CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
LABORATORY
HANDBOOK
APRIL 2016 EDITION
Reference:
CAEC Registration I.D. No. 1043
Written by:
Laboratory Handbook Group
Peer reviewer:
Prof J R Bonham
Approved:
February 2016
Review Due:
March 2017 (do not use this edition after this date)
Purpose
This handbook gives pre-analytical information and guidance to laboratory
service users when requesting tests and includes:
•
•
•
•
•
•
•
Details of services provided
Laboratory contact details and opening hours
Details of phlebotomy services
Instructions for completing sample and request form information
Arrangements for transporting samples to the laboratories
Point of care testing
Test table of analyses provided including details of specific sample
requirements
Intended Audience
All users of laboratory services at Sheffield Childrens NHS Foundation Trust
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 1 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 2 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
CONTENTS
General Information
Clinical Chemistry
Haematology and
Blood Bank
Introduction
Intended Audience
References
Quality
Division contact details
Phlebotomy services
Specimen collection by clinical staff
Phlebotomy and patient identification
The completion of request forms
Protection of Personal Data and
Information
Labelling of pathological samples
Packaging samples
Sample transportation
Reports (including result access via
ICE)
Uncertainty of measurement
Point of care testing
Related laboratory services in
Sheffield
Page Number
5
5
5
6
7
7
9
10
11
14
14
15
16
18
20
20
23
Location of department
Contact details
Laboratory opening times
Services provided
Specialised biochemical services
Urgent requests
Requesting additional investigations
Limitations of results
Consent
Reference Ranges
27
27
28
28
29
33
34
34
34
35
Location of department
Contact details
Enquiries
Laboratory opening times
Services provided
Urgent requests
Requesting additional investigations
53
53
54
54
54
57
59
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Limitations of results
Reference Ranges
60
60
Histopathology
Location of department
Contact details
Laboratory opening times
Services provided
Other investigations
Urgent requests
Limitations of results
Turnaround times
61
61
61
62
63
66
66
67
Sheffield Diagnostic
Genetics Service
Location of department
Contact details
Enquiries and results
Laboratory opening times
Services provided
Urgent requests
Requesting additional investigations
Limitations of results
Consent
68
68
68
69
69
72
73
73
74
Microbiology
Antibiotic Assays
Tobramycin doses and levels in cystic
fibrosis patients
Virology services
Immunology services
76
79
Arrangements for
Microbiology,
Virology and
Immunology
CSF samples
Specimen containers
A-Z Laboratory test
list
80
81
82
83
86
89
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
GENERAL INFORMATION
INTRODUCTION
The Diagnostic Pathology Laboratories form part of the Division of Pharmacy,
Diagnostics and Genetics at Sheffield Children’s NHS Foundation Trust. There
are four laboratory specialities (listed below) and a mortuary service.
•
•
•
•
Clinical Chemistry
Haematology and Blood Bank
Histopathology and Mortuary
Sheffield Diagnostic Genetics Service
This handbook has been prepared following consultation with users of laboratory
services to give pre-analytical information and guidance to laboratory service
users when requesting tests. Any comments or suggestions for improvement
should be directed to the Laboratory Quality Manager.
INTENDED AUDIENCE
This handbook is for the use of all users of laboratory services at Sheffield
Childrens Hospital. This edition of the handbook should not be used after the
stated review date.
1.
2.
3.
4.
5.
Why am I ordering this test?
What am I going to look for in the result?
If I find it, will it affect my diagnosis?
How will this affect my management of the case?
Will this ultimately benefit the patient?
REFERENCES
In addition to the information provided in this handbook the Trust provides
Clinical and Medical guidelines for use within SC(NHS)FT. These are available
on the Trust intranet
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 5 of 168
GENERAL INFORMATION
Before requesting tests, regard should also be given to Asher’s Criteria (BMJ
1954, ii-460)
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
http://nww.sch.nhs.uk/Health%20Services%20Management%20%20SCH/cec/index.asp
http://nww.sch.nhs.uk/Health%20Services%20Management%20%20SCH/pages/guidelines.htm
QUALITY
Quality Commitment
Provided that the guidelines as detailed in this handbook are followed all service
users, including referring laboratories, can expect a commitment to continued
quality from the Diagnostic Pathology Laboratories for all work and services that
are provided on their behalf. The Diagnostic Pathology Laboratories will also
proactively engage with service users and institutions that refer tests and will
notify them of any significant issues or changes (including issues with EQA
performance and turnaround times) that can affect results or interpretations that
are given to them.
External Quality Assessment and Laboratory Accreditation
We have an established quality management system and all our laboratories
participate in regular audit and external quality assessment schemes such as
Clinical Pathology Accreditation (CPA), Medicines and Healthcare products
Regulatory Agency (MHRA), the Human Tissue Authority (HTA) and the Joint
Accreditation Committee-ISCT (Europe) & EBMT (JACIE). All the laboratories
are registered with Clinical Pathology Accreditation (UK) Ltd. The laboratories
are assessed against CPA at regular intervals and are accredited accordingly.
However CPA is now a wholly-owned subsidiary of the United Kingdom
Accreditation Service (UKAS), the UK’s national accreditation body, and these
accreditation standards are in the process of being migrated to the
internationally recognised standard ISO 15189: Medical Laboratories –
Particular requirements for quality and competence. This transition is expected
to be complete by 2018 and the laboratories are currently working towards
UKAS accreditation to ISO 15189:2012.
Laboratory
Clinical Chemistry
Haematology
Histopathology
Sheffield Diagnostics Genetics Service
CPA Reference
0001
0002
0003
3098
UKAS Reference
Not yet known
8091
8093
Not yet known
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Further information can be found on the UKAS website
http://www.ukas.com
Quality Assurance
All our laboratories participate in national external quality assurance schemes to
monitor the accuracy and precision of its analyses. Internal quality control is
used to check the validity of results on a day-to-day basis.
Quality Concerns and Complaints
If you have any issues about the quality of service you receive please contact
the Laboratory Quality Manager, the appropriate Laboratory Manager, the
Associate Director or a Clinical Director. Contact names and numbers are given
in the Contact Details sections of this handbook.
DIVISION CONTACT DETAILS
Sheffield Children’s Hospital
Hospital switchboard
Diagnostic Pathology Laboratories
Clinical Directors
Associate Director
Laboratory Quality Manager
Division I.T. Manager
0114 271 7000
Dr Ann Dalton
Prof Jim Bonham
David Wardley
Karen Bennett
Clive Bradey
Ext 17004
Ext 17404
Ext 53615
Ext 17240
Ext 53064
PHLEBOTOMY SERVICES
1. Collection of venous and capillary blood samples in Outpatients
Children attending outpatient clinics should attend the Outpatient Department
phlebotomy suites for blood sampling when required. A venous and capillary
service is provided.
2. Collection of capillary blood samples on wards
Samples are collected by laboratory staff according to the following schedule.
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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GENERAL INFORMATION
A phlebotomy service is provided for blood sample collection.
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
VENUE
DEPT RESPONSIBLE
Children’s Wards
Clinical Chemistry &
Haematology
Clinical Chemistry
Children’s Wards (NSU,
HDU & ICU only)
COLLECTION
TIME
(Monday to Friday)
09.30
13:30
N.B. On Saturdays, Sundays and bank holidays a collection at 09:30 is
made at the Children’s Hospital for urgent Clinical Chemistry and
Haematology requests. Laboratory staff are unable to carry out capillary
collections at any other time, and venous samples will therefore be
required if request forms are not left out for this round before 9 am.
It is important that request forms are written up before these rounds commence
or phlebotomy requests may be missed.
The weekday 09:30 round is carried out by a team of 4 staff. The other rounds
(including the weekend rounds) are carried out by a maximum of 2 staff, and
therefore requests should be limited to emergencies and new admissions
only.
Outside these times the laboratories can only respond to urgent requests
depending on staff availability. If the child is mobile please send them with
nurse/parent and proper identification to the Haematology OP bleeding room on
A floor.
It is the requester’s responsibility to consider the impact and safety of the patient
on the volume of blood withdrawn by phlebotomy. Please be aware that the
amount of blood collected is always matched to the tests or profiles requested.
It therefore may not be possible to add on extra tests by subsequently phoning
the laboratory. Microbiology samples e.g. gentamycins etc will be collected by
capillary only if they coincide with the scheduled ward rounds. All Microbiology
requests are now analysed at the NGH.
3. Collection of capillary blood samples in the Haematology OP blood
sampling room
Children attending AAU and A&E or those that required blood sampling following
a GP consultation can be sent to the Haematology blood sampling room
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Review date: March 2017
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Laboratory Handbook
between 09:00 and 16:45 for collection of capillary blood samples. No
appointment is required, but patients cannot be bled unless a completed request
form or alternate agreed arrangement is provided. Capillary samples for
haematological, biochemical, immunological and microbiological investigations
will be taken but venous samples need to be taken in Outpatients. There is
wheelchair access.
4. Thumb Prick Sample Collection for Blood group and Save Serum/Cross
Match
This service is offered provided the following are observed. Exceptions may be
discussed with the Consultant Haematologist.
1. Patient must be aged eight years old or under.
2. The patient’s expected potential requirement for blood must be one unit
or under.
3. The patient attends the laboratory’s sampling room and must be
accompanied by ward staff or parent.
4. The patient must have a completed and signed blood bank request
form.
5. Collection of blood for other tests at the same time is limited to a FBC.
Other tests e.g. U/E cannot be obtained. Deferring tests for later
occasions may be considered after discussion with parents and
ourselves.
6. Should serological problems be encountered a venous blood sample will
be needed urgently.
7. Performing a group and save while the patient is an out patient is to be
encouraged. It will forewarn of problems before admission.
Clinical staff are responsible for collecting blood samples themselves in the
following instances.
1. If laboratory staff are not available
2. If venous or arterial blood samples are required
3. If samples are required from patients who are distressed, who carry
serious risk of infection or who refuse a capillary sample
4. Any circumstances where procedures other than straightforward
capillary blood collection might be involved
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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GENERAL INFORMATION
SPECIMEN COLLECTION BY CLINICAL STAFF
CAEC Registration Identifier: 1043
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Laboratory Handbook
5. If checking a high or low potassium result
Blood Sampling from Lines and Catheters
Samples collected from lines are often contaminated with the stagnant or
infused fluid in the line. The results of tests may be so extreme as to be
obviously in error. Contamination of a lesser degree is more likely and may be
impossible to spot.
Skin Biopsies
Requests for skin biopsy cultured fibroblasts from SCH patients must be
accompanied by a consent form. Guidelines for sample collection and consent
forms are available on request (contact Dr Simon Olpin or Dr Jane Dalley on
For further
0114 271 7267 (answer phone) simon.olpin@sch.nhs.uk.)
information and details of arrangements for skin biopsy requests from external
hospitals please refer to the Skin Biopsies section on page 31 of this handbook.
PHLEBOTOMY AND PATIENT IDENTIFICATION
When taking blood or any other pathological samples the instructions provided in
sections 3.1, 4.2 and 4.4 of the Trust’s Patient Identification Policy must be
observed.
Laboratory personnel who take capillary blood samples from in-patients follow
the procedure given below. It is equally applicable to other staff groups who take
pathological samples.
•
•
•
•
Specimen containers should not be labelled in advance of receiving the
specimen.
At the bedside, obtain the patients name and date of birth by asking the
patient/parent carer to state it (do not merely get confirmation of a name
you state). Check this information is compatible with the patient
identification band on wrist or ankle.
If the patient is unable to tell you their name, refer to the identification
band and, if possible verify the information by asking the parents/carer
or another member of the clinical staff who knows the patient.
If the patient is unable to tell you and they do not have an identification
band, ask the patient’s parent/carer if present or another member of the
(clinical staff who knows the patient to identify the patient by name, and
date of birth. An identification band should then be generated and
secured to the patient as soon as possible. Collection cannot go
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
•
•
•
•
•
ahead if the band is absent, and phlebotomists are not obliged to wait
until this is completed.
Check that the details on the identification band match the details given
with those provided on the request form.
The patient must not be bled in the absence of a request form or an
alternate agreed test request arrangement.
Proceed with the collection if all is correct. Note: For patients who
cannot wear identification bands on wrist or ankle it is acceptable to
have the band pinned to their clothing. Collection cannot go ahead if
the band is absent.
Once the specimen is received into the container, the patients
identification band must be re-checked before completing the details on
the container to ensure the correct details are matched to this specimen.
The absence of an identification band, or the presence of conflicting
details on the band and request form, are considered as breaches of
Trust policy. Incidents of this nature should be referred to the Ward
Manager and the patient must not be bled.
N.B.This positive identification procedure only applies to in-patients. It cannot be
applied to children attending the Haematology Department as outpatients.
Sample and request form information must relate to the person from whom the
sample was taken. Samples labelled with ‘mother of’, ‘father of’ or ‘baby of’ etc
will not be accepted. The only exceptions to this are solid tissue samples for
pre-natal cytogenetic analysis, and fetuses up to 18 weeks gestation that are for
post mortem examination.
All request forms must contain a minimum of the following essential
information:
1. Full name (initials will be classed as missing information)
2. DoB (age only will be classed as missing information)
3. At least one of the following
• Hospital number
• A/E or Majax number
• NHS number.
• Clinical Genetics Family ID
4. Name of the requesting consultant (initials or full name) or location
(ward/department) to which results are to be sent.
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GENERAL INFORMATION
THE COMPLETION OF REQUEST FORMS
CAEC Registration Identifier: 1043
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Laboratory Handbook
5. Test required.
6. Blood Bank request forms must also include details of any special
requirements the patient may have i.e. irradiated (see back of request
form), or details of any underlying conditions that mean the patient could
need special products (see back of request form), and state if the patient
is pregnant.
The following information is also highly desirable
7. Name of the person collecting/obtaining the sample.
8. Date & time sample(s) taken (where relevant)
9. Sample type
10. Clinical details (full and appropriate clinical details including
circumstances that may increase the risk of infection e.g. relevant travel
history must be included)
11. Patient’s address including postcode
12. Patient’s sex
13. Clinician’s bleep number
Clinical details and the patient’s age are particularly important in paediatric
requesting so that laboratory staff may:
1.
