Adult User Guide Clinical Biochemistry
Contents
1. pCO2 arterial 4 5 6 0 kPa pO2 arterial 12 0 14 7 kPa pO2 capillary 6 7 10 7 kPa actual bicarbonate 24 30 mmol L base excess male 2 3 to 2 3 mmol L base excess female 3 0 to 1 6 mmol L Green top tube plasma Additional DO NOT use glass tube ACTH 9am 0 46 ng L 2 4 weeks Send to lab in ice immediately Requires rapid separation Adrenaline AN see Adrenaline AN ADH ee Report l Duty Biochemist Arginine vasopressin No ranges or units for interpretation Blood gas syringe Remove needle cap syringe Urgent 30 mins Additional Do not send this specimen by pneumatic tube AFP as tumour marker lt 10 KU L 1 week Yellow top tube serum Alb min 34 48 g L AE 2 hours Yellow top tube serum Routine 4 hours Aldosterone Green top tube Plasma Samples taken as Must be sent to the laboratory random during the day 100 850 pmol L for immediate separation but 4 weeks must not be sent in ice Overnight recumbent 100 450 pmol L general Screening for Conn s guidance only random aldosterone and renin Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 12 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES gt 1000 suggests primary Green top tube Plasma hyperaldosteronism Must be sent to the laboratory2. Author N Howarth Reference ranges and specimen requirements for FAECES Analyte Specimen notes MUST BE COLLECTED INTO PRE WEIGHED CONTAINER SUPPIED BY THE LABORATRY phone extn 64699 NO OTHER CONTAINERS WILL BE ACCEPTED Occult blood Pf This assay is no longer available Random formed stool sample Faecal Elastase gt 200 ug g stool 3 weeks Contact Pancreatic lab Extn 64067 for collection tube Very fresh RANDOM sample sent Straight to lab protected from light Testing of PBG will undertaken to exclude acute Reported as positive 1 2 Porphyria Out of hours the 2 weeks or negative urgency should be discussed with the consultant on call An EDTA blood sample should also be sent to allow full characterisation of a defect in Porphyrin metabolism 3 day Faecal Fat 10 18 mmol 24 hr 2 weeks Porphyrins Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 34 of 37 Author N Howarth Miscellaneous Tests Dynamic Function Tests Dynamic function test protocols are available from Biochemistry laboratory or the Programmed Investigation Unit Please discuss these tests with the Duty Biochemist or one of the Departmental Clinical Scientists or Medical Staff before embarking upon them Sweat Tests These are carried out by the Biochemistry Department at the Royal Manchest
3. Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 21 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Quantitative HCG used as a pregnancy test A result of gt 25 U L would normally indicate a Urgent 2 hours positive test but a result Same Day of lt 25 U L does not exclude early pregnancy Quantitative HCG Yellow top tube serum Interpretation of HCG in the context of monitoring early pregnancy is not provided by the laboratory If used for Ectopic Pregnancy see Clinical Guideline Renin Samples taken at random during the day 0 5 3 5 nmol L h Green top tube Plasma Dark green tubes no gel are preferred light green with gel are acceptable Over night recumbent 1 2 7 nmol L hr 2 4 weeks Must be sent to the laboratory for immediate separation but must not be sent in ice as this encourages conversion Random 0 5 3 5 nmol L hr of pro renin to renin Retinol Binding Protein 0 0 3 mg L Yellow top tube Serum Serum One red or yellow top 0 8 1 5 umol L 3 4 weeks tube Male 15 47 nmol L sm Yellow top tube serum Urgent 2 hours Additional eso mene Routine 4 hours Hyponatraemia Guidelines Available nmol g Hb hour Pink or Purple top EDTA plasma Thiopurine e Methyltransferase ua V 1 2 weeks Additional 6 34 low TPMT Recent blood transfusion 35 79 normal Sa may mask a deficient TP
4. SPECIMEN REQUIREMENTS AND REFERENCE RANGES Specimen requirements and reference ranges are shown in the following tables analytes arranged alphabetically Please note e Ranges are for adults e Desirable values rather than population reference ranges are given for lipids and HbA1c e Information from or copies of the various guidelines referred to e g European Arthrosclerosis Society Guidelines can be obtained by contacting the Duty Biochemist e To simplify requesting a number of organ specific blood profiles are available The tests included in these are listed below Renal profile sodium potassium urea creatinine eGFR Bone profile calcium corrected calcium albumin alkaline phosphatase phosphate Liver profile ALT alkaline phosphatase total Bilirubin albumin total protein Lipid profile cholesterol triglyceride HDL calculated LDL Must be fasting sample for full profile Thyroid profile TSH and free T4 other tests are added if necessary by laboratory clinical scientists lron profile Iron Transferrin and iron saturation SAMPLE VOLUMES One fully filled 4 5 ml yellow topped Vacutainer will generally contain sufficient blood for analysis of all profiles listed above However this does depend on the MCV of the patient and assumes that a minimum of 2mls of serum is able to be separated For single analytes 1 ml of whole blood is usually sufficient For all assays not quoted above please send one full tube of the corre
5. Time limits for requesting additional tests For most general and endocrine requests it is not possible to add on an additional test more than 24 hours from the time that the original results were authorised This only applies to analytes that are stable at 2 8 C REFERRED TESTS Some specialized or low volume assays are referred to external laboratories for analysis In line with CPA requirement we endeavour to use CPA accredited laboratories whenever possible A full list of the tests referred out and the laboratories that are used is available from us however the more common ones are listed below TEST EXTERNAL LABORATORY Royal Bolton Hospital Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 10 of 37 Author N Howarth Tumour markers CEA CA19 9 CA15 3 Christie Hospital a Protein Reference Unit Deficient Transferrin Androgens and Steroids D Sulphate A dione female testosterone Plasma metanephrines and adrenaline Hammersmith Hospital Specialist TDM Guy s amp St Thomas Hospital Huddersfield Royal Infirmary COMMENTS COMPLAINTS PROCEDURE Any complaints or concerns about any aspect of the service should be raised initially with the Departmental Laboratory Manager Ms Christine Hill telephone 0161 701 1201 We are keen to know about any problems arising from the laborator
6. inappropriate samples leading to potential errors in diagnosis The recommended initial test is either a two hour post prandial or a random blood sample A non fasting venous plasma glucose concentration less than 6 1 mmol L is normal 11 1 mmol L or greater is diagnostic for diabetes mellitus A non fasting venous plasma glucose concentration between 6 1 mmol L and 11 1 mmol L should be followed up by a fasting level A fasting venous plasma glucose concentration less than 6 1 mmol L is normal and one of 7 0 mmol L or greater is diagnostic of diabetes mellitus Between these levels an OGTT can confirm the degree of glucose intolerance By measuring venous plasma glucose concentration four possible states of glucose metabolism may be defined 1 Normal 2 Impaired fasting glycaemia IFG 3 Impaired glucose tolerance IGT 4 Diabetes mellitus DM IFG and IGT are intermediate states of carbohydrate intolerance and are risk factors not only for subsequent development of diabetes mellitus but also cardiovascular disease and should form part of a cardiovascular risk assessment These conditions are defined as follows in terms of plasma glucose concentration 1 Normal fasting venous plasma glucose of less than 6 1 mmol L 2 IFG fasting venous plasma glucose of 6 1 to less than 7 0 mmol L and if measured 2 hr post 75g glucose load less than 7 8 mmol L 3 IGT fasting venous plasma glucose less than 7 0 mmol L and 2 hr post glu
