Mannion 83568 Mrs M Sokolowski 82498 Point of Care Team Samantha Kelsall 82870 Claire Yates Saraj Ulldin Directorate Staff Directorate Business Manager Mr J Cottam 84106 Pathology Service manager Mr D squires 84162 Pathology IT manager Mr H Briggs 82473 Chief Biomedical
20. ng the Computer systems ICE pathology system Log into the Ice system Select the patient search option Enter your patient s surname forename Press ENTER All patients with the requested search criteria will now display Select the required patient record by clicking on that row 5 All the results for this patient will now be displayed Click on the row to display the required results 6 Note there is also an option to display results by ward location Be w ue Accessing Patient s INR Dosage 1 Use the ICE system as described above to access the patient record 2 All INR results and patient dosing schedules are directly available in the patient record within the ICE system 19 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 A to Z of routine blood serum plasma tests This table covers the majority of available tests that are performed in house other tests are available but are analysed at other laboratories Please contact the blood science department for information regarding any test not listed Unless specified the reference ranges supplied in the handbook can be assumed to be for adults In some cases age related reference ranges may apply It should be noted that results outside the reference range do not necessarily indicate disease Similarly results within the reference range do not preclude abnormality The laboratory will endeavour to meet the turnaround times stated However in exce
21. o Clinical Laboratory Medicine Burnley site No phlebotomy service is available on the BGH site East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Specimen Transport An air tube system is available for transporting samples to the laboratory s main specimen reception from departments within the Hospital Air tube Policy e All samples must be in a sealed specimen bag attached to a completed request form before being placed in the carriers e Carriers must contain bubble wrap and be closed securely at both ends Bubble wrap available e This system is available for Biochemistry and Haematology and Microbiology samples 24hrs a day 7 days a week e During normal working hours bulky heavy samples e g 24 hour collection bottles patient collected samples e g semen samples and samples for histology should be delivered by hand to laboratory reception e Only one set of Blood Cultures not glass should be placed in a carrier at one time The following must NOT be sent by air tube Glass containers Any leaking sample Blood gas samples Items over 1 5kg Any sharps Any histology samples in formalin Cytology samples CSF samples Any samples requiring immediate processing within 30 minutes eg insulin C peptide Renin Due to the pressure and vibration in the air tube it is important to ensure that tops on bottles are tightened correctly in order that samples do not leak It is important that sample
22. ound Time Comments required These samples Urgent 1 5 Hours mueLNON DS Prothrombin Citrate under filled Time INR Green In Patient 4 Hours GP OPD 12 Hours f vat Samples to be received within 12 hours of collection Urgent 1 5 Hours These samples Citrate APTT Green In Patient 4 Hours must not be GP OPD 12 Hours under filled These samples must not be under filled If the patient is on Warfarin please Request INR If the patient is on Heparin Please request Urgent 1 5 Hours APTT Coagulation Citrate i Screen Green In Patient 4 Hours GP OPD 12 Hours If coagulation Screen is requested for patients on Anticoagulants the turnaround times will be affected Samples to be received within 12 hours of collection Citrate Urgent 1 5 Hours D Dimers Gren In Patient 4 Hours These samples must not be under filled GP OPD 12 Hours This assay is no longer available Use D FDPs ihri i Dimer fibrinogen instead Citrate Urgent 1 5 Hours Fibrinogen Green In Patient 4 Hours These samples must not be under filled GP OPD 12 Hours 12 BS M20 Rev 18 East Lancashire Hospitals INHS NHS Trust 01 10 14 Thrombophilia Screening Due to the cost and complexity of thrombophilia screening the department operates a referral system Please use the thrombophilia referral form which can be obtained from the Haematology Department who in turn will contact the patient directly and make arrangements for the blood collection The pa