2.
3.
4.
Understand the reason for the request
Interpret the results
Consider the need for further investigations
Advise and assist the clinical staff concerning the results obtained.
Additional information may be appropriate
toxicological or blood bank requests.
for
specialised
metabolic.
It is the responsibility of the requestor to ensure that a completed laboratory
request form accompanies every sample for which an analysis is required. The
only exemptions to this rule are:
1. When more than one tube is required to provide sufficient sample for the
test.
2. Routine Newborn screening where a completed Guthrie card is sufficient
Please use the correct request form specified as follows:
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Review date: March 2017
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Green Clinical Chemistry
request form
SCH requests for Clinical Chemistry
Pink Haematology request
form
SCH requests for Haematology (NOT for
Blood Bank – see below)
White Blood Bank request
form
Essential for requests for group, group and
save serum, group and cross-match, DCT
Yellow Histopathology
request form
SCH requests for Histopathology (except
Gastrointestinal Biopsies - see below)
White A4 Gastrointestinal
Biopsies request form
SCH requests for Gastrointestinal Biopsies
(Histopathology) only
Blue Microbiology,
Immunology, Virology
request form
SCH requests for Microbiology, Immunology
and Virology
Sheffield Diagnostics
Genetics Service request
form
Requests for Sheffield Diagnostics Genetics
Service
tests
(available
from
the
department)
High Risk Samples
Medical staff must also indicate on the request form if the sample to be sent to
the laboratory might carry a risk of Category 3 infection (using the yellow Cat 3
labels on both the request form and sample). An indication should also be made
on the form if the patient has a communicable disease such as rubella, for the
protection of any laboratory staff who might attend the patient.
Please alert the histopathology laboratory prior to sending any high risk samples
to them if possible. Such samples must be placed in 10% formalin and
transported to the laboratory by hand. The request form for these samples must
also identify the biohazard within the clinical details. Samples for other
reference labs related to the same case, should be sent directly to the
appropriate laboratory.
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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Page 13 of 168
GENERAL INFORMATION
If exceptional circumstances dictate that a test request is made verbally or by
letter, then this request must be followed by a completed request form within 7
days.
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
PROTECTION OF PERSONAL DATA AND INFORMATION
Personal data and information on request forms is required in order for the
laboratories to operate and may be stored on laboratory computer files. The
intent of the laboratories is to ensure that any personal data and information is
treated lawfully and in accordance with the NHS requirements concerning
confidentiality and information security standards. To this end we fully endorse
and adhere to the Trust Data Protection Policy, the requirements of which are
primarily based upon the Data Protection Act 1998 which is the key piece of
legislation covering security and confidentiality of personal information.
LABELLING OF PATHOLOGICAL SAMPLES
When collecting and labelling samples, the criteria for patient identification
(outlined earlier) must be followed. Sample and request form information
must also be compatible. Samples will only be accepted for analysis if
minimum criteria are met. This responsibility lies with the person collecting
the sample. Failure to meet these requirements may result in the sample being
rejected.
Minimum Criteria
As defined by laboratory policy all pathological samples sent to the laboratory
must contain a minimum of the following information:
1. Surname /family name
2. Forename (or Baby, Twin One/Two, Triplet One/Two/Three etc, if
forenames have not been given. Initials will be classed as missing
information)
3. At least one of the following
• Date of birth (age only will be classed as missing information)
• Hospital registration number
• A/E or Majax number
• NHS number
The Clinical Genetics Family ID number must also be present on samples
sent from Clinical Genetics
And ideally for samples being tested for patient monitoring purposes the
following must also be included.
• Date sample taken
• Sample type
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Review date: March 2017
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Laboratory Handbook
The ‘ward’ space on bottle labels may be used to write the hospital/A/E/NHS
number , ward is not required.
All samples for Blood Bank must contain a minimum of the following
information:
1. Surname /family name
2. Forename (or Baby, Twin One/Two, Triplet One/Two/Three, etc, if
forenames have not been given. Initials will be classed as missing
information)
3. Date of birth (age only will be classed as missing information)
4. Any of the following
• Hospital registration number
• A/E or Majax number
• NHS number
N.B. When cross matching for infants up to 6 months of age the laboratory
prefers to use maternal plasma in addition to the baby sample. Maternal
samples must be labelled with the mother’s surname, forename and DoB. Such
samples should not be labelled with the child’s hospital number.
In the event of an unconscious child being admitted via A&E, laboratory staff
will accept a sample clearly labelled with: A unique identifier i.e. A&E
number/Majax Number, Child’s sex.
Laboratory staff are instructed not to amend details on either the sample or the
request form. If you require further details of the sample acceptance policy
please contact the laboratory.
PACKAGING SAMPLES
In signing a request form the person making the request assumes responsibility
under Section 7 of the Health and Safety at Work Act and must adhere to the
following guidelines regarding the labelling and packaging of samples to
minimise the danger of infection.
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Review date: March 2017
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GENERAL INFORMATION
Ideally all samples should be labelled by hand. The use of addressograph
labels for labelling blood samples is not encouraged (especially for small
sample bottles), and blood samples for Blood Bank shall not be accepted if they
are labelled as such. However it is acceptable to use addressograph labels for
the larger urine and faeces samples. If addressograph labels are used they
should ideally be initialled by the phlebotomist to indicate that the label matches
the patient ID.
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
•
•
•
•
•
•
•
•
•
Every sample must be enclosed in a suitable, leak proof, primary
container.
The sample must be contained in a transparent leak proof plastic
transport bag. When sending Histopathology samples fixed in formalin,
the transport bag must also contain an absorbent pad.
Containers for large specimens, such as some Histopathology or 24hour urine specimens, may be enclosed in individual clear plastic sacks,
sealed to contain any leakage.
The request form must be separated from the specimen. Please place
the specimen inside the plastic transport bag attached to the request
form. For larger containers the request from should be securely taped
to the outside of the transport sack containing the specimen.
The request form should not be attached to the sample container or be
used as a sample label.
For Category 3 risk patients the requester must include full and
appropriate clinical details and danger of infection labels on both
request form and sample.
Any labels and stickers used must be self-adhesive.
Pins, staples, and heat sealed bags should not be used.
Plastic transport bags must not be re-used.
If any samples are to be transported by postal, courier or taxi service directly
from the clinical area to locations outside the Trust, they must be packed and
labelled according to the regulations for the transport of dangerous goods.
Please contact the laboratory for details of this requirement. Specimens for
transport by post should always be labelled as ‘First Class – Royal Mail only’.
SAMPLE TRANSPORTATION
On-site specimen transport
The primary system for transporting samples on-site is the vacuum tube system
which serves the SCH laboratories and has stations located in A&E, HDU, PICU,
M3, CF Unit, OPD (weigh room), Theatres, Haematology OPD/Clinic area, M1,
M2, S2, and the Theatre Admissions Unit. Samples can be sent directly to all
Pathology Laboratories from any of these stations. Copies of operating and
breakdown instructions for the vacuum tube can be found in each of these
areas. Please ensure that the transport pods are properly closed, and do not
attempt to send samples via the vacuum tube unless they are in a pod.
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 16 of 168
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
N.B Urgent frozen sections from theatre and specimens for histopathology
that have a high risk of infection must not be sent via the vacuum tube.
For transport of routine samples not suitable for the vacuum tube there are also
scheduled sample collection rounds of ward and clinic areas carried out by the
laboratory support worker at the following times 09:00, (11:30 if the vacuum
tube system is not working), 13:30 and 15:45 Monday - Friday. These rounds
take about 15 minutes. All samples for collection must be properly packaged and
left at the agreed point on each ward or clinic area. If there is visible leakage of
the specimen prior to transport, this must be reported to the nurse in charge and
it be requested that the specimen is placed in an additional sealed transport bag.
If there is leakage of formalin, the formalin spillage procedure must be followed.
Please refer to local COSHH assessments.
Specimens can also be taken to the relevant laboratory during working hours
and handed to a member of the laboratory staff. If an incident occurs during
transit, it should be immediately reported to the laboratory and if necessary ask
for assistance. Please note that urgent and fresh Histopathology samples
must be taken by hand to the department and handed directly to a member
of staff.
Some samples will need special requirements for transport e.g. should be
transported on ice, please refer to the test table of analyses at the back of this
handbook for specific requirements.
N.B. Health and safety regulations for on-site transport stipulate that when
carrying specimens, staff must use secure specimen transport carriers.
For occasions when the laboratory porter is not utilised, it is the
responsibility of the person carrying samples to the laboratory to ensure
that samples are carried in the green sealable sample transport bag.
Under no circumstances should anyone transport specimen containers in
their hands or pockets.
Transport of urgent samples
The vacuum tube system is the preferred mode of transport for urgent samples
and for transporting samples out-of-hours, with the exception of
Histopathology samples – see previous page. Urgent specimens must be
arranged with the laboratory before dispatch. Do not merely write ‘Urgent’ on
the request form and send.
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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GENERAL INFORMATION
Samples suspected of biohazard category 4 organisms e.g. Ebola virus, viral
hemorrhagic fever etc, must not be sent via the vacuum tube system.
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Sample transport arrangements during vacuum tube failure
In the event of vacuum tube failure the laboratory support worker can be
contacted to collect urgent samples only during the hours of 08:00-16:00hrs
Monday to Friday, with the exception of lunch breaks or other absences. In the
absence of a response users need to make alternate arrangements. Please
bear in mind that the support worker carries out a wide range of other duties,
some of which take him off-site or into areas where he cannot immediately
respond to his bleep. The specimen collection bleep number is 023.
Transport of samples to STH
A regular CampusLink taxi shuttle collects samples at 09:40, 11:10, 13:10,
14:40, 16:00, and 17:10 Mon-Fri for dispatch to the NGH and RHH laboratories;
urgent samples in-between these times may also go via urgent-taxi. Outside
routine working hours, scheduled taxis call into A&E reception at 17:15, 18:30,
20:30 and 22:30 on week nights and at 08:30, 11:30, 14:30, 17:30, 20:30 and
22:30 at weekends and bank holidays.
Please note that Immunology and tests referred to STH must be sent via the
SCH Clinical Chemistry department. Also please ensure that when requests for
CSF protein, glucose and lactate are required alongside requests for M, C & S,
the CSF sample must not be sent to Microbiology. The CSF sample is tested at
SCH, and the sample for M, C & S is tested at STH.
REPORTS
Clinical Chemistry, Haematology, Blood Bank, Histopathology, STH
Microbiology and STH Immunology Reports
From April 2012 no printed reports will be sent out from Clinical Chemistry,
Haematology, Blood Bank, Histopathology, Microbiology or Immunology, with
the exception of post mortem reports, reports to external purchasers, dynamic
function tests reports and reports for samples referred to external laboratories.
Printed post mortem reports are sent to the appropriate requesting
consultant/coroner, printed reports for other exceptions are delivered by hand to
the wards and departments at approximately 09.15 and 15.45.
Urgent reports will be telephoned if requested. The laboratory also has limits
outside of which the results are telephoned automatically. Authorised Clinical
Chemistry, Haematology, Blood Bank, Histopathology, Microbiology and
Immunology results are electronically accessible via ward/office computers
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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Page 18 of 168
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Laboratory Handbook
Using ICE desktop reporting.
ICE is available on at least one PC terminal on each ward and should be used to
access results prior to contacting the laboratory. The snowflake desktop icon is
labelled “ICE desktop reporting.”
• Upon clicking the ICE Desktop reporting icon a login screen is presented
– click login
• Enter username and password (not case sensitive) and click login.
• Select a ward/location from the list that represents where you are.
• The system takes you straight to patient enquiry where a hospital
number or name or DOB can be entered. Click on patient reports
button in left panel. This query will always present all results available
for that patient.
• If you wish to view multiple patient reports by ward then click the View
ward report icon within the left hand panel.
• This will display only the 20 most recent reports for the default location.
The display defaults to patient reports at the same location as your PC
e.g. M3 or ICU however patient’s results at another location can be
viewed from any workstation by selecting an alternative from the top left
hand pull down list.
• To view earlier reports click earlier reports. The default number of days
of previous results in the Ward view is 7 days. This can be changed by
the user or just keep clicking “earlier reports” to go back in time.
• Cumulative report displays with graphical views are available and can
be printed.
• An online manual is available by clicking manuals in the left hand pane.
• The colour of each report indicates the pathology specialty.
• When leaving your workstation unattended please log off using log off
button in the lower left hand panel.
• The Laboratory handbook can be accessed by entering Resources.
• Reports can be filtered by lab speciality and requesting clinician.
• Filing of results is audited monthly to ensure reports are viewed and
acted upon as appropriate.
Users are encouraged to notify the laboratory of patient duplicates or
demographic inaccuracies. The quality of report demographics is dependant
upon the quality of data we receive. Consistent use of the hospital number
enables cumulative reports to be created and viewed.
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Review date: March 2017
© SC(NHS)FT 2016.
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GENERAL INFORMATION
through the hospital network or directly from the PC desktop ‘ICE’ icon.
Passwords can be obtained by contacting the ICE Administrator (Ext 53268)
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Laboratory Handbook
Genetics reports
Genetics reports are sent via internal mail or by first class post. Urgent rapid
prenatal results are faxed directly to the referring centres. Results are available
by phone and urgent results can be telephoned or faxed if requested.
UNCERTAINTY OF MEASUREMENT
In clinical laboratory testing there are potential “uncertainties” that can affect test
results (for example; poor specimen collection or transport, patient related
factors such as biological variation and the presence of drugs, or other
interfering factors).
In addition, the analytical process itself is subject to some degree of inherent
variability and this is often referred to as the “reproducibility” or “imprecision” of
the method. Laboratories regularly monitor this by the use of internal quality
control samples within each batch of analysis and by comparing the results of
external quality assurance schemes designed to ensure that results are
comparable with others laboratories using similar methods.
Despite these control measures it must be recognised that variation can occur
and modestly differing sequential results may not always have clinical relevance.
The relevance of a particular result or a change in value must be considered in
light of both the reproducibility of the method and the biological variation within
the patient.