7. or new left bundle branch block in the ECG e Development of pathological Q waves in the ECG e Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality e Identification of an intracoronary thrombus by angiography or post mortem Thyroid Function Tests Adequate clinical information including a drug history is essential in order to provide information of most value in the diagnosis and management of thyroid disorders The first line investigation is freeT4 and TSH Further tests including free T3 will be performed as considered appropriate Generally free T3 is always elevated if FT4 is elevated and so its measurement is unnecessary Free T3 is added to detect T3 toxicosis when FT4 is normal but the TSH is below normal and to monitor T3 toxicosis and to monitor thyroid function in patients on Amiodarone Otherwise it will not be measured unless there is some other complicating factor that has been discussed with the duty biochemist Other assays such as free hormone investigations and TBG are sometimes helpful but not usually necessary The use of these assays and any interpretative problems can be discussed with the Duty Biochemist Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 25 of 37 Author N Howarth SPECIMEN REQUIREMENTS AND REFERENCE RANGES FOR BLOOD ANALYS
8. s Hospital Opening Hours The core opening hours of the laboratory are 8 00am to 5 00pm Monday Friday Outside of these hours a reduced service is available as part of the CPP service Continuous Process Pathology We aim to provide an extensive range of routine assays e g Renal Bone Liver Lipid and Cardiac profiles at all times A full emergency service is always available and this is listed separately below The out of hours service is manned by a limited number of staff from 5 00pm to 8 30am and only one Biomedical Scientist is available between 8 30pm and 8 30am Please keep use of the service to a minimum between these times to enable us to provide the most efficient urgent and emergency service in these periods General information The department is manned by various clinical and technical staff below is a list of all key personnel Katharine Hayden Consultant Clinical Biochemist Tel 0161 70 11106 Specialist interest in Endocrinology amp Automated Services Head of Service Dr C Chaloner Consultant Clinical Biochemist Tel 0161 70 12752 Specialist interest in Paediatric Biochemistry Deputy Head of Service Specialist interest in Toxicology pares E tae COT Specialist interest in Metabolic Biochemistry Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 3 of 37 Author N Howarth M
9. the patient that the sample has come from to ensure that the sample and card relate to the same person and to identify which tests need doing and any other requirements For some assays it is essential that we know the time that the sample was taken This is especially important in the case of therapeutic drug monitoring It is preferred that samples are labelled with pre printed labels from the patient s notes If handwritten the tube should as a minimum be labelled with surname first name and hospital record number or other unique identifier such as NHS number SPECIMEN ACCEPTANCE A copy of the Directorate Specimen Acceptance policy is included in the DLM user guide In summary Samples must be labelled with 3 unique identifiers from 1 Unique identification number e g hospital number case note number NHS number 2 Surname 3 Forename 4 Date of birth The request form data MUST match the above information on the specimen Foe therapeutic drug monitoring requests the form and or sample should have the following information added Name of drug Dose of drug Time of last dose Time of specimen in relation to the time of the last dose Multiple specimens e g Dynamic function tests MUST include the time of each sample on specimen and request cards using the 24 hour clock format e aa The request form should also include the following information e The patients location destination for the report The tests required Name of consul
10. 4 2015 Approved C Hill age 35 of 37 Author N Howarth POINT OF CARE TESTING POCT Point of Care Testing POCT is laboratory testing performed in the clinical setting by non laboratory healthcare professionals POCT is subject to the same level of public professional and judicial scrutiny as conventional laboratory testing Commonly used POCT devices include blood glucose meters and blood gas analysers However recent advances in technology have increased the repertoire of tests that can be measured by POCT As POCT is performed close to the patient the results are available more quickly than if the sample had been sent to the laboratory This has benefits in the delivery of care to critically ill patients POCT is also used in less acute settings such as Out Patient Clinics to reduce patient waiting times There are also disadvantages with POCT compared with laboratory testing For many POCT tests the equipment used to perform the analysis is not as sophisticated as in the laboratory so the results may not be as accurate Staff are informed about these important limitations at POCT training sessions For example in a patient with decreased peripheral blood flow glucose levels in capillary finger stick samples may not reflect the true physiological state This limitation applies to all POCT glucose meters and has led to two fatalities in Greater Manchester CMFT has a well established POCT infrastructure to ensure that the benefits of th
11. 9 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 31 of 37 Author N Howarth URINE URING ACID PRESERVATIVE BOTTLES PRESERVATIVE BOTTLES following 0 0 2 0 umol 24hr guidelines on individual analytes Metadrenalines Normetadrenaline Male 0 0 5 3 umol 24hr Female 0 0 4 3 umol 24hr IMPORTANT Health and Safety Notice These bottles contain 25 Hydrochloric Acid Keep the bottles out of the reach of children In case of contact with eyes or skin rinse immediately with plenty of water and seek medical advice DO NOT breathe any fumes from this bottle Patients must be advised NOT TO URINATE DIRECTLY into the bottle URINE ACID WASHED PLASTIC BOTTLES required Not routinely available Contact Haematology for Haemosiderin Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 32 of 37 Author N Howarth Reference ranges and specimen requirements for CSF ANALYSES Urgent analysis of CSF for protein and glucose is available at all times Queries regarding any other aspect of CSF analysis can be directed to either 0161 276 4697 or the duty biochemist Analyte Protein total 0 05 0 45 g L Routine Next day Mon Fri Plain 5 ml tube obtained Urgent Same day from Biochemistry 1 ml of CSF if possible
12. Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES guidelines ward appointment GP referral to Clinical Biochemistry with full contact details of patient Yellow top tube Serum Standardised against IS98 574 To compare with previous measurements expressed in mU L multiply the mass unit by 3 Random measurements are of little use see IGF1 Patient MUST be fasting Must send in ice and Git hormones collected in special tube Gastrin i lt 40 pmol L provided by the laboratory Glucagon lt 50 pmol L contact 276 5180 CART lt 85 pmol l 4 weeks Pancreatic polypeptide lt 300 pmol L Ha Sampie mus me d Somatostatin lt 150 pmol L ee VIP lt 30 pmol L needle as the preparation of the tubes leads to loss of vacuum in them Yellow top tube Serum Follow up testing of trophoblastic tumours usually requires testing of urine HCG and is arranged directly with HCG the clinician by the as tumour marker pee Nee TINEEK designated national centre Sheffield in our case Grey Top Fl ox plasma Must be sent to the laboratory for immediate Homocysteine lt 15 umol L 2 4 weeks separation Fasting sample preferred Not routinely available as a cardiovascular risk factor Immuno reactive Green top tube whole blood See report 2 4 weeks Trypsin or preferably blood spots Yellow top tube serum 80 150 pg ml 2 4 weeks Routinely available only as a granulosa cell tumour marker Yellow top tube Serum Mus
13. Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 1 of 37 Author N Howarth J J J J F 4 F 4 Central Manchester University Hospitals LYZ NHS Foundation Trust Directorate of Laboratory Medicine Clinical Biochemistry Adult User Guide Clinical Biochemistry Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 2 of 37 Author N Howarth CLINICAL BIOCHEMISTRY This guide describes the Clinical Biochemistry service provided for adult patients patients over 18 years old Please see the separate Paediatric Biochemistry Guide for children and neonates Location The Clinical Biochemistry Department provides a comprehensive service for the care of patients within the Trust and the wider community served by both the Primary and Tertiary sectors The high volume testing including the urgent and 24 hour access assays are carried out in the Autolab on the ground floor of the Clinical Sciences Building CSB3 This also houses the main specimen reception and most of Haematology including Blood Transfusion Specialist assays are carried out in laboratories on the 1 and 2 floor of CSB3 The Point of Care team are housed on the 4 floor of the new Children
14. ES Paediatric See separate Paediatric Biochemistry User Guide Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 26 of 37 Author N Howarth Toxicology and Therapeutic Drug Monitoring TDM The Toxicology Section provides a laboratory service to support the diagnosis management and prevention of poisoning Tests required to diagnose and facilitate specific emergency treatment e g with antidote are available at as indicated in the A Z of analytes and conform to the NPIS ACB Joint Guidelines for Laboratory Services for Acute Poisoning Tests for the identification of a wide range of common toxic drugs and other poisons are available by arrangement during normal laboratory hours 8 00am 5 00pm Monday to Friday excluding Bank Holidays telephone the Toxicology Laboratory on 0161 276 4699 or bleep the Duty Biochemist Measurement of blood concentrations of the drugs included in the A Z of Tests is provided for individual optimisation of dose TDM and to allow a rational approach to re instating treatment following overdose In all Toxicology TDM investigations interpretation is dependent on timing The time of specimen collection and time of last dose or exposure for poisoning should be recorded on the request form Time of specimen collection should be recorded on the sample tube This is importan
15. MT gt 80 high result Tri oidothyronine 3 6 6 4 pmol L 1 2 weeks Yellow top tube Serum Free free T3 Additional Not standard part of Thyroid Function Test Triiodothyronine a a tell Total T3 not routinely 1 3 3 1 nmol L 1 2 weeks or the duty biochemist if you feel available ee this is required Yellow top tube Serum TestostMane Male 10 35 nmol L SHBG and FAI will be Female lt 1 8 nmol L reported with all female testosterone results 30 minutes upright 2 8 4 5 nmol L hr Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 22 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Yellow top tube Serum Used as a tumour marker Thyroglobulin antibodies may Thyroglobulin Thyro lt 55 ug L 1 2 weeks interfere with the assay and levels will be reported with the test result Yellow top tube serum Thyroid Binding i Not usually necessary as part Globulin TBG a de pee of TFT because free T4 is measured Yellow top tube Serum Thyroxine Free free Low levels of binding protein T4 usually reflected by a low 9 24 pmol L 1 2 weeks albumin cause low results See TFT guideline at High levels of TBG as occur end of this table in pregnancy or HRT have no effect Total Protein 60 80g L Routine same day Ye
16. Orosomucoid 300 1200 mg L 2 4 weeks n a for bowel disease Osmolality serum calculated as 2 x 275 295 mmol kg Urgent 2 hours Yellow top tube serum Routine 4 hours glucose urea Osmolar Gap Urgent 2 hours lt 10 mmol L Yellow top tube Serum Routine 4 hours measured Osmolality Calculated Osmolality Purple top EDTA Plasma Oxalate DAsweaie si be separated and rozen within 1hr of collection mE el markers i Urgent 2 hours Yellow top tube serum Phosphate 0 7 1 4 mmol L Routine 4 hours Adults Plasma L3 lt 180 pmol L 3 4 weeks Yellow top tube serum methoxytyramine Plasma Metanephrines lt 510 pmol L Yellow top tube serum Plasma Normetadrenaline lt 118 pmol L Yellow top tube serum 35_55 mmol L argent c hours Yellow top tube serum Routine 4 hours a r Ner NAN Pregnancy test Directorate of Laboratory Medicine ition 016 Copy No electronic Q pulse Date of issue 22 04 2015 Q pulse identifier CB CLIN PI 009 Department Clinical Biochemistry Approved C Hill Author N Howarth age 20 of 37 ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES S A E see Quantitative HCG Procalcitonin Progesterone luteal peak Prostate Specific Antigen PSA 50 59 yrs 60 69 yrs 70 and over Free PSA by equimolar analysis Prolactin Total Free Prolactin Protein tota Protein tota Consider stopping antibiotics if Procalcit
17. T send this specimen by pneumatic tube If separate sample Green Top tube Plasma Yellow top tube Serum Additional Calcitonin Soon reise 4 weeks Send to lab in ice lt 18 9 ng L Male immediately Requires rapid separation Calcium corrected 2 10 2 55 mmol L Stoo nine NOUS Yellow top tube serum Routine 4 hours Adrenaline 0 1 0 nmol L Purple top tube EDTA i plasma Send to lab in ice ee ease agers immediately Requires rapid separation Chloride 95 108 mmol L ent 2 nurs Yellow top tube Serum Routine 4 hours Chromogranin A lt 60 pmol L b weds Purple top tube EDTA plasma Chromogranin B lt 150 pmol L b waa Purple top tube EDTA plasma 2 guideline LDL will only be calculated CK total Male up to 190 U L Urgent 2 hours Yellow top tube serum Female up to 165 U L Routine 4 hours CKMBmass This test is no longer available JBS 2 Dec 2005 AE dine A hous Yellow top tube serum treatment targets Cholesterol Total lt 4 0 mmol LDL lt 2 0 mmol L HDL male gt 1 0 mmol l HDL female gt 1 2 mol l if TG lt or to 4 0 mmol L Purple top tube EDTA lt 2 non smokers lt 10 for smokers Urgent 30 mins approximate Carboxyhaemoglobin Catecholamine Plasma Cholinesterase Additional See Joint British Societies Total 620 1370U L Yellow top tube serum Additional Phenotype 4 weeks Apnoea investigations See interpretive result should wait until patient is r
18. TE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Deficient treatment required Vitamin D 25 50 nmol l Associated with an increased disease risk and treatment is usually required Vitamin D 51 75 nmol l Adequate treatment may be required if clinically indicated Vitamin D gt 75 nmol l Optimal Vitamin D status 25OHD gt and 25OHD3 are measured separately and Vitamin D 25OHD amp as Total 250OH Vitamin see Total 250H 250OHD Vitamin D added together to give total 250OHD Vitamin D 1 25 OH 48 120 pmol l oo one red or yellow top Male 9 5 18 5 umol L Female 9 5 22 5 umol L 2 4 weeks Blue top tube High sensitivity troponin T guideline CMFT e Acute coronary syndromes incorporate two conditions o Unstable angina and o Acute myocardial infarction AMI which is further differentiated into ST elevation myocardial infarction STEMI which can be diagnosed using an ECG and Non ST elevation myocardial infarction NSTEMI which can only be reliably diagnosed using cardiac biomarkers e Cardiac troponin is the biomarker of choice for diagnosing or excluding acute myocardial infarction AMI e CMFT currently uses the high sensitivity troponin T assay from Roche Diagnostics hs cTnT e Inpatients whose symptoms and or signs lead treating clinicians to suspect a diagnosis of acute coronary syndrome hs cTnT should be measured at the time of admission or as soon as possible following the onset of sy
19. aline phosphatise Should not form part of a routine assessment of liver function GHRH_ C See rreport 4B Weeks Red Top serum Glutathione whole blood Glycated Haemoglobin HbA1c GTT Fasting adult 3 0 6 0 mmol L 1078 1753umol L or 7 49 12 21 mol g haemoglobin Tight Glycaemic Control HbA1c lt 48 mol mol NGSP lt 6 5 Good Glycaemic Control HbA1c lt 59 mmol mol lt 7 5 Review Glycaemic Control HbA1c 2 59 mol mol 27 5 Increased risk of significant hypoglycaemia with tight control Interpretation of results is provided with each report following WHO Urgent 2 hours Routine 4 hours 2 weeks Next day Mon Fri Analysed same day as test carried out on ward Grey top tube plasma See appendix for diagnosis of diabetes according to WHO criteria Contact Pancreatic lab ext 64067 before drawing blood One purple top EDTA Purple top tube EDTA plasma The presence of a variant haemoglobin will be reported Further investigation of these requires patient consent for further analysis which is performed in haematology From 9 Jan 2012 only IFCC values will be reported Doctors working in the hospital contact Programmed Investigation Unit to arrange Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 17 of 37
