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Pathology user guide 2013 - Queen Elizabeth Hospital King's Lynn

1. BLOOD SCIENCES combined Laboratory MICROBIOLOGY VIROLOGY Blood Sciences Enquiries line 3771 3779 Phone Bleep BLOOD SCIENCES amp TRANSFUSION Micro Lab Main Lab 3772 Phone Bleep Lab Manager amp Biochemistry Lab Main Lab 3490 Graham Rogerson Micro amp Cell Path 2876 computer Mgr Haematology Lab Main Lab 2079 Transfusion Main Lab 3782 Prof L Liebowitz Consultant 3627 3627 Richard Pipkin Blood Sciences Mgr 3430 Dr S Sharma Consultant 4360 Stephen Thompson Deputy BS Mgr 3561 Infection Control Chris Brock Quality Manager 3561 Lynne Roberts Inf Control Nurse 2326 2326 Kirsty Bunting Lewis Training Officer Auto lead 4615 CELLULAR PATHOLOGY Adrian Ebbs Transfusion Mgr 3782 Histology Cytology Mortuary Denise Clout Deputy Transfusion Mgr 3782 Phone Bleep Locum Consultant Haematologist 3609 3609 Histology Enquiries 3617 Dr AJ Keidan PB Consultant Haematologist Ann Hennessey Lead BMS 3431 Coates PT Dr M Lewis Consultant Haematologist 3401 2893 Mike Davies Senior BMS 3617 Dr L Cooke Consultant Haematologist 3030 3030 Jeff Smith Senior BMS 3617 Dr E Gudgin Consultant Haematologist 3621 3621 Vacant Locum Consultant 3622 Specialist Registrar 2892 Dr L Ranasinghe Consultant 3624 Vacant Consultant Chem Path Dr Phuoc Tan Diep Consultant 2483 Maggie Pate Secretary ACS 3797 Dr R Ahmed Consultant 3624 Mandy Caldwell Secretary LC EG 3299 Dave Spooner
2. 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 70 of 140 Cellular Pathology Consultants and Senior Staff Name Grade Extension Dr Lilani Ranasinghe Consultant Histo Cytopathology 3624 Dr Phuoc Tan Diep Consultant Histo Cytopathology 2483 Dr Roshina Ahmed Consultant Histo Cytopathology settee Ann Hennessey Cellular Pathology Manager 3431 Mr Mike Davies Senior BMS Histology 3617 Mr Jeff Hammond Senior BMS Histology 3617 Mrs Lynne Macmillan Senior BMS Cytology 3020 Mr Dave Spooner Lead Anatomical Pathology Technician 2561 Marie Ford Brenda Gerrish Bereaved Relative Support 3878 E MAIL Pathology staff can be e mailed at forename surname qehkl nhs uk General information Clinical advice can be sought from a Consultant Histopathologist contact details in the table above Additional tests on specimens can be requested If out of hours advice is required please contact switchboard e Non Gynae cytology within 24 hours e Surgical specimens No time limit for processed blocks and slides Please discuss with a Consultant Histopathologist All requests for slides or blocks to be reviewed or discussed at an external MDT must be either requested by fax or a letter from the reviewing Consultant This measure has become necessary to prevent slides and blocks
3. CPA Number CPA Cert EQA Staus PUP letters TAT Addenbrookes Vit D 0244 Yes Registered No 2 Weeks Samino 0244 Yes Registered No 5 Working days Uamino 0244 Yes Registered No 5 Working days Free total PSA 0244 Yes Registered No 5 Days Not Bitotinidase 0244 Yes Registered No 5 Working days FK506 0244 Yes Registered No 24 Hours TAT TUMS 0244 Yes Registered No 3 Working days Urine Cystine 0244 Yes Registered No 10 Working days Long chain Fatty Acid 0244 Yes Registered No 10 Working days Not Feacel Elastase 0244 Yes Registered No 10 Working days Cyclosporine 0244 Yes Registered No 24 Hours TAT Plasma Viscosity 0244 Yes Registered No Not stated Urine Muccopolysaccharides 0244 Yes Registered No 10 Working days Cytogenetics Chromosomes for Adults and Children 1275 Yes Registered No 8 week reporting time and 2 weeks where mutation Is known Cytogenetic Chromosomes 1275 Yes Registered No 8 week reporting time and 2 weeks where mutation Is known DNA Fragile X 1275 Yes Registered No 8 week reporting time and 2 weeks where mutation Is known Leukaemia Immunophenotyping O466 Yes Registered No 1 2 Days Jak 2 0466 Yes Registered No 1 2 Days Moelcular 0466 Yes Registered No 1 2 Days Cytogentics 0466 Yes Registered No 1 2 Days Morphoroloy O466 Yes Registered No 1 2 Days CSF analysis 0466 Yes Registered No 1 2 Days Coagulation Deparment Lupus 0466 Yes Registered No Urgent 3 hrs if not 14 days Thromophilla O466 Yes Registered No Urgent 4 Hrs if not 14 Days VWD
4. THE QUEEN ELIZABETH HOSPITAL KING S LYNN NHS TRUST Surname Relevant clinical details Forename s Date of Birth Sex Sample Collection Time Date AFFIX ADREMA LABEL ABOVE IF AVAILABLE Date of onset Essential for viral serology Ward OPD Surgery Consultant G P Extra copy to Antibiotic Levels Infusion Start Time Sampling Time Patient category please tick nhs Specimen type PRIVATE _ caTi Name of doctor and bleep number print Serology Virology Form Sample Received Time Date Specimens may be used for Internal Quality Control and Teaching purposes If you do not wish this specimen to be used please put a cross in the box Care should be taken to fill in the form correctly All details are essential and should be written in block capitals if patient demographic stickers are not available Please enter sample type and date time of collection as well as pertinent clinical information Please also state the requester and location you would like the results returned to Please also ensure that current antibiotic history is filled in Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 55 of 140 Bacteriology Serology amp Virology forms are all col
5. Hep B e markers Hepatitis C abs Herpes simplex PCR Herpes simplex virus PCR HIV 1 2 antibody assay Influenza A CFT Influenza A antigen Influenza B CFT Influenza B antigen Legionella CFT Legionella antibody EIA Leptospira Leptospira CFT M pneumoniae CFT mycoplasma P carinii IF Parainfluenza CFT Parvovirus IgG amp IgM Rubella IgM Torch screen as required Viral Load tests Viral Respiratory screen Norfolk amp Norwich University Hospital Microbiology Dept NRP Innovation Centre Norwich Research Park Colney Norwich NR4 7GL Tel 6474 QEH Internal 01603 611816 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 66 of 140 Test Reference Laboratory CMV Viral Load Coronavirus DNA Cytomegalovirus DNA Enterovirus RNA Epstein Barr virus DNA Erythrovirus B19 IgM Hep B DNA Hepatitis A IgG Hepatitis A IgG Hepatitis C Virus genotype Hepatitis C virus RNA Herpes simplex IgG Herpes simplex IgG Herpes simplex virus DNA Influenza A amp B Virus PCR Influenza A RNA Influenza B RNA Measles virus RNA Menigo
6. The request must be completed by the clinician including the reason for the analysis The patient must complete questions 1 6 The laboratory supplies semen analysis packs which includes a sterile tamper proof specimen container request form and patient information leaflet If you require information in other languages please contact the laboratory The service is by appointment only on Wednesdays and Thursdays between the hours of 0830 1600 If semen analysis is required outside of these hours please contact the laboratory on 3757 to arrange a convenient time Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 75 of 140 Specimen Rejection Criteria The specimen has leaked or shows evidence of leaking The specimen has not been produced in the container supplied by the laboratory The specimen has been produced using a condom The specimen is not handed over by the patient or the patient s representative who is able to confirm the instructions for production have been adhered to The specimen has not been delivered within the stated time frame e The specimen has been produced by Coitus interupptus Post vasectomy Two sequential semen samples which are reported as being clear of spermatozoa on microscopy are required before contraception can cease The recommended sampling intervals are 12 16 an
7. 1 8 8 0 Adult a 1 8 7 7 Lymphocytes 1 year 10 L 4 0 10 5 5 years 10 L 1 5 7 0 10 years 10 L 1 5 6 5 Adult 10 L 1 5 3 5 Monocytes All ages 10 L 0 2 1 0 Eosinophils Pre adult 10 L 0 1 1 0 Adult 0 02 0 5 Basophils All Ages 10 L 0 02 0 1 Haemoglobin 1 year g L 110 130 5 years g L 115 155 10 years g L 130 160 Adult M g L 130 170 Adult F g L 125 165 RBC 1 year 10 L 3 7 5 2 5 years 10 L 4 0 5 2 10 years 10 L 4 0 5 2 Adult M 10 L 4 5 5 5 Adult F 10 L 3 8 4 8 Haematocrit 1 year L L 30 38 5 years L L 34 40 10 years L L 35 45 Adult M L L 41 50 Adult F L L 36 46 MCHC g L 310 370 MCH 1 year g L 250 350 5 years g L 240 300 10 years g L 250 330 Adult g L 270 320 MCV 1 year fl 72 84 5 years fl 75 87 10 years fl 77 95 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 43 of 140 Adult M fl 80 94 Adult F fl 81 99 Reticulocytes 1 year 10 L 30 100 Reticulocytes 5 years 10 L 30 100 Reticulocytes 10 years 3 10 L 30 100 Reticulocytes Adult 10 L 31 82 Platelets 1 year 10 L 200 550 5 years a 10 L 200 490 10 years 10 L 170 450 Adult 10 L 150 410 ESR M 17 50 mm in 1h Upper
8. Consultant or GP Requesting doctor plus bleep number if applicable Relevant clinical information including date of onset for serology virology requests Date and time of sampling Tests requested All samples must be appropriately labelled with Patient s Surname and Forename Hospital Number if known Date of birth Date and time of sampling All samples must be labelled with labels generated by the PDA system within the Trust except from those areas with prior agreement with the laboratory where the system has not been fully installed Samples from Primary Care should be labelled using the GP s own system and all labels should be applied perpendicularly on the specimen tube Unacceptable Specimens Labelling details on the specimen must match the details on the request form and enable unique identification of the patient Surname forename DOB and Hospital number if known The request form must be fully completed Specimens must be placed in the appropriate bottles or transport media Specimens must be transported to the laboratory in reasonable time Specimen containers must be sterile properly sealed and not leak Any specimen which does not meet the above criteria will be referred to the senior BMS present and will normally not be processed unless a repeat specimen cannot easily be obtained Interpretation of any results from such specimens must be made with extreme caution Document Number Qual0
9. Protocol available Anaphylactic Reaction C TRYPT SST See tryptase ANCA IS ANCA SST Androgen Profile C SST Sent to Leeds by 1 Androstenedione C ANDRO SST class Angiotensin Converting Enzyme C ACE SST PSG or omi EDTA re aa Antenatal Booking Screening XM 3ml EDTA SST X 2 oogy PG amp G 1 for ferritin if req d Sodium Fluoride Sent 1 class to Anti Adrenal Antibodies IS CAD SST Sheffield Anti B2 Glycoprotein Abs IS B2GG SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 100 of 140 Anti basement Membrane Antibody IS GBM Sent 1 class to Anti Cardiac Abs IS CAB SST Sheffield Anticardiolipin IS CARD SST Anti D c Quantification XM SPI 6ml EDTA sennio Colindale Antidiuretic vasopressin C Lith Hep Seen Anti D Titre XM 6ml EDTA Anti endomycial IS TTG SST l Sent 1 class to Anti GAD IS GAD SST Sheffield Also known as Glomerular Anti GBM IS GBM SST Basement Membrane Anti Gliadin Abs IS TTG SST see TIG Sent 1 class to Anti Glutamic Acid Dicarboxylase IS GAD SST Sheffield j T Sent 1 class to Anti GM1 ganglioside GM1 antibodies IS GANG SST Sheffield Sen
10. Sent to Hallamshire Tryptase Mast Cell C TRYPT SST by 1 class Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 125 of 140 TSH C TFT SST AFP amp BHCG only sent if known r testicular tumour pu ieee o mm sor Sent addenbrookes by 1 class EDTA 5ml Clotted 10ml Universal pate Ai lie Telephone Guys to UK Myeloma Forum Elderly Study H REF sa ao expect samples unstained 2 0207 955 2031 2ml bone marrow in heparinised tissue culture medium Unconjugated conjugated bilirubin C SST l P A Need age matched Unstable Haemoglobin H HBOP 3ml EDTA normal sample Urates C UAC SST Urea C UREA SST Sent to N amp N by 1 Urine Drugs Abuse C UDRUGS Random Urine class 20mL aliquot Sent Urinary Cortisol free C 24 CORT 24hr urine to Leeds by 1 class Sent to Trace Urinary Copper C UCUQ 24hr urine Elements SAUL ONE DY 1 class Urinary Human Chorionic Gonadotrophin HCG H HCG Urine Universal Universal supplied Urinary Myoglobin H MYO Universal SST by haem containing bicarbonate Sent to UCL by 1 Urinary Oxalate C UOXA 24hr urine class Sent to Kings Urinary Steroid Profile C UST 24hr urine college by 1 class
11. Sputum Renal infections 3 MSU Microsco Microscopy 3 specimens of Sterile screw py 4 days T Spot tests Only if approved by Culture i Mycobacteria zo mis cael capped Refrigerated Sensitivity testing if Microbiology Corisultarit Only taken on container Saat Culture 6 8 available Monday to Thursday Must i indicated consecutive weeks be arranged at least 24hrs in advance days Other sites please send as large as specimen as possible up to 20mls Dermapak Microscopy 3 Microscopy 4 days Mycology Scrapings available from Room temperature Culture the laboratory Gufture3 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 62 of 140 Specimen Collection Container Storage Routine Tests sade Notes weeks Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 63 of 140 Serology The list of available serology tests are shown in table 22 below Any tests not shown should be discussed with the relevant department Table 22 Turn around Test Group Tests Purpose Specimen ime Hepatitis B Surface Hepatitis EEAS a Evidence of current viral ep
12. 08 00 18 00 Urgent Requests Including Out of Hours Few tests performed by the laboratory are required clinically on an urgent out of hours basis Exceptionally when circumstances justify a more rapid result the request should be made personally to the relevant Senior technical Staff in the Department Outside normal working hours contact is via the hospital switchboard to contact the on call biochemist in the laboratory Contact information must be supplied when an urgent request is made Routine Requests Most analytes and autoantibodies are carried out on the same day or the day following receipt of the specimen However as many tests are expensive when dealt with in small numbers and in order to maintain an economic cost and acceptable turn around time such assays are batched according to the number of specimens received If in doubt please phone for advice Assays that are batched include neoplastic LKS immunofluorescence and cardiolipin antibodies Sample Requirements Serum Samples Most tests are performed on serum separated at room temperature For serum 10 ml blood should be collected in a yellow top tube with no anticoagulant In most cases samples should be sent to the Pathology Reception area Storage of Specimens Sera are stored at 20 C and retained for at least three months before disposal If further tests are required on a patient in the light of earlier results it may be possible to save the inconvenienc
13. 5H1AA urine C USH1AQ Conc HCl 10mL referred universal container Sent to Leeds 6TGN 6MMP C TGN 6ml EDTA ABMA IS GBM SST Less than 4 hours Acanthocytes H FBC FI 3ml EDTA o roquerhpiogs Sent 1 class to Acetylcholine Receptor Antibody C ACRA SST Oxford Random Sample also known as ACR C ACR Urine Universal Albumin Creatinine Ratio See Acetylcholine ACRA C ACRA SST Receptor Antibodies Sent directly by pe clinician to Acylarnitine C Heel Prick A denirookes Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 98 of 140 ADB S SST Included in Atypical Pneumonia Adenovirus S NADEN SST Complement Fixation tests CFT ADH C Lithium heparin an ke Blood and or urine Adrenal Stimulation test C SST cortisol Dynamic function test of cortisol Adrenal Suppression test C ACFT1 SST baseline and timed samples required On Ice To be Adrenocorticotrophic Hormone frozen Sent by ACTH f ac emi EDTA courier to N amp N Random Sample Albumin Creatinine ratio C ACR Urine universal also known as ACR Alcohol levels C ETOHALB Grey Rest for 30 mins pre TF venepuncture On Aldosterone Renin Activity C RAPROF A kepar Ice Freeze Sent to St Marys by courier Alkaline
14. 80g I FRESH FROZEN PLASMA British Committee for Standards in Haematology 2004 Dose 12 15 ml kg body weight equivalent to 4 units for an adult F1 Replacement of single coagulation factor deficiencies where a specific or combined factor concentrate is unavailable e g factors V F2 Immediate reversal of warfarin effect in the presence of life threatening bleeding Not recommended use factor concentrates F3 Acute disseminated intravascular coagulation DIC in the presence of bleeding and abnormal coagulation results F4 Thrombotic Thrombocytopenic Purpura TTP usually in conjunction with plasma exchange F5 Massive transfusion coagulation factor deficiency can be expected after blood loss of 1 5 x blood volume aim for PT amp APTT lt 1 5 of the control value F6 Liver Disease to correct bleeding or as prophylaxis before surgery when the Prothrombin time is gt 1 5 the control valve Cryoprecipitate BRITISH COMMITTEE FOR STANDARDS IN HAEMATOLOGY 2004 Dose 1 unit 5kg body weight equivalent to 10 units for an adult C1 Acute disseminated intravascular coagulation DIC where there is bleeding and a fibrinogen level lt 1g l C2 Advanced liver disease to correct bleeding or as prophylaxis before surgery when the fibrinogen level lt 1g l C3 Bleeding associated with Thrombolytic therapy causing Hypofibrinogenaemia C4 Hypofibrinogenaemia Fibrinogen level lt 1g l secondary to massive transfusi
15. C 24hr Urine elements Guilford by 1 class Legionella abs S NLEG SST Only first week of Legionella urinary antigen S NLEGU Urine illness Sent to a Addenbrookes by 1 Leptospira S NLEP SST See luitenizing LH C LH SST Hormone Lipase Pancreatic IS SST Lipids C TCHOL SST Lipoprotein APO IS SST Lipoprotein A IS SST Lipoprotein EP IS SST Lithium C LI SST Liver Function Tests C L SST Document Number Qual0035 Version Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 117 of 140 Centrifuge Separate and Freeze Sent to Long Chain Fatty Acids C LCVFA 6ml EDTA Addenbrookes by 1 class Not on Fridays Sent Lupus Screen H LUPUS Citrate x 3 to Addenbrookes by 1 class Luteinizing Hormone C LH SST Sent to Lymphocyte Markers H IMM 10 20mI EDTA oo same M Band electrophoresis C EP SST Magnesium C MAG SST Malaria H MS 3ml EDTA Sragi ie Maem Manganese C SST or Urine Markers S SST Refer to Specific MC amp S blood Bacti Rand enn ole venepuncture SOP bottles MC amp S urine Bacti Universal Urine Measles IgM S SST Measles virus RNA S 6ml EDTA Meningococcus PCR S PCR 6ml EDTA red panang blood culture result Mercury C HG EMU 6ml EDTA Met Haemoglob
16. Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Immune Sciences Location 85 Contact numbers 85 Opening times 85 Urgent requesting 85 Sample requirements 85 Result enquiries 86 Turnaround times 86 Assays 86 Reference ranges 95 Reference laboratories 96 Bel LL a a ae ee ee Eae er ee eee SeenON at Sere 9 _Appendix 1 Test Container Guide Alphabetical 98 Appendix 3 Unlabelled specimen policy 130 Appendix 5 Blood Sciences samples special considerations 132 Appendix 7 Reference laboratory details 135 _Suggestions and handbook satisfaction form MO Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Table 1 QEH King s Lynn Pathology Telephone numbers All QEH King s Lynn numbers can be telephoned externally by dialling 01553 61 and then the 4 digit number Dr Lisa Cooke Director of Pathology 3401 GENERAL Phone Bleep Reception 3769 Phlebotomy room 2882 Jane Thompson Phlebotomy Supervisor 2882 1216 Phlebotomist On wards 1216 1263 1265 Audrey Hudson Stores 2794 Pathology Computer issues IT 4422 Apex Passwords Via email Email Pathology Website Via Communications
17. Freeze Sent to i S Urinary Metabolic Profile C UMETPR Random urine aaa pya Valproate C VALP SST Stat time of last Vancomycin Levels C SST dose and sample time Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 126 of 140 Varicella Zoster chicken pox S VZG SST Varicella Zoster Virus DNA S CSF Sample VDRL S SST Very Long Chain Fatty Acids C VLCFA 6ml EDTA See Long Chain fatty acids Full clinical details Viral Antibodies SST Date of onset required Swab in virus Viral culture VC transport Protect from light Centrifuge freeze Vitamin A amp E VITEA Lithium Heparin Sent to Leeds by 1 class Vitamin B1 THIA Aa m alan heparin Vitamin B42 B12 SST Vitamin D SST Protect from light PONSE i Centrifuge freeze Vitamin E VITE Lith Hep amp clotted Sent to Leeds by 1 class VMA Creatine ratio VCRE 24hr urine 20mLs aliquot Check with Lab as has to arrive at Von Willebrand Disease VWD Citrate x 4 destination within the hour Voriconazole SST See Varicella VZ VZG SST Zooster No more than 4hrs Warfarin Control WC Citrate old on receipt Do not separate S White Cell Enzyme WCE 6ml EDTA et ial DO NOT USE SST CANNOT BE HAEMOLYSED Zinc
18. NBS Sameday ee ee ecole H HFE 3ml EDTA See HFE Haemochromatosis Ring Lab pre Homocystine C SAMINO venepuncture See Cystine Homogentisate Urine Universal Random Sample HTLV S SST Human T Lymphotrophic virus S SST Hydroxyindole acetic acid urine C UH5IAA 24hr Urine See Catecholomines Hydroxyproline C UOHPRO 24hr Urine Hydroxytryptamine 24hr Urine Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 115 of 140 IgA Deficiency Anti IgA Antibodies XM SPI 6ml EDTA Sent 1 class to IgG Subclasses C IGG4 SST Sheffield Immune Neutropenias auto all drug XM SPI Refer to Transfusion ree aad Pon induced for request form Also known as protein Immunoglobins C IGS EP SST electrophoresis Immunoglobulin E C IGE SST Immunoreactive Trypsin C IRT SST Post to S Immunophenotyping H IMM 10 20ml EDTA oo ord Infectious Mononucleosis glandular H GFT 3ml EDTA Fever Influenza A B S FLUA B SST Freeze Sent to i SST amp Sodi Insulin C INS it i Guilford by courier Freeze Sent to Insulin C Peptide C INS C SST Guilford by courier MEn Freeze Sent to Insulin Grawih Factor Binding C INFBP
19. Naam BIS Trans via Switchboard Chemical nik guys Contact Bio BMS via Pathology 08 00 18 00 08 00 12 00 Phone 3771 Switchboard Microbiology 08 30 16 30 09 00 11 00 phone s772 Comtact Mice BMS via switchboard Histology 07 30 17 30 N A Phone 3617 Contact switchboard Cytology 07 30 17 30 N A Phone 3020 N A Contact via Contact via Switch Mortuary 07 30 17 30 Switch board N A board Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 7 of 140 Services provided Ground Floor The laboratory and Mortuary are located at the rear of the QEH The following services are provided on the ground floor Upper Floor The following services are provided on the Upper Floor Blood Transfusion Chemical Pathology Haematology Immune science Phlebotomy Anticoagulation Office Reception Mortuary Semen analysis e Cytology e Histology e Infection Control e Microbiology Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 8 of 140 Results and Requests General It is essential that the request form is correctly and legibly completed with the following information Patient s Surname and Forename Hospital Number if known Date of birth Gender Location
20. Phosphate C ALK SST Also order ALK Alkaline Phosphatase Isoenzyme IS ALKISO SST GGT and B Alloantibody Identification XM SPI 6ml EDTA x 2 pnpa Celndale Alpha 1 Antichymotrypsin IS SST Alpha 1 Antitryspin IS A1AT SST Sent to Hallamshire Alpha 1 Antitryspin Phenotype IS A1ATP SST by 1 class Alpha Feto Protein C AFP SST Request form to Alpha Thalassemia screen H HBOP 3ml EDTA Haem First sample Aluminium C ALU 2 x Clotted Labelled discarded as1 amp 2 Do Not Separate Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Reviewed by C Brock Page 99 of 140 Sent to trace elements in Guilford See SOP Amikacin Levels S SST Sent 1 class to Amino Acids C SAMINO SST or Plasma Addenbrookes Aminolaevulinate C AMINOL 24hr urine Aminophylline C THEO SST Centrifuge Separate Keep in Amiodarone C AMIO Clotted Keep in dark dark Sent to Liandough Hospital by 1 class On Ice Inform Lab Analyse within 30 Ammonia C AM Lithium Heparin mins of venepuncture Amylase C AMY SST Sent to Great S Amylase ISO Enzyme Macro C AMYISO sst ela ood Sent to Royal Free Amyloid A protein C AMAPR SST Hospital by 1 class
21. SST Phosphate blood C PO4 SST Phosphate urine C UPHOS 24hr urine Sent to Kings PIIL NP C PIIINP SST College by 1 class Keep in Dark Sent st PIVKA amp VIT K H PIVKA Clotted to St Thomas by 1 class Picornavirus S SST Centrifuge freeze Plasma Metadrenaline C 3x 6ml EDTA sent to addenbrookes by Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 120 of 140 courier transport tin Centrifuge freeze sent to Plasma Norametadrenaline C 3x 6ml EDTA addenbrookes by courier transport tin Do not send high fee risk specimens Sent Plasma Viscosity H PVA 6ml EDTA x 2 to Addenbrookes by 1 class May require a citrate thromboexact Platelet Count H FBC 3ml EDTA tube as well if requested Platelet Immunolo XM Pe ANTURIO REE ee et 9y for request form Platelet refractoriness HLA XM SPI Refer to Transfusion Saeed go Antibody Screen for request form y Sent Immediately to z Addenbrookes via Platelet Studies H PLAGGS 10ml Citrate sani caurer Pneumococcal PCR S 6ml EDTA Saline induced Pneumocystis S PC sputum minimum requirement Polyomavirus BK DNA S Urine Polyomavirus JC DNA S Urine Polypeptide VIPI C GAST eee ie Porphobilino
22. There will be a record that attempts were made to contact the requester before the results are authorised After the successful attempt another record will be made and the original will be amended if necessary If the ward GP Secretary is not contactable the next day the comment code NOTC Not contactable will be entered into Apex and authorised If the laboratory receives enquires relating to patient results the following information will be required 1 Name qualification and location of person calling Results can only be given to persons authorised to receive it normally the patients Doctor Nurse or other Professional Healthcare Worker who is involved in the immediate treatment of the Patient 2 Full Name Date of Birth and Hospital number if known of the patient Address may also be useful if it is a common name 3 Details of what specimen was taken what tests were requested when the specimen was sent and by whom Please remember that many of the results are often complicated and assurance of understanding that the person who is being telephoned will be assessed Results will not be given if the BMS has any doubts about the suitability of the person to receive results Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 16 of 140 Procedure for accessing Pathology Ward Enquiry Facility Fr
23. UTI prostatitis recent ejaculation within 24 hrs retention prostate biopsy catheterisation and cystoscopy A repeat PSA should be considered if any of these factors are present Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 31 of 140 CEA Carcinoembryonic antigen Although primarily considered to be a tumour marker for colorectal cancer less than 50 of patients with Dukes A or Dukes B colorectal cancer will have an elevated serum CEA level at presentation Furthermore CEA may be elevated in almost any advanced adenocarcinoma Itis also elevated in a variety of non malignant conditions including hepatitis cirrhosis obstructive jaundice due to gallstones ulcerative colitis Crohn s disease renal disease and smokers The main clinical indication for the measurement of CEA is for monitoring patients with known colorectal cancer when it may provide a lead time for the detection of recurrence It may also be helpful for monitoring the response to chemotherapy or radiotherapy in patients with advanced disease Ca 12 5 Ca 12 5 is a glycoprotein antigen associated with epithelial ovarian cancer It is elevated in approximately 80 of all cases of epithelial ovarian cancer but only 50 of early stage 1 disease Ca 12 5 is not specific for ovarian cancer and a variety of non ovarian intra abdo