If in doubt concerning the significance of a result or a change in
sequential results, a member of the laboratory or relevant clinical staff should be
contacted and they can help guide interpretation.
Providing relevant clinical details at the time that the request is made can also
clarify the significance of a particular result or a change in results.
POINT OF CARE TESTING
All POCT equipment is to be used by trained users only. The blood gas
analysers situated on NSU, ICU and A&E Resus room are connected to Clinical
Chemistry by computer link and are for the use of trained and certificated
Anaesthetists/Doctors/Nurses/laboratory staff only. Training is arranged at
induction: see contact details below.
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Review date: March 2017
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Laboratory Handbook
Reporting Point of Care Test results
Test results must be transcribed onto patient charts and/or nursing notes as
follows:1. Transcribe PCCU blood gas reports onto ward charts/patient notes.
2. Sign off all transcribed results as checked.
3. Always include the date and time of test.
4. Always identify the user.
5. Identify all results from POCT equipment as 'POCT' results in the patient
notes, to distinguish results from those obtained by the Clinical
Chemistry main laboratory analysers.
6. Attach adhesive urine dipstick reports to patient notes.
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Review date: March 2017
© SC(NHS)FT 2016.
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GENERAL INFORMATION
Trust policy is that unique barcodes following training are issued to certified staff
and must not be shared with others. Use of the analysers without certification or
training, or the use of another operator’s barcode are disciplinary offences;
constituting both clinical risk , and risk to this vital patient service.
• Haemoglobin fractions, Electrolytes (Sodium, Potassium, Chloride,
Ionised Calcium) and Metabolites (Glucose and Lactate) are available
on each analyser.
• Laminates above each analyser give guidance as to the analytical bias
of assays compared to the main laboratory instruments.
• Capillary, venous, and arterial samples for blood gas analysis should be
transported using a cardboard tray along with a completed request form
or patient addressograph label which acts as the source of patient
identification to key into the analyser.
• Blood glucose testing is undertaken on the wards using Accucheck
Inform II dry chemistry hand held meters. A user Identification number
is required to use this meter and is issued on completion of training and
competency schedules. All patients being monitored for blood glucose
should send a paired sample to the laboratory for analysis daily.
• POCT glucose results less than or equal to 3.1 mmol/L must have a
corroborative sample sent to the Clinical Chemistry laboratory in case of
hypoglycaemia.
• Urine Specific Gravity testing using the Atago refractometer is available
on M3. Staff must be trained and certificated before they use these
meters.
• Urine dipstick testing is performed by trained users using Clinitek Status
analysers.
• Abbott Freestyle Optium H ketone meters are available on ITU, HDU,
M1, M2, A7E, AAU and S2. Staff must be trained and certified before
using these instruments.
CAEC Registration Identifier: 1043
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Laboratory Handbook
7. Highlight all abnormal results generated by POCT equipment according
to local ward procedures.
8. Document all actions taken in response to POCT results in the patient
notes e.g. notification to medical staff.
The Clinical Chemistry Duty Biochemist (bleep 095) is available for advice
and/or interpretation of results.
The Point of Care Testing Committee, chaired by Prof J Bonham, oversees all
ward based testing and any concerns, queries or proposed developments
should be directed to this group. Please note that due to accreditation process
changes POCT services are not currently accredited.
Mrs Carol Hinchliffe
POCT Co-ordinator
Ext 17305 Bleep 053
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 22 of 168
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Laboratory Handbook
RELATED LABORATORY SERVICES IN SHEFFIELD
Telephone
Ext
61424
Laboratory Medicine Directorate
Northern General Hospital
Dr B Perunovic
(Clinical Director)
Telephone 0114 2434343
Mrs L Dunk
(Directorate Manager)
Mr R Fleming (Quality
Manager/Risk Lead)
Ms S Cassidy
(Directorate Business
Manager)
Mr M Bradley (Laboratory
IT Manager)
Ms J Cooper (PA)
69439
Results line & enquiries
Dr G Gillett (Consultant)
Dr H Delaney
(Consultant)
Dr T Hlaing
(Consultant)
Mr K Green
(Lead Lab Manager
Clinical
Chemistry/Immunology)
Mr T Gillott
(Lab Manager
Automation, POCT, IT)
Main Sample Reception
Automated Routine
Manual Immunoassay
Trace Metals
PID Area
RIA Laboratory
Toxicology
14716
14316
14248
69471
52727
14717
52686
15707
15318
14260
14928
14244
14242
14438
15726
67240
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GENERAL INFORMATION
Department of Clinical Chemistry
Northern General Hospital
Telephone 0114 2434343
15319
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Laboratory Handbook
Department of Clinical Chemistry
Royal Hallamshire Hospital
Telephone 0114 2711900
Results line & enquiries
Dr K B Page
(Associate Specialist)
Mr T Gillott
(Lab Manager)
Mrs P Wilson
(Specialist/Technical
Lead)
Sample Reception
Main lab
12348
12787
Department of Haematology
Royal Hallamshire Hospital
Telephone 0114 2711900
Mr A Ward
(Lab Manager)
Results line & enquiries
Automation Laboratory
Blood Bank
Cell Markers
Haemolysis
Reception
12621
Department of Haematology
Northern General Hospital
Telephone 0114 2434343
Results line & enquiries
Dr J Van Veen
(Consultant)
Mr A Weir
(Lab Manager)
Main Sample Reception
Haematology
Coagulation
Blood Bank
Microscope Room
14304
14394
Dr B Perunovic
(Consultant)
Ms L Price (PA)
Ms E Colgen
(Lead Lab Manager)
Ms S Hibberd
(Deputy Lab Manager)
Results line & enquiries
Main Lab
61424
Department of Histology
Royal Hallamshire Hospital
(Satellite Lab only at NGH)
Telephone 0114 2711900
61347
61347
12812
13298
12284
12594
12333
12801
12859
12998
14945
14260
14723
14943
14246
14305
12296
12663
13727
61380
12240
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 24 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Northern General Hospital
Telephone 0114 2434343
Department of Microbiology
Northern General Hospital
Telephone 0114 2434343
Results line
Enquiries
Dr W Egner
(Consultant)
Dr R Sargur
(Consultant)
Dr D Arnold
(Consultant)
Mr K Green
(Lead Lab Manager
Clinical
Chemistry/Immunology)
Main Sample Reception
Electrophoresis
Laboratory
Immunochemistry
Laboratory
Immunofluoresence
Laboratory
PID Area
Pre-natal Screening
Laboratory
RIA Laboratory
15552
69196
15349
Results line & enquiries
Dr S Thompson
(Consultant)
14777
17579
(SCH)
14777
(NGH)
68482
(RHH)
14538
(NGH)
12773
(RHH)
14528
Dr E McLellan
(Consultant)
Dr D Partridge
(Consultant)
Mr M Bell
(Lead Lab Manager)
Main Sample Reception
Automated Serology
Chlamydia Laboratory
CL3 Bacteriology
Laboratory
15704
15700
15707
14260
15724
15720
69767
14438
15725
15726
14260
14928
14256
15538
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Review date: March 2017
© SC(NHS)FT 2016.
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GENERAL INFORMATION
Department of Immunology
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Laboratory Handbook
CL3 Virology Laboratory
Enteric Laboratory
Environmental
Laboratory
Main
BacteriologyLaboratory
(B/C Area)
Main
BacteriologyLaboratory
(GUM Area)
Manual Serology (Bench)
Manual Serology
(Samples)
PCR Laboratory 3
PCR Laboratory 4
PCR Laboratory 4 Lobby
14539
14535
14534
53245
69217
52506
14531
66289
52749
52720
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Review date: March 2017
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Page 26 of 168
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Laboratory Handbook
CLINICAL CHEMISTRY
LOCATION OF DEPARTMENT
B Floor, Orange Wing
Pathology Block
Sheffield Children’s NHS Foundation Trust
Western Bank
Sheffield S10 2TH
CONTACT DETAILS
Mr Craddock-Jones’s PA – Alison Lenthall
ENQUIRIES
Laboratory Office
Laboratory Office Fax
Answering machine and FAX
Duty Clinical Scientist
On-call Clinical Scientist
Acute Section
Routine results/ /Emergency requests
Matthew Jordinson (Lead Biomedical
Scientist)
Fraser Cocker (Senior Biomedical Scientist)
Carol Hinchliffe (Senior Biomedical Scientist)
Metabolic Section
Result enquiries
Camilla Scott (Consultant Clinical Scientist)
Ext 17404
Ext 17318
Ext 17444
Bleep 009
Ext 17340
Ext 17340
0114 270 6121
0114 271 7263
Bleep 095
Bleep 07659 512616
Ext 17305/17306/17427
Ext 17134
Ext 17134
Ext 17134
Ext 17445
Ext 17307
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CLINICAL CHEMISTRY
Professor J R Bonham, Director of Pharmacy,
Diagnostics and Genetics and Consultant
Clinical Scientist
Professor Bonham’s secretary – Lynne
Darwin
Mr P Craddock-Jones Laboratory Manager
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Laboratory Handbook
Joanne Croft (Clinical Scientist)
Dr Jane Dalley (Clinical Scientist)
Jenny Watkinson (Lead Biomedical Scientist)
Louisa Smith (Senior Biomedical Scientist)
Ext 17307
Ext 17307
Ext 17445
Ext 17405
Tissue Culture Section
Dr Simon Olpin (& answer phone)
Dr Jane Dalley (Clinical Scientist)
Prenatal diagnosis enquiries
Ext 17267
Ext 17307
Ext 17267
Newborn Screening Section
Newborn screening results (08.30 to 12.30)
Answering machine and fax
Melanie Downing (Screening Lead Scientist)
Catherine Dibden (Clinical Scientist)
Dr Lynette Shakespeare (Clinical Scientist)
Joyce Baston (Lead Biomedical Scientist)
Sheila Ellin (Senior Biomedical Scientist)
Ullas C-Joseph (Senior Biomedical Scientist)
Mrs G Race (Specialist Nurse)
Mrs A M Casbolt (Specialist Nurse)
Ext 17257
Ext 17263
Ext 17302
Ext 17346
Ext 17346
Ext 17500
Ext 17346
Ext 17346
Ext 17415
Ext 17415
LABORATORY OPENING TIMES
Normal laboratory opening times
Receipt of samples which require special handling (e.g.
growth hormone, insulin, dynamic function tests with
multiple samples or research samples)
Monday to Friday
9.00am- 5.00pm
Monday to Friday
9.00am- 4.00pm
For the analysis of urgent samples outside the above times, contact the
Biomedical Scientist on call for Clinical Chemistry via the Hospital
Switchboard.
SERVICES PROVIDED
A 24 hour service is provided for the Children’s Hospital, Ryegate Children’s
Centre, Ambulatory Clinic (NGH) and Becton Centre (CAMHS). Support is also
provided for the management of ward-based blood gas analysis and glucose
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Review date: March 2017
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Laboratory Handbook
monitoring. Specialist paediatric advice is available to help in the interpretation
and selection of tests on a 24 hour basis. Where appropriate (predominantly for
immunology, toxicology and some endocrinology) samples are referred to other
local hospitals.
The newborn screening section of the laboratory covers all babies born in
Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, Nottinghamshire,
Rutland, South Humberside and South Yorkshire.
A Regional service is also provided for the investigation of children with a
suspected metabolic disorder. This service is available to the Sheffield
Children’s NHS Trust without cross charging and to other users on a cost per
test basis . Many of the more complex investigations are free for patients in the
Trent Region and South Humberside as they are covered by contracts for
Newborn metabolic screening.
SPECIALISED BIOCHEMICAL SERVICES
Drug Analyses
Plasma concentrations of the following drugs are measured in this laboratory for
the purpose of therapeutic drug monitoring or in cases of suspected overdose:
Alcohol, Caffeine, Cyclosporin, Iron, Methotrexate, Paracetamol, Salicylate and
Tacrolimus.
Samples for the measurement of other drugs will be referred.
Therapeutic drug monitoring
Caffeine analyses are performed routinely. Other drug analyses are performed
as required. The laboratory must be contacted for urgent results. For a valid
interpretation of the results, the following information must accompany each
request:
• Type of preparation
• daily dose
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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CLINICAL CHEMISTRY
Specimen requirements are given in the laboratory test A-Z listing at the back of
this handbook. In some instances it may be possible to measure drug levels in
other fluids such as urine by arrangement with the laboratory. A toxicology
service is provided at the Northern General Hospital (ext 12046). For further
information on referral services contact the Duty Biochemist (Bleep 095).
CAEC Registration Identifier: 1043
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Laboratory Handbook
•
•
•
time of last dose
time blood sample taken
other drugs being taken
Suspected overdose
For a valid interpretation of paracetamol levels, blood samples must not be
taken within 4h of ingestion. After suspected overdose of theophylline, caffeine,
iron, methotrexate or alcohol analyses may be available out of hours after
contacting the on-call Clinical Scientist.
After suspected overdose of other drugs collect up to 10 mL whole blood in
lithium heparin and as much urine as possible in a plain container. The
collection of tissues or other fluids may be appropriate. Contact the Duty
Biochemist (Bleep 095). Samples collected after suspected overdose must give
the type of preparation taken and the estimated time of ingestion.
Post Mortem Samples
Dried blood spot and bile samples taken at post mortem will be returned to the
requesting laboratory, along with the report, for disposal or storage according to
the consent obtained.
Forensic Analyses
If police involvement is likely, special precautions are required for sample
collection. For advice on this and other toxicology matters contact the
Toxicology Laboratory at NGH via switchboard.
Sweat tests
The test is performed by laboratory staff. Please contact the laboratory (ext
17305) to arrange an appointment date for the test to be carried out and
immediately forward a request form. Fully completed request forms must be
sent to the laboratory; whilst they do not accompany the patient/carers they are
the means by which the laboratory ascertains consent has been given. Up to two
sweat tests can be carried out per day, therefore, it is advisable to book well in
advance. Tests are booked for 2.00pm only and usually take place in the
Research and Medical Treatment Lounge (outpatients) or occasionally on the
wards or Cystic Unit (inpatients). Urgent sweat tests will usually only be
performed (Tuesdays) if certain criteria are fulfilled (bleep Duty Biochemist 095).