20. ate Action as protocol Routine same day Urgent 2 hours Toxicity increased by hypokalaemia Yellow top tube serum Pre dose By arrangement only Random urine in Universal container min volume 1ml Detects only those drug classes indicated Give full medication details as these are required for interpretation Grey Fluoride oxalate plasma or yellow top tube serum Yellow top tube serum Pre dose By arrangement only Grey Fluoride oxalate plasma Yellow top tube serum Pre dose By arrangement only Yellow top tube serum Pre dose By arrangement only Yellow top tube serum Pre dose Yellow top tube serum 12 0 5 hours post dose Grey Fluoride oxalate plasma Yellow top tube serum Collect as protocol Urgent by arrangement Purple top tube ETDA plasma Pre dose Yellow top tube serum At least 4 hours after overdose Record times of ingestion and sample collection Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 28 of 37 Author N Howarth Therapeutic Range Specimen Notes Phenobarbitone 15 40 mg l 1 week Yellow top tube serum Pre dose Phenytoin 5 20 mg l 1 week PEON OAE SER Pre dose Analgesic Yellow top tube serum 20 100 mg l Repeated measurement Salicylate Anti inflammatory Routine same day may be required Rec
21. bin Renal Profile Chloride Salicylate Creatinine Sodium Creatine Kinase Theophylline Digoxin Troponin T Ethanol Urea Glucose Urine Paraquat phone 64375 to advise of sample being sent lron Quantitative BHCG blood pregnancy only Lithium IMPORTANT 1 You must arrange transport of the sample using the portering service pneumatic tube system or ward Staff 2 Results of these tests are available in between one hour and two hours of receipt of the sample in the laboratory 3 The pneumatic tube must not be used for transport of blood gas samples Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 5 of 37 Author N Howarth REQUESTS FOR INVESTIGATIONS Hospital in patients and out patients All requests should be made using the hospital computer system This is the Clinical Work Station CWS of the Patient Administration System PAS For those areas not covered by CWS the pre printed biochemistry request form should be used with patient labels if possible Primary care requests We provide multi discipline request cards for all practices which we have an agreement to provide services for See the section on GP services in section 3 of this document for contact information All samples and request cards should have as much information on as possible to enable us to positively identify
22. c as both methods and units vary from department to department These should not be published as methodology changes in line with the introduction of new techniques the ranges become outdated and therefore are subject to constant review The current reference therapeutic range is always included with the final report 5 of the healthy population will have results marginally outside the quoted reference range Ranges may be affected by age gender ethnic group pregnancy time of sampling and many other factors Detailed information or advice on interpretation is always available from the laboratory Validity of results Results are automatically validated if they are within preset ranges and have no error flags from the instruments e g Haemolysis Lipaemia and Icterus Ranges have been discussed and approved by senior scientists and consultant staff Results outside these ranges are scrutinised by qualified staff and authorised HCPC registered Biomedical Scientists or the duty Biochemist Medic or Consultant Comments may be appended and additional analyses undertaken based on the clinical details provided and on previous results Whilst internal and external quality assurance programmes are in operation to ensure accuracy and precision of results occasionally random errors may occur and escape detection The clinician is often best placed to detect such errors Therefore if you doubt the validity of a result it is vital that you contact the relevan
23. cose load of 7 8 to less than 11 1 mmol L 4 DM Venous plasma glucose of 11 1 mmol L or greater at any time Il Fasting venous plasma glucose of 7 0 mmol L or greater III Post 75g OGTT 2hr venous plasma glucose of 11 1 mmol L or greater HbA1c Diagnostic threshold for diabetes is 2 48 mmol L
24. ct type if collection of multiple tubes causes a problem please call the duty biochemist for advice Blood samples AVOID CONTAMINATION When taking a series of blood specimens it essential that the yellow top serum sample is taken first followed by green top Lithium heparin samples then the grey top Fluoride Oxalate samples and any EDTA tubes last of all Failure to adhere to this sequence will lead to contamination of blood samples with anticoagulants preservatives This contamination produces spurious and invalid results Avoid haemolysis drip contamination adverse temperatures over 30 C or less than 10 C unless otherwise stated and prolonged venous constriction Ensure thorough and instant mixing of blood with anticoagulant heparin fluoride oxalate or potassium EDTA for plasma samples Do not transfer blood from one tube to another e g EDTA to Lithium Heparin Do not leave Clinical Biochemistry blood samples in the fridge 4 C or overnight at room temperature If in doubt please contact the laboratory Duty Biochemist bleep 4375 for advice Leaking blood tubes will be discarded Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 8 of 37 Author N Howarth DO NOT send blood gas samples to the laboratory via the pneumatic tube systems DO NOT send blood gas samples to the labo
25. d on non serum fluids and no interpretation is offered Ca 125 lt 21 U ml Yellow top tube Serum Fluid other than blood should be put into a yellow top tube 1 2 weeks However non of the tumour markers are validated on non serum fluids and no interpretation is offered Ca19 9 lt 31 U ml Yellow top tube serum Fluid other than blood should be put into a yellow top tube 1 2 weeks However non of the tumour markers are validated on non serum fluids and no interpretation is offered CEA 0 3 0ug ml Yellow top tube Serum Fluid other than blood should be put into a yellow top tube 1 2 weeks However non of the tumour markers are validated on non serum fluids and no interpretation is offered Yellow top tube Serum Caeruloplasmin 200 600 mg L 1 week vals gt PASEU immunoassay not copperoxidase activity Carbohydrate deficient Negative lt 2 6 of total Yellow top tube serum 2 4 weeks l Transferrin Transferrin This test is available only Purple top tube Plasma Not affected by fasting Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 14 of 37 Author N Howarth SS Positive gt 2 6 of total after discussion with the duty Transferrin biochemist or after prior agreement If sent with blood gas Blood gas syringe Remove needle cap syringe Additional Do NO
26. ecimen in a blood gas syringe is available The sample cannot be analysed if it is not suitable for analysis on the blood gas analyser Interpretation Light s Criteria for a transudate 1 The ratio of pleural fluid protein to serum protein is less than 0 5 The ratio of pleural fluid ane plasma LDH less than 0 6 The pleural fluid LDH is less Renin of the upper reference limit Although these criteria have been re evaluated there is no clear cut case for using anything other than Light s criteria 2 A pH lt 7 3 is seen with emphysema tuberculosis malignancy collagen vascular disease or oesophageal rupture Glucose lt 2 2 mmol L is associated with an emphysema rheumatoid arthritis tuberculosis or malignancy Other tests may be useful 3 An exudates is more often associated than a transudate with A cholesterol level gt 11 7 mmol L A pleural serum Bilirubin ratio lt 0 6 A pleural serum albumin gradient of lt 12 g L Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 37 of 37 Author N Howarth DIAGNOSIS OF DIABETES MELLITUS Investigation of Suspected Glucose Intolerance Diagnosis should be based on two independent glucose measurements unless the patient has symptoms of diabetes All samples should be collected into fluoride oxalate blood tubes as glucose deteriorates rapidly in