24. Version 4 03 Pathology User Guide Review date Guided by lsotracker lsotracker Reviewed by C Brock Document Number Document Name Review Interval Page 88 of 140 Sm Specific for SLE but found in only 20 30 of SLE patients with a higher incidence in non Caucasians especially those of Afro Caribbean descent U RNP A high titre positive result of only URNP is diagnostic for MCTD but these antibodies are also found in 30 40 of SLE patients Ro or SS A The Ro SS A antigen also occurs in the cell cytoplasm and very rarely a serum may be positive for Ro antibodies even in the absence of an ANA These antibodies can cause congenital heart block and it is recommended that all female patients suspected of SLE or Sj6gren s syndrome are screened for anti SS A Ro antibodies especially if they are considering pregnancy These antibodies are associated with Sj gren s syndrome up to 75 in primary Sj gren s Sicca syndrome and in many cases of Sj6gren s syndrome secondary to a variety of other autoimmune diseases They are also found in variants of SLE including subacute cutaneous lupus and neonatal lupus with congenital heart block and also in SLE resulting from homozygous C2 or C4 deficiency La or SS B Usually found with anti Ro in both primary and secondary Sj gren s syndrome and SLE Sj6gren s patients with anti La are likely to have more extra glandular disease Ro and La antibodies These are often found t
25. ZN Clotted 2ml SENT TO TRACE ELEMENTS GUILFORD Document Number Version Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Reviewed by C Brock Page 127 of 140 Appendix 2 Inadequately Incorrectly labelled specimen policy This policy deals with specimens or forms that are inadequately or incorrectly labelled Labelling Requirements Minimum and preferred labelling requirements are set out below Identifying data Minimum of 4 As below Essential identifiers e g full name and DOB a with the form sample Ne as a NHS number number HS Location Destination for report and or GP Consultant name Identifying data Minimum Preferred identifiers e g full name DOB and one other Date and time of Date amp Time of collection collection Location of origin Clinical Information Signature of requesting clinician Bleep number of requesting clinician Patients address for GP requests The patient s name will normally be a minimum of two parts forename and surname It is permissible due to the restraints imposed by the space available on a specimen label for the requester to record any two parts of a hyphenated name or to abbreviate individual names longer than 12 letters e g Georgina Barclay Humphreys may be abbreviated to Georgina Barclay on the specimen similarly Rajarajesuwari Subramanium may be abbreviated by shorte
26. becoming lost in transit and to provide an audit trail of the material No requests will be accepted over the phone or via e mail Please ensure these requests are received in the laboratory promptly Laboratory working hours Mon Tue Wed Thurs Fri Sat Sun BH 07 30 17 30 gt No on call service Out of hours Consultant on call via Hospital Switchboard gt 01553 613613 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 71 of 140 Enquiries During Working Hours Results Histology 3617 Results Cytology 3020 Frozen sections Histology Lab 3617 Histology FAX 01553 613070 Cellular Pathology Manager 3431 Cytology 3020 Mortuary Mr Dave Spooner 2561 Bereaved Relative Support 3878 Out of hours Please contact the Hospital switchboard Reporting Times 01553 613613 Reporting time working days Category immediate 30mins Frozen sections Intra operative sentinel lymph node imprints 6 hrs 24 hrs Urgent same day biopsies without complete immunohistochemistry IHC Urgent non gynaecological cytology 24 hrs 72 hrs A preliminary report will normally be available within 24 hours In patient biopsy non gynaecological cytology with complete IHC Surgical resection specimens urgent 48 hrs 1 we
27. cases all of a specimen will have been used Specimen Retained for Urines 1 day CSF 4 weeks Other bacteriology specimens 6 days Mycology specimens 3 weeks Antenatal Serology Specimens 2 years Genito urinary Medicine serology Specimens 2 years Needlestick injury serology specimens 2 years Other Serology Virology specimens 4 weeks All Cultures which have sensitivity tests perfomed are held for 6 days further antibiotic testing may be requested during that time by contacting one of the Microbiology Consultants Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 58 of 140 Bacteriology Specimens This section is intended only to give a quick guide for more detailed information please contact the laboratory ext 3772 Table 21 outlines specimen requirements for microbiology specimens If possible specimens for Bacteriology should be taken before commencement of antibiotic therapy Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 59 of 140 Table 21 Turn around Specimen Collection Container Storage Routine Tests time Notes Quantitative sterile screw MIGTOSEORY Specim
28. have regular monitoring of their liver function and CK Guidance on the requesting of tumour markers Tumour markers are relatively expensive tests please request them selectively The following guidance has been formulated to assist with the selection of the most appropriate assays for a given clinical situation General Guidance 1 No serum marker in current use is specific for malignancy 2 Many patients with early localised disease will have normal levels of serum tumour markers 3 No cancer marker has absolute organ specificity PSA however appears to be relatively specific for prostate tissue 4 Requesting of multiple markers such as CEA and the CA series of antigens in an attempt to identify an unknown primary cancer is rarely of use 5 Reference ranges for cancer markers are not well defined and are used only for guidance Please note that a level within the reference range does not exclude malignancy while concentrations above the reference range do not necessarily mean the presence of cancer Changes in levels over time are often more clinically useful than absolute levels at one point in time PSA PSA is an extremely useful marker for the detection of prostatic cancer and for monitoring treatment of patients with known carcinoma of the prostate It is important to recognise that in addition to prostate cancer and benign prostatic hypertrophy a number of factors can give rise to significant increases in PSA including
29. is the most common autoimmune liver disease of childhood Turn around time 1 week Mitochondrial antibodies Part of Tissue Autoantibody Screen Present in gt 95 of cases of primary biliary cirrhosis usually in high titre Also occasionally present in chronic active hepatitis and halothane induced hepatitis patients but with weaker titres Serum IgM levels are invariably polyclonally increased Turn around time 1 week Mitochondrial M2 antibodies For those wishing to confirm the presence of mitochondrial abs or to monitor patients with a quantitative assay an EIA method is available which affords a quantitative assay of M2 Turn around time 3 weeks Myelin associated glycoprotein MAG Myelin associated glycoprotein MAG is a glycoprotein component of the myelin of central and peripheral nervous systems present in the periaxonal region Schmidt Lantermans incisures lateral loops and outer mesaxon of the myelin sheath A member of the immunoglobulin super family MAG probably functions as an adhesion molecule and mediates cell cell interactions Monoclonal reactivities against MAG are detected in about 50 75 of patients with IgM paraproteinaemia and peripheral neuropathy Sera from patients with neuropathy that are negative for MAG antibodies often exhibit reactivity against various gangliosides Myeloperoxidase MPO Also see Anti Neutrophil cytoplasmic antibodies ANCA Antibody to myeloperoxidase is associated with organ limited va
30. limit 10 M 51 60 mm in 1h Upper limit 12 M 61 70 mm in 1h Upper limit 14 M gt 70 mm in 1h Upper limit about 30 ESR F 17 50 mm in 1h Upper limit 12 F 51 60 mm in 1h Upper limit 19 F 61 70 mm in 1h Upper limit 20 F gt 70 mm in 1h Upper limit about 35 PT APT Seconds 7 7 13 8 Fibrinogen g l 2 32 5 04 Clauss APTT Seconds 24 4 41 1 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 44 of 140 Transfusion Department Request Form The transfusion department request form is shown in figure 5 Figure 5 THE QUEEN ELIZABETH HOSPITAL KING S LYNN NHS TRUST POSITIVE PATIENT IDENTIFICATION AT SAMPLING IS ESSENTIAL CHECK WRIST BAND OF INPATIENTS MINIMUM SAMPLE LABELLING REQUIRED SURNAME FORENAME DATE OF BIRTH AND HOSPITAL NUMBER HANDWRITTEN ON SAMPLE Casualty numbers and addressograph labels are NOT acceptable on the sample IN ALL URGENT CASES CONTACT THE LABORATORY EXT 3782 OUT OF HOURS CONTACT BMS via SWITCHBOARD afo Patient identified amp blood taken by CAPITALS Date amp time sample collected Ere eeN e x Date amp time sample received in lab A REQUEST FOR BLOOD COMPONENTS Diagnosis Clinical Information PRE OP LOW Hb or Anaemia NOT ACCEPTABLE Consultant Private Y N BLOOD TRANSFUSION LABORATORY REQUEST 1 Blood group and ant
31. lsotracker Reviewed by C Brock Page 109 of 140 Factor VIII F8 3 x Citrate Factor VIII Inhibitor F8l 2 x Citrate Sent to Factor VIllc Assay F8R 2 x Citrate Addenbrookes Factor X HEPL Citrate Factor XI F11 2 x Citrate Sent to Factor XIIE F12R 2 x Citrate Addenbrookes Farmers Lung FL SST FBC FBC 3ml EDTA Frozen Sent to St Feacal Alpha 1 Antitrypsin FA1AT Faeces George s by courier Random Sent to i S Feacal Elastase ELAS Faeces Addenbrookes by 1 class Ferritin FER SST Fibrinogen FIBC Citrate Fibrinogen Degradation Products i Sent to 10ml Lithium Addenbrookes by 1 FISH Cytogenetics FISH Heparin Aine Sent to Addenbrookes or FK506 FK506 3ml EDTA Kings college by 1 class See SOP Flecainide FLEC SST O Flucytosine SST ee m SST 3ml EDTA for f required RCF FBC Follicle Stimulating Hormone FSH SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Reviewed by C Brock Page 110 of 140 Requested with Chromosomes not 10mL EDTA 10ml on Fridays Sent to Fragile X C Lithium Heparin Addenbrooke
32. outweigh the potential risks the most important of these being Acute Haemolytic Reactions and Transfusion transmitted Infections Stringent procedures must be followed to ensure that the correct blood is given and that any adverse reactions are dealt with promptly and efficiently This document has been developed using information from local and national audit and National Guidelines It incorporates recommendations from SHOT Serious Hazards of Transfusion Scheme recently published Guidelines on Blood Transfusion Practice and Guidelines on the use of Blood Derivatives Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 47 of 140 e The Blood Transfusion Policy Document Trust Transfusion Policy is the responsibility of the Hospital Transfusion Committee who are required to formally review and where necessary update the document biannually This procedure will be recorded in the minutes of the Hospital Transfusion Committee The Trust Transfusion Policy is available on the Intranet If any part of the policy is printed off it is the responsibility of senior staff in each department to check that any document complies with the most recent version In the event of computer failure a hard copy of the Trust Transfusion Policy is available in the Transfusion Laboratory e This is a Trust wide policy and is relev
33. positive for mitochondrial nuclear and dsDNA abs 25 Low titre antibodies are found in a few patients with other liver diseases such as viral hepatitis or cholelithiasis Tissue Transglutaminase antibody IgA Tissue Transglutaminase antibodies are present in at least 80 of patients with active coeliac disease It will be absent in patients after 3 6 months on a gluten free diet Patients with Dermatitis Herpetiformis may also have positive coeliac serology All samples with a very low result will have total IgA measured to detect patients with selective IgA deficiency The endomysial autoantigen has been identified as the protein cross linking enzyme tissue transglutaminase tTG Antigen specific EIA assays provide an alternative to the conventional indirect immunofluorescence assay based on primate oesophagus The EIA assay provides a quantitative measurement of IgA anti tTG antibodies and is not adversely influenced by the presence of other autoantibodies such as ANA or ASMA Turn around time 2 working days U RNP antibodies See ENA Anti Voltage Gated Potassium Channel abs anti VGKC Antibodies to voltage gated potassium channel are found in 40 of patients with acquired neuromyotonia Anti Voltage Gated Calcium Channel abs anti VGCC The Lambert Eaton myasthenic syndrome LEMS is a form of myasthenia often associated with small cell lung carcinoma In 50 of cases there is IgG mediated reduction in presynaptic voltage gated calci
34. should be made to the medical staff reporting the case through the histopathology office or histopathology laboratory on 3617 If there is an urgent case please let the laboratory know as soon as possible Out of hours clinical advice and requests The department of Cellular Pathology does not operate a 24 hour service If out of hour s advice is required contact the hospital switchboard to access a Consultant Histopathologist Cytopathology There is no gynaecological cervical screening service available at the Queen Elizabeth Hospital The laboratory acts as a collection and transport provider for LBC samples LBC samples from Norfolk are screened at the Cotman Centre NNUH Colney Lane Norwich and Wisbech cases at Peterborough and Stanford Hospitals All enquiries regarding these samples should be addressed to the referral centre For advice on tests not listed below please contact the laboratory on extension 3617 Non Gynae Cytology All specimens of sputum aspirates and urine must be sent to the laboratory without delay Specimens should not be sent after 16 00 hrs or at weekends An appropriate request card containing the patient s name date of birth hospital number and or NHS number and the reason for request must accompany all specimens For all specimens taken outside of normal working hours these must be stored at 4 8 degrees Celsius Reports will be available after 2 3 working days If a result is required urgently please
35. takes the blood sample for patients too ill to attend The INR result is reviewed by the Nurse Specialists who then dose the warfarin and arrange the date of the next test phoned to the patient by the anticoagulation assistants Once the patient s INR has stabilised they are transferred to either the main anticoagulation clinics or to the community clinics for monitoring of their anticoagulation therapy Patients who attend the main anticoagulation clinics held daily have a capillary INR blood sample taken and are then dosed manually or by a computer dosing system The computer dosing system enables the anticoagulation assistants and laboratory technicians working within agreed protocols to dose warfarin therapy for patients Patients who are due for review of the duration of their warfarin therapy are seen in clinic by one of the Coagulation Sisters The decision to stop therapy is based on the reason if any for the Venous Thromboembolism VTE previous and current medical history if symptoms have resolved and the agreement of the patient Any patients with difficult histories are referred to the Consultant Haematologists Patient leaflets have been produced by the Coagulation Nurse Specialist and Deep Vein Thrombosis DVT Sister to help patients understand their condition why they are on anticoagulation therapy and how it works Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date
36. the detection of circulating IgE antibodies directed against specific antigens in sensitised patients are available for a range of allergens Common assays include animal fur or dander house dust mite tree and grass pollens moulds and a range of food substances including a variety of nuts Tests against allergens in stock have a turnaround time of around 14 days N B Total IgE will be carried out on all RAST requests Clinical details and suspected allergens MUST be stated on the request The use of RAST testing must be carefully considered and is not a substitute for careful clinical assessment Many specific allergens are available for testing however screening for allergy using RAST is not usually helpful If requesting testing please provide as much clinical information as possible The detection of allergen specific IgE in serum is not synonymous with clinical allergy nor does the failure to detect allergen specific IgE exclude the diagnosis Turn around time 2 weeks Scl 70 antibodies Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 94 of 140 See ENA Skin antibodies See Pemphigus and Pemphigoid antibodies Sm antibodies See ENA Smooth muscle antibodies Part of Tissue Autoantibody Screen Present in high titre in up to 70 of patients with autoimmune hepatitis who may also be
37. very high levels may be seen acute and chronic pancreatitis cholangitis and cirrhosis Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 32 of 140 The main clinical indication for the measurement of Ca 19 9 is as a diagnostic aid for pancreatic adenocarcinoma and for monitoring patients who are known to have the disease Alpha Fetoprotein AFP AFP is a glycoprotein which performs some of the functions of albumin in the foetal circulation AFP is usually elevated in the serum of patients with non seminomatous germ cell tumours of the testis ovary and other sites hepatocellular carcinoma and hepatoblastoma Measurement of AFP may be useful for diagnosis and monitoring treatment of patients with these tumour types Non malignant conditions which may give rise to elevated serum levels include hepatitis cirrhosis biliary tract obstruction alcoholic liver disease ataxia telangiectasia and hereditary tyrosinaemia Serum AFP is also increased in pregnancy and the first year of life Infants have extremely high levels which fall to adult values between 6 months and 1 year of age Simple dynamic function tests NB Protocols for a more extensive range of dynamic function tests are available from the Biochemistry Laboratory if required Document Number Qual0035 Version 4 03 Document
38. 035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 9 of 140 Specimen Collection General All biological samples represent a potential health hazard to healthcare staff Please ensure that specimens are properly sealed before transportation to the laboratory Leaking or contaminated samples must not be sent to the laboratory Drivers and porters must follow the model rules as described in the Laboratory Transport Policy Phlebotomy Services Outpatient and GP A phlebotomy service is provided at the Queen Elizabeth Hospital The Phlebotomy blood taking suite is open for outpatient and GP phlebotomy from 08 15 17 00 hours Monday to Friday It is located on the ground floor of the Pathology Department of the Hospital Patients with pre booked appointments for Glucose Tolerance Tests and other pre booked Clinical Chemistry tests are seen from 08 15 with up to 3 patients booked in for 08 15 and 2 booked in for 08 45 Booking system for pre booked Phlebotomy Health care professionals who need to book their patient for GTT should phone extension 3769 in the first instance We operate a queuing system for patients attending for phlebotomy based on sequential ticketing Patients except those attending the Warfarin clinics would be instructed by sign display to collect a ticket from the dispenser attached to the wall adjacent to the reception win
39. 0466 Yes Registered No Urgent 5 Hrs if not 14 Days Tissue Typing HLA B27 1091 Yes Registered No 14 Days Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 135 of 140 Bedford Pophorin 0352 Yes Registered No Not stated Central Middlesex Hospital Haemoglobinopathy 1018 Yes Registered No within 14 days but could be longer Charing Cross Hospital Calcitonin 1050 Yes Registered No Over 7 Days Gastrin 1050 Yes Registered No Over 7 Days Gut Hormones 1050 Yes Registered No Over 7 Days Hallamshire sheffield C1IN 0113 Yes Registered No 7 14 Days Typtase 0113 Yes Registered No 7 days A1AT phenotype 0113 Yes Registered No 7 days CAD 0113 Yes Registered No 7 days Funcab 0113 Yes Registered No 7 14 Days GANG 0113 Yes Registered No 14 Days Gad 0113 Yes Registered No 7 14 Days Subclasses 0113 Yes Registered No 7 14 Days Icab 0113 Yes Registered No 7 14 Days Myag 0113 Yes Registered No 7 14 Days Aspergillus 0113 Yes Registered No 7 days Avain 0113 Yes Registered No 7 days Guildford Insulin 1167 Yes Registered No 7 14 Days assayed on Weds amp Friday c peptide 1167 Yes Registered No 7 14 Days assayed on Weds amp Friday IGF1 BP3 1167 Yes Registered No 7 Days Kings College Hospital Erthropoietin 1245 Yes Registered No 3 5 Working Days PIIINP 1245 Not sent ACC Registered No Not stated Tacro 2321 Not sent
40. 10 15ml Reaction AN arl Clotted 10 15ml 1O NBS same day See Neurone NSE z IS SST Specific Endase Occult Blood FOB Faeces Oestradiol E2 SST Sent to Queens Oligoclonal banding C CSFP SST Square by 1 class Random Sample Sent to Organic Acids C UORGAN Urine Universal Addenbrookes by 1 class Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 119 of 140 Orosomucoids C OROSO SST Osmolality blood C OSMO SST Osmolality Urine C UOSMO Urine Universal 20mLs aliquot 50 Oxalate urine C UOXA 24hr urine mLs 2 5 HCIL P carinii PCR s Saline incuced Sputum Centrifuge freeze sent to P Mets C 3x 6ml EDTA addenbrookes by courier transport tin Pancreatic Polypeptide C GAST oe asi Paracetamol C PARA SST Parainfluenza S SST Parathyroid hormone C SPTH SST UnCuffed Parietal Cell Antibodies IS APCA SST Parovirus B19 S PAR SST Paul Bunnell S SST PCR testing S PCR 6ml EDTA State which organism required Sent 1 class to Pemphigoid pemphigus abs IS PEAB SST Sheffield Also Known as PEP C EP SST ioen l Electrophoresis PET Pre eclamptic toxaemia C SST Phenobarbitone C PHENO SST Phenytoin C PHENY
41. 140 Urgent Requests instructions for non Trust requesters e g GPs Please ensure that any urgent sample sent to the laboratory is clearly labelled as such Please advise us of urgent samples in transit by contacting us Blood Sciences 01553 613771 613779 Microbiology 01553 613772 Transfusion 01553 613782 Please also ensure that you provide a contact number direct line to surgery or personal telephone number so that the results can be reported without delay and often outside of normal surgery hours Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 14 of 140 Instructions for the air tube system The air tube systems are for the transport of pathology specimens to the laboratories Ports are situated in the areas as shown in table 5 Table 5 Location Address Emergency Department A E 100 MAU 110 ITU 120 Stanhoe 234 Microbiology 222 Blood Sciences 211 GU clinic 456 Tilney 808 NICU CDS 111 The air tube system is NOT to be used for Danger of Infection samples blood gases blood cultures or unrepeatable samples Microbiology specimens must not be sent via the air tube after 21 00 hours Please send all these samples by Porter instead Instructions for use of the air tube system 1 Ensure that all samples and accompanying forms are sealed in
42. 21 00 Serology Virology specimens sent out of hours will be processed the next working day Meningitis A BMS is available on call at all times to examine specimens for the diagnosis of meningitis and meningococcal disease High Risk Patients Danger of Infection Advice from Microbiology staff should be sought from the outset in the case of investigation of patients from High Risk Groups All samples and request forms must be clearly labelled Danger of Infection This applies to all specimens suspected of containing hazard group 3 or 4 organisms The list of organisms requiring special precautions are detailed in table 20 Table 20 Mycobacterium spp Salmonella typhi amp paratyphi rucella spp Coxiella burnetti Chlamydia psittaci avian strains reponema pallidum Leptospira icterohaemorrhagia Blastomyces dermatitidis Coccidioides immitis Histoplasma spp L Haemorrhagic fever viruses patitis C virus Ri i B CMvirusess fHepatitis B virus E Human Immunodeficiency virus 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 57 of 140 This list is by no means exhaustive if in doubt about the status of a patient please contact microbiology staff Specimen Reception During normal working hours 08 30 to 16 30 Mon to Fri specimens may either be sent by air tube Not
43. 3 SST Norfolk and Norwich Protein 3 Freeze Sent to Insulin Growth Factor 1 C INSGF1 SST Norfolk and Norwich Sent to N amp N by 1 Intrinsic Factor Antibodies H IFA SST class P Refer to Trust Investigations for Haemolytic PG amp CG amp I Miseace of ihe Newborri XM DAGT Capillary EDTA Transfusion Policy Iron Studies C FE SST Includes FER TIBG Sent 1 class to Islet Cell Antibodies IS ICAB SST Sheffield See ALK Phos ISO ISO enzymes ALKISO C ALKISO SST enzyme ISO enzymes CKMB C CKISO SST JAK 2 H MOLEC 2 x 6ml EDTA Sent to Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 116 of 140 Addenbrookes by 1 class Kaolin Cephalin Clotting Coagulation Sent to Time E H KOGI ee Addenbrookes oes Refer to 10ml Lithium Karyotyping C Heparin Chromosomes Kleihauer Count XM K EDTA 3ml Lactate C LACT Sodium Fluoride Re Lactate Dehydrogenase C LDH SST See LDH Sent to Hallamshire Lamotrigine C LAMO SST by 1 class Only for Haem and LDH C LDH SST ONC consultants Do not separate Sent to trace Lead levels C LEAD 6ml EDTA elements Guilford by 1 class Sent to trace Lead Levels urine
44. 8 In cases where the cause of death is unclear the initial consultation should be with your consultant or other senior medical staff or with consultant Histopathologists In cases of unexpected perioperative drug related or traumatic death or death of a patient with industrial disease the Coroner s office should be consulted For further information and advice contact the Consultant Pathologist Designated Individual Human Tissue Authority or alternative Consultant Histopathologists Requests for Hospital Autopsies The Clinician in charge should contact the Pathologist before the autopsy in order to discuss any points of interest and to state the mode of death to the best of their knowledge The medical team who looked after the patient should discuss the possibility of the autopsy with the relatives If permission is granted the consent form should be completed signed and witnessed Use only Human Tissue Authority Consent forms available from the Bereaved Relative Support office or the Mortuary Advice of Death Certificate and Coroners Before the body is removed it is the responsibility of the doctor concerned to examine the patient whose death is suspected and to establish that death has taken place A registered or pre registered medical practitioner may issue a Death Certificate when he she knows the cause of death knows it to be natural has attended the patient within fourteen days of death and has no reason to refer the case to the