Advice sheets, directions and map are sent to parents prior to the test and a
further information sheet will also be provided on arrival. Analysis takes place
each Wednesday.
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Author: Laboratory Handbook Group
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Review date: March 2017
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Laboratory Handbook
Investigation of Inborn Errors of Metabolism
A service is provided for the detection, diagnosis and monitoring of patients with
inborn errors of metabolism. Analyses performed are included in the laboratory
test A-Z listing at the back of this handbook. It is important that requests for the
investigation of inborn errors of metabolism are accompanied by adequate
clinical information including drugs being taken at the time of sampling. If the
relevant clinical information is detailed, the laboratory should be contacted by
letter or telephone. See User’s Handbook for Metabolic Investigations for further
details (available from the laboratory).
•
•
•
•
•
•
•
•
•
•
•
•
•
Screen for disorders of long-or medium-chain fatty acid
oxidation This screen will detect defects of carnitine transport
and deficiency of carnitine-palmitoyltransferase types 1 and 2,
carnitine acylcarnitine translocase deficiency, very-long- or
medium-chain acyl-CoA dehydrogenases, long-chain 3hydroxyacyl-CoA dehydrogenase and other disorders of the
trifunctional enzyme complex and mild to severe multiple acylCoA dehydrogenation defects (ethylmalonic-adipic aciduria and
glutaric aciduria type 2).
Carnitine-acylcarnitine translocase
Glutaryl-CoA dehydrogenase (for glutaric aciduria type 1)
Palmitoyl carnitine transferase Type I and II
Propionyl-CoA carboxylase (for propionic acidaemia)
Pyruvate carboxylase
3-Methylcrotonyl-CoA carboxylase
Fumarate hydratase
14
14
Release of CO2 or C-incorporation from various substrates
for the detection of methylmalonic aciduria, isovaleric acidaemia
and other disorders
Very long-chain fatty acids
Very long chain acyl-CoA dehydrogenase
Citrulline incorporation into fibroblasts for detection of defects of
argininosuccinate synthase and argininosuccinate lyase.
Acylcarnitine profiles on cultured fibroblasts incubated with
palmitate and L-carnitine.
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Review date: March 2017
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CLINICAL CHEMISTRY
Skin Biopsies
Further investigation of some disorders requires the use of cultured fibroblasts.
The following are routinely available:-
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Enquire for disorders not listed. In general the laboratory will advise on the need
for tissue based assays and make the necessary preliminary arrangements.
Consent for skin biopsy collection is the responsibility of the requester. For skin
biopsies taken in SCH within normal working hours (Mon-Fri; 9.00-17.00), a
consent form and pot of sterile culture media is obtainable from the Metabolic
Laboratory Ext. 17445. Please ensure the Trust’s Patient Identification Policy is
followed prior to sample collection (see page 10), and that a fully completed
request form with full clinical details and test request is included. Samples are
transported at room temperature to Clinical Chemistry Department to arrive
ideally no later than 4.30pm.
For skin biopsies sent from external hospitals within the Trent Inherited
Metabolic Disease Group a request form with full clinical details and test request
is required. Sample transport at room temperature, normal first class post to
Clinical Chemistry Department to arrive ideally no later than 4.30pm Mon – Fri.
Please contact laboratory if sample to arrive on the weekend (0114 271 7445 or
271 7267).
For skin biopsies sent from external hospitals outside the Trent Inherited
Metabolic Disease Group, please contact the Tissue Culture laboratory prior to
sample collection to discuss sample collection details and turnaround times. A
request form with full clinical details and test request is required.
Please note turnaround times (TAT) are flexible when applied to cultured cell
assays. As different patient cell lines grow at different rates. In general for most
assays starting from a skin biopsy the TAT is 8-12 weeks.
Muscle Biopsy/CSF Neurotransmitters
Please contact the laboratory on ext 17445 when arranging muscle biopsies and
CSF neurotransmitters. The laboratory requires at least 24 hrs advance notice
of these procedures, in order to commit staff. Appropriate collection medium etc
will be provided by the laboratory staff as well as liquid N2 in which to freeze the
samples. All collections except those taking place in theatres will be attended by
a metabolic member of staff.
Newborn Screening
Dried blood spot samples are collected on newborn babies ideally at day 5 (5-8
days) by midwives to screen for phenylketonuria, congenital hypothyroidism,
cystic fibrosis, sickle cell disease, medium chain acyl CoA dehydrogenase
(MCAD) deficiency, maple syrup urine disease (MSUD), homocystinuria, iso
valeric acidaemia (IVA) and glutaric aciduria type 1 (GA1). Results are sent out
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Review date: March 2017
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Laboratory Handbook
to the appropriate Child Health Record Department for entry into the Child
Health Computer and checking against birth lists. Positive cases are referred for
further investigation and treatment to designated paediatricians/haematologists.
Individual negative results are NOT normally sent out to hospital doctors or
Family Practitioners.
This service is largely separate from the routine analytical services offered in the
hospital and in general it is NOT appropriate to enquire directly of the Newborn
Screening Laboratory for a test result. If an abnormal result has been found
then, as soon as it has been confirmed the patient’s Family Practitioner will have
been informed. If you have clinical suspicion of ANY of the disorders screened
for, it is better to initiate further investigations since these are screening assays
only. Please bleep the Duty Biochemist on 095 if advice is required on further
investigations. The newborn screening test for congenital hypothyroidism will
not detect secondary hypothyroidism. Immunoreactive trypsin is not always
abnormal in cystic fibrosis patients with meconium ileus.
URGENT REQUESTS
Requests for urgent analyses out of normal working hours should only be
made if the results must be known before the next full working day and are
likely to have a direct affect on patient management (see Asher’s criteria
pg 5).
Outside normal working hours
The following analyses are available by contacting the Biomedical Scientist on
call through the hospital switchboard.
Blood:
Urine:
CSF:
urea, creatinine & electrolytes (sodium, potassium,
chloride,
bicarbonate),
calcium
(with
albumin),
magnesium, osmolality, glucose, LFT, amylase, uric
acid, salicylate, paracetamol, iron, alcohol, lactate,
methotrexate (if previously arranged), ammonia, CRP.
sodium, potassium, osmolality.
glucose and protein.
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 33 of 168
CLINICAL CHEMISTRY
During normal working hours
Urgent requests must be arranged with the laboratory by telephone so that if
there is any delay in receipt, steps can be taken to locate the sample. Urgent
samples which arrive in the laboratory without prior arrangement may be
delayed.
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Any samples arriving in the laboratory without contacting the on-call
Biomedical Scientist will be treated as non-urgent and stored for analysis
the following morning.
Where possible please contact the Biomedical Scientist on call after the sample
has been taken unless specific collection information is required. Please keep
calls after 10 pm to a minimum. Calls between 07:30 am and 9:00 am will be
routed via a Principal or Consultant Clinical Scientist.
Other tests may be performed out of hours after discussion with the Biomedical
Scientist on-call who may refer you to the Consultant Clinical Scientist.
REQUESTING ADDITIONAL INVESTIGATIONS
Please be aware that laboratory staff will obtain volumes of blood on capillary
phlebotomy ward rounds appropriate to the tests requested when the
phlebotomist first saw the form. Therefore there is no guarantee that there will
be enough spare for investigations requested later. However laboratory staff will
endeavour if at all possible to maximise the use of that sample.
Furthermore, samples with a high haematocrit/PCV often have much less
available plasma available for analysis following centrifugation; consequently for
the same tests required as another patient with normal haematocrit/PCV either
more blood is required or else fewer tests can be performed.
LIMITATIONS OF RESULTS
(Also see section on Uncertainty of Measurement in the General Information)
Results may be affected by poor storage conditions, delays in sample
transportation, incorrect use of sample preservatives, inappropriate collection
site (e.g. drip arm), or collection time (e.g. therapeutic drugs) and analytical
interferences. Consecutive sample results may be affected by biological and
analytical variation. If advice is required on any of the above issues, please
contact the laboratory. If any report contradicts clinical findings then please
discuss the case with the Duty Biochemist.
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 34 of 168
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Laboratory Handbook
CONSENT
It is the responsibility of the referring clinician to obtain consent for testing. A
completed consent form should accompany all tissue culture samples.
REFERENCE RANGES
Reference ranges are provided for guidance in clinical decision making, rather
than for prescriptive use.
They are conventionally set to give the range of values which would be found in
approximately 95% of a statistically ‘Normal’ population. They are derived from
results obtained by this Department and from other sources. Reference ranges
for blood refer to serum or plasma samples unless stated otherwise.
Changes during growth and development create age-related reference ranges
for most analytes. Detailed ranges are kept in the Department and information
upon them may be obtained from one of the Biochemists.
For the day to day interpretation of results age-related reference ranges have
been condensed to cover generally recognised stages of development. These
are generally added to the report automatically by the laboratory computer when
the result is generated.
Newborn:
Neonate:
Infant:
Child:
CLINICAL CHEMISTRY
Adult:
First 7 days of life for term baby.
First month of life for a term baby. Ranges may not apply to
pre-term or small-for-dates babies.
Normally from the second month to one year, neonates are
included in these ranges if not separately quoted.
Normally one year to adolescence, neonates and infants are
included in these ranges if not separately quoted.
From the end of adolescence (>16 yr)
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 35 of 168
CAEC Registration Identifier: 1043
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Laboratory Handbook
CLINICAL CHEMISTRY REFERENCE RANGES
Test
Age
Reference
Range
Newborn
Neonate/Infant
Child/Adult
32-47
35-48
35-45
pH
Newborn
Neonate/Infant
Child/Adult
7.33-7.49
7.32-7.45
7.35-7.45
pC02 (kPa)
Neonate
Infant
Child
3-6-5.4
3.5-5.5
4.4-6.1
pO2 (Kpa)
Neonate
Child
Adult
Imprecision
6.7-12.0
11.0-13.5
10.5-13.5
1.7
Calculated standard bicarbonate (mmol/L)
Child
Adult
17-27
24-27
Calculated base excess (mmol/L)
Newborn
Infant
Child
Adult
Child
(>5y)/Adult
-10 to –2
-7 to –1
-4 to +2
-2 to +3
0.4-1.0 female
0.6-1.2 male
ACTH, 9am (ng/L)
Child/Adult
<46
Acute phase reactants
Alpha-1-antitrypsin (g/L)
Neonate
Infant
Child
Adult
0.9-2.2
0.8-2.0
1.1-2.3
1.1-2.1
Acid base (blood gas)
Hydrogen (H+) (nmol/L)
Acid Glycoprotein (orosomucoid) (g/L
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 36 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Alpha-1-antichymotrypsin (g/L)
Alanine aminotransferase (ALT, SGPT)
(U/L)
Adult
Neonate
Child
Adult
Neonate
Infant
Child
Adult
Neonate
Infant
1y-14y
14y-16y
Adult
Newborn
2 weeks
4 weeks
6 weeks
8 weeks
10 weeks
3 month - Adult
Neonate
Infant/Child/Adult
Alkaline Phosphatase (U/L)
Alpha fetoprotein (kU/L)
Ammonia (µmol/L)
Amylase
Plasma U/L
Urine amylase/creatinine ratio u/mmol
creatinine
Angiotensin Converting Enzyme (ACE)
(U/L)
Androstenedione (nmol/l)
Aspartate aminotransferase (AST, SGOT)
(U/L)
30-100
Child/Adult
6m-19y
<38
29-112
1-7 days
1-12 months
1- 10 years
10-17 years
Male 17 yrs +
Female 17 yrs +
Female 60 yrs +
Neonate
Infant/Child
Adult
0.7-10.1
0.2-2.4
0.3-1.7
0.3-8.4
2.1-10.8
1.0-11.5
<6.3
18-92
13-61
5-61
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 37 of 168
CLINICAL CHEMISTRY
Albumin (g/L)
Reference
Range
0.3-0.6
Up to 38
5-44
3-46
24-40
25-49
35-48
35-50
73-391
59-425
76-308
49-242
30-130
50,000-150,000
7,000-20,000
1,500-2,500
200-400
50-100
6-12
3-8
Up to 100
Up to 50
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Bicarbonate (total carbon dioxide)
(mmol/L)
Neonate
Infant
Child
Adult
Reference
Range
14-30
16-30
19-28
22-29
Bile Salts
Glycodihydroxycholanoate
Plasma (µmol/L)
Urine (µmol/mmol creatinine)
0-6
0.02-0.47
Glycotrihydroxycholanoate
Plasma (µmol/L)
Urine (µmol/mmol creatinine)
0-2
0.04-1.39
Taurodihydroxycholanoate
Plasma (µmol/L)
Urine (µmol/mmol creatinine)
0-2
0.01-0.08
Taurotrihydroxycholanoate
Plasma (µmol/L)
Urine (µmol/mmol creatinine)
0-2
0.01-0.08
Bilirubin, conjugated (µmol/L)
Neonate
Child/Adult
Bilirubin, total paediatric (µmol/L)
Neonate
Biotinidase (U/L)
C-peptide (fasting adults, pmol/L)
Caffeine (mg/ml)
Child/Adult
Child/Adult
Adult
Up to 10
Up to 2 (97.5
centile)
Variable
dependent on
child. Action
limits
phototherapy;
325. Exchange
transfusion 440
Up to 21
2.5-10.5
298-2350
8-20
26-40 when
higher levels
may be required
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 38 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Calcium ionised (mmol/L)
Child/Adult
Reference
Range
1.18-1.32
(adjusted to pH
7.4)
Neonate
Infant
Child
Adult
Adult
Child/Adult
2.14-2.74
2.13-2.72
2.10-2.56
2.14-2.51
2.5-7.5
4-12
Urine (mmol/24h)
Carbamazepine (Tegretol) (mg/L)
Carnitine (µmol/L)
Total
Free
Chloride (mmol/L)
Cholestanol (µmol/L)
Cholesterol (mmol/L)
Cholinesterase (IU/L)
Complement
Profile (g/L)
C3
C4
Components (g/L)
C1 esterase inhibitor
C3 nephritic factor
Copper (µmol/L)
Urine µmol/24h
Neonate
Infant
Child
Adult
All
Neonate
Infant
Child
16y-19y
Adult (desirable)
23-60
15-53
97-114
98-113
98-111
95-108
3-16
1.5-4.0
1.2-4.7
2.8-6.0
2.8-5.7
<5.2
>5300
0.75-1.65
0.14 -0.54
0-6 months
6 months to 1y
Female 1y-13y
Female 13y-49y
Adult (male)
Adult (female)
Child/Adult
0.15-0.35
Negative
5.9-16.3
3.8-23.8
11.0-27.0
11.0-38.9
11.0-27.2
14.2-35
<0.9
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 39 of 168
CLINICAL CHEMISTRY
Calcium total
Plasma (mmol/L)
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Cortisol (nmol/L) 09.00 hrs
(Plasma/serum samples now analysed
at SCH Clinical Chemistry)
9.00am – 12 noon
midnight
Urinary free nmol/24h
0-1m
1m-1y
1y -14y
Adult
Adult
Adult
Reference
Range
50-300
70-480
80-580
198-720
<100
10-147
Creatinine
kinase
(creatine
phosphokinase (CK, CPK) (U/L)
0-90d
90d-1y
1y-10y
11y-14y
15y-18y
Adult
Newborn
Neonate
Infant
1y-2y
2y-4y
5y-11y
12y-14y
15y+ Male
15y+ Female
28-470
24-240
24-175
30-170
27-145
30-170
31-107
24-76
13-34
13-34
21-39
29-53
40-69
54-90
43-71
Child
0.045-0.34
Neonate
Child
Adult
Child/Adult
40-65
95-150
Over 100mL/min
100-400
(trough levels)
Creatinine (µmol/L)
Urine Creatinine mmol/kg body
weight/24h
Creatinine clearance (ml/min/1.73 sq.m)
Cyclosporine (Ciclosporin) (µg/L)
7-Dehydrocholesterol (µmol/L)
For the diagnosis of Smith Lemli Opitz
Syndrome)
Normal (µmol/L)
>5
<2
8-Dehydrocholesterol (µmol/L)
<3
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 40 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Reference
Range
DHEAS (µmol/L)
Male 1-7 days
Male 8-15 days
Male 1-6 months
Male 6-12
months
Male 1-4 y
Male 4-7 y
Male 7-11 y
Male 11 y
Male 12-15 y
Male 15-17 y
Male 17 y
Male 18-19 y
Male 20-29 y
Male 30-39 y
Male 40-49 y
Male 50-59 y
Male 60-69 y
Male >70 y
Female 1-7 days
Female 8-15
days
Female 1-6
months
Female 6-12
months
Female 1-4 y
Female 4-7 y
Female 7-9 y
Female 9-11 y
Female 11 y
Female 12-14 y
Female 14-17 y
Female 17-20 y
Female 20-29 y
Female 30-39 y
Female 40-49 y
Female 50-59 y
2.5-10.2
1.0-6.1
<2.0
<0.7
<0.8
<0.5
<2.6
<4.1
<9.3
1.3-9.7
2.8-9.3
2.8-11.9
7.6-17.3
3.2-14.0
2.6-14.0
1.9-8.4
1.1-7.8
0.8-4.8
2.0-10
1.2-6.7
<0.7
<2.1
<1.0
<1.8
<4.3
<2.7
0.8-4.8
0.9-9.6
2.6-10.9
1.8-10.3
1.2-7.3
0.9-6.5
0.7-5.4
QPulse Document Reference: 999-0018
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CLINICAL CHEMISTRY
<2.0
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
DHEAS (µmol/L) continued
Female 60-69 y
Female >70 y
Child/Adult
Child/Adult
Diazepam (with Nordiazepam) (µg/L)
Digoxin (µg/L) Ideally 6-8h post dose
Dimethylglycine (µmol/mmol creatinine)
Dopamine (nmol/mmol creat.)