27. eport issued fully recovered Purple top tube EDTA plasma Requests will be vetted this Chromium nmol L 4 weeks assay is only available for monitoring patients with specific types of metallic joint replacements plasma Requests will be vetted this Cobalt nmol L 4 weeks assay is only available for monitoring patients with specific types of metallic joint replacements Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 15 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES 11 20 umol L Blue top tube serum Yellow top tube Serum Random cortisol is not an effective means of screening for Cushing s syndrome use 1 mg overnight Mid night Dexamethasone suppression 60 250 nmol L or 24 hour urinary free Cortisol Next day Mon Fri cortisol 9am 200 650 nmol L All samples taken as part of a Synacthen test should be sent to the laboratory ina single batch A baseline and thirty minute sample is required Yellow top tube Serum Must be sent to the laboratory on ice for immediate separation If the test is requested because of 4 weeks hypoglycaemia then an appropriately low glucose taken simultaneously is required and will only be measured if insulin is raised inappropriately Yellow top tube Serum CRP is useful to monitor inflammatory proce
28. er Children s Hospital please contact them to arrange for the test to be carried out Creatinine clearance calculation If creatinine clearance is specifically requested and a 24 urine and blood sample are received the clearance will be calculated automatically and reported in the normal way A Information used in the calculation Creatinine clearance UxV P Where U urinary creatinine in mmol L V urinary flow rate in ml minute see note 1 below P plasma creatinine in mmol L see note 2 below Additional notes 1 For a 24 hour urine collection V total volume in ml divided by 1440 2 Plasma creatinine on biochemistry reports is in umol L therefore P plasma creatinine umol L divided by 1000 B Example of calculation Assuming a full 24 hour urine collection the creatinine clearance may be calculated from the reported results for urine creatinine output and plasma creatinine concentration as shown below Creatinine clearance UCRO x 694 units are ml minute PCR where 1 the factor 694 takes into account the difference in units and the number of minutes in 24 hours 2 UCRO urine creatinine output in mmol 24 hour 3 PCR plasma creatinine in umol L If any doubts about the calculations please contact the duty Biochemist Bleep 4375 Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 0
29. es Printed reports are distributed to all wards and departments twice daily Monday Friday at approximately 10 00am and 4 00pm If you wish to have results of specimens for routine biochemical profiles included on these reports on the same day the samples must arrive in the laboratory no later than 1 00pm Emergency requests and blood gases The list below shows those analytes that are provided on an Urgent and Emergency basis Samples requiring these tests and labelled as Urgent will usually be analysed and reported in 60 120 minutes from receipt in the laboratory If results are required very rapidly for the immediate treatment of a patient or if you wish to send a sample for arterial blood gases and pH please contact the laboratory to let us know that the sample is coming Contact details are Monday Friday 8 00am 5 00 pm Tel 0161 27 64375 Saturday Sunday 8 00 am 12 00 noon Tel 0161 27 64375 All other times Tel 0161 27 64375 or bleep 2 722 Access to urgent and emergency requests Analytes other than those on the list below may be analysed on an urgent or emergency basis but only after consultation and arrangement with the Biochemistry Department Requesting urgent analyses The following analytes are available at any time Albumin Liver Profile Amylase Magnesium Bicarbonate Methaemoglobin in heparinised bottle if not sent with blood gas Bilirubin Osmolality Blood gases Paracetamol Calcium Potassium Carboxyhaemoglo
30. gt 2000 indicated that the for immediate separation but patient almost certainly 4 weeks MUST NOT BE SENT IN ICE has hyperaldosteronism as this encourages general guidance only conversion of pro renin to renin Alkaline phosphatase Male 40 129 U l Urgent 2 hours Yellow top tube Serum U L Female 35 104 U L Routine 4 hours Alkaline Phosphatase a LEA 2 weeks eal oe Isoenzymes ontact Pancreatic La plasma One green or yellow ext 64067 top tube 1 0 2 0 g L Phenyotyping will be Aldosterone Renin Ratio 1 week Yellow top tube Serum Alpha 1 Antitrypsin A if results are lt 1 28 Alcohol See Ethanol and Methanol in section Urgent 2 hours aur f5 40 U L aaa hare Yellow top tube serum Yellow top tube serum tube Serum Purple top tube EDTA Additional Ammonia 5 50 umol L Urgent 2 hours Contact lab on 65180 prior Routine 4 hours to collection Sample must be fresh send to lab in ice immediately Amylase Amylase 28 100 28 4000 Urgent 2 hours Yellow top tube serum Routine 4 hours Amylase koenz me o AN Pancreatic Lab J Siweaks Serum One red or yellow top y y Ext 64067 tube 2 1 10 8 nmol L Androstenedione Female 4 0 11 nthol L Yellow top tube Serum Yellow top tube serum Separate within 2 hours 1 2 weeks Store and send cold if less than 24 hours If gt 24 hours store at 20 C Anion Gap 10 18 mmol L STENE A NOU Yellow top tube Serum Rou
31. ical Biochemistry Date of issue 22 04 2015 Approved C Hill age 30 of 37 Author N Howarth URINE PLAIN BOTTLES If there is a known family history of acute Porphyria an EDTA sample for genetic analysis is required and also faecal analysis may be necessary but faeces need not be sent in the first instance Protein lt 150 mg 24 hr Plain bottle Routine Next day Mon Fri Urgent Same day Used as a screening test l for proteinuria UK CKD is greater than 45 guidelines mg mmol creatinine Routine 12 mmol 24hr Next day Mon Fri Plain bottle Urgent Same day Sodune Next day Mon Fri Plain bottle Urgent Same day Urobilin ogen Quantitative test ROURDE NEXE CAY TED Random urine Urgent Same day Protein Creatinine A positive test for ratio proteinuria in adults URINE ACID PRESERVATIVE BOTTLES HAA 0 50 umol 24hr_ tweek O Acid bottle required 2 5 7 5 told Masp Routine Next day Mon Fri Urgent Same day youn 2 4 weeks Acid bottle required Homocystine Acid bottle required Avoid 3 3 5 0 mmol 24 hr 2 4 weeks eee containers because of the danger of contamination Phosphate 15 50 mmol 24 hr ROUNE Next day Mon Fri acid bottle required Urgent Same day Total Males Metadrenalines 0 95 5 26 umol 24 hr Females 0 6 4 2 umol 24 hr 2 4 weeks Acid bottle required Salford Royal Hospital issues the Male amp female Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 00
32. is exciting technology can be realised while managing the inherent risks and costs associated with it The CMFT POCT Policy and multi professional POCT Committee are central to the governance structure The POCT Team Leaders manage operational matters such as evaluating equipment provision of training programs writing Standard Operating Procedures operator proficiency testing auditing and recording of POCT test results paper and electronic The POCT Team has a comprehensive website to facilitate access to information about the CMFT POCT governance structure and the POCT devices used in CMFT This includes training dates Standard Operating Procedures and e learning competency assessments Contact details for the POCT Team Leaders are also accessible via the POCT website Intranet access to the POCT website http labmed staffnet xcmmce nhs uk Point of Care Testing Internet access to the POCT website httop Awww cmft nhs uk info for health professionals laboratory medicine point of care testing aspx Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 36 of 37 Author N Howarth Light s criteria for evaluating pleural fluid Analysis The following tests should be performed e Pleural fluid protein glucose and LDH and serum protein glucose and LDH if available e Pleural fluid pH if a sp