45. ACC Registered No 24hr hours of reciept Urine Steroid Profile 1245 Yes Registered No 21 Days of reciept Llandough Hospital Ethosuxamide 2141 Yes Registered No 7Days clozapine 2141 Yes Registered No 7Days Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 136 of 140 Norfolk and Norwich ACTH O868 Yes Registered No Up to 7 Days test done on a Tuesdat CA153 O868 Yes Registered No Up to 4 Days test done on Monday and Thursday HFE O868 Yes Registered No 10 14 Days HLA B27 0868 Yes Registered No Upto 48hrs test run daily IGF1 O868 Yes Registered No Up to 7 days tests done on a Tuesday IF O868 Yes Registered No Up to 7 Days TT NTP 0868 Yes Registered No 48 Hours 5HIAAQ 0868 Yes Registered No Up to 7 Days UDrugs O868 Yes Registered No 3 Days SFLC O868 Yes Registered No 2 Weeks SHBG 0868 Yes Registered No 2 weeks run on a Tuesday Oxford ACRA 1040 No Registered No Not Stated Queen Square CSF oligoclonal bands 1839 Yes Registered No 7 Days None tau protein 1839 Yes Available No 6 Days Royal Free Hospital None Amyloid A Protein 268 No Available 4Weeks None None CKISO 268 Yes Available Available 3 4 weeks SAS leeds Inspected Sept 170hp 3057 2010 Registered No 6 Days Inspected Sept Andro 3057 2010 Registered No 19 Days Inspected Sept Dheas 3057 2010 Registered No 10 Days Document Number Qual0035 Ver
46. ANCA 2 MPO P ANCA Systemic vasculitis eg Microscopic Polyangiitis Churg Strauss Crescentic glomerulonephritis Various Atypical Wide range of inflammatory infective amp neoplastic ANCA diseases but the clinical utility of atypical ANCAs has not yet been established NB all types of ANCA have been reported in a wide range of other conditions e g infection neoplasia and inflammatory disease as well as vasculitis Serial monitoring of positive ANCAs may be valuable in the course of clinical disease Patients with treated vasculitis can remain weakly ANCA positive for years in clinical remission Aspergillus fumigatus IgG precipitins Associated with Allergic Broncho Pulmonary Aspergillosis ABPA which usually presents as deteriorating or brittle asthma IgE antibodies should also be checked This test is also useful in pulmonary aspergilloma fungus ball which may form in cavities or bronchiectatic lung and hence may be of use in assessing aspergillus colonisation in Cystic Fibrosis and asthma Aspergillus species can also cause invasive aspergillosis IA IA is the most difficult to diagnose is most common in AIDS and lung transplant patients is often fatal and occurs only occasionally in non immunocompromised individuals Avian IgG precipitins Positive levels indicate exposure to pigeon antigens and may be associated with Bird Fancier s Lung The IgG precipitating antibodies will react particularly with avian serum and f
47. Birmingham Birmingha University of Abid R Accredited Clinical m Birmingham Karim Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 96 of 140 Immunology Division of Immunology 0121 415 Service and Infection 8797 Vincent Drive Results on Edgbaston 0121 414 Birmingham 3824 B15 2TT Norfolk and Norwich Biochemistry University Hospital Dr lan amp Norwich coney Lang Jhirkettig Accredited Immunology Norwich 01603 NR4 7UY 286922 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 97 of 140 Appendix 1 Current version April2013 Test container guide L Dark green lithium heparin without gel S Refer to consultant E Light green lithium heparin with gel RT Room Temperature i Lavender EDTA C Chemistry Gold clotted with gel Haematology E Red Clotted XM Transfusion S Serology Light blue citrate IS Immunosciences Referred out Specimen Discipline Code Container PEE Details nstructions BHCG C QHCG SST 17 Hydroxyprogesterone C 170HP SST G sent to Leeds U5H1AA 24hr urine 10mLs Acer alt
48. Coroner Categories which should be reported to the Coroner 1 Sudden and unexpected deaths in adults and infants 2 Deaths involving accidents violence neglect or poisoning 3 Deaths on the operating table or before the patient has regained consciousness after anaesthesia Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 82 of 140 Death which might have been caused by an industrial injury or disease H M prisoners or other detained persons under court order Maternal deaths Falls Pia The Coroners Officer can be contacted at King s Lynn Police Station Relatives Agreement Hospital Post mortem Examination e Relatives written agreement to the examination is required to be given on a standard form that the deceased had expressed no objection during life or the relatives next of kin e Relatives consent to retain tissue samples or organs must be obtained on the form for agreement e The consent form and the accompanying information following the recommended style by the Human Tissue Authority are explicit and the form distinguishes between retention for the purposes of verifying the cause of death and investigation of the effects of treatment and retention for medical education and research e Relatives are also given the options for the lawful disposal of any retained tissue Paediatr
49. DNA i or PCR mentioned Hepatitis C Virus S HCV SST then 6ml EDTA also required Hepatitis D abs S SST Hepatitis E lgG IgM S SST Herpes Simplex S HSV SST CSF Sample 6ml Herpes Simplex Virus DNA S EDTA Sent to N amp N by 1 HFE H HFE 3ml EDTA class Part of High Density Cholesterol HDL C TCHOL SST al Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 114 of 140 Refer to Transfusion Must be in time to go Histocompatibility amp Immunogenetics XM SPI for request form to NBS same day Sent to Sheffield by Histone Antibodies IS HIST SST 1 class Histoplasma S SST Consent to testing ny ar required HIV Maternal transmission S 6ml EDTA HIV proviral DNA PCR S 6ml EDTA HIV resistance testing S 6ml EDTA HIV Viral Load S 6ml EDTA Must be in time to go eas Refer to Transfusion HLA Antibodies Anti paternal XM SPI for request form to NBS same day Mon Thurs Sent to N amp N in tins HLA B27 H B27 3ml EDTA HLA Class amp Il typing of Patients amp XM SPI Refer to Transfusion Polen go Family Members for request form y l Must be in time to go HLA Class typing for HLA Matched Refer to Transfusion Platelets ANI hi for request form IO
50. Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 11 of 140 A nurse led DVT clinic is now held on a daily basis This has relieved resources for MAU and is of benefit to patients as one person now cares for them from initial consultation to diagnosis or exclusion of DVT Contacts Anticoagulation Sisters Phone bleep 2798 2195 Pat Fysh Anticoagulation Referrals Phone 3355 Handling and Labelling Danger of Infection Specimens 1 It should be confirmed on the request form that appropriate counselling has been given and consent obtained from the patient before samples for HIV testing are despatched to the laboratory 2 All high risk Danger of Infection samples e g Hepatitis B or C HIV TB etc samples must be identified with the use of a high risk label yellow amp black Danger of Infection label and double bagged in the approved plastic bags 3 Each specimen must be accompanied by a request form which must also be highlighted with a high risk label 4 The bags should also be high lighted with a high risk label Ward clinic department staff are responsible for ensuring an adequate supply of labels are made available Availability of clinical advice and interpretation Interpretation of the results of laboratory tests and clinical advice is always available and is provided by the Departmental Consultants as shown in table 4 Table 4 Consultan
51. L blood films fixed by medics Sent to 3ml EDTA London Hospital See SOP Renal C R SST Sent 1 class to Renal Calculus C STONE Renal Stone Piring na Respiratory Syncytial virus S RSV NPA RETICS H RETIC 3ml EDTA Reticulocytes RETIC 3ml EDTA Rhinovirus NPA Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 122 of 140 Rickettsial S SST Sent to Ristocetin Co Factor H RICOF Citrate x 4 ad iadi Ross River S SST RPR S SST RSV S RSV NPA Rubella S RUB SST Salicylate C SALS SST SBR C SST Must be in time to go Screening for HLA Class Refer to Transfusion Antibodies AM an for request form ONE aguas Must be in time to go l a Refer to Transfusion Screening for HPA Antibodies XM SPI for request form to NBS same day Sent to bet Bone Marrow Aspirate pase ata Marrow Blood Film H MORPHA amp Trephine slides or Se by PER Blood film Sent to trace elements Guilford by Selenium C SE SST 1 class Sero Conversion Hepatitis B post S AHBS SST vaccine Serum Bilirubin C SST Serum free Light Chains C SFLC SST Sent to N amp N Sex Hormone Binding Globulin Sent to N amp N SHBG C SHBG SST Sezary Cells H FI 3ml EDTA Les
52. MAXIMUM of 48 hours prior to likely transfusion to avoid the risks of newly developed antibodies Patients with atypical antibodies will require blood to be specifically ordered and therefore such cases MUST be discussed with the laboratory prior to operation Unusual cases should also be discussed with the laboratory Note that it is the clinicians responsibility to ensure that the laboratory has received satisfactory samples and that blood will be available on the date of operation ACCORDING TO THE DISCRETION OF THE CONSULTANT FOR PATIENTS GOING TO THEATRE OUT OF HOURS BLOOD SHOULD BE REQUESTED Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 53 of 140 Transfusion Reactions More detailed information is available in the Trust Transfusion Policy document In the event of a possible transfusion reaction a completed request for investigation of suspected transfusion reaction form available in the Trust Transfusion Policy on the intranet together with the following samples must be sent to the transfusion laboratory 1 Bags of all transfused products given to the patient prior to and during the reaction 2 6mls EDTA blood sample 2 3 mls EDTA blood sample A Where possible first specimen of patient s urine Turnaround time The
53. Months 0 40 to 1 60 9 Months 1 Year 0 60 to 2 10 1 Year 9 Years 0 50 to 2 20 9 Years 99 Years 0 50 to 1 90 99 Years 150 Years 0 50 to 2 00 Male 11 6 to 31 3 umol L oon oe Female 9 to 30 4 umol L Iron Saturation SAT No Range Lactate LACT 0 50 to 2 20 mmol L Lactate Dehydrogenase LDH 120 to 246 U L Lithium LI 0 6 to 0 8 mmol L Low Density Lipoprotein LDL No Range mmol L Follicular 1 9 to12 5 ee Luteal 0 5 to16 9 Luteinizing Hormone LH Post Menopausal 15 9 to 54 IU L Male 1 5 to 9 3 MAG Serum 0 53 to 1 11 mmol L Magnesium 24UMAG 24 hour urine 3 00 to 5 00 mmol 24hr UMAG Random urine No range mmol L Metadrenaline UMET Urine 0 200 nmol 24hrs Microalbumin UALB Random urine No range mg L Noradrenaline UNOR Urine 0 700 nmol 24hrs Normetadrenaline UNMET Urine 0 390 nmol 24hrs Male lt 146 pmol L Oestradiol E2 Pos lt 118 Female Menopausal pmol L Reproductive 72 1309 Osmolality OSMO Serum 280 to 300 mOsmol kg UOSMO Urine 300 to 1100 mOsmol kg Parathyroid Hormone PTH 1 50 to 7 60 pmol L pco2 PCO2 Blood gas 4 7 to 6 0 KPa pH PH Blood gas 7 35 to 7 45 PO4 Serum 0 78 to 1 65 mmol L Phosphate UPHOS Urine No range mmol L 24UPHO 24 hour urine 12 9 to 42 0 mmol 24hr pO2 PO2 Blood gas 10 to 14 KPa Phenobarbitone PHENO 15 to 40 mg L Phenytoin PHENY 10 to 20 mg L K Serum 3 5to5 mmol L Pot ssidm 24UK 24 hour urine 25 to 125 mmol 24hr UK Random urine No Range mmol L K Blood gas 3 5 to 5 0 mmol L Procalcitonin PCT 0 0 5 ng ml Follicu
54. Mortuary Lead 2561 Maureen Phillips a Locum New 3684 Relative Support 3878 Sasha Munnelly Secretary ML 3702 CYTOLOGY Lisa Robinson Secretary LC EG 3329 Cytology Enquiries 3020 Claire Atterbury Transfusion CNS 2620 2795 Lynne Macmillan Senior BMS 3020 alder aes ee Haematology Sisters 2795 1277 ee ee y Anticoagulation Sisters A 3355 IMMUNE SCIENCES ANDROLOGY Pat Fysh Anticoagulation Assistant 3355 Karen Ashurst Lead Scientist 3207 Sam Fairless Transfusion Admin 3561 David Pemberton Point of care Manager 3599 9am 5pm PATHOLOGY FAX NUMBERS PATHOLOGY 01553 613955 BLOOD SCIENCES amp TRANSFUSION 01553 767742 MORTUARY 01553 613266 CELLULAR PATHOLOGY 01553 613070 E MAIL Pathology staff can be e mailed at forename surname qehkl nhs uk Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 6 of 140 Pathology Reception Opening Hours The Pathology Reception is open for receipt of specimens at the following times Monday Friday Reception General enquiries can be made by phoning 08 00 17 00 01553 613769 The Phlebotomy blood taking suite is open for outpatient and GP phlebotomy from 08 15 17 00 hours Monday to Friday It is located on the ground floor of the Pathology Department of the Hospital Patients with pre booked appointm
55. Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 33 of 140 The Queen Elizabeth Hospital NHS King s Lynn NHS Trust BNP Request Form Consultant Chemical Pathologist Blood Sciences Department Hospital NO ccccccceee ee Date Of Birth 12 cccccccceccneeeeee een eeeeeceenaeeeesaeees SUIM ING eins ciciscaeds casscanethenatvsasd r io FOPENAME S oo ccc ccececccececceceeesueeeceeeueeeuaueuueeeeues Male _ Female PaO LO lE AE sect cay cng cbedeh ae A inte tied ca A EA ic Saadea ak dame can gnagsa AES Affix adrema label above if available Name OF GP ag caccceccececenet sags annee chested SUIQELY sessin aranan Heese Sample required 3mL EDTA Date of Sample ccccccccec nee eeee ee eeeeeneeeeenees Time of collection 0 2 cceceeec tee c eee teen ee eeeeeeneeneeeaes Symptoms Breathlessness L On exertion L At rest L None Oedema L Yes L No Fatigue L Yes L No Investigations Chest X ray L Normal L Abnormal L None done yet ECG L Normal L Abnormal L None done yet Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 34 of 140 Department of Chemical Pathology Specimen requirements Adult Reference and therapeutic drug ranges Tests not appearing on this l
56. Ps OPD s results will be phoned if they are outside the Action Limits over the page Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 23 of 140 If Apex Ward Enquiry is not working Same as above but we will endeavour to telephone all A amp E ITU MAU and SCBU results Telephoning Abnormal Results Table 7 shows the action limits for telephoning abnormal no previous history chemical pathology results Table 7 Test Result Result Units Sodium lt 126 gt 150 mmol L Potassium lt 2 8 gt 6 1 mmol L Urea N A gt 15 0 mmol L Creatinine N A gt 250 umol L Non diabetic glucose lt 2 8 gt 15 mmol L Diabetic glucose lt 2 8 gt 20 mmol L Adjusted calcium lt 1 8 gt 2 85 mmol L Chloride lt 80 gt 110 mmol L Amylase N A gt 300 UI L Digoxin N A gt 2 7 ug L CK N A gt 400 U L Paediatric Bilirubin N A gt 300 mmol L Lithium N A gt 1 20 mmol l Phosphate lt 0 3 mmol L AST 15 X upper limit of normal ULN U L ALT 15 X ULN U L Carbamazepine gt 25 mg L Theophylline gt 25 mg L Phenytoin gt 25 mg L Phenobarbitone gt 70 mg L Triglyceride Greater than 20 mmol l CRP Greater than 300 mg L Troponin GP Greater than 0 04 Results that are critical as defined above with no previous history will be telephoned to the requesting ward clinician GP as soon as possible and a comment of the action will be e
57. Qual0035 Version 4 03 June 2013 Pathology user guide 2013 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Introduction The guidance in this handbook has been written as a guide for all users of The Queen Elizabeth Hospital King s Lynn Pathology services to enable clinical staff to make the best use of our Pathology services Should you have queries with regard to any aspect of the service staff members will be pleased to discuss these with you Histopathology Blood Sciences Transfusion and Microbiology Laboratories are accredited by CPA and we regularly update our facilities and equipment We welcome enquiries to visit our laboratories This handbook builds on earlier issues with amendments to inform on changing service developments The authors would welcome comments and suggestions for the next edition Dr Lisa Cooke Director of Pathology 01553 613621 e mail lisa cooke qehkl nhs uk Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock For details of other Senior Pathology Staff please see first page of each Departmental section Contents Page General 6 _Pathology opening hours 7 Requests and results Anticoagulation services z I
58. Reference Laboratory Singleton Hospital Swansea SA2 8QA 01792 285055 Department of Clinical Parasitology Hospital for Tropical Diseases Mortimer Market Capper Street London WC1E 6AU Tel 020 Schistosomal antibodies bilharzia 7387 4411 Amoebic FAT Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 69 of 140 Notification of Infectious Diseases Please consult the Trust Policy Duty to notify suspected disease infection or contamination in patients Infection Prevention and Control Service Appropriate advice on infection control issues for Trust staff will be facilitated by members of the Infection Prevention and Control Service Relevant Infection Control guidelines and policies are located on the Trust Intranet Members of staff may require advice on infection control issues relating to Clinical issues e g Source isolation Protective isolation Patients with infections Staff contact with infectious diseases Outbreak management Exposure to microbiological hazards Environmental issues e g Decontamination of environment equipment Spillages Waste management Food hygiene The Infection Prevention and Control Service will provide appropriate education for all Trust employees as appropriate and negotiated with departmental heads
59. Stiff man syndrome and in IDDM where the titres are much lower The contribution of GAD abs to IDDM has not been proved Histone antibodies In cases of suspected drug induced SLE the antibodies are more likely to be directed against the histone moiety of the nucleoprotein complex than to the dsDNA IgG Subclasses IgG subclass deficiency is mainly related to IgG1 and IgG2 where individuals suffer recurrent infections as they are unable to mount an antibody response against organisms Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 90 of 140 IgE total Part of Allergy Test Screen Serum IgE may be helpful in the confirmation of atopic diseases however the normal range is very wide and levels do not correlate well with symptoms A high level of specific IgE to a single allergen may be seen with a normal level IgE Very high levels of IgE are seen both in atopic eczema and in parasitic infestations and also in the rare hyper IgE syndrome Turn around time 2 weeks Jo antibodies See ENA antibodies LKM antibodies Liver Kidney Microsomal Part of Tissue Autoantibody Screen These antibodies which stain the cytoplasm of hepatocytes and proximal renal tubules are found in a subgroup of patients with ANA negative autoimmune chronic active hepatitis CAH LKM antibodies are positive in CAH type 2 which
60. TEST SST sex when booking in TFT C TFT SST TG C TG SST See Alpha Thalassemia Screen H HBOP 3ml EDTA thalassemia screen Theophyline C THEO SST O Sent to St Thiopurine Methyl Transferase C TPMT 6ml EDTA Thomas by 1 class Thromboexact H FBC 3ml EDTA and Form and both Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 124 of 140 special samples to Haem thromboexact tube Sent to SI Thrombophilia Screen H TPSA Citrate x3 P ay INR clinic Thrombotest H INR Citrate Fingerprick Prerequisite TSH Thyroglobulins C THYRO SST FT4 sent to UHW by 1 class Thyroid Antibodies C TPO SST Thyroid Binding Globulin C TBG SST Thyroid function test TFT TSH C TFT SST TIBC C TIBC SST Sent to Tissue Typing HLA H HLA 3x 6ml EDTA Addenbrookes by courier Tobramycin S REFSER SST Full clinical Torch S SST details dates required Total Iron Binding Capacity C TIBC SST Toxocara abs SST Toxoplasmosis S TOXO SST O Sent to St TPMT C TMPT 6ml EDTA Thomas by 1 class TPPA S SST See Anti TSH TRAB C TRAB SST receptor Abs Transferrin C FE TIBC SST TRH C TRAB SST Triglycerides C TG SST Troph Whippelii DNA S 6ml EDTA Troponin C TROPI SST
61. UCRE 24 hour urine 9 to 16 mmol 24hr UCRE Random urine No range mmol L gt Male 32 to 294 U L Creatinine Kinase CK Female 33 to 211 U L Digoxin DIG 0 78 to 2 0 ug L Direct Bilirubin DBIL 0 to 3 4 umol L Dopamine UDOPA Urine 0 3300 nmol 24hrs Indirect Bilirubin IBIL No range umol L Estimated Glomerular EGFR gt 90 mL mn 1 7 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 35 of 140 Assay Code Comment Reference Range Units Filtration Rate eGFR Ethanol ETOH No range mg dL it Male 22 to 322 ng ml conn a Female 10 to 291 ng ml Deficient lt 3 4 ng ml Folate SF Indeterminate 3 4 to 5 4 ng ml Normal gt 5 4 ng ml Follicular 2 5 to10 2 A F Luteal 1 5 to 9 1 Follicle Stimulating Hormone FSH Post Menopausal 23 0 to 116 IU L Male 1 4 to 18 1 Free T3 FT3 3 5 to 6 5 pmol L Free T4 FT4 11 5 to 22 7 pmol L Gamma Glutamyl Male 0 to 73 Transferase Got Female 0 to 38 Ua Globulin GLOB 12 to 40 g L GLUC Serum 3 2 to 6 0 mmol L Glucose CGLUC CSF No range mmol L GLUC Blood gas 3 2 to 6 0 mmol L Growth Hormone GH No Range ug L i HBDCCT 3 8 to 5 4 MASMOJIORINATIE HBIFCC No Range mmol mol Haptoglobin HAPT 0 30 to 2 00 g L High Density Lipo
62. UNESME g y 9 f y Must be within one week of 1 week of 1 day antigen referred antigen onset onset Date of onset required Swab in Virus culture Culture of mucosal The detection of HSV and viras sites transport 2 weeks referred enteroviruses Culture of faeces medium Faeces PCR for HSV VZV Investigation of viral CSF PCR for encephalitis and meningitis enteroviruses Viral PCR PCR for HIV Investigation of congenital Purple top 12 Weeki referred PCR for CMV HIV CMV reactivation HCV EDTA blood PCR for hepatitis C infection and others PCR for other viruses HIV viral load Quantitative HIV The monitoring of HIV Purple top co anedk referred RNA infection EDTA blood 4 is Bronchial Pneumocystis carinii STO PTOVIRP Gene OL ter washings Pneumocystis eyes infection in immunodeficient 1 3 days y patients Induced sputum Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 65 of 140 Reference laboratories Test Reference Laboratory Adenovirus CFT Adenovirus antigen Adenovirus antigen test Adenovirus DNA Anti HBc total Anti Dnase B AVIAN PRECIPITINS Br melitensis aggn test Brucella abs CFT C burnetii CFT Chlamydia CFT CMV CFT Coxsackie B Enterovirus Enterovirus CFT Erythrovirus B19 IgG HBsAg confirmatory
63. ad Gorleston Great Yarmouth Norfolk NR31 6LA Main switchboard 01493 452452 Bacterial Identification Laboratory of Gastrointestinal Pathogens HPA Centre for Infections 61 Colindale Avenue London NW9 5EQ Tel 020 8327 7116 Mycology Reference SouthWest HPA Laboratory Myrtle Road Kingsdown Bristol BS2 8EL Tel 0117 342 5028 Leptospira Leptospira Reference Unit LRU Department of Microbiology and Immunology County Document Number Qual0035 4 03 Version Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 68 of 140 Hospital Hereford HR1 2ERT Tel 01432 277707 Oxford Immunotec 94 Milton Park Milton Abingdon Oxfordshire Tel 01235 442780 T SPOT TEST Dengue fever Rickettsial Ross river Porton Down Salisbury Wiltshire SP4 0JG 01980 612 100 Lyme Borreliosis Unit Lyme RU Southampton Southampton Laboratory B burgdorferi abs Level B South Laboratory Block Southampton General Hospital Southampton SO16 6YD Tel 023 8079 6408 The Regional Antimicrobial Reference Laboratory Department of Medical Antibiotic levels Microbiology North Bristol NHS Trust Southmead Hospital Bristol BS10 5NB Tel 0117 959 5653 Toxoplasma IgM Toxoplasma DNA Toxoplasma IgM etc CYSTICERCOSIS SCREEN HYDATID Toxocara abs Amoebiasis serology Toxoplasma
64. aecal proteins The presence of precipitins does not automatically mean that disease will be present as positive results may be seen in some healthy individuals exposed to birds Any bird species is capable of inducing precipitins but the most common causes are pigeons psittacine cage birds and domestic poultry occupational disease High levels may be found in severe acute disease Beta 2 Glycoprotein I antibodies lgG M Beta 2 glycoprotein antibodies are 50kD plasma proteins apolipoprotein H that inhibit the intrinsic coagulation pathway ADP mediated platelet aggregation and the prothrombinase activity of activated platelets Anti cardiolipin abs bind to an altered form of B2GP1 which may be reproduced by binding B2GP1 directly to an ELISA plate The detection of anti B2GP1 abs is said to have enhanced specificity for APS and related coagulation disorders over the traditional anti cardiolipin assay which may display some false positive results due to cross reactivity of these abs with some infectious disease related antigens Brain antibodies See Neoplastic antibodies Cardiac antibodies Serum Negative Though the diagnostic value is low these abs are found in some patients with Dresslers syndrome following myocardial infarction after cardiac surgery in some cardiomyopathies and after acute rheumatic fever Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by lsotra
65. aemia 20 These antibodies have a strong association with pernicious anaemia and autoimmune gastritis 90 positive Low titres are commonly found in normal elderly females If positive the more specific assay for antibodies to intrinsic factor is performed This is reported as part of the Tissue Autoantibody Screen request Turn around time 1 week N B Clinical Biochemistry carries out assays for Vitamin B Gliadin antibodies This test has been superseded by Tissue Transglutaminase antibodies see below Glomerular basement membrane antibodies These antibodies test for Goodpastures syndrome which is a rapidly progressive glomerulonephritis Antibodies to the non collagenous portion of type IV collagen are detected by EIA as indirect immunofluorescence is both less sensitive and less specific being positive in only 75 or less of proven cases The antibody levels can also be of value in monitoring response to therapy of this disease Urgent requests for GBM abs as with ANA ANCA and dsDNA abs must be arranged with the laboratory If the laboratory is contacted arrangements can be made to carry out a test with results ready in 4 hours during the working day if received by 13 00 hrs Turn around time 1 working day Glutamic acid decarboxylase GAD Glutamic acid decarboxylase GAD is an enzyme concentrated in neurons which control muscle tone and exteroreceptive spinal reflexes Antibodies to GAD are found in 60 of patients with
66. ak end of day If the requester is able to confirm all of the labelling on the specimen is correct but an error was made in completing the form then the specimen may be processed so long as a new request form is generated by the requester delivered by hand for work on site or by fax from outside It is not permissible for the Pathology staff to alter or correct any of the labelling on the form or specimen If the requester refuses to provide a new request form the matter should be referred to a senior BMS If the requester confirms all details on the form as correct hence the sample data is incorrect then a new sample must be requested In the event of the requester insisting upon the analysis of the current incorrectly labelled sample the matter should be referred to a senior BMS Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 129 of 140 Appendix 3 Unlabelled Specimen Policy This policy sets out the action to be taken by the Sample preparation staff in the event of receipt of unlabelled specimens or forms Unlabelled specimens Unlabelled specimens are not processed unless they are unrepeatable e g Histology Cytology specimen or CSF In the case of these samples the sample preparation Staff should bring the sample to the attention of a senior member of the lab staff as soon as it is receiv