Follicle stimulating hormone (FSH)
(IU/L)
Free T3 (pmol/L)
Free T4 (pmol/L)
0-1y
1y-3y
3y-5y
5y-8y
8y-11y
>12y
0-1 Month
Male 1 month -6y
Male 6y-11y
Male 11y-14y
Male 14y +
Female 1 month
– 14y
Follicular phase
Mid cycle
Luteal phase
Female 60y +
(post
menopausal)
0 – 1 year
1 – 5 years
6 – 10 years
11 – 14 years
15 – 18 years
0 – 1 year
1 – 5 years
Reference
Range
0.4-4.0
0.4-2.4
<2500
0.5-2.0
Comprises of 0.5
– 1.0 in heart
failure and 1.0 –
2.0
in
arrhythmias
0-16
<1950
<1450
<950
<850
<750
<650
<22.0
<2.8
<3.8
<4.6
1.5-12
0-11
3.5-13
4.7-22
1.7-7.7
26-135
3.4 – 7.6
4.3 – 7.2
4.4 – 6.8
3.4 – 6.5
2.9 – 6.8
11.0 – 23.6
11.0 – 20.8
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Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 42 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Test
Age
Reference
Range
Free T4 (pmol/L) continued
6 – 10 years
11 – 14 years
15 – 18 years
Child/Adult
10.9 – 19.0
10.0 – 16.9
10.2 – 17.3
Up to 30
>0.6
Newborn
Neonate
1-m-3m
4m-6m
7m-12m
Child
Adult
Neonate
Child
Neonate
Child
Diabetic in
control
24-227
11-149
<123
<53
8-20
10-27
9-31
2.5-5.5
3.0-6.5
Up to 1.1
Up to 0.3
Galactose-1-Phosphate (µmol/GM-Hb)
Galactosaemia on galactose free diet
Gamma-glutamyl transferase (U/L)
Glucose plasma fasting (mmol/L)
Urine (mmol/L)
CSF (mmol/L)
CSF/plsma glucose ratio (mmol/mmol)
Glycated haemoglobin (HbA1c)
(mmol/mol Hb)
Child
Child/Adult
Up to 150
mmol/24 h
2.8-4.4
>0.6
20.0-48.0
Glycosaminoglycans
(mucopolysaccharides MPS) (Screen)
Mg/mmol creatinine
0-1m
1m-3m
3m-6m
6m-12m
1y-2y
2y-3y
3y-5y
5y-7y
7y-9y
9y-11y
11y-13y
13y-15y
over 15y
22.1-40.8
9.2-38.8
11.9-34.5
4.2-30.5
6.8-21.7
9.7-19.5
6.2-15.4
6.2-12.1
4.1-10.8
4.5-10.8
2.8-10.4
2.0-7.6
1.7-4.4
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 43 of 168
CLINICAL CHEMISTRY
Laboratory Handbook
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Growth hormone (µg/L
0-7d
8-15d
15d-11y
11y-18y
18y+
Normal
Hexanoylglycine
(µmol/mmol creatinine)
High Density Lipoprotein (HDL) –
Cholesterol (mmol/L)
Homocysteine Total (µmol/l)
Homovanillic acid (HVA) (µmol/mmol
creatinine)
Human chorionic gondatrophin (hCG)
(IU/L)
17-alpha-Hydroxyprogesterone (nmol/L)
Range may be higher in ill and
premature neonates
IGF-1 (µg/L)
Child
Adult
Adult male
Adult female
Infant
1y-5y
>5
Males, Non-preg.
women
1-10d
2-13w
3m-11m
1y-2y
3y-10y
11y-15y
0-2y
2-4y
4-6y
6-7y
7-8y
Female 8-9y
Female 9-10y
Female 10-11y
Female 11-12y
Female 12-13y
Female 13-14y
Female 14-15y
Female 15-16y
Female 16-17y
Female 17-18y
Female 18-19y
Reference
Range
1-23
1-15
<4.7
<11
<4.3
0.1-1.1
0.8-2.1
1.0-1.7
0-18
0-16
4-25
2-15
2-13
<2
<15
0.58-8.5
<4.7
<3.1
<2.6
<4.9
28-156
40-189
50-223
62-248
78-281
99-376
114-369
134-426
160-581
201-707
256-716
284-713
279-700
270-660
246-533
233-499
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 44 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Test
Age
Reference
Range
IGF-1 (µg/L) continued
Male 8-9y
Male 9-10y
Male 10-11y
Male 11-12y
Male 12-13y
Male 13-14y
Male 14-15y
Male 15-16y
Male 16-17y
Male 17-18y
Male 18-19y
19-20y
20-30y
30-40y
40-50y
50-60y
60-70y
70-80y
>80y
90-284
102-304
117-305
129-339
141-419
179-540
229-691
269-697
267-673
243-527
235-512
220-471
115-340
109-324
103-310
97-292
91-282
47-207
40-184
Neonate
Infant
Child
Adult
Neonate
Infant
Child
Adult
Neonate
Infant
Child
Adult
Neonate
Infant
Child
Adult
Fasting adult
3.9-17.0
2.1-10.9
3.1-16.1
6.0-16.0
0.01-0.15
0.05-0.7
0.3-2.8
0.8-4.0
0.05-0.4
0.15-2.1
0.5-2.2
0.5-2.0
Up to 5
Up to 11
Up to 63
Up to 120
17.8-173
Immunoglobulins
IgG (g/L)
IgA (g/L)
IgM (g/L)
IgE (kU/L)
Insulin (from 24/1/11) (pmol/L)
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CLINICAL CHEMISTRY
Laboratory Handbook
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Age
Iron (µmol/L)
Child
Adult
Neonate
Child
Adult
Neonate
Child
Adult
Lactate fasting (mmol/L)
Lactate dehyrogenase (LDH) (U/L)
Lipase (U/L)
Lithium (mmol/L)
Luteinising hormone (LH) (IU/L)
Luteinising hormone (LH) (IU/L)
continued
Magnesium
Plasma (mmol/L)
Urine (mmol/kg body weight/24h)
(mmol/24h)
Manganese (nmol/L)
Risk of toxicity
Methylmalonate (µmol/mmol creatinine)
Microalbumin (mg/mmol creatinine)
Male 0-1y
Male 1y-11y
Male 11y-14y
Male 14y-17y
Male 17y+
Female 0-6y
Female 6y-11y
Female 11-14y
Follicular phase
Mid cycle
Luteal phase
Female 60y +
(post
menopausal)
Neonate
Infant/Child
Adult
Child
Adult
<1y
Child/Adult
Normal
Adult
Reference
Range
<24
9-32
Up to 3.0
0.9-1.8
0.6-2.4
Up to 1300
400-900
340-670
<60
0.4 – 1.0
(risk of toxicity if
>1.5)
<3.2
<1.4
<7.8
1.3-9.8
1.7-8.6
<0.5
<3.1
<11.9
2.4-13
14-96
1.0-11
7.7-59
0.6-1.04
0.64-1.09
0.7-1.0
Up to 0.18
2.4-6.5
127-327.6
72.8-218.5
364
1.0-8.0
0.2-2.4
<2
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CAEC Registration Identifier: 1043
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Laboratory Handbook
Age
Myoglobin (µg/L)
Serum
Urine
Noradrenaline (nmol/24h)
17β-Oestradiol (pmol/L)
Orotic acid (µmol/mmol creatinine)
Osmolality
Plasma (mmol/kg)
Urine (mmol/kg)
After water deprivation administration
Maximum dilution
Maximum concentration
Oxalate (mmol/24h)
-1
Paracetamol (mg.L )
Therapeutic range 1-2 h after last dose
Overdose; sample taken not less than
4h after overdose:
4 hour levels
0-1y
1y-3y
3y-5y
5y-8y
8y-11y
>11y
Male 1-10y
Male 10y +
Female 1-10y
Female 10-14y
Follicular phase
Mid cycle
Luteal phase
Female 60y +
(post
menopausal)
Infant/Child/Adult
Child/Adult
Neonate/Child
Reference
Range
28-84
<10
<430
<200
<190
<180
<170
<130
<73.4
28-156
22-99.1
No range
46-607
315-1828
161-774
18.4-201
<3.5
Adult
Adult
Child
Adult Female
Adult Male
275-295
100-800
over 800
40-100
600-1400
0.14-0.42
0.04-0.34
0.08-0.49
Child/Adult
Up to 30
100-200
(treatment
probably indicated)
>200
(treatment
definitely indicated)
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CLINICAL CHEMISTRY
Test
CAEC Registration Identifier: 1043
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Laboratory Handbook
Test
Age
Parathyroid hormone (PTH) (ng/L)
2-20y
>20y
Neonate
Child
pH Urine
Within 3 hrs of an ammonium chloride
load
Phenobarbitone (Phenobarbital) (mg/L)
Trough level after at least 14d of
constant therapy
Phenylalanine fasting (µmol/L)
Phenytoin (mg/L)
After at least 10 days of constant
therapy
Phosphate fasting (mmol/L)
Plasma
Urine (mmol/kg/body weight/24h)
(mmol/24h)
Phosphoethanolamine (µmol/mmol Cr)
Heterozygote 3-8 x normal
Homozygote 10-50 x normal
Phytanate (µmol/L)
Plasmalogens in red blood cells(ratio)
C16 Palmitate
C18 Stearate
Potassium
Plasma (mmol/L)
Reference
Range
11-35
14-72
Over 5.0
5.3-7.2
<5.3
Child/Adult
10-40
Newborn
<6m
6m-2y
2y-10y
10y-17y
Adult
40-110
32-128
40-140
20-130
30-115
40-100
Child/Adult
5-20
Neonate
Infant
Child
Adult
Child
Adult
Child/Adult
1.0-2.7
1.1-2.4
0.8-1.9
0.8-1.5
0.33-1.28
15-50
<10
Normal
0.2-19.3
Neonate
Infant
Child
Adult
0.060-0.160
0.150-0.400
3.5-6.5
3.5-5.7
3.5-5.4
3.5-5.3
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Laboratory Handbook
Test
Potassium continued
Urine (mmol/kg body weight)
Age
Reference
Range
Neonate
Child
Pristanic acid (µmol/L)
Normal
Up to 2.3
Up to 2.0
(25-125 mmol/L)
25-100
mmol/24h
0-1.88
Progesterone (nmol/L)
Male
Female 14-60y
Female 60y +
0.7-4.3
No range
0.3-2.5
Prolactin (mU/L)
0-1y
Male 1y +
Female 1y +
No range
86-324
102-496
Neonate
Infant
Child
Adult
Neonate
Child
Adult
33-72
48-78
60-83
60-80
Up to 10
Up to 50
Up to 100
Adult
Protein total
Urine (mg/24h)
Urine protein/creatinine ratio (mg/mmol
creatinine)
CSF (g/L)
Salicylate (mg/kg)
2 hr post dose – therapeutic range
Overdose 4h after ingestion
<20
Newborn
Neonate
1m-2m
2m-6m
>6m
Child
0.3-1.4
0.3-1.2
0.2-0.9
0.1-0.7
0.1-0.4
> 125 (mild)
> 250 (moderate)
> 500 (severe
possibly fatal)
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CLINICAL CHEMISTRY
Plasma (g/L)
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Laboratory Handbook
Test
Age
Reference
Range
Selenium (µmol/L)
<2y
2y-4y
4y-16y
Adult
Child/Adult
Child prepubertal
Male 17y +
Female 17-50y
Female >60y
(post
menopausal)
0.2-0.9
0.5-1.3
0.7-1.7
0.8-2.0
13-25 µ/g-Hb
No range
14.5-48.4
26.1-110
Neonate
Infant
Child
Adult
Neonate
Child
131-143
133-142
133-144
133-146
Up to 4.4
Up to 3.7(40-200
mmol/24h)
Adult
100-200
mmol/24h
<10
Male 0-1 month
Male 1m-6m
Male 6m-6y
Male 6-13y
Male 13-18y
Male 18y +
Female 0-1
month
Female 1m-10y
Female 10-12y
Female 12y +
2.6-14
<6.1
<1.12
<2.37
0.98-38.5
9.9-27.8
Glutathione peroxidase (µ/g-Hb)
Sex hormone binding globulin (SHBG)
(nmol/L)
Sodium
Plasma mmol/L)
Urine (mmol/kg body weight/24h)
100-200 (mmol/24h)
s-Sulphocysteine (µmol/mmol creatinine)
Testosterone (nmol/L)
Testosterone (nmol/L) continued
14.1-68.9
0.7-2.2
<0.4
<0.9
0.22-2.9
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Laboratory Handbook
Test
Age
Reference
Range
Theophylline (mg/L)
>1 month/Adult
10-20
Can be lower in
neonates
Thyroid stimulating hormone (TSH,
thyrotrophin) (mU/L)
0 – 2 weeks
2 weeks – 12
months
1 – 10 years
11 – 14 years
15 – 18 years
Child/Adult
0.70 – 7.40
Neonate
Infant
Child
Adult
<1.8
0.3-1.7
0.4-2.1
<2.5
Neonate
Infant
Child
Adult
2.5-10.9
17.0-147.0
0.05-0.21
0.5-5.7
0.3-4.7
1.6-6.0
2.5-7.8
Triglyceride fasting (mmol/L)
Trimethylamine (and Oxide) (µmol/mmol
cr.)