23. ptional circumstances this maybe prolonged Approximate Tube type Analyte Reference range furnaround Sarstedt Comments time ALT i 3 531U L 4 Hours Alanine transaminase Albumin 35 50g L 4 Hours Age related ALP alkaline phosphatase 30 130 IU L 4 hours reference ranges apply Alpha feto protein AFP lt 8 KU L Next day Mon Fri Amykacin see antimicrobial formulary 4 hours Send on ice within Ammonia 11 32 umol L 4 Hours Orange 15 minutes of collection Amylase 30 110 IU L 4 hours Angiotensin converting enzyme ACE Adult 20 70 IU L Next Day Mon Fri APTT 0 9 1 18 seconds 4 hours AST Aspartate transaminase 14 59IU L 4 hours B12 vitamin 160 1000 ng L Next day Mon Fri Bicarbonate 22 29 mmol l 4 hours 20 gt 260 ng l Vitamin B12 deficiency highly unlikely BS M20 Rev 18 East Lancashire Hospitals Bile acids 0 9 umol L Next day Mon Fri Bilirubin total Adult lt 21 umol L 4 hours B type Natriuretic peptide 2 3 days Available Orange lt 400 ng L BNP 8 in primary care only C reactive protein lt 10 mg L 4h m ours CRP b CA125 lt 30 KU L Next day Mon Fri CA19 9 lt 35 KU L Next day Mon Fri Calcium 2 20 2 60 mmol L 4 hours Carbamazepine 4 12mg L 4 hours CEA lt 5 ug l Next da
24. re Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Analysis of the following tests is performed on random urine samples however an early morning urine sample is preferable Due to the variability of the random urine sample e g dietary fluid intake some tests may not have a reference range and should be interpreted in light of clinical findings and the disease being investigated male lt 2 5mg mmol Microalbumin creatinine ratio Plain universal Female lt 3 5mg mmol Up to 0 75 mmol mmol in adults Calcium creatinine ratio Plain universal Age related reference ranges available for children Protein Creatinine ratio lt 45 mg mmol Plain universal Sodium Interpret in light of clinical picture Plain universal U amp E Interpret in light of clinical picture Plain universal Samples referred to other laboratories When the laboratory does not offer a particular test samples will often be referred to an external laboratory The laboratory has a list of referral laboratories and the more frequently requested tests This list is available upon request For more esoteric tests that do not appear within the ICE requesting system please ring the duty biochemist via the general enquiry number to discuss the request BEFORE arranging to take the sample so that appropriate instructions can be given The majority of laboratories to which samples are referred are CPA UKAS accredited However individual circumstan
25. s are batched where possible to reduce the traffic of carriers in the Pathology Reception With the exception of transfusion there is no need to telephone the laboratory for urgent work sent by the pneumatic air tube system East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Packaging and Transport of Specimens Biological specimens are a potential hazard to porters laboratory staff and yourself All specimens including emergency specimens must be transported in the approved manner to conform to Health and Safety requirements ie in sealable plastic bags Caps lids on specimen containers must be secure When emergency samples are transported out of hours they must be sealed in the polythene sealable bag attached to the request form available from the laboratory office Incorrectly packed specimens will not be analysed High Risk Samples These are defined as specimens taken from cases of Confirmed or suspected Hepatitis B infection of HBsAg carriers Confirmed or suspected HIV infection Infection or suspected infective disease of the liver Confirmed or suspected enteric fever Confirmed or suspected TB Any other confirmed or suspected high risk disease All specimens from known or suspected cases must be sealed within the plastic sample bag or the smaller compartment of a plastic minigrip bag and the request form if not the attached type inserted within the larger compartment A Danger of Infection la