33. llow top tube serum Yellow top tube Serum Provided as part of iron Transferrin 2 0 3 60 g L Routine same day profile and used as the denominator to calculate iron saturation Fasting guideline JBS 2 Dec 2005 treatment target an optimal level lt 1 7 mmol l Triglycerides Same day Yellow top tube Serum Troponin T Yellow top tube Serum Urgent 1 hour NICE has recommended a Routine 4 hours testing protocol at admission and 6 hours later for hs cTnT New high sensitivity lt 14 0 ng L 99 centile assay introduced 6 of reference range and Oct 2010 limit of detection See clinical guideline at end of this table TSH 0 2 5 0 mU L Same day Yellow top tube See TFT guideline at end of this table Male 0 17 0 48 mmol L Female Routine 4 hours Yellow top tube 0 14 0 39 mmol L 3 5 7 4 mmol L Urgent 2 hours Yellow top tube Routine 4 hours Vitamins Vit A amp E Yellow top tube amin a See individual reports 1 2 weeks a aa Vitamin B2 plasma Vitamin B6 Contact Specialist Biochemistry lab before MAMINE aun Ween drawing blood Ext 64067 2 heparinised green top tubes Vitamin D total 250H Vitamin D lt 25 nmol l zei one red or yellow top Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 23 of 37 Author N Howarth ANALY
34. mptoms The test should be repeated 12 hours after the onset of the peak symptoms The lowest reportable level of hs cTnT is 3ng L the limit of blank or LoB The normal range of hs cTnT is lt 14n gL the 99 percentile in apparently healthy individuals Levels between the limit of blank 3ng and 14ng L are normal and will be detected in more than half of apparently healthy individuals e If any patient has a hs cTnT level gt 14ng L they should have a second sample sent for hs cTnT testing 6 hours later Haemolysis e Haemolysis can cause a falsely low level of hs cTnT e AMI must not be ruled out using a haemolysed sample Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 24 of 37 Author N Howarth e Haemolysed samples cannot be used to quantify the rise and or fall of hs cTnT on serial testing the delta troponin e A positive hs cTnT gt 14ng L may still be used to risk stratify patients even in the presence of haemolysis However the sample should still be repeated immediately in order to allow quantification of the rise and or fall To rule out AMI e Inpatients who present to hospital gt 12 hours after the onset of peak symptoms a single hs cTnT level lt 14ng L can be used to rule out AMI However o The clinician should be certain that the peak symptoms occur
35. onin concentration has decreased by more than or equal to 80 from the PEAK concentration or is less than 0 5 ug L gt 30 nmol L consistent with ovulation lt 3 0 ng ml lt 4 0 ng ml lt 5 0 ng ml Department of Health Referral Guidelines 2002 Interpretation is by close scrutiny of latest evidence Male 86 324 mU L Female 102 496 mU I Male 67 251 mU L Female 79 384 mU L Same day Next day Mon Fri Next day Mon Fri Variable depending on demand Next day Mon Fri Urgent 2 hours QO WO g L Routine 4 hours g 7 Yellow top tube Serum Yellow top tube Serum Yellow top tube Serum Yellow top tube Yellow top tube Serum Free Prolactin will be measured if there are two consecutive elevated prolactins not explained by hypothyroidism antidoaminergic drugs or pregnancy However samples referred from Endocrinology will automatically be assessed for free rolactinif rolactin is elevated Free rolactin will only be estimated once in each patient Yellow top tube serum Adults Purple top EDTA plasma Needs special tube contact laboratory on 276 5180 must be sent on ice for rapid separation A PTH should have been found to be Suppressed and hypercalcaemia demonstrated However modest artefactual elevation of PTH above suppressed levels may be seen if eGFR is reduced Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016
36. ord 100 250 mg l Urgent 2 hours Overdose see Toxbase or BNF 5 10ug L Purple top tube EDTA Overdose see 1 week whole blood Toxbase or BNF Pre dose Purple top tube ETDA whole blood Pre dose times of ingestion and sample collection Tacrolimus Same day Mon Fri if in lab Prograf FK506 3 15 ug l before 10 30am Routine same day Yellow top tube serum Phespnynine ee mg Urgent 2 hours Pre dose Random urine in Universal container min volume 2ml Additional TLC screen s depending on volume 5ml LC MS Detects a wide range of Toxicology screen therapeutic and 1 week urine misused drugs Only compounds found are reported per screen Full details of suspected poisons medications required for interpretation Yellow top tube EDTA Valproate 50 100 mg l 1 week plasma Pre dose Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 29 of 37 Author N Howarth URINE SAMPLES URINE PLAIN BOTTLES Test Therapeutic Range Turnaround Time Specimen Notes Plain bottle This should only be requested when a 18 Hydroxy Cortisol 40 550nmol 24 hrs 1 month diagnosis of primary hyperaldosteronism has been established Amino acids 2 weeks Full drug history must be Random Collection included with the request Plain bottle Additional Albumin e
37. ratory with the needle attached Urine samples General points e Most of the urine assays are normally reported as a 24 hour output and a full 24 hour collection is required Please ensure that start and end dates and times are noted on the bottle label e Random samples or overnight collections are adequate for some tests and these are marked in the table e Some analyses require a specific preservative in the collection bottle see table check before starting collection Special bottles are held by the Biochemistry Department and can be collected from there or the reception area in the Clinical sciences building by the portering service or ward staff e Please complete the bottle label as well as the request form e Creatinine clearances can only be calculated if the blood creatinine is measured within 24 hours of the 24 hour urine Pleural fluid samples For general biochemistry collect into a red or yellow top tube glucose into a fluoride oxalate grey top and sample for acid base assessment collected into a blood gas syringe and treated as a blood gas specimen A simultaneous blood sample for general biochemistry into a yellow top tube and glucose into a fluoride oxalate grey top tube will be helpful for interpretation See page 41 for Light s criteria for evaluating pleural fluid REFERENCE RANGES Reference ranges are supplied strictly for guidance only and these should be used rather than those quoted in textbooks diaries et
38. red gt 12 hours ago If there is any doubt repeat the test 12 hours after the latest symptoms e Inpatients who present to hospital lt 12 hours after the onset of peak symptoms or whose symptoms occur while in hospital o AMI can be ruled out if both hs cTnT levels are lt 14ng L e Patients with hs cTnT levels gt 14ng L may still have AMI ruled out if they do not demonstrate a significant rise and or fall delta troponin on serial testing see below Ruling out AMI in these circumstances is a clinical decision and must be based on the clinical context putting together all of the relevant clinical information for the individual patient Review by a senior clinician with expertise in this area is recommended In order to rule out a rise and or fall of hs cTnT serial samples should be taken 6 hours apart e Inpatients who present for medical attention very late gt 72h after symptom onset hs cTnT levels may have returned to baseline precluding the detection of a rise and or fall of hs cTnT If there is ongoing suspicion of late presenting AMI additional investigation is recommended To rule in AMI e Hs cTnT cannot rule in AMI The result must be interpreted in the clinical context A diagnosis of AMI can be established in the following circumstances A rise and or fall of hs cTnT to above 14ng L in conjunction with at least one of e Symptoms of myocardial ischaemia e New or presumed new ST segment T wave changes