TMA
TMA Oxide
TMA;TMA oxide ratio
Urea (mmol/L)
Uric acid
Plasma (µmol/L)
Urine (mmol/mmol creatinine)
Neonate
Child <10y
Child >10y
Adult (male)
Adult (female)
Neonate
Infant
Child
Adult
120-470
160-390
160-500
200-430
140-360
0.3-1.7
0.3-1.3
0.3-0.8
0.3-0.5
(1.5-4.5
mmol/24h)
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CLINICAL CHEMISTRY
Transferrin (g/L)
0.80 – 5.40
0.70 – 4.50
0.50 – 3.60
0.40 – 3.40
2.0-3.2
CAEC Registration Identifier: 1043
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Laboratory Handbook
Test
Age
Reference
Range
Valproate (mg/L)
Child/Adult
50-100
>150 may be
toxic
Very long chain fatty acids (peroxisomal
disorders)
C22 (µmol/L)
C24 (µmol/L)
C26 (µmol/L)
C24/C22
C26/C22
Vitamins
A (µmol/L)
15-112
14-80
0.33-1.50
0.44-0.97
0.005-0.030
Neonate/Infant
1-6y
>6y-Adult
0.50-1.50
0.70-1.50
0.84-3.60
11-114
C (ascorbic acid µmol/L)
E (µmol/L)
Neonate
Child <16y
>16y-adult
4.6-14.0
9.0-28.0
11.6-35.5
Vitamin E/Lipid ratio (µmol/L)
1y-6y
7y-12y
13y-19y
Adults
Infant
1y-5y
>5y
3-5
2-5
2-4
>1.6
2-12
2.9
1-7
Infant/Child/Adult
9.8-20.6
Vanilyl mandelic acid (VMA) (µmol/mmol
creatinine)
Zinc (µmol/L)
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Laboratory Handbook
DEPARTMENT OF PAEDIATRIC HAEMATOLOGY
AND BLOOD BANK
LOCATION OF DEPARTMENT
A Floor, Orange Wing
Pathology Block
Sheffield Children’s NHS Foundation Trust
Western Bank
Sheffield S10 2TH
Departmental Fax
0114 276 2289
Professor A J Vora
Secretary
Consultant Haematologist
Dr J Welch
Secretary
Tel Ext
17358
17477
Bleep
119
Consultant Haematologist
17358
17477
136
Dr J Payne
Secretary
Consultant Haematologist
17349
17477
168
Dr K Patrick
Secretary
Consultant Haematologist
53662
17477
249
Specialist Registrar
811
Mr G Bellamy
Laboratory Manager
17260
Mrs A Baxter
Specialist Practitioner of Blood
Transfusion
17107
Mrs J Williams
Clinical Data Manager
67905
Mr S Emmitt
Nurse Consultant
17329
Administrative Assistant
60865
123
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HAEMATOLOGY AND BLOOD BANK
CONTACT DETAILS
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Laboratory Handbook
Enquiries/Results
Haematology Main Laboratory
Blood Bank
17221
17478
ENQUIRIES
During routine hours technical or clinical enquiries may be made by visit or by
telephone. Out of hours contact is via hospital switchboard.
LABORATORY OPENING TIMES
Normal laboratory opening times
Monday to Friday
9.00am- 5.30pm
Receipt of routine samples
Monday to Friday
9.00am- 5.00pm
Receipt of samples for crossmatching
next day
Monday to Friday
9.00am-2.30pm
Capillary blood collection service for
AAU, A&E and GP patients
Monday to Friday
9.00am-4.45pm
SERVICES PROVIDED
A 24-hour service is provided for the Children’s Hospital and the Ryegate
Children’s Centre. A laboratory service is also provided for local GPs.
Specialist paediatric advice is available to help in the management of patients
with haematological problems and in the interpretation of results and selection of
tests from consultant/SpR staff on a 24-hour basis.
The following is extra information not suitable for inclusion in the test table.
Therapeutic materials available from Blood Bank.
Patients with special transfusion needs can be catered for. Please indicate on
the form. It is crucial that clinical details are given to allow appropriate materials
to be selected e.g. CMV seronegative and gamma irradiated following e.g. IUT
or fludarabine therapy.
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For urgent, emergency, MAJAX and complicated cases it is imperative good
communication is maintained with blood bank. During MAJAX events Blood
bank requests must include the patient gender and approx age.
Red cells request - Require blood bank request form. User to complete
usage/tracing label and return to blood bank lab.
Platelets, Fresh frozen plasma (FFP) and Cryoprecipitate. Requires phone call
to blood bank and a subsequent blood bank request form. For elective cases
also requires phone call to consultant haematologist to confirm need and dose.
A group and save sample will be required if blood group is unknown. User to
complete usage/tracing label on blood pack and return to blood bank lab.
Human albumin solution (HAS) stored in Blood Bank Laboratory (4.5% 250ml,
20% 50ml). Only need to phone Blood Bank Laboratory if massive amounts are
required or continuous therapy anticipated. Porter to collect from A floor lab
corridor. User to complete usage/tracing label on package and return to Blood
Bank Laboratory.
Clotting factor concentrates – a variety is stocked. Requires phone call to blood
bank lab following approval from a consultant haematologist.
HLA/HPA selected platelets can be supplied. Requires phone call to consultant
haematologist and blood bank lab and subsequent blood bank request form.
May require a sample.
For infants under 6 months of age we require 0.5ml EDTA (pink top) of baby
blood sample (fully labelled with registration number) and 2.5ml EDTA (pink top)
of maternal sample fully labelled with maternal name and DOB. Subsequent
blood issues do not require further samples. It is crucial we are informed of
historical intra-uterine transfusions.
When a crossmatch is requested, service users are responsible for notifying the
laboratory when blood transfusion has been received at another hospital after a
Blood Bank sample has been taken.
Transfusion Reaction Investigation.
Inform a consultant haematologist. Require 5ml plain clotted sample (glass vial
white top not sera gel) and 5ml EDTA (pink top), the remainder of all units given.
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HAEMATOLOGY AND BLOOD BANK
Baby group and crossmatch samples for Blood Bank
Complete the dedicated blood bank request form including the maternal details
section.
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Laboratory Handbook
D-Dimers in the diagnosis of venous thrombo-embolism.
D Dimer testing in the SC(NHS)FT Haematology laboratory is set up to detect
cases of disseminated intravascular coagulation (DIC). The method used is not
validated by SCH for the exclusion of deep vein thrombosis (DVT) or pulmonary
embolism (PE) in children The test must not be used for this purpose.
In general blood samples should not be sent to the Royal Hallamshire Hospital
for more sensitive testing, as the protocols used there have only been validated
in adult patients. For individual adolescent children with suspected VTE d-dimer
measurement at STH may be useful as part of the investigative algorithm but
should always be discussed with a consultant haematologist prior to sending
samples.
If a DVT is suspected it should be investigated with Doppler ultrasound scan,
after discussion with the Radiologist. If in doubt, please contact the on-call
Haematology Consultant or SpR to discuss.
Note there is detailed guidance available in the M3 Haematology/Oncology
guidelines which can be found in a folder on M3 above the nurses station in
Section 12- Anti-Coagulation - 1333 Acute Venous Thrombosis (M3/12/1333).
The guideline can also be located in the SC(NHS)FT Guidelines on the intranet.
Guidelines, minutes, policies, committees/approved clinical guidelines and
protocols/ Haematology+Oncology/Ward M3/Anti-Coagulation/ 1333 Acute
Venous Thrombosis (Section 11.9 reviewed by Jeanette Payne, March 2012).
Capillary sampling for coagulation tests.
Bearing in mind the need to have a free flowing and thoroughly anticoagulated
sample for coagulation tests we normally require venous or arterial samples.
We will take capillary samples if venous access is unavailable. The following
circumstances/notes apply: •
•
•
•
During routine ward rounds or haematology OP room. (not out of hours)
Prothrombin time (PT) for paracetamol overdose. 1 other test e.g. FBC
may be obtained – if this is exceeded the whole request will be left for
medical staff.
INR for monitoring of oral anticoagulants in infants and small children. 1
other test may be obtained – if this is exceeded the whole request will
be left for medical staff.
Capillary samples are unsuitable for APTT and will give erroneous
results.
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Laboratory Handbook
Specialist Coagulation assays/studies.
The fill level in coagulation vials is crucial. Please discuss your request with the
lab prior to sampling to determine exact requirements for volume and vial type.
Approval with a consultant haematologist is required for factor assays, platelet
function and thrombophilia tests. SCH performs assays for FII, FV, FVIII, FIX,
FX, FXI, FXII, FVIII inhibitor, FIX inhibitor, lupus anticoagulant, platelet function
(PFA100), Von Willebrands ( vWf, Rcof) and anti-Xa assay (for monitoring Low
Molecular Weight heparin) and APTT ratio (for monitoring unfractionated
heparin).
Other available tests which require approval by an SCH consultant
haematologist and which we refer onto Royal Hallamshire hospital include FXIII
assay, tests for thrombophilia (ATIII, protein C, protein S, FV Leiden, antiphospholipid antibodies), and more specialised tests of platelet function.
Bone Marrow investigations.
Discuss requests with a consultant haematologist.
The following is available on fluid bone marrow: morphology; cytochemistry for
classification of acute leukaemia; Perl’s stain for ferritin/haemosiderin (iron
status); immunophenotyping by flow cytometry for classification of acute
leukaemia; CD34 cell enumeration; (and karyotype and molecular genetic
analysis by Sheffield Diagnostic Genetics Service)
Lymphocyte subsets.
Includes determination of total (CD3), helper/inducer
suppressor/cytotoxic (CD8) T cells, B cells and NK cells.
(CD4),
and
Urgent samples that arrive in the laboratory without prior notification run the risk
of being delayed.
For the analysis of urgent samples outside normal hours, contact the Biomedical
Scientist on call for Haematology/Blood Bank via the Hospital Switchboard.
Please note that the service is run from home with staff travelling to the
laboratory to analyse urgent tests as appropriate.
Requests for urgent analyses out of normal working hours should only be
made if the results must be known before the next full working day and are
likely directly to affect patient management (see Asher’s criteria pg 5).
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HAEMATOLOGY AND BLOOD BANK
URGENT REQUESTS
CAEC Registration Identifier: 1043
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Laboratory Handbook
Outside normal working hours
The following analyses are available by contacting the Biomedical Scientist on
call through the hospital switchboard. NOTE: Out of hours samples taken for
FBC, film examination, ESR sickle test and slide test for infectious
mononucleosis, and for which results are not required until the next
working day, can be stored at 4°C and sent to the Haematology
Department for the following morning or sent to the laboratory but indicate
“not urgent” on the form. Any samples arriving in the laboratory without
contacting the on-call Biomedical Scientist will be treated as non-urgent
and stored for analysis the following morning.
•
•
•
•
•
•
•
•
•
•
•
•
Full blood count (Hb, Hct, Red cell count and indices, platelet count,
total and differential white cell count).
Examination of blood film for malarial or other blood-borne parasites.
Sickle solubility (HbS) screening test.
Slide test for infectious mononucleosis.
Reticulocyte count.
Screening test for red cell G6PD deficiency.