67. ame Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 76 of 140 Reference Values of Semen Variables WHO 2010 manual 5 Edition Semen variable Reference level Lower reference limit Sperm Concentration 15 million per ml 12 16 million per ml Total sperm number per 39 33 46 ejaculate millions Total Motility 40 38 42 Morphology Normal A 3 4 forms Volume ml 1 5 1 4 1 7 pH gt 7 2 Crystal microscopy This test is for the identification of uric acid and calcium pyrophosphate crystals in joint fluids Please send the aspirate in a plain universal container and dispatch to the laboratory on the same day If further analysis is required for example culture and sensitivity please indicate on the request form Please refrigerate the sample at 2 8 degrees Celsius Cytogenetics The laboratory refers all samples requiring cytogenetic analysis to the Regional Genetics Laboratory in Cambridge The transport media required for the sample can be obtained from the Histopathology laboratory upon request Only a small stock is kept so it is necessary to contact the laboratory in advance Specimens destined for cytogenetic analysis must be received dry unless the tissue is already in transport media If histology is also required please send the specimen dry and laboratory personnel will select the appropriate tissue and dispatch to Cambrid
68. amp REASON FOR INVESTIGATION NAM EB saasenesene ences eeeneseac sentences PLEASE TICK DATE OF BIRTH O INFERTILITY ADDRESS L post vASECTOMY CLINIC GP PRACTICE L VASECTOMY REVERSAL CONSULTANT GP THE POT MUST ALSO BE LABELLED WITH THE PATIENTS NAME AND DATE OF BIRTH INSTRUCTIONS TO PATIENTS IT IS IMPORTANT THAT YOU DO NOT HAVE INTERCOURSE OR EJACULATE FOR 3 5 DAYS PRIOR TO SAMPLE PRODUCTION YOU MUST PRODUCE A SPECIMEN OF SEMEN NOT URINE IN THE CONTAINER PROVIDED BY YOUR DOCTOR OR CLINIC DO NOT USE A CONDOM TO COLLECT THE SPECIMEN YOU MUST KEEP THE SPECIMEN AT BODY TEMPERATURE UNTIL IT IS HANDED OVER AT THE HOSPITAL FOLLOW THE SIGNS TO PATHOLOGY RECEPTION QUESTIONS 1 6 BELOW MUST BE COMPLETED BEFORE ATTENDING YOUR APPOINTMENT 1 DATE SPECIMEN PRODUCED 2 TINIE OF PRODUCTION 3 WAS ANY OF THE SPECIMEN LOST OR SPILT YES NO 4 1HAVE NOT HAD SEXUAL INTERCOURSE OR EJACULATED FOR AT LEAST DAYS 5 1 CONFIRM THAT I HAVE KEPT THE SPECIMEN AT BODY TEMPERATURE SINCE PRODUCTION i e COAT POCKET YES NO PATIENTS REPRESENTATIVES SIGNATURE FOR LABORATORY USE ONLY RECEIVED BY DATE amp TIME RECEIVED
69. ample for D Dimer cannot be processed All samples for coagulation should be processed within 4 hours of venepuncture ESR samples bottles must always be correctly filled otherwise anticoagulant dilution will cause inaccurately high results Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 133 of 140 Appendix 6 Instructions for transportation of samples Sample Deliveries All samples delivered to the laboratory reception area must be in the correct sealed packaging if not they will be disposed of in the appropriate manner All samples should be labelled correctly and placed inside the request form leak proof specimen carrier sample transit bag Please do NOT remove the absorbent paper insert found inside the specimen carrier bag as this is in place to minimise any spills from the samples All samples should then be placed in the large plastic bag labelled Pathology Diagnostic Specimens Handle with Care the bags are colour coded by individual department This should then be passed on to the Driver from the Queen Elizabeth Hospital who will then transport the samples to the hospital If the large metal carrier tins are available the samples in the appropriate carrier bag may be used Please ensure that sample container caps are screwed on tight and the samples securely sealed in its transp
70. ance as the samples have to be handled in a special way Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 26 of 140 Investigation of suspected phaeochromocytoma and carcinoid For suspected phaeochromocytoma the initial screen is measurement of 24 hour urinary free catecholamines adrenaline noradrenaline and dopamine In addition to physiological stress a number of drugs may interfere with the results including labetalol atenolol captopril enalapril lisinopril tricyclic antidepressants phenothiazines MAOIs dopaminergic drugs eg levodopa It is preferable to instruct patients to stop beta blocking or dopaminergic drugs for 2 days prior to collection However this may be contraindicated in some patients where a rebound hypertensive episode can be precipitated There are no dietary restrictions other than to refrain from excessive coffee intake Sample 24 hour urine Collection Note that the container supplied contains an acid preservative The appropriate collection instructions are issued with each container The patient is instructed not to void urine directly into the container It is important to reinforce this precaution A single 24 hr urine collection is usually sufficient However in the presence of highly suggestive symptoms such as paroxysmal hypertensive episodes multiple 24 hr urine c
71. ansfusion Association of Anaesthetists 2001 British Committee for Standards in Haematology 2001 Scottish Intercollegiate Guidelines Network 2001 Many patients undergoing elective surgical operations should not require transfusion support if their Hb concentration is normal before surgery Assuming Normovolaemia has been maintained the Hb can be used to guide the use of red cell transfusion R2 Hb concentration below 70g l R3 Hb concentration below 90g I in patient with known Cardiovascular Disease or those with significant risk factors for Cardiovascular Disease e g elderly patients and those with Hypertension Diabetes Mellitus Peripheral Vascular Disease Critical Care British Committee for Standards in Haematology 2001 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 48 of 140 R4 Transfuse to maintain the Hb gt 70g I Post chemotherapy R5 There is no evidence base to guide practice Use a transfusion threshold of a Hb of 9g dl Radiotherapy R6 Transfuse to maintain Hb above 100g l Chronic Anaemia British Committee for Standards in Haematology 2001 R7 Transfuse to maintain the Haemoglobin just above the lowest concentration which is not associated with symptoms of anaemia Many patients with chronic anaemia may be asymptomatic with Haemoglobin concentration gt
72. ansfusion or Ext 3771 Blood Sciences or page the relevant shift staff outside hours via Switchboard to arrange immediate action During normal working hours phone 3771 3779 to expedite test results if they are not available within 2 hours of booking on the laboratory computer Outside hours Mon Fri 18 00 to 08 00 Weekends 24 hour cover on Saturday Sunday The Biochemist and Haematologist on call will pick up samples deposited in the laboratory fridge by porters every 2 hours and analyse and report these within the hour There are scheduled runs at 6pm 8pm 10pm midnight 2am 4am 6am There is NO NEED to page the on call staff unless the sample is for the immediate management of the patient e g malaria CSFs massive blood loss etc Response times for urgent requests The target turnaround time between arrival in the lab and the reporting time of urgent requests such as U amp E FBC is 2 hours Current turnaround time is less than 1 hour for high dependency areas such as A amp E Medical Assessment Unit Intensive Care Unit Unexpected grossly abnormal life threatening results will be telephoned as soon as they are available see telephoning policy Blood Transfusion requests MUST be bleeped to Haematology BMS in every event Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 13 of
73. ant Haematologist 3779 3779 the duty Haematology BMS via Switchboard contact via switchboard Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 40 of 140 Laboratory Services provided Table 13 outlines the routine laboratory services provided within haematology and specimen requirements Table 13 Tests Specimen Bottles Full blood count differential film reticulocytes 1x purple EDTA 3ml Hb electrophoresis malarial parasites Glandular Fever screening test 1x purple EDTA 3ml Solubility testing for HbS G6PD screen 1x purple EDTA 3ml 1 x Viesse Vesmatic 30 1 ml FoR tube Coagulation Please note that is essential that samples for Coagulation must be filled correctly and NOT haemolysed otherwise they will be rejected For paediatric samples please discuss with laboratory on extension 3779 Screening tests anticoagulant control FDP s D Dimers 1x blue citrate 2 7ml Factor assays 2x 2 7ml Thrombophilia screening 4 x citrate 1 EDTA 1 gel Special notes e Sickledex solubility Test not valid for infants lt 6months please request Hb electrophoresis e The department offers Haemoglobinopathy screening As from April 1 2007 all women will be offered antenatal screening as a part of the National Antenatal and Newborn Screening p
74. ant to all clinical workers involved in the blood transfusion process Blood transfusions must be conducted within this Trust according to the procedures contained in this policy Managers are responsible for ensuring that all staff who give blood transfusions have been assessed as competent in procedures which ensure that the correct blood is given e Annual Transfusion risk updates are mandatory for all clinical and non clinical staff involved in the transfusion process from vein to vein Managers must ensure that evidence of competency is reviewed at appraisal Transfusion Indication codes for requesting and prescribing blood components Red cell concentrates Acute Blood Loss British Committee for Standards in Haematology 2001 R1 Objective to maintain circulating blood volume and haemoglobin Hb concentration gt 7 g dl in otherwise fit patients and gt 9g dl in older patients and those with known cardiovascular disease 15 30 loss of blood volume 800 1500m in an adult transfuse crystalloids or synthetic colloids Red cell transfusion is unlikely to be necessary 30 40 loss of blood volume 1500 2000m1 in an adult rapid volume replacement is required with crystalloids or synthetic colloids Red cell transfusion will probably be required to maintain recommended Hb levels gt 40 loss of blood volume gt 2000m in an adult rapid volume replacement including red cell transfusion is required Peri operative Tr
75. arker C CA19 9 SST A Urine universal 3m Cadmium C EDTA Sent to trace 3 CAERUQ amp elements Guilford by Caeruloplasmin Copper C CUQ SST 1 class On ice freeze Calcitonin C CALCIT 6mlEDTA Sent to Charing Cross by courier Calcium C CAL SST eneuniee Carbamazapine C CARB SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 104 of 140 Carbohydrate deficient transferring CDT amp IS SST See Carbon Monoxide levels C COHB Lithium Heparin A Carboxyhaemoglobin C COHB Lithium Heparin Honotgeparaig Carcino Embryonic Antigen C CEA SST Cardiac C C CK SST Sent 1 class to Cardiolipin Antibodies IS CARD SST Addenbrookes 20 ml aliquot i Record volume Catecholamines urine C 24UCAT 24hr urine ensure pH lt 3 0 Copy of FBC results CD4 CD8 SUBSETS H SUBS 3ml EDTA Bova MON ee Do not refrigerate See Carbohydrate CDT IS SST deficient transferring See Carcino CEA G CEA wail Embryonic Antigen Chlamydia genital S CHY Swab Chlamydia respiratory psittacosis S NCHY SST Chloride C CL SST CHOL Cholesterol Total cholesterol HDL C TCHOL SST Cholinesterase C PCHOL SST Cholinesterase for Suxamethonium Sent to So
76. armers lung ppt HPA Regional Laboratory Bristol Myrtle Road Kingsdown Bristol BS2 8EL Tel 0117 342 5028 Hepatitis E IgG Hepatitis E IgM HHV 6 amp 8 Human herpes virus Hep D antibodies HIV Proviral DNA PCR Maternal transmission HTLV Human T lymphotropic virus HPA Colindale Cfl VRD HPA Cfl Colindale 61 Colindale Avenue London NW9 5HT Tel 020 8327 6017 6266 B quintana IgM Cat scratch B henselae IgG Cat scratch B henselae IgM B quintana IgG B pertussis IgG B pertussis HPA Colindale Cfl RSIL HPA Cfl Colindale 61 Colindale Avenue London NW9 5HT Tel 020 8327 7331 Pseudomonas abs Anti staphylococcus abs Anti streptococcus abs HPA Colindale SRMD LHCA HPA Cfl Colindale 61 Colindale Avenue London NW9 5HT Tel 020 8327 7241 Troph whippelii DNA MICROPATHOLOGY Ltd University of Warwick Science Park Barclays Venture Centre Sir William Lyons Road Coventry CV4 7EZ 012476 323222 M tuberculosis PCR HPA National Mycobacterium Reference Laboratory Abernethy Building Institute of Cell and Molecular Science ICMS 2 Newark Street London E1 2AT Tel 020 7377 5895 Meningococcus Meningococcal Reference Unit Men RU Manchester Clinical Science Building Manchester Royal Infirmary Oxford Road Manchester M13 9WZ Tel 0161 276 6757 Mycobacteria Culture James Paget University Hospitals NHS Foundation Trust Lowestoft Ro
77. aryngeal 2 hours syncitial virus Please deliver to Pathology f aspirate Reception me Cervix swab chiamyaia PORorcamysia Peectonof Caschomats Urethral gay y trachomatis DNA ngn y swab y specimens f f First void Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 64 of 140 urine Eye swab Gastroenteritis Rotavirus antigen Please refer to bacteriology viruses Norovirus antigen manual The monitoring of antibiotic ao Gentamicin levels levels UR IONCaSaye Vancomycin levels The times of dose and of serum tagay sample required Table 23 below shows the virology tests referred to other sites For any tests not listed please contact the laboratory 01553 613772 Table 23 Referred Turn around Tests Purpose Specimen Virology time Respiratory viral Atypical pneumonia antibodies Date of onset required Referred viral serology Measles IgG The determination of viral Serum 1 2 weeks CMV IgG immunity in haematology HSV IgG patients VZV IgG Referred bacterial Pseudomonas Ab The investigation of some cerolo Bordetella Ab bacterial infections Serum 1 3 weeks 9y Anti DNase B Ab Date of onset required Investigation of Legionella Legionella urinar Legionella urinar pneumophila infection
78. ber Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 108 of 140 ENA Antibodies IS ENA SST Endomysial Anti see TTg IS TTG SST Enterovirus S ENT SST Enterovirus RNA S CSF Sample EP C EP SST Epanutin Levels C VALP SST soe valptoale Epilim C VALP SST See erythropoietin send copy of FBC results Sent 1 EPOE H EPO Clotted class to Kings college London Epstein Barr Virus Glandular Fever S EBV IM SST Epstein Barr Virus DNA S 6ml EDTA Send copy of FBC results Sent 1 Erythropoietin H EPO Clotted class to Kings college London ESR H ESR Black cap DAD El Sent to Liandough Ethosuximide anticonvulsant C ETHOS Clotted Hospital by 1 class Extended RBC Phenotyping XM a or PG mi EDTA Sent to F13 Deficiency H F13R 2 x Citrate Addenbrookes Sent to Factor Il H FIIR 2 x Citrate Addenbrookes Factor IX H F9 2 x Citrate Sent to Factor V H F5R 2 x Citrate Addenbrookes Request needs to be on a molecular Factor V Leiden H FVL 3ml EDTA genetics form Sent to Factor VIl H FVIIR 2 x Citrate Addenbrookes Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval
79. ble Please enter sample type and date time of collection as well as pertinent clinical information Please also state the requester and location you would like the results returned to Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 73 of 140 Submission of Diagnostic Surgical Histopathology Specimens Accurate patient details and salient points of history are essential For example date of the first day of LMP should be indicated with endometrial curettings A completed request form must accompany each patient s sample each specimen must display an addressogram label containing the patients name and date of birth Always provide clear information regarding HIGH RISK specimens Hepatitis HIV TB etc The request form and specimen container MUST have a High Risk Sticker attached Please state if the sample is urgent on the request form Treatment of Specimens Most specimens should be submitted in adequate 10 neutral buffered formalin sufficient to cover the specimen the minimum amount of formalin is 10x the volume of the specimen as a general rule Fixation must be done without delay and with the least amount of handling Specimens which are allowed to dry are thereby rendered useless When possible large specimens should be incised to allow proper fixation In problematic or unusual
80. blood cultures CSFs or unrepeatable specimens or sent to the Laboratory Office Please send specimens as early in the day as possible Outside normal working hours specimens must be left in the Blood Sciences Specimen Reception Area e Urines should be refrigerated e Blood Cultures should be placed in the 35 C incubator e All other specimens should be left in the Blue box at room temperature Every effort will be made to ensure that all specimens received by 21 00 are processed on the day of receipt Results All results can be found on the APEX Laboratory Computer System as soon as they are available Microscopy results Urines CSF AAFB and Gram Stains are available on the Computer as soon as they have been done Serology Virology Culture and if indicated sensitivity results are available immediately after Clinical Authorisation on Ward VDUs and for electronic reporting to GP surgeries Hard copies of all reports are also available Time limits for requesting additional examinations Microbiology specimens are retained for the following time periods after processing additional examinations may be requested at any time during that period Initially please contact the laboratory by telephone to check that there is sufficient specimen remaining Please note 1 Microbiology specimens will often deteriorate with time so if further examinations are required then if possible it is better to submit a fresh specimen 2 In some
81. boratories Jan 2011 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 138 of 140 Appendix 8 Time constraints for additional tests Blood Sciences Further tests on samples already received in the laboratory may be performed on receipt of the appropriate and correctly filled in Additional request form Further test requested Time constraint from receipt of sample Electrolytes 2 days Glucose SST 3 hours Liver 2 days CRP 2 days Cardiac CK 24 hours Amylase 2 days Bone profile 2 days Haematinics B12 Folate Ferritin 1 day Thyroid Function 2 days PSA 2 days Oestradiol Progesterone Prolactin 2 days Troponin 2 days Therapeutic Drugs 2 days Paracetamol amp Salicylate 1 day Blood Film 12 hours Glandular Fever Screen 2 days Further Coagulation tests 4 hours D Dimers 4 hours Example Additional request form Blood Sciences Department The Queen Elizabeth Hospital Additional Test Request HospitaliN Atcdacnva neues aii ate nee Surname ee e dai eiee ae idee des FOPEMAIME ns a eea naraha Er a a KE Siia i Sample N GC a ana E E a Test Requested ccceeeeceeee eee eee tenses ea een ees Bleep NO weisiccvsscecine deieieersevazeiciibia vedere Additional tests can only be r
82. by the Cambridge University Addenbrookes NHS Foundation Trust Please contact the QEH laboratory for further information QEH extension 3797 Sample requirements A comprehensive list of available tests with reference ranges sample requirements and expected turnaround times is provided at the end of the Chemical Pathology section of this Handbook The vast majority of biochemistry tests are performed on Becton Dickinson Gold Top SST tubes Quality Control In order to maintain high standards of analysis this Department participates in national quality control schemes and maintains its own internal system of quality control checks However additional errors can arise from problems of sample acquisition and delivery such as arise by poor bleeding technique delays in transport poor identification etc and equally as a result of errors in recording results transmitted by telephone It is generally prudent to adopt a policy of thoughtful diligence in these processes Examples are illustrated below e Do not use large tubes for small blood samples as this greatly reduces the volume of serum plasma which can be obtained e Blood samples taken for estimation of potassium phosphate and bicarbonate must reach the lab in timely fashion as delay compromises the validity of these tests Prolonged retention of such samples such as late acquisition leading to overnight retention should be guarded against e Order of draw of blood samples It is n
83. cal cord Products of conception e We would prefer that the whole products of conception sample be sent to us for complete examination e If Histopathology assessment is required Please ensure that a Histopathology request form is included with the Cytogenetics referral card IUD or macerated fetus Send a placental biopsy only Where fetal death has occurred in utero fetal skin samples have a very high failure rate ACC Working Party Report 1995 Fresh spontaneous abortion or termination of pregnancy where the fetus is known to structurally abnormal Send fetal skin and placental biopsy see above Sampling skin muscle consent must be obtained for fetal skin e Take the skin muscle sample from the inside of the thigh buttock or back of shoulder e Using sterile forceps and scissors take a full depth skin biopsy 1cm x 5mm if possible e Place the skin muscle sample in a universal containing 5ml of tissue transport media available from laboratory Accurately label the universal with the sample type patient name date of birth hospital number and date of sampling Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 78 of 140 If samples cannot be sent straight away store in a refrigerator at 4C DO NOT freeze or place in formalin Samples should be accompanied by a Cytogenet
84. cases or in special circumstances please discuss with a Consultant Histopathologist Frozen Sections Frozen sections must be by prior arrangement with Consultant Histopathologist Please ensure that Transport the dry specimen to the laboratory promptly Hand the specimen over to a member of the laboratory staff Ensure there is a theatre extension number on the request form All the details on the form and specimen are correct Frozen section result should be available between 15 20 minutes from receipt of specimen Immunofluorescence Tissue transport media is available from the laboratory for all samples requiring Immunofluorescence studies General Practioners should request transport media at least 1 week prior to the procedure to allow for delivery The media should be stored at 4 8 degrees Celsius in a refrigerator Do not place the specimen in formol saline If no transport media is available the specimen can be stored in normal saline for transport purposes For Immunofluorescence the turnaround time will be 7 10 days Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 74 of 140 Semen Analysis Semenology Request Form LABORATORY NUMBER REQUESTING CLINICIAN TO COMPLETE Please use Adrema labels where possible HOSIPITAL NO CLINICAL INFORMATION
85. ce Please ensure the Laboratory are included in such plans and kept informed of any changes x3782 Hospital Transfusion Department policy is to offer the fast efficient provision of blood to cover both operations and the use of red cells generally This procedure gives fast provision of blood when required and utilises the blood stocks as efficiently as possible The patient s group amp antibody status is confirmed checked by testing two samples taken at different times i e a current sample and a historical sample thereby eliminating the biggest risk i e ABO incompatible transfusions due to error in blood sampling Details would normally be in the patient s laboratory record if they have been previously grouped and screened at the Queen Elizabeth Hospital since 1988 When the patient is first seen and put onto the waiting list the patient s laboratory record should be checked to see if they have been previously grouped and screened at the Queen Elizabeth If the patient has not previously been investigated by the blood transfusion laboratory obtain a sample for group and screen at the first clinic visit Current sample when the operation has been scheduled arrange for the patient to have their pre operative bloods taken a maximum of 14 days prior to the operation If the criteria for sample one have been fulfilled then this preoperative sample will be the second sample and the patient will therefore be eligible for fast
86. ch cases should be discussed with the Laboratory prior to operations As much notice as possible will be required to enable us to provide compatible blood in such cases depending on the specificity of the antibodies The Laboratory operates a surgical blood order tariff for such cases to ensure that sufficient blood will be available at the time of surgery 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 51 of 140 b Policy for the Provision of Blood for Obstetric Cases 1 ELECTIVE AND EMERGENCY CAESAREAN SECTIONS Blood for such cases can be made available by fast issue provided suitable samples are available in the Laboratory see Section 4 1 If an antibody has been detected in the mother during her antenatal monitoring inform the Laboratory of the date and time of operation so that appropriate blood will be available for the mother and if indicated for the baby In a dire emergency 2 units of O Rh D Neg Kell negative blood are available in the Laboratory Inform the Laboratory staff if this blood has been removed 2 PLACENTA PREVIA ACCRETA PERCRETA Compatible blood will be made available to Theatre in a cold box for such cases using electronic crossmatch unless antibodies are present 4 units for Previa 8 10 units for Accreta Percreta It is usual for a medical plan to be made in advan
87. cker Review Interval lsotracker Reviewed by C Brock Page 87 of 140 Centromere kinetochore antibodies Performed as a reflex from a positive ENA screen Autoantibodies to centromeres CENA are found in 22 of patients with systemic sclerosis These antibodies are characteristic of the CREST limited scleroderma syndrome a variant of systemic sclerosis with limited skin involvement but associated with Calcinosis Raynaud s phenomenon oEsophageal immobility Sclerodactyly and Telangectasia They are also found in up to 12 of patients with primary biliary cirrhosis that often overlaps with systemic sclerosis whom about half will have clinical signs of scleroderma Patients with severe Raynaud s and other features of scleroderma especially lung and other organ involvement should also been screened for Scl 70 which is associated with diffuse systemic sclerosis Positive CENA in patients with Raynaud syndrome suggest a transition to limited scleroderma Serum 0 10 U ml Turn around time 2 working days dsDNA binding antibodies Serum 0 10 U ml A positive result for dsDNA antibodies supports the diagnosis of SLE dsDNA antibodies are not found in other connective tissue diseases however only 60 of all patients with SLE have these antibodies in their serum and a negative test do not exclude the diagnosis Occasionally DNA antibodies may be found in patients with lupoid chronic active hepatitis Weak positives ar
88. coccal PCR Metapneumovirus RNA Mumps IgM Mumps virus RNA Mumpsvirus IgM P carinii PCR Parainfluenza group RNA PCR PCR for Respiratory Viruses Polyomavirus BK DNA Polyomavirus JC DNA Respiratory Virus PCR Rhinovirus RNA RSV RNA Rubella abs referred Rubella IgM Varicella zoster virus DNA Clinical Microbiology and Public Health laboratory Health Protection Agency Box 236 Addenbrooke s Hospital Hills Road Cambridge CB2 0QQ Tel 01223 257034 Fax 01223 242775 Out of hours Tel 01223 245151 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 67 of 140 Test Reference Laboratory HIV resistance testing Birmingham HPA Antiviral Resistance Testing Service WMPHL Heart of England Foundation Trust Bordesley Green East Birmingham B9 5SS Tel 0121 424 2256 Rapid Plasma Regain RPR Referred syphilis serology Syphilis IgG ELISA Syphilis IgM ELISA T pallidum particle aggn VDRL slide test HPA Regional Laboratory Bristol Myrtle Road Kingsdown Bristol BS2 8EL Tel 0117 342 5551 Cryptococcus antigen test Histoplasma immunodiffusion Histoplasma CFT Mycelial Ag Histoplasma CFT Yeast antigen F