39. required 20 45 mmol L Routine Next day Mon Fri Grey top tube 1ml of CSF if Urgent Same day possible required Plain 5 ml tube obtained from Biochemistry Clotted 2 4 weeks blood must be sent at same time 7 ml of CSF if possible required To check for the presence of CSF in other fluids for example discharges from nose or ear send a few drops of fluid of doubtful No range origin A simultaneous blood Tau Proteins Test reported as ve 2 4 weeks sample is also required This or ve assay iS expensive and time consuming Full clinical details are required to support this request and to aid interpretation Blood must be sent as well CSF Xanthochromia Collection kits are available from AMU and from the Laboratory Central Specimen Reception in the Clinical Sciences Centre CSC Guidelines for collection are in the packs and on the Clinical Handbook Adults under Measurement of bilirubin in CSF xanthochromia Adults A minimum of 1 ml CSF is required If these procedures are not followed full and valid analysis will NOT be possible Not seen in healthy Oligoclonal Bands subjects No range Qualitative Same day Mon Friday for samples received by 4pm Xanthochromia Screen interpretation Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 33 of 37
40. rple top tube EDTA In patients same day Mon whole blood Fri if in lab before 10 30am Pre dose 1 0 2 0 ug l Yellow top tube serum Target for heart Routine same day Pre dose or at least 6 hours failure 0 7ug l 0 5 Urgent 2 hours post dose 1 0 ug l Urgent by arrangement Ciclosporin cyclosporin 100 300 ug l Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill Author N Howarth age 27 of 37 Therapeutic Range Specimen Notes Dosulepin Drugs of Abuse Screen amphetamines barbiturates benzodiazepines Reported as positive same day Mon Fri or next cannabinoids or negative working day cocaine methadone Opiates integrity tests as antidote e g methanol 800 1200 mg l Legal limit for driving Routine same day Urgent 2 hours 800 mg l rs rer 2 3 days Urgent out of hours Ethylene glycol See Toxbase analysis can sometimes be arranged but cannot be guaranteed ne 0 4 1 0 mmol l araa ra next normal Lithium S working day Mon Fri Urgent 2 hours 2 3 days Urgent out of hours analysis can sometimes be arranged but cannot be guaranteed Routine 2 working days Urgent same day Mon Fri Urgent analysis out of hours can sometimes be arranged but cannot be guaranteed 10 20 mg l Paracetamol In overdose refer to treatment graph Methotrex
41. rs Allison Gaskell Chief BMS Auto lab Tel 0161 27 65574 Mr Neil Howarth Chief BMS Specialist section Tel 0161 27 64699 Ms Carol Chadwick POCT Co ordinator SMH amp RMCH Tel 0161 701 2216 POCT Co ordinator MRI REH and external locations Tel 0161 27 64891 Departmental Fax CS Te 0161 27 64586 es Re ee a Results and Clinical Advice Results Line If you need to telephone for results call the Results Line 0161 276 8766 Monday Friday 8 00 am 8 00 pm Duty Biochemist Clinical advice is available at all times The duty biochemist is one of the Clinical Scientists or medical staff and includes those on the list above They participate in a rota and will assist and advise on problems involving the biochemical investigation of patients and the interpretation of results The Duty Biochemist can be bleeped on 4375 during normal hours Out of normal hours one of the Consultant staff is available via the Trust switchboard Out Of Hours specialist contact Outside of normal working hours contact is made directly by mobile phone or Air Bleep via switchboard Mobile number 07771 703383 Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 4 of 37 Author N Howarth SERVICES AVAILABLE Service provision Specimen reception is open for the receipt of samples at all tim
42. sis by the departmental duty biochemist 0161 276 1234 bleep 4375 REPORTING OF RESULTS All results will be issued on a printed report unless clinical users specifically request that this is not done This may take several forms 1 A Cumulative report giving a maximum of the four most recent results is issued for the majority of profiles and commonly requested single tests 2 Single shot reports are issued for all tests not on Cumulative reports 3 Interim or Ward reports are also issued in some circumstances or to meet special requirements of some wards These are temporary reports and should not be stored in the patient s notes 4 Electronic Reporting This can be carried out in two different ways e The first is results reporting back to OCM for those requests made by that system e The second is direct to a department s clinical system but this will only be done through a special development arranged with the laboratories 5 Telephone reporting will be used for urgent results for which the other systems would not provide a report quickly enough Results which are outside of the limits listed below will be telephoned Other results may be telephoned if they appear to be inconsistent with previous results or of particularly relevant for diagnostic or treatment purposes Telephone action limits Abnormal results for key tests will be telephoned to users the full list of these tests and ranges is available from the department
43. sses and is at least as useful as Orosomucoid for monitoring inflammatory bowel disease for which purpose CRP is preferred Creatinine Male 59 104 umoll Urgent 2 hours oe q fare neh Adults Female 45 84 pmol l Routine 4 hours Aea ee eae supplements meme ANS O S markers C peptide Level depends on glucose concentration C reactive protein Urgent 2 hours 0 3 5 0 mg L CRP Routine 4 hours Directorate of Laboratory Medicine ition 016 Copy No electronic Q pulse Date of issue 22 04 2015 Q pulse identifier CB CLIN PI 009 Department Clinical Biochemistry Approved C Hill Author N Howarth age 16 of 37 ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Gamma GT Male 1 5 12 4 IU L Female Follicular 3 5 12 5 IU L Mid cycle 4 7 21 5 IU L Luteal 1 7 7 7 IU L Menopausal gt 30 IU L _ Male 10 71 U L Female 6 42 U L Urgent 2 hours Routine 4 hours Routine 4 hours Yellow top tube Serum Yellow top tube Serum Provide where an analytically correct measurement of HbA1c cannot be obtained due to the presence of a variant haemoglobin Target ranges for control of diabetes are not well validated Measurement of HbA 1c by different means may solve the problem NICE suggests direct measurement of glucose day curves for which HbA1c is a proxy Yellow top tube Serum Mainly used to distinguish between liver and other causes of a raised alk
44. t Advice Interpretation extension at once so that we can investigate and re test samples whenever possible Please remember that certain factors may affect and possibly invalidate some test results causing potential biological and analytical interference For example blood transfusion and other intravenous fluids Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 9 of 37 Author N Howarth antibiotics anticoagulants drugs timing of specimen in relation to drug dose type of tube Please remember to give details of recent or current treatment on the request forms GP samples In order to maintain sample viability there is a requirement for samples to arrive within the target times outlined below For the routine Biochemistry blood profile tests blood glucose and HbA1c and endocrine tests that are collected in primary care the target time from venepuncture to delivery in the laboratory is 4 hours with a maximum of 6 hours This includes samples for PTH collected into EDTA tubes A small number of specialised tests must be delivered to the laboratory in under this time and or be transported on ice as indicated in the User Guide for Clinical Biochemistry These tests are not ones that would normally be collected in primary care Advice on these specialised tests is provided on a test by test ba
45. t be sent to the laboratory 2 3 26 0 mIUIL fasting 1 week Omics ONEA separation A simultaneous fluoride oxalate sample for glucose must be provided Insulin Like Growth OME 202 TANEN Red top tube Serum ranges See the range on l Factor 1 1 2 weeks Preferred test for screening your report or contact the IGF 1 for acromegally duty biochemist Level dependant on age sex and clinical circumstance ug L Growth Hormone 2 4 weeks Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 18 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Yellow top tube Serum Ferritin provided by haematology is a better test of iron deficiency Measurement of iron is not necessary lron and iron status 7 29 umol L Urgent 2 hours Transferrin 2 0 3 6 g L Routine 4 hours iron saturation 15 45 a lron saturation is more sensitive than ferritin for detecting iron overload Grey top tube plasma Specimen to be sent to Lactate 0 6 2 5 mmol L Urgent 2 hours laboratory ingmecicieyy within an hour but must be separated immediately so lab staff must be alerted Purple top tube EDTA Plasma If environmental testing in the work place is undertaken arrangements must be made to store a sample for confirmatory testing Yellow