Coagulation screen-prothrombin time, activated partial thromboplastin
time, fibrinogen level, and D-dimers if disseminated intravascular
coagulation is suspected.
Tests for monitoring anticoagulant control can be performed if clinically
urgent.
Blood group (ABO and RhD type).
Crossmatch.
Direct antiglobulin (Coombs) test.
Blood product issue.
The following guidelines on Haematological test choice are provided for
specific clinical situations:
Children with Petechial Rash and Fever (? Septicaemia)
Full blood count only is required; coagulation screen is not, if it is being
done merely to exclude the diagnosis of meningitis.
Neonates with prolonged jaundice
Prothrombin time is indicated in this situation (in practice a coagulation
screen comprising PT, APTT and Fibrinogen will be performed).
FBC in children with probable bacterial infection to whom antibiotic therapy has
been given
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Urgent FBC cannot be justified if treatment has already been given. The
sample can be obtained but sent for analysis on the next routine working
day.
ESR as an urgent request
An ESR will only be performed as an urgent test in cases of suspected
septic arthritis where the presentation is not clear-cut. It is not
warranted when the diagnosis is obvious, or when the child can be
monitored until the morning. The test is only performed when the
request is made after consulting the on-call consultant orthopaedic
surgeon.
Blood counts on febrile neutropenic oncology patients
These may not be necessary, depending upon the time and level of the
last neutrophil count. The requesting clinician should be asked to check
the last count on the Ward Enquiry System before the on-call
Biomedical Scientist agrees to the request.
Issue of blood products (fresh frozen plasma, cryoprecipiate, platelets) after discussion between the requesting medical officer and the on-call
Clinical Haematologist.
Other tests may be performed out of hours only after reference to the Clinical
Haematologist on call, who can be contacted via the hospital switchboard.
The ability to extend original requests is dependent on having sufficient
remaining sample, its storage arrangements and technical/quality constraints.
Typically: • Glandular fever screens up to 24h
• Sickle screen up to 48hours.
• Blood films up to 24h
• Coagulation tests up to 8 hours
• Group and save samples are retained for approx 6 months.
In general contact the laboratory by telephone to determine the practicalities and
then provide an additional request form to confirm the additional anaysis.
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HAEMATOLOGY AND BLOOD BANK
REQUESTING ADDITIONAL INVESTIGATIONS
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Laboratory Handbook
LIMITATIONS OF RESULTS
(Also see section on Uncertainty of Measurement in the General Information)
The effect of storage on analyses is dependant upon the choice of analysis and
storage conditions. No sample should be stored (even temporarily) at greater
than room temp unless specifically requested to do so. Avoid using shelves
above radiators or workstations with lamps beneath. It is best practice to forward
all samples to the lab upon collection. If delay is unavoidable or analysis not
immediately required see later note re non-urgent FBC on call, then storage
within a suitable fridge is preferable. Please ensure date and time sample
collected is noted on all request forms - thus allowing the lab to judge whether
to process the individual analysis".
Significant interference can occur in coagulation testing due to heparin; on Hb
due to severe lipaemia and on Hb phenotype/fraction quantitation due to
transfusion. Difficult sampling causing sample activation/clotting interferes with
coagulation tests and platelet count and possibly other FBC parameters.
Samples diluted at source with e.g. infusion liquid or line flush will influence
results for all analyses and may go un-noticed.
Variability of results due to analytical imprecision is dependent upon the test,
method and result value. Blood bank investigations will be influenced by
previous transfusions/infusions. Users may contact the laboratory to discuss
particular concerns.
REFERENCE RANGES
Reference ranges are provided on ICE and the printed laboratory report for
guidance in the interpretation of results. Age related reference ranges are
provided as appropriate but they do not take into account normal racial variation
or differences between venous and capillary sample type. Please seek advice
from the laboratory if necessary.
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Review date: March 2017
© SC(NHS)FT 2016.
Page 60 of 168
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
HISTOPATHOLOGY DEPARTMENT
LOCATION OF DEPARTMENT
Laboratory and Office - C Floor
Mortuary – A Floor
Pathology Block
Sheffield Children’s NHS Foundation Trust
Western Bank
Sheffield S10 2TH
CONTACT DETAILS
The Consultant Head of Department, Dr M Cohen
Acting Lab Manager, J Ager
Senior Biomedical Staff, A Cutts, P Arnold
Mortuary Manager, T Donn
PM consent advice
Mortuary enquiries
Reports/Results
Technical laboratory advice
Urgent requests
On call pathologist (24 hours)
On call mortuary staff
Bereavement coordinator, S McGovern
17486
17373
17264
53460
67809
17246
17254
17264
17264
Through
switchboard
Through
switchboard
67809
Normal laboratory opening times
Monday to Friday
8.00am – 5.15pm
Mortuary
8.00am to 4.15pm
Please call ext 17264 to inform the Laboratory if fresh samples (i.e. not in
formalin) are to be sent after 4.30pm.
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LABORATORY OPENING TIMES
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SERVICES PROVIDED
The Histopathology Department provides a specialised paediatric and neonatal
biopsy service to the Surgical and Medical Directorates at the Sheffield
Children’s Hospital NHS Foundation Trust and provides a perinatal service to
the regional Trusts. The Department also supports the provision of services for
Oncology, Metabolic Disorders and Neuromuscular Disorders to North Trent,
operating within the Children’s Hospital Trust. Local expertise is available for
special investigations in enzyme histochemistry and immunochemistry. This
laboratory is accredited under the UKAS accreditation scheme and holds a HTA
licence.
Regular clinico-pathological conferences are held in the Department with the
Oncology, Clinical Genetics, Surgical and Gastroenterology teams and the
Department contributes to the monthly perinatal audit meetings at the Jessop
Wing (STH).
A paediatric post mortem service is provided to the Children’s Hospital and
Health Authorities throughout South Yorkshire and North Derbyshire.
Mortuary staff will provide advice on death procedures to bereaved relatives
following a death (SCH only).
The Department participates in the death Review Panels from South Yorkshire
and Derbyshire.
Consultation
We welcome telephone calls to discuss the appropriate handling of specimens
and interpretation of the histological findings (Tel ext 17264).
Requests for Post Mortems
Clinical staff are welcome to attend post mortem examinations related hospital
deaths. Mortuary APTs inform of the starting time on request. (Tel ext 17246)
Requests for post mortem examination should be directed to the Consultant
Head of Department. (Tel ext 17486)
In certain circumstances, the death must be reported to the Coroner. The Junior
Doctors’ handbook gives some guidance on this issue but you may wish to
discuss this with the pathologist before contacting the Coroner’s Officer.
Requests for post mortem examination on all other deaths must be
accompanied by a completed consent form and detailed request form. Consent
forms must accompany all fetuses including those < 24 weeks gestation. You
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will be notified of the starting time of the post mortem and you are entirely at
liberty to attend. Preliminary post mortem findings can be made available within
48 hours, if requested, and a microscopic report with full conclusion within 6
weeks.
The mortuary staff are available between 8am and 4.15pm (ext 17246), for
advice regarding consent for post mortems and can supply the consent forms
and booklets to parents explaining post mortems. Doctors who obtain consent
are strongly advised to read these before talking with parents.
OTHER INVESTIGATIONS
Routine Histology (i.e. samples received in buffered formalin)
Fixed tissue samples (samples in buffered formalin) can be sent to the
laboratory by the air tube delivery system or by hand to Histopathology
Specimen Reception. Samples may be placed in a plastic universal or larger
container in tissue fixative (buffered formalin), which is available from Theatres.
The laboratory does not supply containers with fixative. However, the laboratory
can provide fixative for the larger specimens that need to be placed in a
specimen bucket, please phone the laboratory to arrange. Samples should only
be placed in fixative for routine histology. If in any doubt, please telephone the
laboratory for advice (ext 17264).
The container should be large enough to accommodate fixative at least 10 x the
volume of tissue to ensure adequate fixation. Avoid squeezing tissue specimens
into small containers as this will cause distortion and result in difficulty with
diagnostic interpretation.
Unfixed Samples and Special Investigations
The following specimens must not be placed in fixative and if small must be
kept moist by placing on gauze or cotton wool moistened with saline. They must
be immediately transported by hand to the Laboratory and handed directly to a
member of the Histopathology staff. Unfixed samples for histopathology
must not be sent via the vacuum tube. Please be aware that if the vacuum
tube fails during transit of a precious sample (i.e. a sample which cannot be
repeated), the material may be unsuitable for histology once retrieved.
a) Rectal biopsies for the investigation of Hirschsprung’s disease.
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NB Please be aware of the hazards associated with buffered formalin
(available from the laboratory).
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The rectal biopsy card should be placed onto a piece of cotton wool moistened
with saline in a specimen container to prevent drying. The sample must not be
immersed in saline, nor should it be placed on dry cotton wool. The request
form must clearly state if the report is for :
• Pull through (immediate report) or
• Urgent acetylcholinesterase (urgency dependent on clinical need). This
technical procedure takes approximately 4 hours, if a result is required
on the same day the sample should be received by the laboratory before
1.30pm.
• Next day acetylcholinesterase
Please include your bleep or extension number on which to receive the
telephoned report or discussion of the case.
b) Liver biopsies
Place samples in a small amount of saline and hand to a member of
Histopathology in person. A portion can be sent away for copper measurement
if requested.
c) Needle or trucut tumour samples
Place samples in Hams F10 culture medium (obtained from Histopathology ext
17264) and hand to a member of Histopathology in person.
d) Large tumour samples and lymph nodes
Place samples in a dry specimen container and deliver to a member of
Histopathology in person. Flow cytometry may be undertaken by the laboratory
on suitable samples.
e) Renal biopsies
Please contact a consultant histopathologist to discuss details of the case.
f) Needle biopsies of muscle
These are collected by a Biomedical Scientist who will attend the procedure and
advise on the adequacy of sampling if requested by the clinician. The
specimens are placed on filter paper moistened with saline in a disposable Petri
dish to ensure that drying does not occur.
It is important that the Laboratory be given advanced warning of renal and
needle biopsies of muscle in order that arrangements can be made for
appropriate technical advice and assistance.
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g) Open muscle biopsies are usually taken in Theatre. The sample should be
placed in a Petri dish with moistened filter paper as above. It must be
dispatched to Histopathology without delay by the Theatre porter. Biomedical
Scientists do not attend open muscle biopsies in theatre.
As far as possible muscle biopsies should be taken from the vastus lateralis
muscle for the purpose of standardisation to permit fibre type proportions to be
assessed accurately. Fibre type proportions vary considerably between muscle
groups. The sample must not be taken near the myotendonous insertion, and
under no circumstances should the specimen be squeezed with forceps. Please
contact histopathology if further advice is required. Muscle biopsies for clinical
chemistry must be frozen in theatre; please contact Clinical Chemistry with
regards to this.
h) Neuropathology samples
These samples are not dealt with by histopathology at SCH but must be sent
directly to the Histopathology department at the Royal Hallamshire Hospital (see
section Transport of samples to STH page 16). These samples include:
• CSF specimens
• Nerve biopsies
• Surgical brain tissue
If these samples are fresh (i.e. not in buffered formalin) they must be delivered
by hand direct from the clinical location and without delay to the Histopathology
department at the Royal Hallamshire Hospital.
j) EM samples
• Tissue samples – place directly into PG fix (available from
histopathology lab) and send to SCH histopathology laboratory.
• Blood for Battens – 2mls of whole blood in an EDTA (pink container) or
Citrate tube (purple container) and send to histopathology laboratory
without delay.
Please be aware of the hazards associated with PG fix (available from the
laboratory).
k) Cytology samples
All samples for cytology should be placed in a sterile container and handed to a
member of histopathology in person before 4.30 pm.
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i) Bone marrow trephines
Place directly in buffered formalin and transport to histopathology laboratory.
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•
•
BAL, Please state if fat laden macrophages and / or differential counts
are required. Tel ext 17264 for further information.
CSF. These must be sent directly to the Histopathology department at
the Royal Hallamshire Hospital.
l) Out-of-hours
When specimen is taken out of hours the consultant pathologist may be
contacted via the switchboard (0).
URGENT REQUESTS
During normal working hours
Examination of frozen sections must be pre-arranged with a Pathologist,
preferably giving at least 24h notice. Please give a contact phone number to
which the urgent report will be given. Rectal biopsies for acetyl
cholinesterase histochemistry may be reported within 4 hours of receipt when
we are specifically instructed and they are received before 1.30pm, the
procedure will otherwise be carried out the following day. The Laboratory must
be informed if an urgent result is required.
Outside normal working hours
Frozen sections for intra-operative diagnosis or suction rectal biopsies requiring
acetyl cholinesterase staining during evenings or weekends can be arranged if
necessary through the consultant head of department via the hospital
switchboard. Every effort will be made to respond to short notice/urgent
requests as quickly as possible. A pathologist will telephone all urgent reports to
the requesting clinician, followed by written confirmation.
LIMITATIONS OF RESULTS
(Also see section on Uncertainty of Measurement in the General Information)
The opinion described in a Histopathology report must be interpreted within the
clinical findings and a judgement made. If any Histopathology report contradicts
clinical findings, please discuss the case with the Consultant Histopathologist.
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TURNAROUND TIMES
•
•
•
•
•
HISTOPATHOLOGY
•
Routine samples not requiring special stains or immunocytochemistry or
EM – 5 working days.
Routine samples requiring special stains or immuno – 10 working days.
Muscle biopsies for enzyme histochemistry – 10 working days.
Sample for EM – up to 6 weeks depending upon the service provider
turnaround time.
Inter-operative frozen sections – as soon as possible but between 15 an
30 minutes.
Rectal biopsies for acetylcholinesterase – urgent samples within 4 hours of
receipt if received before 1.30pm, otherwise they will be carried out the
following day.