89. contact the laboratory as soon as possible on the next working day Services provided Fine needle aspirates If performing FNA at clinics please prepare the smear as blood film and provide at least air dried and fixed slide labelled with the patients name DOB and hospital number Exfoliative cytology Bronchoscopy and other endoscopic samples Please contact the laboratory if you require advice on specimen collection Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 81 of 140 Sputum Collection technique An early morning deep cough sample is desirable The patient should rinse the mouth well with water to avoid contaminating the sample with food particles Please send to the laboratory within one hour of production Urine Please send 50 mls 2 x 25ml universal containers The optimum sample is the second sample of the day The patient should collect the early portion of the stream A mid stream urine is not suitable for cytology because it contains fewer cells Body fluids If enough material is available please send 2 x 25ml universal containers to the laboratory This will allow us to prepare extra slides cell block for conducting immunocytochemistry Autopsies Mortuary Written consent is required from the next of kin for hospital post mortems Contact Patient Affairs on Ext 387
90. cted into WHITE CAPPED Sterilin bottles Reporting results Completed printed reports will be returned to the wards and units as soon as possible but interim reports may be issued when any delay is expected because a more difficult or time consuming analysis has been requested Results on routine in patient and out patient samples are usually available on Ward Enquiry as soon as they are authorised Unexpected or grossly abnormal results will whenever possible be telephoned to the requesting doctor Results of emergency analyses may also be telephoned but results reported in this way are a frequent source of error so please repeat the results back to the laboratory staff when they have been recorded Please do not telephone the laboratory for results unless you cannot find them in any other way Constant interruptions delay the flow of work Phoning Policy Results will be telephoned under the following circumstances If Pathology Ward Enquiry is working i If we have been contacted by the Doctor who requests results to be phoned ii When the request is from a GP or Outpatients and marked please phone iii Results for salicylate paracetamol carboxy Hb iv For SCBU and ITU we will inform the units that the results are now available on Ward Enquiry Results will not normally be phoned unless we have been requested to do so by the doctor or they are outside the Action Limits over the page v For all other wards and G
91. cubated for pan Paediatric the Blood Sciences 5 days Bottle dept reception area IV Catheter Cut off 2 Sterile screw Room temperature Culture 2 3 days Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 61 of 140 Specimen Collection Container Storage Routine Tests TA Arens Notes Tips 3cm from the capped Sensitivity testing if tip container indicated Wet film for Giardia ut res 23 Culture according to A Walnut clinical details days sized piece Sterile screw S ake Cl difficile Appropriate tests will be performed Clostridium difficile i rae i Faeces of faeces or capped Room temperature toxin testing if toxin testing based on Age Clinical details 10ml if container rae a same day if Specimen source and consistency liquid received by Ova cyst amp parasite e 10 00 am screens if indicated Red and White Cell Counts White cell ee 2 days Donotuethesir differential if Cerebro Sterile screw tb svet m indicated Micros o If PCR virology or other tests Spinal Fluid capped y Gram and ZN stains if rey required please discuss with the Keep at room foe available 8 CSF container indicated ares Consultant Microbiologist temperature within 2 hours Culture of receipt Sensitivity testing if pt indicated Pulmonary infections 3 specimens of
92. d 24 weeks post operation The requirement for further samples to confirm the absence of spermatozoa is not unusual The report will contain information regarding the presence or absence of spermatozoa if present the report will state if the spermatozoa are motile or non motile Please ensure that the patients have sufficient packs for at least 3 tests further packs can be obtained from Pathology reception or the Histology laboratory Semen Specimens for infertility Specimens must be brought to pathology reception as soon as practicably possible ideally within one hour The specimen must be kept warm during transit the sample can be kept warm in a pocket do not over heat the specimen body temperature is ideal The Report The report will contain the following information Time Produced Time received Time examined Liquefaction Complete incomplete Volume ml pH Presence of white blood cells Count million per ml of ejaculate Total Motility all spermatozoa which are motile Non motile The report will be issued on the same day If advice is required concerning the report or the specimen please ring the Andrology Lead Karen Ashurst Reporting times The report will be clinically authorised within 2 days of the analysis Patients must not ring the laboratory for results The laboratory participates in the National Quality Assurance Scheme for Andrology Document Number Qual0035 Version 4 03 Document N
93. dow The phlebotomist will call in the patient by displaying the accession number on the display that is situated next to the phlebotomy suite clinic room 1 door Outpatients with the exception of children under 4 years may attend Pathology for phlebotomy Children under 4 years will be directed to Rudham ward first floor rear of QEH for phlebotomy Location Ground Floor Pathology department Times Mon Fri 08 15 17 00 Phlebotomy Services Wards A full service in respect of ward phlebotomy requirements is offered on a daily basis starting at 08 00 each day This service is also offered on weekends and bank holidays but is restricted to a limited number of hours Please do not abuse the service by placing requests for non urgent bloods on the weekend In the event that the demands for weekend phlebotomy are over subscribed the phlebotomy team have been instructed to request that the ward staff prioritise the requests Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 10 of 140 Anticoagulation service Anticoagulation Referrals Please phone 3355 Anticoagulation Advice Please phone 2798 2195 bleep 3355 Role e To act as a source of expertise and knowledge for both patients and other health care professionals The post holders will be aware of current clinical research protoco
94. e clearly conveyed In the case of massive blood loss see Hospital Transfusion Policy available on the intranet Procedure for the Collection of Blood from a blood bank The procedure for collection of blood from a blood bank is available in the Trust Transfusion policy on the intranet This procedure must only be carried out by staff who have completed the appropriate training and been assessed as competent Procedure for the Administration of Blood The procedure for administration of blood is available in the Trust Transfusion policy on the intranet This procedure must only be carried out by staff who have completed the appropriate training and been assessed as competent 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 50 of 140 Elective Surgery e Pre operatively any correctable causes of anaemia should be identified and treated accordingly A full blood count 4 6 weeks before elective surgery allows detection of anaemia in time for the cause to be investigated and Iron replacement to take effect e Consideration should be given to a pre operative course of oral Iron Ferrous Sulphate 200 mgs 3 times a day if tolerated even in the absence of obvious Microcytic anaemia e Aclinical history of abnormal bleeding tooth extractions surgery Menorrhagia or a family history of bleeding s
95. e found in other connective tissue diseases and in chronic and acute infection A rising concentration may predict clinical relapse and treatment on a rising concentration before symptoms reappear may reduce the total amount of immunosuppression required Turn around time 2 working days Endomysial IgA antibodies This test has been superseded by Tissue Transglutaminase tTG antibodies 4 11 ENA Extractable nuclear binding Antibodies Currently part of ANA screen ENA is a term used to describe antibodies to the soluble components of the nucleus At the moment seven main antibodies are recognised see below Samples are firstly screened in an assay that detects all seven antibodies If this screen is equivocal or positive the antibodies are tested for individually ENA Profile Specificities of Diagnostic Value Autoantibodies to Disease association positive Comment RNP MCTDs gt 95 SLE 40 Weak positive in Sjogren s syndrome amp scleroderma Ro Sj gren s 70 SLE 40 Congenital heart block 60 La SjOgren s 50 SLE 15 Usually in association with anti Ro Sm SLE 30 Specific for SLE when present Jo 1 Polymyositis 30 Associated with pulmonary fibrosis Scl 70 Scleroderma 30 Specific marker associated with severe visceral impairment Centromere CREST syndrome 60 70 Limited cutaneous scleroderma Turn around time 2 working days Qual0035
96. e heparinised syringe has been filled with blood remove any air bubbles and seal with a plastic syringe cap Mix the blood by inversion and label the syringe before taking it to the analyser Keep the syringe in ice if the analysis cannot be performed immediately Capillary Blood Capillary blood should be collected whenever possible in children to avoid the occasional hazards of venepuncture However good collecting technique is essential in the interests of both the quality and the quantity of the specimen Cerebrospinal Fluid Cerebrospinal fluid CSF for protein estimation should be collected after the microbiology samples to minimise inadvertent contamination with blood CSF samples for measurement of glucose should be collected into fluoride oxalate and accompanied by a blood sample collected into a similar tube Urine Random urine samples An aliquot of random usually early morning urine is best collected into plastic WHITE CAPPED universal Sterilin bottles NEVER use red capped Sterilin bottles for chemical pathology Random urines for osmolality should be accompanied by a sample for serum osmolality Timed urine samples Urine collection bottles may contain a preservative that has safety hazards It is important that the patient is instructed NOT TO VOID URINE DIRECTLY INTO THE CONTAINER It is essential that timed urine collections are made with great care Precise instructions must be given regarding the emptying of a patien
97. e of a repeat venepuncture for the patient by contacting the laboratory and arranging further tests on the stored serum subject to remaining serum Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 85 of 140 Result Enquiries Authorised results are available on the APEX system which is updated regularly throughout the day If a result is needed urgently and or cannot be found via the APEX system the laboratory may be contacted on 01553 613207 during normal working hours Telephone Results Results of urgent requests if APEX access or electronic delivery is not available and unexpected results which may aid the immediate patient management will be telephoned Turnaround Times Turnaround times are quoted alongside each assay Assays Disease associations specimen requirements and turn around times are described below Reference ranges are quoted on all reports 4 1 Adrenal cortex antibodies Serum Negative Adrenal autoantibodies are detected in about two thirds of patients with idiopathic autoimmune Addison disease where there are other autoimmune diseases Their prevelance falls when autoimmune adrenalitis occurs alone The adrenal cytochrome P450c21 enzyme 21 hydroxylase is the major target autoantigen in Addison disease and type autoimmune polyglandular syndromes APGS Other antigenic enzymes i
98. ecessary to adhere to an order of draw as some sample tubes have preservatives that might interfere with analyses When using the Becton Dickinson vacutainer system tubes must be filled in the following order to minimise contamination from tube additives 1 Gold top 2 Heparin green top 3 EDTA purple top Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 20 of 140 4 Fluoride grey top 5 Others Never tip blood from one tube into another Contact the department if any difficulties in interpretation occur and do not just ignore results which cannot be explained or are thought to be erroneous Common Specimen Artefacts Contact the department if any difficulties in interpretation occur and do not just ignore results which cannot be explained or are thought to be erroneous Problem Common Causes Consequences Delay in separation of serum Delay in transit High K AST LDH Mg or plasma Low Na occasionally Haemolysis Expelling blood sample High K through a needle into High phosphate PO specimen tube Low Na and Cl Over vigorous mixing of High AST LDH sample High Mg Sample stored in deep freeze Excessive delay in transit Sample left in hot place Incorrect container or No enzyme inhibitor Low glucose anticoagulant EDTA tube contamination High K L
99. ed The senior BMS receiving this sample should endeavour to arrange for the sample to be labelled at the earliest convenient time and ensure that the requester realises that the final results of this sample will be withheld until such time that the sample is labelled and compliant with the Pathology specimen reception policies With regard to all other samples the Reception Supervisor or his her deputy should be informed of the receipt of an unlabelled specimen as soon as it is received If marked urgent or if the request was generated by a department for which much of the work is urgent A E MAU ITU SCBU etc the requester must be informed immediately In the case of non urgent samples contact with the requester may be delayed for a short period of time The Supervisor should telephone or page the requester and inform them that the sample is unlabelled and that the Pathology policy forbids the processing of the sample or the labelling of the sample at this point The requester should be clear that another sample would be required if the test results were still wanted The original request form can be booked in to the system and recorded as Sample unlabelled unable to analyse The time and date of the telephone contact with the requester should be logged on the system along with the details of the Supervisor or his her Deputy All unlabelled specimens should be bagged with a copy of the original request form and stored in a refrigera
100. eep Number Date Care should be taken to fill in the form correctly All details are essential and should be written in block capitals if patient demographic stickers are not available Please enter sample type and date time of collection as well as pertinent clinical information Please also state the requester and location you would like the results returned to Vacant Consultant Haematologist 3609 Dr AJ Keidan Dr P Coates Consultant Haematologist Dr M Lewis Consultant Haematologist 3401 Dr L Cooke Consultant Haematologist 3030 Dr E Gudgin Consultant Haematologist 3621 Mr Stephen Thompson Haematology Lead Biomedical Scientist 3561 Mr Adrian Ebbs Transfusion Manager 3782 Laboratory fax 01553 767742 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 39 of 140 E MAIL Pathology staff can be e mailed at forename surname gehkl nhs uk General information Laboratory Working Hours Table 12 shows the haematology and blood transfusion department working hours Table 12 Mon Tues Wed Thurs Fri Sat Sun Bank Hol 0800 1800 Out of hours procedure Enquiries Working hours Reception results Urgent requests Out of hours All transfusion requests MUST be bleeped to On call Consult
101. ek Out patient and GP biopsies Surgical resection specimens routine gt 1 week Specialist external referrals Highly complex cases Decalcification specimens Adjunctive molecular testing HER2 testing currently referred to Addenbrookes 24 48 hours Infertility and Post vasectomy Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 72 of 140 Histopathology Histology Request Form Leave this space free Laboratory use only Queen Elizabeth Hospital Kings Lynn NHS Trust Thank You NHS Department Cellular Pathology Number Hospital Request Type Surgical Cytology Post Mortem Number Synovial Fluid Immunofluoresence Surname Category Routine Urgent Date of Clinic For name Clinical Details Sex DoB Address Address Address Post Code Consultant GP Gynae Cases Hormones Cycle LMP Hosp Ward Practice Date amp Time of Request Patient Category NHS GP Sandringham Date and Time of Receipt In accordance with Trust Policy all reports will be sent to the secretary of the Consultant Please leave the area below blank for laboratory use thank you Care should be taken to fill in the form correctly All details are essential and should be written in block capitals if patient demographic stickers are not availa
102. ens should be pre screened at P Midstream capped Culture 1 day aah Urine Refrigerated re aaa source for nitrites amp leucocytes urine MSU universal Sensitivity testing if j ee If negative unlikely to be infected container indicated Saliva is not Gramstaih acceptable Sterile screw Keep oral capped Culture Delay in processing may adversely Sputum ROA Room temperature Sensitivity testing if 2 3 days contaminatio universal SEA affect results i indicated ntoa container minimum Fluids For aspirates Sterile strew Gram Stain 2 3 days please send Culture Anaerobe Aspirates amp capped MR ae Delay in processing may adversely f as much as i Room temperature Sensitivity testing if cultures are Tissues universal wavs affect results possible up container indicated incubated for to 20mls 4 days For aspirates s Gram Stain 2 3 days Sterile screw please send capped Suture Aniaerobe Delay in processing may adversel Pus as much as Pp Room temperature Sensitivity testing if cultures are yup oe y universal papier 7 affect results possible up container indicated incubated for to 20mls 4 days Candida Trichomonas HVS in Amies medium Culture Sensitivity testing if serious GTI indicated 2 3 days Cervical Trichomonas culture Anaerobe Delay Th orocescinainavadvers l Genital swabs Urethral Transport Swab Room temperature will be set up if cultures are yinp g may y affect results swab in requested
103. ent Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 28 of 140 Paracetamol poisoning The National Poisons Information Service recommend treatment following ingestion of more than 5g paracetamol by an adult 12 years or over or 150 mg kg body weight by a child The risk of developing liver damage is best assessed by measuring a serum paracetamol concentration Blood should be taken at not less than four hours post ingestion Samples do not have to be taken before Parvolex is given If the level falls above the relevant treatment line shown in figure 2 then the patient is at risk of liver damage The prothrombin time and serum transaminase measurements are helpful in monitoring the development of liver damage NB malnourished people or those with induced liver enzymes e g alcoholics or epileptics on anticonvulsant drug therapy may be more susceptible to lower doses of paracetamol and should be treated with lower paracetamol levels This also applies if the overdose has been taken chronically Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 29 of 140 Figure 2 PCA AHHH EIE AHHH H o s jos z z 2 se ee c w Co gz e oO x E 2 t oO e po n Qa Time hours Pati
104. ents for Glucose Tolerance Tests and other pre booked Clinical Chemistry tests are seen from 08 15 with up to 3 patients booked in for 08 15 and 2 booked in for 08 45 There is no outpatient phlebotomy provision at the weekends GP Information The Pathology department is open for receipt and processing of routine specimens during the hours as shown in table 2 departmental telephone numbers Please consult the Pathology telephone directory table 2 for Table 2 Site Department Monday Friday Saturday Sunday Bank Hol Reception 08 00 17 00 Closed Haematology and Pee Tesnendcion 08 00 18 00 Out of hours policy applies Chemical Pathology 08 00 18 00 Out of hours policy applies Microbiology 09 00 17 00 Out of hours policy applies Histology 07 30 17 30 N A Cytology 07 30 17 30 N A Mortuary 07 30 1630 See on call policy for Mortuary Semen Analysis Tuesdays Wednesdays and Thursdays N A Information for hospital users The Pathology Department is open for receipt of samples at the times shown in table 3 Please note the conditions for processing of samples outside of normal office hours and for processing of urgent samples at any time Table 3 Site Dept Mon Fri Sat Sun BH Urgent samples Outside hours Normal hours Reception 08 00 17 00 Closed Haem and Bl 08 00 18 00 08 00 12 00 Phone 3779 Contaci
105. ents name and date of birth will be conveyed along with the pertinent abnormal results It will then be necessary for the results to be read back to the BMS to ensure that results have been exchanged correctly The BMS will require the results to be read back to them to ensure that the results have been exchanged correctly The BMS will require the name of the person receiving the results It then becomes the responsibility of the person receiving the results to communicate them to the doctor in charge of the patient s care for clinical intervention if required Abnormal in patient results The Staff Nurse Doctor on the ward will be informed that results are available on ward APEX terminals and an appropriate comment will be entered into APEX as a record Abnormal out patient results The requesting clinician s secretary will be telephoned with the abnormal results and an appropriate comment will be entered into APEX as a record GP within surgery hours The relevant GP surgery will be telephoned via the GP reception and an appropriate comment will be entered into APEX as a record GP outside surgery hours The relevant GP messaging service will be telephoned The BMS will identify themselves the department and hospital They will request the duty GP to contact the BMS on call for the results Professional judgement will be used After 3 reasonable attempts to telephone results the results will be authorised and left to be phoned the next day
106. ents whose plasma paracetamol concentrations are above ihe normal treatment line should be treated with acetylcysteine by intravenous infusion ar provided the overdose has been taken within 10 12 hours with methionine by mouth Patients on enzyme inducing drugs e g carbamazepine phenobarbitone pheny toin rifampicin and alcohol or who are malnourished e g in anorexia in alcoholism or those who are HIV positive should be treated if their plasma paracetamol concentrations are above the high risk treatment line Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 30 of 140 Lipid analysis When lipids are requested on fasting samples the laboratory will routinely measure total cholesterol HDL cholesterol Triglycerides will be measured when specifically requested Please note that meaningful triglycerides measurements can only be undertaken on fasting samples Lipid results are significantly affected by major acute illness and following myocardial infarction it may take up to 8 weeks for lipid values to return to pre infarct baseline values Prior to initiation of long term lipid lowering therapy secondary causes of hyperlipidaemia such as hypothyroidism diabetes alcohol abuse obstructive liver disease and nephrotic syndrome should be excluded All patients on lipid lowering drug therapy should
107. ephoned Specimens must then be sent either via air tube Not blood cultures CSFs or unrepeatable specimens to the Laboratory Office or if out of hours to the Blood Sciences specimen reception area 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 56 of 140 Out of hours requests Out of hours service On Saturdays the laboratory is open in the mornings from 09 00 11 00 am for urgent bacteriology work only For the remainder of the weekend and on bank holidays a Biomedical Scientist BMS from the Bacteriology Section will attend the laboratory each day to process urgent work and continue the processing of previously received work All specimens for bacteriology should ideally be tested immediately after collection Although most samples will keep for up to 24 hours in the correct conditions results will not be as reliable as those for fresh specimens Therefore out of hours sampling should be limited where possible to 1 Samples which are unrepeatable e g immediately before antibiotic therapy or during surgery 2 Samples whose results will directly affect the management of the patient before the next routine working period One BMS from the Bacteriology Section attends the laboratory each evening to process any urgent emergency bacteriology work which arrives in the laboratory before
108. eptor Antibodies C TSHRAB SST l Sent to Oxford 1 Anti V Gated Calcium Potassium Ca K 2T Chan EL IS VGC VGK SST class Must give name of Anti Xa H HEPL Citrate heparin used Full lipid profile Apolipoprotein C APO SST Citrate amp 3m EDTA if APTT H APTT not requested Only neurologists Sent 1 class to Aquaporin 4 abs IS AQUA4 SST alora Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 102 of 140 Unseparated unfrozen see white Arlysulphatase A C Lith Hep cell enzyme Sent 1 class to Aspergillus ppts IS ASPERP SST Sheffield Spin separate Sent Atenolol Levels C ATE Clotted te encougn Hospital by 1 class Atypical Mycobacteria S Lith Hep Atypical Pneumonia Complement s SST Fixation Tests CFT Auto Antibodies liver IS LIV SST Auto immune profile IS ANF SST l Must be in time to go Autoimmune Haemolytic Anaemia Clotted Investigation AN pa 2 x 6ml EDTA TO RMS SAME Cay Must be in time to go Autoimmune Thrombocytopenia Refer to transfusion PAIg AM SP for request form ONET SANE Aay Avian Precipitins S AVP SST B12 Folate C BSF SST amp 3ml EDTA B12 Vitamin C B12 SST B2 Microglobulin C B2M SST Bar
109. equested if the sample N is provided and this completed form is sent to the laboratory with the next sample collection round or down the air tube situated in MAU and A amp E Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 139 of 140 Thank you NHS Department of Pathology Queen Elizabeth Hospital King s Lynn NHS Trust Gayton Road King s Lynn Norfolk PE30 4ET 01553 613430 01553 767742 http www qehkl nhs uk gp asp We hope you are satisfied with this handbook To help us better serve you please print this page complete this survey and return it to us at your convenience Name Grade of Doctor Consultant GP Registrar SHO HO please delete not applicable Address E mail Phone Fax atonal Agree Neutral Disagree Strongly Agree Disagree This handbook is helpful This handbook is easy to use The bookmarks enable easy navigation Comments that will help us to improve the handbook Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 140 of 140