46. t in acute poisoning as well as TDM as sequential sampling can give information as to the severity of poisoning and the need for additional treatment In all unconscious patients and cases of suspected poisoning with drugs the first available urine specimen should be retained It is important to give presenting clinical features and full details of suspected poisons and medication on the request form as these are required for interpretation TDM Details of the total daily dose or individual doses and times should be given for all medications not just the drugs being measured Blood for lithium measurement should be collected 12 0 5 hours post dose For most other TDM pre dose trough sampling is preferred After initiation or dose adjustment at least 5 plasma half lives should be allowed to elapse before sampling to allow a steady state to be achieved before checking for adequacy of dose For pharmacokinetic data and information on dose adjustment see the Therapeutic Drug Monitoring guidelines Adults Specimen requirements for Toxicology and Therapeutic Drug Monitoring TDM Yellow top tube serum Amiodarone 0 6 2 5 mg l 4 weeks Pre dose By arrangement only Yellow top tube serum Amitriptyline 50 150 ug l 4 weeks Pre dose By arrangement only ee Yellow top tube Serum Carbamazepine 4 12 mg l ome Lees Pre dose Urgent 4 hours Urgent by arrangement Yellow top tube Serum Clomipramine 150 450 ug L 4 weeks Pre dose Pu
47. tant or GP Name of requestor and a contact number telephone or bleep no Date and time that specimen was collected All clinical information required for proper interpretation of the test result Patient address for GP requests The sender of the sample will be notified as soon as possible if the sample is inadequately labelled so that the investigation can be repeated if it is still required Inadequately labelled or unlabelled samples will NOT be analysed The request form should be sent to the laboratory with the appropriate specimen sealed in a plastic bag by the specimen transport system pneumatic tube or by messenger porter or ward staff The forms must be kept separate from the samples Specimens and forms for individual Laboratory Medicine Departments must Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 6 of 37 Author N Howarth be sent in individual specimen bags to avoid delays in processing An electronic request via CWS is preferred If tests are requested using the CWS system an electronic report will be sent back to the unit from which the request was made Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 7 of 37 Author N Howarth
48. tine 4 hours Angiotensin converting enzyme 20 70 IU L 1 O asw 2 O asw Yellow top tube Serum ACE Purple top EDTA plasma This is a genetic test and the APO E genotype No range 2 4 weeks whole blood sample is required miley 2 hours e top tube serum Anti Mullerian Contact lab or refer to Hormone AMH report for guideline Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 13 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Contact Pancreatic lab ext 6 Carotene Ane 64067 before drawing blood Beta carotene 19 254 ug l Serum One red or yellow top tube Bicarbonate 19 28 mmol L Urgent 2 hours Routine 4 hours Bile Acids lt 14 umol L Next day Mon Fri Yellow top tube Serum Bilirubin total lt 22 umol L Urgent 2 hours Yellow top tube Serum Bilirubin No range Routine 4 hours Adults Conjugated direct BNP see NT proBNP S Bone Markers CTX 0 1 0 5 ug L Purple top tube plasma Fasting morning sample is 2 4 weeks preferred P1NP Premenopausal lt 56yrs women 30 78 ug L Postmenopausal gt 56yrs women 26 110 ug L Men 20 76 ug L Ca 15 3 lt 32 KU mL Yellow top tube serum Fluid other than blood should be put into a yellow top tube 1 2 weeks However non of the tumour markers are validate
49. top tube Serum 20 220 U L Routine 4 hours Additional By special special arrangement Male 1 7 8 6 IU L Lead Environmental exposure lt 250 ug L guidelines Routine 5 working days Female LH Follicular 2 4 12 6 IU L Next day Mon Fri Yellow top tube serum Mid cycle 14 95 6 IU L Luteal 1 0 11 4 IU L Urgent 2 hours Magnesium 0 7 1 0 mmol L Routine A hours Yellow top tube serum Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 19 of 37 Author N Howarth ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES lt 1 year 7 18 ug L Purple top tube EDTA If sentin a blood gas syringe for additional measurement of acid base parameters remove needle Urgent 2 hours and cap syringe Routine 4 hours DO NOT send this specimen by pneumatic tube If separate sample Green Top tube Plasma Met haemoglobin lt 1 5 Noradrenalin see catecholamines Only available NT pro BNP Up to 400pg ml routinely for GP Yellow top tube Serum samples Men 99 192 pmol L oneal Yellow top tube Follicular phase Additional Oestradiol 98 571 pmol L a aE Measurement of Oestradiol is not recommended for monitoring of HRT Next day Mon Fri Mid cycle 177 1153 pmol L Luteal phase 122 1094 pmol L Yellow top tube
50. xcretion lt 10ug minute 1 week Preferred timed overnight collection Male Plain bottle Albumin creatinine 0 2 5 mg mmol pactional 2 working days Random sample ratio Female preferred first sample on 0 3 5 mg mmol waking Cortisol free lt 165 nmol 24 hr Plain bottle Creatinine ES Next day Men 5F Plain bottle ES Same day Routidk Nokt Qawdflon Fri 24 hour collection or Electrolytes Related to intake a y adorn re Same day Plain bottle 24 hour collection Lead 1 2 weeks random Plain bottle Mercury 1 2 weeks random Plain bottle Routine Related to blood Next day Mon Fri osmolalit Urgent random y a Plain Bottle Same day PABA excretion Contact Pancreatic Lab to Contact Pancreatic Lab to PABA index PEI gt 0 70 order test Ext 64067 order test Ext 64067 Routine Very fresh RANDOM Porphobilin ogen Next day Mon Fri sample sent straight to lab Protected from light Screen 4 hours Very fresh RANDOM veipnyans Quantitation if positive 1 2 weeks 24 hour collection or Osmolality sample sent straight to lab Protected from light EDTA blood sample Whether patient s present with an acute Porphyria or a skin rash a similar Porphyrin screen approach Is taken requiring a fresh random urine sample protected from light and an EDTA blood sample Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clin
51. y service Feedback from our users will help in our constant efforts to improve our service ACCREDITATION The department was fully inspected in March 2011 and is now Fully Accredited by CPA UK Ltd for all laboratory based analyses Processes for accreditation for Point of Care Testing POCT have been changed by CPA and this process is under review Directorate of Laboratory Medicine Q pulse identifier CB CLIN PI 009 ition 016 Copy No electronic Q pulse Department Clinical Biochemistry Date of issue 22 04 2015 Approved C Hill age 11 of 37 Author N Howarth A Z OF TESTS These tables cover the most requested tests please contact the Duty Biochemist for any tests not on these tables Specimen requirements and reference ranges for blood analyses ANALYTE REFERENCE RANGE TURNAROUND TIME SPECIMEN NOTES Yellow top tube Serum Must be sent to the laboratory on ice for immediate separation Do not screen 11 deoxy cortisol 5 0 12 1 nmol L 4 weeks a fag Nygroxylase eficiency in adults unless there is significant androgen excess and the cause is not apparent and the result would affect treatment 17 a OH Progesterone 0 10 nmol L Yetow op be senm top tube Yetow op be senm Purple Top Tube EDTA plasma or Yellow top tube 4 8 weeks Serum Establish a diagnosis of Conn s before considering this test Supine 0 7 6 5 nmol L Ambulant 1 6 10 7 nmol L 18 hydroxy cortisol Acid Base status pH 7 36 7 44
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