26. sfusion Sample and a Transfusion request form Platelet Antibodies Possible Cause of Blood Transfusion Reaction Contact Blood Transfusion for request form and sample requirements Samples should arrive in the Laboratory before 12 00hrs Monday to Thursday only excluding Bank Holidays for referral on to the Blood Transfusion Centre Turnaround Times Specimen Frequency of Testing Time to Result GERAR ANGSANA Daily on request 6 Hours Crossmatch Daily onrequest Blood can be provided in an emergency within 15 minutes Fresh frozen plasma Daily on request amang Concentrated platelets Daily on request A ponr Direct Coombs Daily on request i 48 h Cold Agglutinins Daily on request wae Non urgent antibody 12 hours ae Daily on request identification HLA Typing Daily on request 21 Days WBC Platelet antibod Pa ERa Daily on request 21 Days screens 18 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 Ward Based Pathology Enquiries The majority of wards and departments within the Trust are able to access the Anglia Ice System to enquire on patient s results Access is only available to staff who have an individual User ID and Password To obtain a User ID please contact the IT help desk on extension 83135 Patient Search Instruction To reduce the risk of errors when searching for patient details and results the following method of searching should be adopted by all staff usi
27. tient must not be in the acute phase of any event The patient should not be currently pregnant The patient should not be on any anti coagulants A Thrombophilia screen will consist of Antithrombin III Protein C Protein S Fibrinogen Lupus Screen Factor V111 Factor V Leiden Prothrombin Gene Variant T Test Sample tube required urnareune Comments Time Lupus Screen only 2 3ml citrate Green 14 Days Factor V Leiden only 2 EDTA Pink 14 Days Prothrombin Gene Variant Only 2 EDTA Pink 14 Days Miscellaneous tests Test sample TUDE Turnaround Time Comments required 12 hours if urgent G6PD EDTA pink 48 hours for routine Can beanalysed on FBC sample samples EDTA now referred to Manchester Osmotic Fragility Pink Childrens Hospitals for Cell membrane Studies EMA Cell marker Samples must be received in 2 EDTA Pink 10 D Studies CD4 weak a laboratory on Monday Wednesday Jak2 EDTA pink 28 Days Performed following discussion with Consultant Haematologist BCR ABL EDTA pink 28 Days Performed following discussion with Consultant Haematologist Plasma Viscocity EDTA pink 14 days Anticoagulant Therapy Follow the Directorate of Medicine protocol available on all wards 13 East Lancashire Hospitals INHS NHS Trust BS M20 Rev 18 01 10 14 BLOOD TRANSFUSION Blackburn Site Telephone Transfusion lab 84529 01254 734529 Outside core hours Bleep 019
28. y Mon Fri Chloride 95 108 mmol l 4 hours Desirable range Cholesterol 2 4 hours 3 0 5 0 mmol l Desirable range Cholesterol high density HDL M 1 0 3 5 mmol L 4 hours F 1 2 3 5 mmol L Cholesterol low density Desirable range 4hours LDL lt 3 0 mmol l Complement C3 0 75 1 65 g L 6 hours Complement C4 0 14 0 54 g L 6 hours 9am sample 150 650 nmol L Cortisol on 4 hours Midnight sample lt 150 nmol L CK Male 25 2001U I ine ki 4 hours creatine kinase Female 40 320lu I Male 58 110 umol L Creatinine 4 hours Female 46 92 umol L 21 NHS Trust 01 10 14 Pro BNP lt 400 in an untreated patient makes heart failure unlikely East Lancashire Hospitals BS M20 Rev 18 0 5 1 0 ug L in heart failure Digoxin 4 hours Up to 2 ug Lin AF Male 1 10 mm hr ESR 6 hours Female 3 15 mm hr Male 30 365 ug L Ferritin Next day Mon Fri Female 10 160 ug L FAI free androgen index 0 7 5 females only 2 3 days Mon Fri Folate 3 0 20 0ug Next day Mon Fri Follicular 1 0 11 0 IU L Mid cycle 6 0 21 0 IU L FSH id cycle 6 0 0 IU folicule stimulating Luteal 1 0 8 0 IU L Next day Mon Fri hormone Male 1 1 11 0 IU L Gentamicin See antimicrobial formulary 4 hours GGT Gamma glutamyl 0 65 IU L 4 hours transferase Glucose Fasting 3 0 6 0mmol L 4 hours Growth Hormone gt 5 8 u
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