110. es See Glutamic Acid Decarboxylase ab s Ganglioside antibodies GM1 The presence of antibodies directed against GM1 monosialoganglioside GM has been associated with motor and sensorimotor neuropathies and in particular with multi focal motor neuropathies IgM Lower titres of GM1 abs may also be found in amyotrophic lateral sclerosis Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 89 of 140 and Guillain Barr syndrome tends to be IgG GM1 abs may occur as either polyclonal or IgM monoclonal abs The carbohydrate moiety of GM1 in particular the galactose and sialic acid residues is the site of antibody binding to gangliosides Due to the presence of similar moieties on other gangliosides low levels of antibody cross reaction may be experienced in tests for gangliosides other than GM1 Other ganglioside tests are listed below IgG anti GQ1b These antibodies are found in over 90 of patients with Miller Fisher syndrome IgM anti GQ1b These antibodies are associated with a minority of patients with of chronic sensory neuropathy Gastric parietal cell antibodies These antibodies are present in up to 90 of patients with atrophic gastritis and pernicious anaemia They are also present in gastritis without anaemia 12 autoimmune thyroid disease 30 Addison s disease 25 and iron deficiency an
111. es does not exclude the diagnosis Antibody levels may fall with treatment Patients with persisting elevations are more likely to relapse Patients with limited Wegener s granulomatosis are less likely to be positive for ANCA either by IIF or ELISA Up to 25 of patients with Wegener s granulomatosis may have a Perinuclear ANCA P ANCA pattern on IIF and be positive for MPO antibodies by ELISA Microscopic polyangitis pANCA which is specific for MPO is seen in 50 80 of patients with active microscopic polyangiitis which may affect only the kidney The titre of antibodies reflects disease activity Patients with persisting elevations are more likely to relapse About 40 of patients with microscopic polyangiitis may be positive for PR3 antibodies Churg Strauss syndrome Some patients may be positive for either P PANCA or C ANCA Rapidly Progressive Glomerulonephritis Some patients may have C ANCA or P ANCA Drug induced SLE or Vasculitis High levels of MPO ANCA are found in patients with some forms of drug induced SLE or vasculitis These levels drop after the drug is withdrawn Other diseases Low titres of MPO ANCA are occasionally found in RA SLE Chronic Hepatitis and Inflammatory Bowel Disease and Sclerosing Cholangitis Such findings are of uncertain clinical significance Low titre pANCA with specificities directed against antigens other than MPO also occurs commonly in the same group of diseases and again such findings are of u
112. ge All specimens must be accompanied by the orange cytogenetics request form if Histology is also required a separate Histology request form must be submitted with the specimen Products of conception must only be taken to the Mortuary if they are for disposal only The transport of samples to Cambridge will be as soon as possible via courier or other hospital transport If the specimen is to be taken out of hours please place the specimen in a standard fridge or arrange to collect transport media from the laboratory It is crucial that a sample destined for cytogenetics is received promptly Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 77 of 140 POSTNATAL TISSUE SAMPLES FOR CYTOGENETIC STUDIES KARYOTYPING FOLLOWING PREGNANCY LOSS OR TOP umbilical vessels e Please ensure that a biopsy of placenta approximately 2 cmiin size is taken using sterile forceps and scissors e Take the sample from close to the cord insertion site to ensure that it is foetal in origin e Include membranes and underlying villous material e Place the placental sample in a universal containing 5ml of tissue transport media available from laboratory accurately labelled with the sample type patient name date of birth hospital number and date of sampling B L amnion SNE umbili
113. gen C UPOBIL 24hr urine Keep in dark Also faeces 5g amp urine Porphyrins C QPORPH 5 10ml EDTA 20ml Sent to edford by 1 class Must be in time to go Refer to Transfusion Post Transfusion Purpura XM for request form to NBS same day Potassium blood C K SST Potassium urine C UK 24hr Urine Pre eclampsia test PET C SST Private Blood Groups eg Speedway XM G 6ml EDTA Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 121 of 140 Riders Progesterone PROG SST Prolactin PROL SST Prostate Specific Antigen C PSA SST Part of Thrombophilia Protein C Level H PROTC Citrate x 3 Seres Part of Protein S H PROTS Citrate x 3 Thrombophilia Screen Prothrombin Time H WC Citrate Pseudomonas abs S SST Only if AMA sent Pyruvate Dehydrogenase PDH M2 IS LIV M2 SST to Birmingham 1 class Only after abnormal Red Cell Folate C RCF 3ml EDTA x 2 serum folate Refer to Transfusion See Transfusion Red Cell Immunohaematology XM for request form Sent to Red Cell Markers H IMM 3ml EDTA x 2 oo same Sent to Referred Coagulation H COAA Citrate x 4 Addenbrookes by courier Must have blue 2 x thick 2 x thin referral form filled in Referred Malaria Parasites H MA
114. gether with persistently longer than 12 weeks elevated anti phospholipid antibodies The syndromes associated with anti phospholipid antibodies are treatable and it is appropriate to seek its presence in the following groups of patients a Women with recurrent unexplained foetal loss b Young patients with stroke myocardial infarction or transient ischaemic attacks without other predisposing factors c Young patients with recurrent venous or arterial thromboses d Patients with unexplained thrombocytopenia e Patients with chronic false positive VDRL f Patients with SLE as part of assessment of thrombotic risk in pregnancy Please note that the cardiolipin antibody assay particularly IgM may sometimes give false positive results in patients with infectious diseases i e syphilis and in some individuals with anti DNA antibodies Proteinase 3 PR3 antibodies PR3 antibody is a marker for Wegeners granulomatosis and is occasionally detected in microscopic polyarteritis The value of PR3 antibody generally parallels disease activity with higher levels in the active state of the disease EIA affords a quantitative assay which is useful when monitoring the disease Antibodies to PR3 an elastinolytic neural serine protease are responsible for the characteristic granular cytoplasmic pattern of the neutrophils when stained by IIF Urgent requests must be arranged with the laboratory RAST tests allergen specific IgE Assays for
115. hase1 amp 2 S SST Samples taken when date of onset Coxsackie Enterovirus S ENT SST lt 2weeks will be stored Freeze Sent to C Peptide C C PEP SST Guilford by 1 class C Reactive Protein C CRP SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 106 of 140 Creatinine C CRE SST SST to be taken oy within 3 days of Creatinine Clearance C CRECL SST 24 hr urine arine collection Also known as CK Creatine Kinase C CK SST 4 POINTS OF ID REQUIRED SEND EXTRA SAMPLE IF Crossmatch XM C 5ml EDTA PATIENT HAS KNOWN ANTIBODIES 37 C for 1hr i 0 Transfer to fridge Cryoglobulin C CRYO Taken into 37 C SST once separated Cryptococcus antigen S SST CSF Serum CSF Studies oligoclonal banding C CSFP concurrent Pre dose Do not separate Sent to Cyclosporin Adult C CYCLOA 3ml EDTA Addenbrookes by 1 class Pre dose Do not separate Sent to Cyclosporin PAED C CYCLOA 3ml EDTA Addenbrookes by 1 class Phone Lab pre venepuncture Sent Cystine Homocystine C SAMINO to addenbrookes by 1 class Do not spin separate Sent Cytogenetics Chromosomes H CYTOA a SAA neh tes to Addenbrookes by Lithium Heparin st 1 class Cytomegalovirus Antibodies S CMV SST Cytomegaloviru
116. hould be investigated e Measures to minimise blood loss at the time of surgery should be considered e g stopping Aspirin and NSAID if clinically acceptable at least 10 days prior to the operation e Patients on anticoagulants should be managed in accordance with Haematology Guidelines Section A e Peri operative Cell Salvage In some situations this may be available to reduce requirements for transfusion of donor blood Discuss with Consultant Surgeon and Anaesthetist e Postoperative Cell Salvage This procedure is available for some patients undergoing Orthopaedic operations and should be discussed with the Consultant Surgeon and Anaesthetist e Donor Blood should only be used when there is no alternative and the patient has clinically symptomatic anaemia Procedures to Ensure Provision of Donor Blood for Surgical Patients e Details of procedure and timing of samples required in Section 4 1 e It is the Clinician s responsibility to ensure that satisfactory samples have been received by the Laboratory and that blood will be available on the date of operation e All requests for pre operative transfusion work MUST state the nature of the operation and the likely date and time of surgery This to ensure the Laboratory can make the necessary pre operative checks and ensure that blood will be available at the time of the operation e Patients with atypical antibodies will require blood to be specifically ordered and therefore su
117. ibody screen 7ml EDTA 4 2 Direct Coombs 7ml EDTA and Clotted sample 3 Kleihauer Count 3ml EDTA _ Date amp Time delivered LA Blood will be available by Fast Issue if requirements have been met ALL REQUESTS FOR PLATELETS FFP or i See Trust Transfusion Policy section 4 1 CRYOPRECIPITATE PLEASE DISCUSS WITH LAB Care should be taken to fill in the form correctly All details are essential and should be written in block capitals if patient demographic stickers are not available Please enter sample type and date time of collection as well as pertinent clinical information Please also state the requester and location you would like the results returned to An accurate transfusion history special requirements and number of products and location for transfusion is essential ee Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 45 of 140 Transfusion Requests Table 17 shows transfusion requests and specimen requirements Table 17 Test Specimen s Blood group antibody screen cross match 1 x lavender EDTA 6ml Neonatal blood group cross match Paediatric EDTA Child age gt 4 months 1 x lavender EDTA 3ml Direct antiglobulin Coombs Test Red top 1 lavender EDTA 6ml Kleihauer Test 1 lavender 3ml EDTA N
118. ic and Perinatal Autopsies These post mortems are performed with the appropriate consent at Cambridge University NHS Trust The appropriate consent forms must be received in the Mortuary to facilitate transport to Addenbrookes Hospital Cambridge For advice please telephone the Mortuary on extension 2561 Viewing of deceased by Next of Kin The relatives of the deceased should be informed that appointments are always necessary to view Only in exceptional circumstances will viewings take place outside the working day During the working day viewings are arranged between the hours of 13 00 and 16 00 Monday to Friday Morning viewings may be possible upon consultation with the Mortuary staff Contact the Mortuary on 2561 to arrange an appointment or Bereaved Relative Support For viewings out of hours refer to the Mortuary out of hour s policy on the Trust intranet Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 83 of 140 Ward Information Information required from ward personnel Body must have legible IDENTITY BRACELETS on wrists One completed Mortuary Card taped on to the shroud This stays on the body One completed Mortuary Card taped on to the top sheet This is used to copy information for Bereaved Relative Support who informs GP s of their patients death Please fill in ALL deta
119. ical reason for testing please contact the lab in the first instance for discussion Please supply adequate information of Therapy Drugs dose frequency date and time of last dose Time when sample taken Clinical Type of fit frequency toxic side effects etc Sampling Time Immediately before next dose Following a change in therapy it is advisable to allow time for re equilibration of the new dose 2 3 weeks Digoxin Collect specimens at least 6 hours after last dose Lithium Collect specimen 12 hours after last dose Theophylline Collect specimen immediately before next dose trough or if given IV 6 8 hours post dose Investigation of drug abuse The most useful specimen for detection of drugs of abuse is urine If possible a minimum of 20 ml fresh urine collected under supervision should be sent to the laboratory The urine must be collected in a white top universal container Red top universal containers boric acid preservative are unsuitable for Chemical Pathology investigations Where possible information on the drugs the patient may have taken should be provided on the request form In certain circumstances for medico legal purposes gastric washings if available and 10 ml heparinised blood can be sent to the laboratory where they can be stored for two weeks and made available for collection by a legally authorised party later if appropriate Document Number Qual0035 Version 4 03 Docum
120. ics referral card Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 79 of 140 QUICK REFERENCE GUIDE FOR THE PROCEDURE REGARDING PRODUCTS OF CONCEPTION HISTOLOGY REQUIRED Take fixed 10 formal saline specimen to the histology lab With completed consent forms and pink cards indicating patients wishes regarding residual tissue and blocks and slides Laboratory arranges dispatch of cytogenetics sample to Addenbrookes via courier action PRODUCTS OF CONCEPTION 12 WEEKS Foetus and Placenta associated with Paediatric post mortem Take to Mortuary with Consent forms Placenta for histology only Tissue required for all Cytogenetics must be fresh unfixed or in tissue media Media is available from the lab Samples for cytogenetics must be dealt with promptly refrigerate until placed into media NO HISTOLOGY Take to Mortuary with green card Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker _ Review Interval Isotracker Reviewed by C Brock Page 80 of 140 Routine Histopathology Reports Copies of authorised reports are sent to the requesting Consultant or General Practitioner and are available through Apex system Any enquiries about current cases
121. ils on card Use the descriptive term yellow metal YM do not use the term gold to describe an item of jewellery Use the descriptive term white metal WM do not use the term silver to describe an item of jewellery Use the descriptive term stones not diamonds etc If possible please ensure that deceased body arrives in the mortuary in the following condition e Eyes closed e Mouth closed e Hair combed e If the teeth cannot be placed back into mouth please send them down with the body e Leave any tubes and or lines in situ if the case is to be reported to the Coroner If not remove lines and or tubes and tape over e f the deceased is in a body bag the reason why must be stated on the top Mortuary card Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 84 of 140 Immune Sciences Introduction The Immune Sciences Department is part of Pathology at The Queen Elizabeth Hospital NHS Trust Department Location The Immune Sciences Department is located on the ground floor of Pathology at the rear of the hospital It can be sought from the reception area at the main entrance to the hospital Contact Numbers General Enquiries 3771 3779 Results 3207 Karen Ashurst Lead Scientist 3207 Normal Hours of Service Normal working hours are Monday to Friday
122. in H METHB Lithium Heparin Straight to lab For high dose chemotherapy patient SST only by special Methotrexate C METHO NOT FOR ROUTINE arrangement USE Sent to Addenbrookes same day by courier Microalbumin C ACR Urine Universal Sent to SI Molecular JAK mutation H MOLEC 2x 6ml EDTA aa B Random Freeze Mucopoly saccharides C UMUC EMU Sentio Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 118 of 140 Addenbrookes by 1 class Mumps IgM S SST Mumps Virus RNA S 6ml EDTA Mycoplasma Antibodies S SST Myeloma Screen C EP BJP SST universal urine Refer to EP BJP Comes Myeloma Trial Birmingham H MMB Clotted 20ml accompanied by a Universal urine letter Universal Supplied by Haem containing Myoglobulin H UMYO Urine bicarbonate Must be in time to go Neonatal Alloimmune XM SPI Refer to Transfusion a gay Thrombocytopenia NAITP for request form di P isCuss Sent 1 Class to Neurone Specific Endase IS SST Sheffield Neurotensin C GAST pee astin Nickel C Universal Urine Pancomsample Only for E Neurologists sent 1 NMDA S NMDA r class to Oxford N MethyID aspartimine receptor abs NMDA See NMDA Must be in time to go Non Haemolytic Febrile Transfusion EDTA
123. incubated for Amies 4 days medium Gram Stain for Bacterial vaginosis Bacterial vaginosis smear of the discharge Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 60 of 140 Specimen Collection Container Storage Routine Tests eae Notes Ensure that there is adequate material on the swab and that contaminatio Other swabs misreduced 2 3 days 3 toa Culture Wound Skin rae vet T Anaerobe minimum Sensitivity testing if Delay in processing may adversely Ear Nose Transport Swab Room temperature Sai cultures are For example indicated affect results Throat Eyes in legulcers incubated for etc the ulcer 4 days should be cleaned with normal saline and a swab taken from the leading edge MRSA Nose and Break both Colonisation Axilla swabs ew abs Le One Sore Delay in processing may adversely Selective laboratory Room temperature Sensitivity testing if 1 2 days Screen t See affect results Mannitol supplied bottle indicated Broth of MRSA broth Transport Laboratory immediately to the a6 Blood supplied laboratory Out of 2 3 days Aerobic and Hours specimens Culture Blood cultures Blood culture 3 aan ba an 7 cultures collection Anaerobic must be placed in Sensitivity testing if are routinely olic Bottles or the Incubator in indicated in
124. ine profile 3 4 spots of blood on a Guthrie card Where possible samples should be collected during acute illness Relevant clinical details must be provided including drug and diet history Please contact senior biochemistry staff for advice and when urgent analyses are required Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 25 of 140 Thyroid Function testing For routine thyroid function testing TSH will be measured as first line testing Secondary testing including FT4 and or FT3 will be initiated by the laboratory depending upon the clinical details supplied and the result of the initial TSH result If the TSH level is less than 0 50 mU I or greater than 4 0 mU I a free T4 level will be measured on the same sample An FT3 request will be added if the TSH is low and the FT4 result is high normal or abnormally high and the patient is either suspected of having hyperthyroidism or on carbimazole treatment Please state suspected diagnosis and give details of any recent thyroid related therapy otherwise the test cascade will not operate properly Please do not request thyroid function tests on acutely ill patients unless there is reason to believe that thyroid disease is responsible for their acute condition The results are difficult to interpret in the acutely ill Patients on total parenteral
125. issue electronic cross match This sample must be in the laboratory by 2 30 pm on the day prior to the proposed date of morning operations and by 10 30 am on the day of afternoon operations By providing the laboratory with the two samples as stated patients except those with atypical antibodies will be eligible for fast issue i e blood will be issued when required in theatre within 5 minutes of receipt of a telephoned request Telephone numbers for transfusion laboratory extension 3782 and 2398 8 am 6 pm Mon Fri Out of hours 6 pm 8 am and weekends contact duty Haematology BMS via switchboard If the laboratory has NOT received two samples then fast issue blood via electronic cross match cannot be made available and in such cases formal cross match will be required according to the tariff This will delay the provision of compatible blood 4 03 Guided by Isotracker C Brock Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by Page 52 of 140 All requests for pre operative transfusion work MUST state the nature of the operation and the likely date and time of surgery This is to ensure that the laboratory can make the necessary pre operative checks and ensure that blood will be available at the time of the operation Patients with a history of transfusion or pregnancy within the last three months will require samples to be taken a
126. ist may be available Advice should be sought from the laboratory Chemical Pathology Assay Code Comment Reference Range Units Acetaminophen ACTM 10 to 30 mg L Adjusted Calcium CCA 2 20 to 2 60 mmol L Adrenaline UADR Urine 0 250 nmol 24hrs Alanine Transaminase ALT 10 to 49 U L Albumin ALB 32 to 48 g L Albumin Creatinine Ratio ACR 0 to 2 5 mg mmol Alkaline Phosphatase ALP 20 to 140 U L Alpha 1 Antitrypsin A1AT 0 90 to 2 00 g L Alpha Fetoprotein AFP 0 7 0 KU L Ammonia AM 11 2 to 35 4 umol L Amylase AMY 30 to 118 U L Angiotensin Converting ACE 20 to 112 U L Enzyme Aspartate Aminotransferase AST 0 to 34 U L Beta 2 Microglobulin B2M 1 1 8 mg L Bicarbonate BIC 20 to 31 mmol L Bile Acid BIAC O to 14 umol L B Type Natriuretic Peptide BNP 2 to100 pg ml CA125 CA125 0 37 KU L CA19 9 CA19 9 0 37 KU L CAL Serum 2 20 to 2 60 mmol L Calcium 24UCAL 24 hour urine 2 5 to 7 5 mmol 24hr UCA Random urine No range mmol L Carbamazepine CARB 4 to 12 mg L Carboxyhaemoglobin COHB 0 4 0 Carcinoembryonic Antigen CEA 0 10 ug L Chloride CL Serum 99 to 109 mmol L Cholesterol CHOL 3 6 to 6 7 mmol L Cholinesterase PCHOL 4 9 to 11 9 KU L Complement C3 C3 75 to 165 mg dL Complement C4 C4 20 to 65 mg dL Cortisol CORT No range nmol L C Reactive Protein CRP CRP 4 to 10 mg L CRE Serum 55 to 120 umol L Creatinine 24
127. l S Haemoglobinopathy Referral H HBOPH 3mlEDTA se aad Dy Refer to Trust Transfusion Policy Haemolytic Transfusion Reaction XM Boe ami EDTA culiuras Complete Transfusion DAGT 3ml EDTA FBC reaction Ohi Haemosiderin H UHAEM Urine Hairy Cell Leukaemia SST Haptoglobins C HAPT SST Ensure separate HBA1C C GLYHB POTA Or Sodium sample to FBC Fluoride HCG BLOOD C HCG SST HCG URINE H HCG Urine Universal Also known as HCO3 C BIC SST Bicarbonate Part of hii g TOR SST lipid cholesterol profile Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Reviewed by C Brock Page 113 of 140 Heinz Bodies H HBO 3ml EDTA Arapa Haam Citrate amp 3m EDTA Heparin H HEP if not already requested l i Must name Heparin i Low Molecular Weight anti H HEPL Citrate used Must name Heparin Heparin unfractionated i m anti Xa H HEPU Citrate used Heparin Induced Thrombocytopenia XM SPI Refer to Transfusion eae go HIT for request form y Hepatitis A IgG S SST Hep B DNA S 6ml EDTA Hep B DNA Viral Load S 6ml EDTA Hep B Genotype S 6ml EDTA If genotype RNA DNA or PCR Hepatitis B Surface Ag S HEPB SST mentioned then 6ml EDTA also required Hep C DNA Viral Load S 6ml EDTA Hep C Genotype S 6ml EDTA Hep C RNA S 6ml EDTA Consent required If genotype RNA
128. lar 0 48 to 4 45 nmol L Luteal 16 4 to 59 nmol L ROIEAETONE ie Post ND 2 32 nmol L Male 0 89 3 88 nmol L Prolactin PROL 56 to 566 mlU L Prostate Specific Antigen PSA 0 1 to 4 0 ng ml Red Cell Folate RCF 280 to 791 ng ml Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 37 of 140 Assay Code Comment Reference Range Units Rheumatoid Factor RHF 9 3 to 14 IU ml Salicylate SALS Toxic 10 to 300 mg L NA Serum 135 to 145 mmol L Sodi 24UNA 24 hour urine 40 to 220 mmol 24hr UNA Random urine No range mmol L NA Blood gas 135 to 145 mmol L Sweat NaCl Equivalent SWEAT 0 to 80 mmol L TCO2 TCO2 Blood gas 23 to 33 mmol L Male 6 6 to 25 3 nmol L nestetslOne eas Female 0 5 to 3 0 nmol L Theophylline THEO 10 to 20 mg L Thyroid Peroxidase Antibody TPO 0 35 U ml Tnyrotchsumulsung TSH 0 35 to 5 50 mIU L Hormone Total Bilirubin TBIL 0 to 20 umol L Total Cholesterol HDL Ratio T CHRT No range Total Iron Binding Capacity TIBC 45 to 81 umol L TP 57 to 82 g L P 24UTP 24 hour urine 0 01 to 0 14 g 24hr TOIALRVOLEIN UTP Random urine g L CTP CSF 0 15 to 0 40 g L Triglyceride TG 0 8 to 1 9 mmol L Troponin I TROPI 0 01 to 0 04 ng ml UREA Serum 2 5 to 6 5 mmol L Urea 24UURE 24 hour urine mmol 24hr UUREA Random
129. ls investigations and procedures employed in the diagnosis and treatment of clotting disorders and anticoagulation dosing protocols e To work in collaboration with other hospital staff and community anticoagulation services to provide the highest possible standard of care and support to patients who are on anticoagulation therapy and their families e To organise the provision of a comprehensive nurse led service for patients who are on anticoagulation therapy and to provide advice with regard to coagulation queries for staff patients and other healthcare professionals e To undertake a lead role in the promotion and development of anticoagulation services across the primary secondary interface e Nurse prescribing duties as independent supplementary prescriber is undertaken by the Coagulation Nurse Specialist There are now five GP based anticoagulation clinics St James Medical Practice Gayton Road Health Centre Bridge Street Surgery in Downham Market Fakenham Surgery and the Suttons Medical Centre Additionally two community based anticoagulation services Swaffham Community Hospital covering the Swaffham and Heacham surgery areas and the Fenland Anticoagulation Nursing Service who cover the Wisbech and Fenland area There are currently 5 members in the Queen Elizabeth Anticoagulation team and clinics are held daily Patients new to warfarin therapy have an INR blood sample taken either in Pathology at QE or NCH or the district nurse
130. minal cancers may give rise to elevated serum levels including colorectal gastric cervical endometrial and pancreatic cancers Ca 12 5 may also be elevated in patients with advanced lung and breast cancer Ca 12 5 is also elevated in a range of non malignant conditions including endometriosis pelvic inflammatory disease cirrhosis and peritonitis Furthermore menstruation and pregnancy may be associated with moderately raised levels up to 3 times the upper reference limit The main established clinical applications for the measurement of Ca 12 5 are for monitoring treatment of patients with known ovarian cancer and as an aid in the differentiation of malignant and benign pelvic masses Ca 153 Ca 153 is a transmembrane glycoprotein antigen most commonly associated with breast and other adenocarcinomas Unfortunately Ca 153 is rarely elevated in patients with early disease and may be elevated in non malignant conditions including cirrhosis The main clinical application for the measurement of Ca 153 is for monitoring patients with known breast cancer Ca 19 9 Ca 19 9 is a mucin antigen most commonly associated with pancreatic adenocarcinoma Ca 19 9 may also be elevated in patients with gastric and cholangiocarcinomas For colorectal cancer CEA is generally more valuable than Ca 19 9 Unfortunately Ca 19 9 is also frequently elevated in a variety of non malignant conditions particularly obstructive jaundice due to gall stones where
131. n Press return until cursor is at the bottom right of the screen with an A in it Press return and this will accept these details or to see a full list of all specimens type S and Press return twice Move through different dates samples using Page up and Page down or Prev and Next on keyboard Move through results from one day using up and down arrows on keyboard To look at results over a period of time find sample results of the necessary discipline and enter U in the bottom right of the screen Press return To exit out of any screen move to the bottom of the screen by pressing return enter X and press return Except in patient demographics screen of Ward Enquiry where you simply move the cursor up using keyboard arrows until the page exits Remember always log out of system at the end of the session by pressing X and return at the main menu Update your password using UPASS before it expires Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 17 of 140 Never allow anyone else to know your username and password Apex basic troubleshooting If you cannot access Apex exit the programme and re select the icon on the desktop If this fails to give access reboot the PC and repeat the procedure If this fails to give access try from another PC on the ward de
132. n steroid producing cells include the P450 side chain cleavage enzyme P450scc associated with premature ovarian failure and 17a0 hydroxylase P450c17 associated with type autoimmune polyendocrinopathy syndrome Autoimmune adrenal disease is closely associated with other organ specific autoimmune disease Thyrogastric Schmidt s syndrome Parathyroid autoimmune disease The titre of antibody is of no significance therefore a qualitative result is reported Turn around Time 14 days Anti Nuclear Antibodies This indirect immunofluorescence IIF assay has been largely superseded by the EIA screening assay however may be performed by special request Please contact laboratory Anti Neutrophil cytoplasmic antibodies ANCA Indicated in the investigation of vasculitis and performed by IIF There are three main patterns C ANCA PANCA and atypical ANCA These patterns relate to different antigenic specificities e g proteinase 3 PR3 myeloperoxidase MPO and others All ANCA requests are tested for reactivity against PR3 and MPO Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 86 of 140 Interpretations of ANCA staining patterns are shown below Antigen Pattern Disease Association PR3 C ANCA Wegener s granulomatosus microscopic polyarteritis 90 Churg Stauss 30 P
133. ncertain clinical significance Atypical ANCA refers to a variety of observed immunofluoresence patterns and such antibodies are directed against a range of antigens including bacterial permeability increasing protein azurocidin lactoferrin elastase cathepsin G and lysozyme The clinical significance of atypical ANCA is uncertain Ovarian antibodies These antibodies are found in 15 50 of patients with premature ovarian failure under the age of 40 years These antibodies react with steroid producing cells and thus also stain the steroid producing Leydig cells of the testis the placenta and often also in the adrenal cortex They are often seen in Autoimmune Polyglandular Syndrome 1 APS 1 where adrenal and ovarian failure may co exist Up to 70 of women may have transient anti ovarian antibodies during IVF therapy Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 92 of 140 Turn around time 3 weeks Pancreatic islet cell antibodies At the time of diagnosis 75 of type diabetics have detectable levels of circulating islet cell abs Such antibodies decrease and eventually disappear with duration of disease Some studies have indicated persistent levels of abs in association with polyendocrine disease type Ib There have been no reports of abs to pancreatic islet cells in type II diabetics Paraneo
134. nction e g post cardiopulmonary bypass possibly combined with the use of potent anti platelet agents such as Clopidigrel P6 Acute disseminated intravascular coagulation DIC in the presence of bleeding and severe thrombocytopenia P7 Inherited platelet dysfunction e g Glanzmanns Thrombasthenia with bleeding or as prophylaxis before surgery Immune Thrombocytopenia P8 Autoimmune thrombocytopenia in the presence of major haemorrhage P9 Post transfusion Purpura in the presence of major haemorrhage P10 Neonatal alloimmune thrombocytopenia to treat bleeding or as prophylaxis to maintain the platelet count gt 50 x 10 l Specimen labeling All forms and samples must be labelled with the patient s hospital number surname and first name and date of birth Patients who do not have a previous hospital number must be given an emergency registration number which must be used on all samples and forms Do not use casualty numbers SAMPLES MUST BE LABELED BY PDA or by hand from areas where the PDA system is not available NB Samples without a hospital number and date of birth will be rejected as will samples with addressograph labels on Haemolysed or clotted samples may be unsuitable for testing and will be rejected Emergency requests Where blood is required urgently the laboratory MUST be notified as soon as possible and the appropriate correctly labelled samples sent to the laboratory The urgency of the request must b
135. nd the area disinfected with Precept 1000 ppm for routine disinfection of surfaces 10 000 ppm if visible contamination In the event of any difficulty with the performance or interpretation of such tests please contact point of care team on ext 3599 or the main laboratory on ext 3771 Paediatric investigations Test priority Because of the small sample volume available for measurement of blood constituents test priority should be indicated in case there is insufficient sample to perform everything requested Sweat tests Sweat tests are carried out by a biomedical scientist trained and experienced in this technique Arrangements for sweat tests can be made by telephone extension 3797 Maggie Pate Blood Sciences Secretary Suspected inborn errors of metabolism In addition to general biochemistry the majority of these requests will require some or all of the following investigations e plasma amino acids 1 ml blood in paediatric lithium heparin tube green top e urine amino acids urine organic acids 5 10ml urine in a plain white top universal urine glycosoaminogylcans e blood ammonia 2 ml blood in paediatric lithium heparin tube green top collected on ice Lab must have prior notice Sample must reach Lab within 20 mins of collection e blood lactate 1 ml blood in fluoride oxalate tube Lab must have prior notice Take sample without stasis and ensure sample arrives in lab within 1 hour of collection e acyl carnit
136. ning the first or surname to a total of 15 characters These examples form guidelines not absolute rules If in doubt please refer the matter to the Specimen Reception Supervisor or his her deputy or a senior member of lab staff Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 128 of 140 In the case of unidentified casualties e g from RTA s it is permissible to accept samples with a hospital number only providing the sample and form are also identified as Unknown Male Female and a tag number if more than one such person exists at the time Please note that from November 2010 all Trust samples MUST be labelled with labels generated by the PDA SafeTx system except from areas with a prior agreement with the laboratory Incorrectly labelled specimens or forms An incorrectly labelled specimen is one that has the relevant labelling information supplied but the information on the specimen and form do not match In this case the Reception Supervisor or his her deputy is to be informed The Supervisor Deputy will be required to confirm which information is correct that on the specimen or form In order to do so they must telephone the requester immediately in the case of urgent samples or at the first available opportunity for non urgent requests mid morning break lunch break afternoon bre
137. nstructions for the air tube system 46 Procedure for accessing Pathology Ward Enquiry Facility 18 _Sample requirements 21 Paediatric investigations 26 Patients on total parenteral nutrition 27 Protein electrophoresis 27 Faecal occult blood testing 28 Investigation of drug abuse 29 Lipid analysis 32 Simple dynamic function tests 33 _Specimen requirements and Adult reference and therapeutic drug ranges n 35 _Haematology And Blood Transfusion 8 Consultants and senior staff 39 Laboratory services provided specimen requirements 40 i Response time 42 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock General Information and Enquiries 56 Urgent requests 56 Request forms and labelling 55 Specimen reception 58 Time limits for requesting additional requests 58 Serology 54 Notification of Infective diseases 70 Cellular Pathology 71 Opening hours 71 MUSE STEIN OLS hahaa Na athe a tae a tate dade 73 _Request Form 73 Treatment of specimens 74 _Immunofluorescence 74 Crystal microscopy 77 Quick reference guide products of conception 78 Exfoliative cytology 81 _Autopsies Mortuary 82 _Requests for hospital autopsies 82 _Paediatric and perinatal autopsies 83 Ward Information 84
138. ntered into APEX When the results have been phoned and the appropriate comment entered into LIMS the results are then authorised as complete Near patient testing The Trust Point of Care Committee oversees the practice of all professional staff involved in the use of point of care devices near patient testing The Point of care team with support from Blood Sciences are responsible for staff training maintenance and quality control of the Blood Gas Electrolyte analysers which are situated in the following areas A amp E MAU CCU Theatres NICU CDS Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 24 of 140 e Oxborough These analysers may only be used by staffs that have a record of training and instruction via a point of care team delegated trained member of staff from blood sciences Arrangements for this training should be made to the point of care co ordinator by telephone ext 3599 9am 5pm only or email david pemberton gehkl nhs uk point of care co ordinator It should be remembered that safety regulations apply equally to biochemical investigations carried out away from the main laboratory and side room analyses Whether automated or simple stix tests are used this must not be undertaken in rooms used for eating drinking or smoking Any spillage s must be promptly wiped up a
139. nutrition Blood samples from patients on total parenteral nutrition must be sent to the laboratory as early in the day as possible and preferably by 09 30 Please write TPN on the request form The results will then be telephoned and or made available on the Ward Enquiry system as soon as possible so that the patient s fluid and electrolyte intake can be adjusted accordingly Troponin testing Assay of serum Troponin is available for the investigation of patients with suspected acute coronary syndromes ACS The samples should be taken on admission and repeated 12 hours post admission if the initial Troponin result is not elevated Levels of Troponin frequently remain elevated for up to 7 days post AMI ACS Protein electrophoresis Serum protein electrophoresis is carried out e When specifically requested e When total protein and albumin results indicate a very high globulin value Immunoglobulins IgG IgA and IgM are measured e When specifically requested with appropriate clinical details e In order to investigate an abnormality detected by serum protein electrophoresis When myeloma is suspected please send a fresh random preferably early morning 20 mL urine sample for Bence Jones protein in a white capped universal container along with the serum sample for electrophoresis Without the urine sample myeloma cannot be excluded It is important to discuss investigation of cryoglobulinaemia with the laboratory in adv
140. ogether La is a phosphoprotein and Ro a ribonucleoprotein and both can bind to the same molecule of a transfer RNA SLE patients positive for Ro amp La are likely to have lower DNA antibody titres and less renal disease Jo l Antibodies to aminoacyl tRNA histidyl synthetase Associated with inflammatory muscle disease especially idiopathic polymyositis Scl 70 Antibodies to Topoisomerase I an enzyme catalysing the breaking and re joining of ssDNA Found in 20 40 of patients with systemic sclerosis it is associated with facial skin kidney and heart involvement ischaemic fingertip ulcers and pulmonary fibrosis Epidermal antibodies See Pemphigus and pemphigoid antibodies Functional antibodies These comprise abs to tetanus pneumococci and Hib and are indicated as part of the investigation of suspected immune deficiency Specific antibody production is recommended for first line investigation of B cell function in patients with recurrent infections functional antibody responses can be abnormal even if immunoglobulin and Ig subclass levels are normal T cell dependent protein antigens e g Tetanus and Diphtheria produce an IgG1 response whilst polysaccharide antigens e g Pneumovax and unconjugated Haemophilus influenzae vaccine elicit an IgG2 response Normal antibody production would include a rise in specific antibody levels within two weeks for protein antigens and within three weeks for polysaccharide antigens GAD antibodi
141. ollections might be required Please contact the lab for further advice For suspected carcinoid tumours there are no drug or dietary restrictions Sample 24 hour urine Collection Note that the container supplied contains an acid preservative The appropriate collection instructions are issued with each container The patient is instructed not to void urine directly into the container It is important to reinforce this precaution Faecal occult blood testing The following dietary drug restrictions are advised 3 days prior and during the tests e Avoidance of Red meat e g beef lamb pork liver sausages etc eat poultry or white fish e g cod instead e Avoidance of the following vegetables and fruit Cauliflower Turnip Parsnip Horseradish French Beans Melon Artichoke Bananas Broccoli Radish Cucumber Mushrooms Courgette Beetroot Tomatoes uncooked e Avoidance of Vitamin C tablets Aspirin and aspirin like drugs i e Brufen Indocid Naproxen etc Alcohol Iron tablets Therapeutic drug monitoring Anticonvulsants Routinely measured include e Phenytoin e Carbamazepine Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 27 of 140 e Phenobarbitone Other anticonvulsants including valproate ethosuximide are not routinely available If there is a persuasive clin
142. om front screen choose Pathology This is usually option number 2 and press enter At Login prompt enter APEX and press enter At Unknown answerback enter ZLN PATH1 or PATH3 Some terminals may not ask for this and may go straight on to the next screen if left for 10 15 seconds Enter username and password when prompted Entering your password incorrectly 3 times will lock you out and Pathology will have to rectify this Passwords can be obtained from pathology When first entering a new password you will be asked to change it from the one you were given to another word of 6 or more letters Passwords last for 3 months and can be renewed near the time of expiration at any terminal using the UPASS option Usernames never expire The front screen of APEX system should appear You should have access to Ward Enquiry Result Enquiry and Change Password only To access patient results from the disciplines Biochemistry Haematology Microbiology and Transfusion enter Ward Enquiry WENQ Enter patient s hospital number press return and enter first 2 letters of the patient s surname and press enter After patient details have come up press return until the cursor is in the discipline option To see all results from all disciplines leave this blank use the space bar to clear whatever discipline is showing or enter C for Biochemistry H for Haematology M for Microbiology or T for Transfusio
143. on C5 Renal failure or liver failure associated with abnormal bleeding where DDAVP is contraindicated or ineffective PLATELET CONCENTRATES British Committee for Standards in Haematology 2003 Consensus Conference on Platelet Transfusion 1998 Schiffer et al for the American Society of Clinical Oncology 2001 Dose 15ml kg body weight equivalent to 1 adult therapeutic dose for an adult P1 To prevent spontaneous bleeding when the platelet count lt 10 x 10 1 P2 To prevent spontaneous bleeding when the platelet count lt 20 x 10 I in the presence of additional risk factors for bleeding such as Sepsis or Haemostatic abnormalities P3 To prevent bleeding associated with invasive procedures The platelet count should be raised to gt 50 x 10 1 before lumbar puncture epidural anaesthesia insertion of intravascular lines Transbronchial and liver biopsy and Laparotomy and to gt 100 x 10 l before surgery in critical sites such as the brain or the eyes Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by 4 03 Guided by Isotracker C Brock Page 49 of 140 Critical Care Surgery P4 Massive blood transfusion The platelet count can be anticipated to be lt 50 x 10 I after 1 5 2 x blood volume replacement Aim to maintain platelet count gt 50 x 10 1 P5 Bleeding not surgically correctable and associated acquired platelet dysfu
144. ort bag If any leakage or damage to samples occur follow your recommended guidelines for safe disposal Advice may also be sought from the laboratory reception on 01553 613769 who will then pass you on to the relevant department for assistance Hospital drivers collect the samples from GP surgeries at regular times and bring them direct to the reception area at Town Surgeries approx 10 00 14 00 and 16 00 Country Surgeries approx 14 00 Coastal Surgeries approx 14 00 Wisbech Surgeries and Hospital approx 11 00 14 00 16 00 and 18 00 Pathology reception will be notified if for any reason the drop time alters Porters deliver samples from the wards throughout the day to the sample tray located at the sample reception window Sandringham Hospital samples delivered by their porter must be checked for three points of identification on all samples and forms before accepting them The forms must be date stamped On receipt of RAF Marham samples any result reports can be returned with the driver Sample Distribution All Samples received will be sorted and distributed to the correct area of Pathology as soon as possible after receipt Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 134 of 140 Appendix 7 Referred Laboratories details See also Microbiology policy for sample referral
145. ote All specimen tubes MUST be labelled with 4 identifiers patient s forename surname DOB hospital number using the PDA system from within the QEH Where the PDA system is not in use it is acceptable to hand label the samples with the statutory 4 points of identification If you wish to convert a group and screen to a cross match please phone the laboratory on extension 3782 Pre Admission Group amp screen samples are kept for 28 days Specimen Time Constraints for Transfusion Samples Timing of transfusion samples is dependent on the time date of the latest transfusion If a transfusion has taken place within the previous 3 months then a sample must be taken within the 48 hours prior to the start of transfusion and transfusion must be complete within 72 hours from the time of sampling If there has been no previous transfusion the blood can be issued and transfused for up to 1 week from the date of sampling Allow 1 clear working day for elective crossmatching Crossmatched blood is routinely returned to stock after 24 hrs unless discussed with the laboratory Other Blood components and products available For guidelines on use of blood and blood components and products refer to the Trust Transfusion Policy amp Procedure on the Administration of Blood and Blood Products available on intranet Fresh frozen plasma Blood group specific Order by phone giving clinical disorder requiring the product Volume issued is dependen
146. oured Blue Requests for bacteriology must be made on a bacteriology form Requests for all other Serology Virology tests including antibiotic levels must be made on a Serology Virology form A separate combined Haematology Serology form is provided for routine Ante natal screens Consultants and senior staff Professor Lynne Liebowitz Consultant Microbiologist 3627 Dr Sunil Sharma Infectious Diseases Consultant 4360 Mr Graham Rogerson Chief Biomedical Scientist Microbiology 2876 Sandra Robinson Senior Biomedical Scientist Microbiology 2486 General information Opening Hours Microbiology Serology amp Virology Normal times for receipt of specimens are between 08 30 and 16 30 Monday to Friday Enquiries Working hours Microbiology medical advice 3627 Microbiology general enquiries 3772 Microbiology results 3772 Out of hours Clinical advice Technical advice Contact via hospital switchboard Contact via hospital switchboard Please only bleep Microbiology out of hours for CSF specimens Laboratory Services Urgent requests Samples requiring urgent analysis require a prior telephone call During the normal working day any requests for urgent processing of specimens must be made by telephoning the appropriate section of the department Out of hours requests for urgent processing of specimens should be made to the on call BMS Request forms MUST be clearly marked URGENT and MUST give details as to where results are to be tel
147. ow Ca Excess liquid heparin Abnormal blood gases and analytes Lipaemia Taken before intra lipid is Interferes with many due to cleared Taken after fatty turbidity of sample May meals anxiety and stress cause low Na Contamination of blood by High MW dextrans Elevated proteins infused fluids Dextrose High glucose Crystalloid solutions Spurious Na K Cl etc Low Ca high Na Bubbles in blood for arterial Leaking syringe needle Low pCO gases junctions Inadequate Increased pO stoppering of syringe in transit Venous Blood Specimens of venous blood should preferably be taken with the patient sitting or lying down and without prolonged venous stasis Do not collect specimens from a vein in a limb into which an intravenous infusion is being given If there is anticoagulant in the tube mix by repeated gentle inversion do not shake the specimen Patients with very high platelets or white cell counts may give spuriously high serum potassium levels and should be checked on lithium heparin plasma green top tube Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 21 of 140 Arterial Blood Arterial blood specimens are usually taken only for blood gas analyses in which case it is important that the syringe is properly heparinised and that the blood is collected anaerobically When th
148. partment or check with another ward department to determine if the problem is localised or more wide spread Trust wide If the problem is localised report the failure to the Trust IT department helpdesk ext 4422 or to the Site Co ordinator out of hours IT support via switchboard If the problem appears Trust wide determine if the problem is a network problem PAS system will also be down or a specific Apex problem PAS working normally Network problems should also be reported to Trust IT on 4422 Specific Apex problems need to be reported to the Pathology IT Manager ext 3430 in hours or the Haematology or Biochemistry BMS on call via Switchboard who will attempt to solve the problem Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 18 of 140 Chemical Pathology Request Form The chemical pathology request form is combined with the haematology discipline as shown by figure 1 Figure 1 F THE QUEEN ELIZABETH HOSPITAL KING S LYNN NHS TRUST Hospital No HAEMOCHEMISTRY Surname Sample Type Forename s Sample Collection See reverse for specimens required Address Date Time Date of Birth Sex Glucose _ Other please specify Electrolytes AFFIX ADREMA LABEL ABOVE IF AVAILABLE Consultant G P Ward O P D S
149. pati hepatitis infection Date of Serum 1 2 days screening serology antibodies oe onset required Hepatitis A antibodies Anti HBs Seroconversion check Hepatitis B following hep B vaccine antibodies serum ee deys Anti HBc total To provide evidence of past antibodies HBV infection HIV A HIV antibody antigen Evidence of HIV infection Serum 1 day Rubella IgG Hepatitis B s Immunity to rubella check amp Antenatal antigen screen for HBV HIV and f sent Serum 3 days screening HIV syphilis infections antibody antigen yellow antenatal form Syphilis antibodies s Treponema Evidence of past or recent ayphilis serology pallidum antibodies syphilis infection serum Tays Evidence of past or current E oa te CMV infection Serum 5 days gy g Date of onset required Varicella zoster VZV IgG Evidence of immunity to VZV Ser m 2 days virus serology Date of contact required F Evidence of past recent Toxoplasma Toxoplasma gondii i serology antibodies Toxoplasma infection Serum 3 days Date of onset required Evidence of past recent Lyme Lyme disease Borrelia burgdorferi disease S r ni 3 das serology antibodies Date of onset or of tick bite y required Infectious Please send sample for full mononucleosis blood count to Haematology serology Lab Sirept coccal Evidence of recent P ASO antibodies streptococcal infection Serum 2 days serology Date of onset required Detection of RSV in Respiratory nasopharyngeal secretions Nao Trae RSV antigen A ph
150. plastic neurological antibodies Paraneoplastic neurological syndrome and systemic malignancies antibodies are associated with paraneoplastic neurological Screening of neuronal and purkinje antibodies are performed by indirect immunofluorescence If there is any staining present the specimen will be referred for further tests Further classification of paraneoplastic neurological antibodies will include the following Antibody Neurological disorder s Most frequent tumour s Yo PCA 1 paraneoplastic cerebellar degeneration Ovary breast Ma Ma1 paraneoplastic neurological disorder Various lung cancer brainstem encephalomyelitis Ta Ma2 brainstem encephalomyelitis Testicular cancer limbic encephalomyelitis Hu ANNA1 paraneoplastic cerebellar degeneration small cell lung carcinoma paraneoplastic encephalomyelitis sensory neuropathy Ri ANNA2 opsoclonus myclonus paraneoplastic Cerebellar Breast small cell lung degeneration brainstem Encephalomyelitis GAD Stiff person syndrome Breast colon small cell lung carcinoma CV2 CRMP5 paraneoplastic encephalomyelitis sensory small cell lung carcinoma Neuropathy thymoma Amphiphysin Stiff person syndrome paraneoplastic Breast cancer small cell Encephalomyelitis lung carcinoma Tr paraneoplastic cerebellar degeneration Hodgkin s lymphoma Turn around time 4 6 weeks Pemphigus and Pemphigoid Antibodies Abs are found in i inte
151. protein HDL No range mmol L Human Chorionic HCG 2 to 10 IU L Gonadotropin 0 14 Days 0 01 to 0 08 14 Days 6 Weeks 0 02 to 0 15 6 Weeks 2 Months 0 05 to 0 40 2 Months 6 Months 0 20 to 0 70 6 Months 9 Months 0 15 to 1 00 9 Months 1 Year 0 30 to 1 20 e ii IGA 1 Year 2 Years 0 30 to 1 30 g L 2 Years 3 Years 0 50 to 2 40 3 Years 6 Years 0 70 to 2 50 6 Years 9 Years 0 80 to 2 80 9 Years 15 Years 0 90 to 3 40 15 Years 150 Years 0 80 to 4 0 0 14 Days 5 0 to17 0 14 Days 6 Weeks 3 9 to13 0 6 Weeks 2 Months 2 1 to 7 7 2 Months 6 Months 2 4 to 8 8 6 Months 9 Months 3 0 to 9 0 9 Months 1 Year 3 0 to 10 9 mmunegiebulinG ag 1 Year 2 Years 3 1 to 13 8 g L 2 Years 3 Years 3 7 to 15 8 3 Years 6 Years 4 9 to 16 1 6 Years 9 Years 5 4 to 16 1 9 Years 45 Years 5 4 to 16 1 45 Years 150 Years 5 3 to 16 5 0 14 Days 0 05 to 0 20 Immunoglobulin M IGM 14 Days 6 Weeks 0 08 to 0 40 g L 6 Weeks 2 Months 0 15 to 0 70 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 36 of 140 Assay Code Comment Reference Range Units 2 Months 6 Months 0 20 to 1 00 6 Months 9
152. rcellular substance of the epidermis desmosome which strongly suggest a diagnosis of pemphigus though these abs may also be found in patients with severe burns or a trichophyton infection ii dermal epidermal basement membrane which is highly specific for bullous pemphigoid and is present in 80 of these patients Turn around time 2 weeks Phospholipid antibodies Phospholipid antibodies are a family of antibodies Cardiolipin b2 glycoprotein 1 and the Lupus Anti Coagulant useful in the investigation of the anti phospholipid syndrome This may be primary or secondary to SLE Patients with the anti phospholipid syndrome may be positive for both the lupus anti coagulant and for the cardiolipin autoantibodies or for only one of these assays Therefore samples should be sent for both tests Indications would include recurrent miscarriages and arterial and venous thrombosis Slightly elevated levels may be found in some infections and so only positive results at two time points Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 93 of 140 at least 12 weeks apart are considered significant IgG and IgM antibodies are assayed separately Please note that lupus anticoagulant is referred by Haematology The diagnosis of the anti phospholipid syndrome requires the appropriate clinical setting detailed below to
153. rogrammes The Haematology department is providing this service e Thrombophilia screening only performed after referral to Consultant Haematologist e D Dimer testing will only be performed on samples from patients where a Well s score and clinical information have been supplied it is not routinely offered to GP s Telephoning Abnormal Results Table 14 displays the telephone alert limits of abnormal results Table 14 Results that are critical as defined above with no previous history will be telephoned to the requesting ward clinician GP as soon as possible and a comment of the action will be entered Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 41 of 140 into APEX When the results have been phoned and the appropriate comment entered into LIMS the results are then authorised as complete Test WBC Haemoglobin Haematocrit Platelets ESR Malarial parasites Direct Coombs B12 INR not on warfarin INR on warfarin APTT ratio not on heparin APTT ratio on heparin Response time GP amp Clinics Inpatient Neutrophils lt 1 0 New neutropenia s lt 1 0 lt 0 5 chemo gt 20 0 new lt 80 if no history lt 60 if new gt 0 55 gt 0 6 lt 70 if on anticoagulants lt 20 on chemo if falling lt 10 on chemo lt 30 new gt 100 new Po
154. s 1 class Only Dr Free T3 C FT3 SST George Jennings Only Dr Free T4 C FT4 SST George Jennings except Paeds Sent to Addenbrookes by Free Total PSA Ratio C RPSA SST interlink 9 30am Also known as Follicle Stimulating FSH C FSH SST Harmone Also known as Free T3 and Free T4 Dr FT3 FT4 C FT3 FT4 SST George Jennings only except Paeds Full Blood Count FBC H FBC 3ml EDTA Sent 1 class to Functional Antibodies IS FUNCAB SST Sheffield See Glucose 6 phosphate G6PD H G6PD 3ml EDTA dehydrogenase deficiency GMMP C TPMT ee TENT Galactomannan Antigen Test C GAL SST Galactosidase See WCE C WCE 6ml EDTA Gamma Glutamyl Transferase yGT C GGT SST Gastric Parietal Antibodies S APCA SST On ice Frozen Sent Gastrin C GAST 6ml EDTA to Charing Cross by courier Also known as GBM IS GBM Sot Glomular Basement Membrane Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 111 of 140 Sent to Addenbrookes by 1 Genetic Test H DNA 2 x 6ml EDTA class Sent to S Genetics DNA C 10mL EDTA Addenbrookes by 1 class State time sample GEN amp taken and time of Gentamicin Level C TIME SST jas doce Also known as Gamma Glutamyl GGT C GGT SST Transferase Glandular fever Test GFT mono
155. s DNA S 6ml EDTA Cytomegalovirus States S SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 107 of 140 Less than 4hrs old D Dimer H DIMS Citrate Requires wells score or probability score DAGT XM DAGT See Coombs Test Sent to Leeds by 1 Dehydroepindrosterone Sulphate C DHEAS SST class Dengue Fever S SST Dexamethasone Suppression test C CORT PER Gorey Sent to Leeds by 1 DHEAS C DHEAS SST class Diagnostic Coag Screen H HC Citrate 3m EDTA bess ANANE Og See Dibucaine C SUXTYP SST SUXTYP Digoxin C DIG SST Sent to Addenbrookes by 1 Dilute Russells V Venom Time i class on same day DRVVT pi Weare AA GRAI Only bleed mon thurs 9am 2pm Direct Antihuman Globulin Coombs Test Fractions AM RAGI omi EDTA Direct Antihuman globulin test DCT XM DCT 6ml EDTA Contact Serology wi Early Antigen Fluorescent s DEAFF 6ml EDTA Direct Granulocyte XM s EETA 10ml Straight to Lab DNA Antibodies ds IS DSDNA SST DNA Studies Fragile X C DNA 5 10ml EDTA SES TIADA DsDNA IS ANF SST EBV S SST EBV DNA S 6ml EDTA 3 Samples at timed EDTA Clearance C CEDTA Lithium Heparin intervals EGFR C E SST Electrolytes C E SST Electrophoresis C EP SST Document Num
156. s than 1hr old See Adrenal Short Synacthen test C ACFT1 Suppression Test Also book in for Sickle Cell H HBS 3ml EDTA HBOP Sent to Harefield by Sirolimus C SIR 3ml EDTA 1 class Sent 1 class to Skin reactive Antibodies IS PEAB SST Sheffield SLE Screening IS ANF SST Sodium Valporate C VALP SST Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 123 of 140 Somatostatin C GAST See Gastrin SPEP C SST Split Bilirubin C SST Streptococcal anti s SST Deoxoyribonuclease B Copy of FBC results Sent to Subsets H SUBS 2x 3ml EDTA Addenbrookes by courier Suxamethonium Sensitivity Reaction Cholinesterase for i e teux 27 Sodium Genetic See cholinesterase for Fluoride b liti Suxamethonium sensitivity aonormatues Sweat test C SWEAT Conacykag Syphilis IgG M S SYP SST Copy of FBC results Sent to T amp B Cell Quantitation H SUBS 2x 3ml EDTA Addenbrookes by courier T Pallidum S SST Must be sent to lab T spot S 3 x Lith Hep before 2pm mon fri Sent to Kings College or Tacrolimus Levels C FK506 6ml EDTA Andenordokes refer to SOP TAU proteins C TAUP Nasal ear secretions FNI r GEArgER Teicoplanin levels SST Must state patients Testosterone C
157. sculitis including necrotising and crescentic glomerulo nephritis The assay is useful in confirming MPO specific abs in sera which are positive for anti neutrophil cytoplasmic abs of the perinuclear type pANCA Typically the level of MPO abs parallel disease state with increasing levels when vasculitis is active Urgent requests must be arranged with the laboratory Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 91 of 140 Neutrophil cytoplasmic antibodies ANCA This term encompasses antibodies to enzymes within the cytoplasmic granules of neutrophils These are detected by indirect immunofluorescence IIF using human neutrophils Antibodies directed against different enzymes are associated with different patterns of neutrophil cytoplasmic antibodies as detected by IIF Please see below for clinical associations of ANCA Enzyme Linked Immunosorbent Assays ELISA assays are recommended for the complete characterisation of ANCA i e antibodies to Proteinase 3 PR 3 and Myeloperoxidase MPO These assays allow more accurate quantitation of the antibody than titration by IIF Diseases in which ANCA antibodies may be found Wegener s granulomatosis Cytoplasmic ANCA C ANCA is found in only about 85 of patients with active generalised Wegener s granulomatosis Therefore the absence of these antibodi
158. sion 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 137 of 140 Inspected Sept UCort 3057 2010 Registered No 9 Days Southmead Hospital Cholinesterase 0034 Yes Registered No 3 4 Weeks Suxamethonium 0034 Yes Registered No 3 4 Weeks Not Cholinesterase Genotyping 0034 Yes Registered No 10 12 Weeks St Marys Renin and Aldosterone 0563 Yes Registered No 3 4 Weeks St Thomas Hospital Pivka11 0909 No Registered No Not stated TPMT 0909 No Registered No Not stated Trace elements Guildford Aluminum 1167 No but full ACC Registered No Within 10 Working Days Copper 1167 No but full ACC Registered No Within 10 Working Days Caeuloplasmin 1167 No but full ACC Registered No Within 10 Working Days Urinary Caeuloplasmin 1167 No but full ACC Registered No Within 10 Working Days Urinary Copper 1167 No but full ACC Registered No Within 10 Working Days Lead 1167 No but full ACC Registered No Within 10 Working Days Selenium 1167 No but full ACC Registered No Within 10 Working Days zinc 1167 No but full ACC Registered No Within 10 Working Days cobalt 1167 No but full ACC Registered No Within 10 Working Days chromium 1167 No but full ACC Registered No Within 10 Working Days University Hospital of Wales Thyroglobulin 0841 Yes Registered No Not stated Willink Manchester White Cell Enzyme 2766 Yes Registered No Not Stated Reference Audit of referral la
159. sitive Positive If patient has pancytopenia gt 2 5 lt 1 5 or gt 4 5 gt 2 5 N A lt 20 on chemo if falling lt 10 on chemo lt 30 new Positive Positive amp anaemic gt 2 5 gt 6 5 gt 2 5 gt 4 0 The response times for haematology requests are outlined in table 15 Table 15 Request Turn around time Urgent routine requests Within 1 hour Routine results Available on ward enquiry FBC ESR GFST coagulation Same day Hb electrophoresis 7 days occasional samples are referred for confirmation results then available 10 days from request G6PD 24 48 hr Thrombophilia screen 2 weeks HLA B27 Within 2 weeks Reports Adult reference range and normal values for age and sex are available on Apex or via Pathology web site Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 42 of 140 Haematology Reference Ranges Table 16 shows the haematology reference ranges Table 16 Test Age Sex Units Normal Range WBC 1 year 10 L 6 0 17 5 5 years g 5 0 14 5 10 years 4 5 13 0 Adult 4 4 10 0 Neutrophils 1 year 10 L 1 5 8 5 5 years 1 5 8 0 10 years
160. spot H GFT 3ml EDTA Glomular Basement Membrane Abs GBM IS GBM SST See Gastrin Glucagon C GAST 6ml EDTA Cortisol and GH Glucagon Stimulation Test C SST measurements Glucose C GLUC Sodium fluoride GH testing Glucose Suppression Test C SST Sample 1 at fasting Different Sample 2 two hours codes for after glucose loading Glucose Tolerance Test C Different Sodium fluoride drink Locations If screen shows a deficiency send EDTA to Glucose 6 phosphate Addenbrookes for dehydrogenase deficiency screen H CEPR aro G6PD assay with aged matched sample Gonadotrophins C INF SST enero Granulocyte Immunology XM SPI See XM IBGRL Bristol 0117 991 2108 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 112 of 140 PG amp GOR Group amp Antibody Screen XM PGS 6ml EDTA Growth Hormone C GH SST On ice Centrifuge freeze Sent to Gut Hormones C GUT 6ml EDTA Charing Cross by courier Haematinics C BSF FER SST Sent to N amp N by 1 Haemochromatosis H HFE 3ml EDTA class Stat test by prior Haemoglobin H H HBH 3ml EDTA arrangement Also book in with Haemoglobin Solubility test H HBS 3ml EDTA HBOP Form to go to Haem Haemoglobinopathy screen H HBOP 3ml EDTA desk Sent to Centra
161. sts Phone laboratory ext 4255 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 131 of 140 Appendix 5 Blood Sciences samples special considerations Haemolysis releases cell contents into the plasma serum The differential concentration across cell membranes is maintained by the energy from glycolysis In vitro erythrocytes use up glucose and therefore the energy source and so concentration in plasma cells will equalise So if the plasma is not separated from the cells within 4 hours similar effects to that of haemolysis is observed Hormones enzymes and antigens are proteins and start to denature soon after venepuncture and subsequent separation So unstable proteins should be stored at recommended temperature e g Thyroid short term 4C long term 20C Enzymes short term 4C long term 20 C PSA immediate 20 C Specimens must be allowed to reach room temperature before assaying as most are performed at 24 37 C Visual Tests of Samples 1 Haemolysis depending on the degree of haemolysis in the sample may lead to Falsely raised K and Bilirubin 2 Lipaemia can cause low sodium due to space occupying effect and interferences with several assays 3 Icteric high bilirubin 4 Cryoglobulins proteins that precipitate when cooled below body temperature may be associated with disease kno
162. t s bladder at the start of the collection period discarding the urine It is usually convenient to collect a 24 hour urine from one morning to the next At some suitable time e g 08 00 hrs the bladder is emptied and the urine discarded All urine passed during the day and the following night is collected The bladder is emptied at the same time the following morning and this sample is added to the collection The bladder should be emptied and the urine saved before defecation Refrigerate the urine during the collection if possible and send it to the laboratory with the minimum of delay when the collection is complete Appropriate preservatives may be necessary and since these will be added to each bottle when it is requested from the department the bottles should not be emptied or rinsed before use and they should not be used for assays for which they were not requested Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 22 of 140 Faeces A small sample of a random specimen is best put in a plastic white capped universal Sterilin bottle For occult blood detection it is advisable to send specimens collected on three consecutive days and note dietary restrictions Calculi May be sent in any clean container Miscellaneous body fluids Pleural ascitic and fluids of unknown origin should be colle
163. t 1 class to Anti Histone Abs IS HIST SST Sheffield Sent 1 class to Anti Islet Abs IS ICAB SST Sheffield Anti LKM Abs IS LIV SST Sent 1 class to Anti MAG Myelin associated glycoprotein C MYAG SST Sheffield Anti Mitochondrial Antibodies IS LIV SST Anti Neuronal Abs IS NP SST Anti Nuclear Antibodies Ro La Sm RNP So Sel D AN oat Anti Neutrophil Cytoplasmic IS ANCA SST AOS 10 MPO amp PRG Antibody Anti Perkinje Abs IS NP SST Anti Phospholipid Part of Lupus IS CARD SST Cardiolipin profile normally with lupus Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 101 of 140 Anti PR3 MPO IS ANCA SST Anti Skeletal striated Muscle Abs IS SST Sent 1 class to Sheffield Anti Sperm Antibodies S SST Anti Staph S SST Anti Strep abs S SST Antistrepolysin O S ASO SST Part of TPSA Only to be taken Mon Thurs 9am 2pm To Anti Thrombin H ATH Citrate be sent same day Sent 1 class to Addenbrookes Part of TPSA Only to be taken Mon Thurs 9am 2pm To Anti thrombin III H ATH Citrate be sent same day Sent 1 class to Addenbrookes Anti thyrotrophin Receptor Abs C TRAB SST Cardiff Anti topoisomerase l scl70 abs IS ANF SST Anti TSH rec
164. t arene How to Dept antai Availability anaa Email ar Ext 3797 or Clinical Chemistry Vacant via switchboard On Call Via Haematology Consultant oe switchboard DrL Eo g lynne liebowitz qehkl nhs uk Microbiology Liebowitz 24 7 oF via sunil sharma qehkl nhs Dro cnarnma switchboard Cellular 08 00 17 30 Ext 3622 Pathology Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 12 of 140 Urgent Requests instructions for Trust requesters Chemical Pathology Haematology service Blood Sciences Normal working hours Mon Fri 08 00 to 18 00 Weekends 09 00 to 12 00 Midday The Pathology Reception is manned Mon Fri between 08 15 and 17 00hrs so there is no need to page the Biochemistry or Haematology BMS Within the hospital samples may be sent by air tube or porter Please note that samples for blood cultures blood gas analysis and Danger of Infection must not be sent by air tube In the event of the air tube system being down the portering system should be used for delivery of all samples The laboratory aims to analyse and report results within the working day for most routine requests Urgent requests are reported within a maximum of 2 hours from receipt in the lab In circumstances dictating a faster turnaround time e g patient bleeding in Theatre please phone the appropriate lab Ext 2330 Tr
165. t on weight if patient Allow 20 min for FFP to be defrosted in laboratory Not used for reversal of warfarin Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 46 of 140 Cryoprecipitate Platelets Anti D Immunoglobulin Blood group specific Fibrinogen level required prior to request Order by phone giving clinical disorder requiring product Allow 20 min for defrosting Blood group specific usually available within 2 3 hrs In emergency within 2 hours For Rhesus negative woman post delivery of Rh D positive child give 500iu Kleihauer performed automatically Ward will be informed if further dose of anti D is required and the need for a further Kleihauer test Following any sensitising event lt 20 weeks gestation give 250 iu anti D gt 20 weeks 500 iu and a Kleihauer test should be requested Prophylactic anti D 1500 iu given at 28 weeks gestation Transfusion brief policy guide All staff involved in the Transfusion process should be aware of the Trust Transfusion Policy The Trust Transfusion Policy is detailed as The Trust Transfusion Policy document is available in all clinical areas It provides details of all Trust policies relating to Transfusion Blood Transfusion is a potentially hazardous procedure which should only be given when the clinical benefits to the patient
166. tonella S SST Sent 1 class to St Beta 2 transferrin tan protein IS TAUP Nasal Ear Secretions George s Freeze protect from Beta Carotene C SST light Beta Hydroxybutyrate Urine Dipstick Ketone DKA suspicion BFT C B SST Uncuffed sample BHCG C HCG SST Bicarbonate HC03 C BIC SST Bile Acids C BIAC SST Bilirubin total split conjugated unconjugated 7 TILBA as Biotinidase C BIOT Lithium Heparin Centrifuge separate Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 103 of 140 and freeze Sent to Addenbrookes by 1 class Bleeding time H BT By appointment Blood Film H FI 3ml EDTA Lose Hannie ds Blood group XM 6ml EDTA Blood Metal C PEP DOBAILANG chromium BNP C BNP 3ml EDTA Specialised Form Bone Profile TP ALB Ca ALK ie ues Uncutfed as Ca GLOB Borrelia Burgdorferi Lyme disease S LYM SST 6 52 post onset Brain Natriuretic Peptide C BNP 3ml EDTA Specialised Form Bromide C SST Brucella S SST Sent to Hallamshire C1 Esterase Inhibitor C C1IN SST by 1 class See Complement C3 C4 C COMP SST levels CA125 Ovarian Tumour Marker C CA125 SST Sent to N amp N by 1 CA153 Breast Tumour Marker C CA153 SST class CA19 9 Pancreatic Tumour M
167. tor for a suitable period minimum of 24 hours In case of complaint by the requester they should be advised to speak to the relevant consultant in Pathology regarding the policy Unlabelled forms In the event that a fully labelled specimen is received in the laboratory along with an unlabelled form if the locator information can be gained from the specimen or deduced from the company kept by the specimen e g arrived in tin from specific Health Centre then the Supervisor should contact the likely requester location and confirm that the patient details are known to them If confirmed the Supervisor should request that a completed request form be faxed to the Reception to allow sample processing If the patient is unknown to the requester Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 130 of 140 location the sample and form should be bagged and stored in a refrigerator for a suitable period before discard a minimum of 24 hours Appendix 4 Blood Sciences requests turnaround times Test Profile Maximum turn round time Routine Chemistry Serum Urine Fluids FBC including film Urine HCG 24 Hours Coagulation ESR Factor assays 8 Hours Routine Endocrinology 48 hours Special Endocrinology Immunoassay Haemoglobinopathys 7 days Malarial Parasites 2 Hours Referred Te
168. transparent plastic bags Place the sealed bag s containing sample amp form in an air tube pod having checked that the lid is properly closed and that the pod is in good condition no cracks or breaks 2 Input the three digit address of the target destination onto the keypad e g for Blood Sciences it is 211 3 Place the pod into the carrier 4 The pod should send to its destination If any defect is noticed with the operation of the air tube system please notify the laboratory at the earliest convenience Results Printed reports are returned to all wards and outpatients on a daily basis For all GP practices results are transmitted electronically Within the hospital results are also available via the Pathology Ward Enquiry facility Apex for all disciplines as soon as they are validated Please note that validated results in Haematology may be preliminary and can change prior to the issue of the final report Significantly abnormal results see individual department s policy on telephoning results will be telephoned to the requesting doctor nurse or consultant s secretary as appropriate Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 15 of 140 In general In all instances the BMS will identify themselves communicate which department and hospital they are telephoning from The pati
169. turnaround time for transfusion samples depends on the nature of the request being made As a routine all group and antibody screen requests will be reported within 12 hours of receipt However this may be delayed by the presence of atypical antibodies and the possible need to refer to NHSBT All requests for blood components will completed according to the time stated at request Any urgent requests for blood components will be completed as soon as processing is complete and it is safe to do so Antenatal Sample testing will be completed within 1 week of receipt This may be delayed if the sample is referred to NHSBT for antibody quantitation Sample referral Occasionally samples are referred to NHSBT The National Blood Service when more complex testing is required This will affect the sample turnaround time Document Number Qual0035 Version Document Name Pathology User Guide Review date Review Interval Isotracker Reviewed by 4 03 Guided by Isotracker C Brock Page 54 of 140 Medical Microbiology Request Form The microbiology department request forms are shown in figure 7 Figure 7 MICROBIOLOGY DEPT THE QUEEN ELIZABETH HOSPITAL KING S LYNN 01553 613772 Relevant Clinical Details Sample Collected Date Time Sample Received Date Time Specimens may be used for Quality and Teaching purposes If you do not wish this specimen to be used please tick the box
170. um channels Reference ranges Autoantibodies REFERENCE RANGES Negative Equivocal Positive Units lt 10 lt 0 7 lt 5 lt 5 Ro lt 7 Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 95 of 140 lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml Jo 1 lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml lt 7 7 10 gt 10 U ml Allergy REFERENCE RANGES Assay Rast Score Eevee kd t auergen specific antibody 0 Absent Undetectable P85 0 69 Low Po 070 349 Moderate PT 350 1749 High Po 17 50 52 49 Very High P52 99 99 Very High ee o Very High Reference Laboratories Detailed in the table below are the reference laboratories for immunology assays not performed in the department REFERENCE LABORATORIES Contacts Laboratory Location Address amp Phone CPA Status Numbers Dr A Vincent Neurosciences Group John Radcliffe Oxford Institute of Molecular Dr Angela Unconditiona Hospital Medicine Vincent John Radcliffe Hospital OXFORD OX3 9DU Immunology Department Kevin Green Kevin f P O Box 894 Green oe Sheffield Sheffield 0114 271 Accredited S5 7YT 5707 Unit
171. urgery Liver Cardiac Extra copy to Bone Patient Category please tick NHS O Private C Cat Il T HAEMATOLOGY Relevant Clinical Details and Therapy FBC Other please specify s ESR p Warfarin Control INR Heparin Control APTT Diagnostic Coag Screen Name of Doctor print Bleep Number Date Care should be taken to fill in the form correctly All details are essential and should be written in block capitals if patient demographic stickers are not available Please enter sample type and date time of collection as well as pertinent clinical information Please also state the requester and location you would like the results returned to Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 19 of 140 Senior Staff Senior staff and contacts within chemical pathology are detailed in table 6 Table 6 Contact Title Phone Number Vacant Consultant Chemical Pathologist Mr Richard Pipkin Blood Sciences Manager 3430 Mrs Maggie Pate Secretary 3797 Results enquiries 3771 Clinical advice Contact Consultant via Out of hours Switchboard On call BMS Bleep via Switchboard Please note that when the Consultant Chemical Pathologist is not available 24 hour cover is available via a service provided
172. urine mmol L UA Male 0 22 to 0 55 mmol L Uric Acid Female 0 18 to 0 46 mmol L 24URIC 24 hour urine mmol 24hr UUA Random urine No range mmol L Valproate VALP 50 to 100 mg L Normal gt 246 pg ml Vitamin B12 B12 Deficient lt 211 pg ml Indeterminate 211 246 pg ml Unknown genders will default to male reference ranges for Chemical Pathology analytes Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 38 of 140 Haematology amp Blood Transfusion Request Form The haematology request form is combined with the chemical pathology discipline as shown by figure 4 Figure 4 F THE QUEEN ELIZABETH HOSPITAL KING S LYNN NHS TRUST Hospital No HAEMOCHEMISTRY Surname Sample Type Forename s Sample Collection See reverse for specimens required Address Date Time Date of Birth Sex Glucose _ Other please specify C El ctrolytes M AFFIX ADREMA LABEL ABOVE IF AVAILABLE Consultant G P Ward O P D Surgery tiver Cardiac Extra copy to Bone Lt Patient Category please tick HAEMATOLOGY NHS O Private ki Cat II T Relevant Clinical Details and Therapy FBC EA Other please specify Kal ESR pes F Warfarin Control INR Heparin Control APTT p Diagnostic Coag Screen vi Name of Doctor print a Bl
173. uth Mead Sensitivity G SUATYP Hospital by 1 class i Sent 1 class to Chromogranin A IS SST Sheffield es Before noon not on Chromosomes C aa Ae Lithium Friday If DNA Adult eparin fragile X required 3mL EDTA Do not CHROMC spin separate Sent Chromosomes PAED C Child Dark green 5ml to Addenbrookes by 1 Class Citrate Urine C UCIT EMU Document Number Qual0035 Version Document Name Pathology User Guide Review date Guided by Isotracker Review Interval Isotracker Reviewed by C Brock Page 105 of 140 CK C CK SST _ Sent to Royal Free CK Isoenzymes C CKISO SST Hospital by 1 class Clonazepam C NCDS SST Clozapine H FBC 3ml EDTA See clozeril Clozeril H FBC 3ml EDTA CMV S SST CMV Viral load S 6ml EDTA Less than 4hrs old Coagulation Screen H COA ees eer not requested Centrifuge separate freeze Cobalt Chromium C COBAL CR rite ree Sent to trace elements Guilford by 1 class Coeliac disease IS TTG SST Keep at 37 C T 5ml EDTA Cold Agglutinins XM CAT Clotted Complement C3 C4 C COMP SST Complement Fixation Test IS SST Conjugated unconjugated bilirubin C SST Coombs test XM 5ml EDTA Clotted Sent to trace Copper C CUQ SST elements Guilford by 1 class Coronavirus DNA S Swab VTM Cortisol C CORT SST Coxiella burnetti pb
174. w to produce paraproteins Occasionally if concentrations are high and precipitation is above 22C there may be skin lesions Purpura and Raynaud s Influences of Age Gender and Race 1 New born bilirubin rises and peaks at day 5 Glucose is low due to low glycogen reserves and adrenal immaturity Urea falls after birth as infant syntheses protein Urea increases when tissue catabolism increases 2 Childhood to puberty ALP is high in children as its main source is from bone 3 Adult to elderly creatinine is increased due to renal damage urea is increased due to renal damage Document Number Qual0035 Version 4 03 Document Name Pathology User Guide Review date Guided by Isotracker Review Interval lsotracker Reviewed by C Brock Page 132 of 140 4 Gender men have higher ALK ALT CK due to increased muscle mass Fertile women have lower iron due to menstrual loss Full Blood count samples taken in EDTA are stable for 24hrs if kept at 4C Samples should not be exposed to extremes of heat Samples are best stored at 4C before transportation to the laboratory Short samples may contain clots and provide unreliable results overfilled samples may also clot Coagulation samples should always be sent filled correctly Short samples will provide inaccurate results and will be discarded Haemolysed Coagulation samples will cause contact inititiation of the coagulation cascade resulting in short inaccurate time S

Pathology user guide 2013 - Queen Elizabeth Hospital King's Lynn

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