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SHEFFIELD DIAGNOSTIC GENETICS SERVICE
LOCATION OF THE DEPARTMENT
C Floor, Blue Wing
Sheffield Children’s NHS Foundation Trust
Western Bank
SHEFFIELD S10 2TH
CONTACT DETAILS
Departmental Director
Business Development Manager
Head of Laboratory Services
Ann Dalton
Denise Harris
Post vacant
17004
17005
17005
Head of Oncology
Deputy Head of Oncology
Lead Scientist – Oncology
Gill Wilson
Polly Talley
Miranda Durkie
17016
17011
17047
Head of Constitutional
Deputies of Constitutional
Kath Smith
Joanne Martindale
James Steer
Richard Kirk
Rebecca Pollitt
60743
60723
17019
60723
17012
Lead Scientists – Constitutional
General enquiries
Fax Machine
Email address
Website link
0114 271 7014
0114 275 0629
SDGS@sch.nhs.uk
http://wwwsheffieldchildrens.nhs.uk/SDGS.htm
Samples coming via the STH/SCFT vacuum tube system – address 51
ENQUIRIES AND RESULTS
Contact can be made by telephone, email, fax or letter during normal working
hours. For further information, clinical advice and interpretation contact the
relevant Head of Section or the Director as detailed above.
To contact a member of staff by email use the following formula:
forename.surname@sch.nhs.uk
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LABORATORY OPENING TIMES
Normal laboratory opening times:
Monday to Friday
Saturday
9am – 5.30pm
10am – 11.30am
The laboratory does not offer an out of hours service. However, it may be
possible to organise analysis of urgent samples outside of these times by prior
agreement.
SERVICES PROVIDED
We aim to outline the service offered by each group for the guidance of medical,
nursing and laboratory staff. The laboratory should be contacted for advice
should there be any doubt concerning any of the procedures; some of the tests
require discussion with the laboratory before the sample is sent.
Oncology
Cytogenetic, FISH and molecular tests are offered as part of the diagnosis and
management of acute leukaemia, chronic myeloproliferative disorders and
myelodysplastic syndromes and for a number of specific solid tumours (including
sarcomas) and lymphomas. We offer molecular testing by sanger sequencing or
next generation sequencing panel testingfor a number of hereditary
predispositions to cancer and also screens for specific somatic mutations used
to define treatment sensitivity.
Please note that at present the service does not cover routine analysis in NonHodgkin’s lymphoma (other than those described in the table) or Hodgkin’s
disease. Other cases of particular diagnostic value or research interest will be
accepted where possible, preferably by prior arrangement.
Cytogenetic analysis can be performed on bone marrow, blood or fresh tumour
biopsy. We require between 0.25 and 1.0 ml of bone marrow aspirate (preferably
not the final exudate) in 5ml of transport medium containing heparin and
antibiotics. This medium is supplied on request from the department and should
be stored at +4ºC and kept in sterile containers e.g. universals. In addition, one
drop of marrow should be placed in transport medium with colcemid as the
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The genetic services are currently organised into two main groups: Oncology
and Constitutional.
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marrow is taken. The medium is provided ready for use, and these direct
cultures should arrive at the laboratory within one hour for immediate
processing.
If blood samples are sent for cytogenetics we require 5-10 ml of blood in a
lithium heparin tube. Please do not put blood into transport medium. Provided a
suitable marrow sample has been sent there is no need for an accompanying
blood. Cytogenetic analysis on blood is only possible if there are sufficient
immature cells present, as in CML and some acute leukaemias.
FISH testing will be performed alone or as an adjunct to cytogenetic analysis for
detection or clarification of abnormalities or to exclude/confirm cryptic gene
fusions where appropriate. FISH can be carried out on bone marrow, blood,
solid tissue biopsy and on certain archive material including paraffin embedded
tissue sections (PETS). We carry a large number of FISH probes including those
required for the accurate diagnosis of the diseases described above and probes
for some lymphomas and sarcomas which are listed in the test tables by
disease. This list of probes is regularly updated and many other probes may be
obtained if considered of value in patient management.
For molecular analysis 2-5ml of blood or bone marrow in K-EDTA (pink or purple
tops) is required. Smaller samples can be processed but may not be sufficient
for the test required and are more likely to fail. If in doubt please contact the
laboratory.
Samples should arrive no later than the day after they are taken. Solid tumour
samples should preferably arrive on the day they are taken and no later than the
following day. Please do not rely on first class post at weekends or bank
holidays.
Molecular testing and FISH are also available for some disorders from paraffin
embedded tumour tissue samples.
For the accumulation of accurate information on the relationship between
genetic findings and clinical conditions, it is important to have accurate referral
information.
Constitutional
Please see testing information for a full list of tests. This includes genetic
analysis (cytogenetics, FISH, microarrays (arrayCGH) and molecular testing for
dosage and/or sequencing or by next generation sequencing panels of patients
with learning disabilities, neurodegenerative conditions, connective tissue
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disorders, infertility, recurrent pregnancy loss, disorder of sexual development,
inborn errors of metabolism and haemochromatosis, haemostasis and
haemoglobinopathies and also includes fetal karyotyping for the detection of
aneuploidy or chromosomal rearrangements in pregnancies that are at a high
risk of producing a chromosomally abnormal child.
Karyotype analysis is carried out from in vitro culture of blood or solid tissue
samples and FISH is offered as an adjunct to classical chromosome analysis for
the detection of specific sub-microscopic deletions. This is carried out secondary
to full chromosome analysis for confirmation of an associated syndrome. All
microdeletion FISH tests are for confirmation of the associated syndromes,
rather than exclusion.
FISH for specific syndromes is not carried out on prenatal cytogenetics samples
unless indicated by a family history or to clarify a result from the chromosomal
analysis. An exception is the use of the TBX1 probe for the 22q11.2 region. All
referrals with heart defects are screened by FISH using this probe as some
cases may be associated with deletion in this region.
Microarray (arrayCGH) testing is available for patients with developmental delay
and/or multiple congenital abnormalities and for autistic spectrum disorder. This
is carried out as a higher resolution alternative to karyotyping. Please note that
Fragile X syndrome testing will not be initiated prior to array testing but is
available after a normal array result has been issued.
2-3ml venous blood in lithium heparin is required for a blood karyotype. 4ml
venous blood in lithium heparin is required for chromosome breakage / fragility
testing. 2-3ml venous blood in lithium heparin and 2-3ml of blood in K-EDTA is
required for microarray (arrayCGH) testing. Skin biopsy samples from patients
should be around 1-2mm in diameter, and 1mm in depth, taken from an alcohol
swabbed area. The depth is important as dermal tissue needs to be sampled.
The sample should be transported in bottles of sterile tissue culture medium
(available by request from the laboratory). Sterile saline can be used if no
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For fetal karyotyping, chromosome preparations are obtained from the in vitro
cultures of amniotic fluid, chorionic villus or fetal blood samples. Rapid
aneuploidy screening by FISH or QF-PCR is offered and abnormalities
detectable include trisomy 21, 18 and 13, sex chromosome aneuploidies and
triploidy. This is a preliminary result only and is backed up with conventional
karyotype analysis (this rapid service is also offered for newborn babies to
detect these abnormalities).
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medium is available. If delay in transport is unavoidable, samples should be
stored at +4oC. Samples must not be placed in Formalin.
In cases of fetal loss, IUD, stillbirth or therapeutic termination due to fetal
3
abnormality, we require a small biopsy of fetal placenta (approx 1cm
membrane, cord and placenta taken from, at or near the cord origin). We are
unable to accept a fetus. Specimens should be placed into sterile tissue culture
medium as above. In addition to placental biopsy, when possible, 1-3 ml sample
of fetal cord blood in lithium heparin can be successful. (NB Cardiac blood is
rarely successful).
Blood samples in K-EDTA (pink or purple tops) are received routinely for
molecular genetic analysis. Volume should be 2-5ml: smaller samples can be
processed but may not be sufficient for the test required and are more likely to
fail. DNA can be extracted from a variety of other tissues but if in doubt about
the sample size or suitability please contact the laboratory before taking the
sample.
Certain other diseases, also listed in the back of this booklet, are covered by our
consortium partners, to whom samples are forwarded by the laboratory. Tests
referred to our consortium partner or to other laboratories can be delayed in
reporting due to transfer time and factors beyond the control of this laboratory.
Please contact us if the sample is urgent.
Molecular prenatal diagnosis should be arranged well in advance if possible to
allow time to acquire any relevant test results or samples. Clinical genetics
service involvement is essential for all prenatal diagnosis referrals. Reliable
prenatal diagnoses require that the initial diagnosis has been clearly established
and it is important to appreciate the need for rigorous investigation even when
the index case presents in a terminal phase with little hope of useful intervention.
URGENT REQUESTS
Turnaround times listed in the test tables are generalised and we will always
endeavour to process urgent samples as quickly as possible. Urgent samples
should be clearly identified and telephone contact numbers listed in order to
report results. In the case of clinical need do not hesitate to contact the
laboratory to request an urgent result so that appropriate arrangements can be
made.
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REQUESTING ADDITIONAL INVESTIGATIONS
If further tests are required on samples already sent, this may be possible as
cytogenetics samples are stored for a period of between one month and one
year before disposal. DNA / RNA samples are stored, as appropriate, on the
majority of samples received in the laboratory for the purposes of validation,
controls and family studies. If further testing is required contacting the laboratory
directly is the most straight forward way to do this.
LIMITATION OF RESULTS
(Also see section on Uncertainty of Measurement in the General Information)
Microarray (arrayCGH) testing will not detect balanced rearrangements and is
limited in detecting mosaicism. The resolution of arrayCGH analysis will be
stated on the report.
Prenatal reports are based on the analysis of a minimum of three banded cells,
and therefore are unlikely to detect mosaicism. It should be noted that the
majority of samples sent for prenatal chromosome analysis are taken with a view
to screening for common numerical chromosomal abnormalities, particularly
Down syndrome. For technical reasons, the quality of structural analysis on such
samples is often conducted at a lower level than that which is required to reliably
detect small and unexpected chromosomal deletions and other rearrangements.
Although many structural chromosomal abnormalities will be detected, those that
fall below the limits of resolution of the analysis will be missed.
For oncology samples a normal cytogenetic result is based on the complete
analysis of a minimum of 10 G-banded cells usually with the examination of at
least a further 10 cells. The number of cells analysed in abnormal cases or
previously abnormal cases may be increased or decreased according to the
reason for referral. A normal in situ hybridisation result is based on the exclusion
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Cytogenetic results
Cytogenetic results from blood samples will be based on the analysis of a
minimum of 3 banded cells. The presence of mosaicism for any chromosome
abnormality is not routinely investigated by the level of analysis performed
unless dictated by the clinical referral reason or suggested by an observation
during routine analysis. The standard count for detection of a clone present at
greater than 10% level is 30 cells. This is reported in the karyotype comments if
carried out.
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of a given abnormality in a minimum of 100 interphase cells. An indication will be
given if minimum standards are not reached.
For all cytogenetics analyses the ability to detect subtle, unexpected
chromosome rearrangements is governed by the resolution of banding achieved
This is intrinsically highly variable. If the quality of the preparation or extent of
the analysis performed is not considered adequate for the reason for referral this
will be indicated on the report.
DNA Sequencing
Sensitivity of DNA sequencing is over 95%. Since all mutations are checked in
two separate amplicons, if possible by two independent methods, sensitivity
is>99%. Rare cases of single nucleotide polymorphisms under the primer
binding sites may lead to non-amplification of one allele. The specificity is 100%
where the mutation or type of mutation has been previously reported. Where the
change is novel, it may be necessary to carry out family studies and it still may
not be possible to reach a conclusion regarding pathogenicity.
Low Level Mutations
In some circumstances it may prove difficult to detect mutations present at a low
level, e.g. in cases of mosaicism or mitochondrial heteroplasmy or where there
is a mixed cell population due to malignancy. Sensitivity of detection may be
tissue-specific and in some cases alternative sample types may be required.
Non-paternity
An error in the diagnosis of disease status may occur if the true biological
relationships of the family members being tested are not as stated. For example,
non-paternity means that the stated father of an individual is not the true
biological father. Any erroneous diagnosis in a family member can lead to an
incorrect diagnosis for other related individuals who are being tested.
CONSENT
Samples received in the Genetics laboratory are accepted under the assumption
that the patient has consented to genetic testing and to laboratory disposal of
any remaining sample. This is clearly identified by the information for the
referring clinician on the laboratory referral form. When the patient has not
consented for disposal by the laboratory, all remaining sample will be returned to
the referring hospital for appropriate disposal. To keep return of sample to a
minimum, large amounts of tissue should not be sent.
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DNA (either pure or a crude preparation) is retained from the majority of samples
received in the Laboratory for the purposes of validation, controls and family
studies. It is important that the patients are aware of this. A consent form
covering this and other issues is available. If there are any problems with the
storage of samples, please contact the laboratory. The guidelines for consent
have recently been revised by the Royal College of Pathologists (September
2011). The changes recommended will be implemented in line with pathology
services nationally.
Predictive testing in late onset disorders such as Huntington disease or
Hereditary Cancer is only available through the Genetic Counselling Service, as
is diagnostic testing for dominant disorders where the family implications can be
complex, and the issues of consent require detailed discussion and
documentation. Predictive testing for adult onset disorders in children lies
outside our professional guidelines; in the event of a sample being referred, the
referring clinician will be contacted.
All prenatal testing involving assessment of maternal cell contamination using
the Powerplex 16 kit assumes that the appropriate consent has been obtained
for the analysis of all chromosomes. If this is not the case the laboratory must
be contacted, prior to the prenatal sample being taken, to discuss the matter
further.
All Other Genetic Disorders
For those diseases not available in Sheffield, testing may be available through
the UK Genetic Testing Network; access to the Network at present is through
the laboratory. Many of the tests sent elsewhere attract a charge. There is a
ring-fenced budget for this under the control of the Sendaways group and
overseen by the Commissioners. This group meets regularly and all clinicians
are welcome to present a request, either in person, by proxy, by letter or by
submission of the appropriate form (available from Denise Harris). For further
information please contact the Head of the Laboratory Ann Dalton, who is also
Chair of the Sendaways Group. Tests referred to our consortium partner or to
other laboratories can be delayed in reporting due to transfer time and factors
beyond the control of this laboratory. Please contact us if the sample is urgent.
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Carrier testing in children is generally to be avoided until the child is considered
Gillick competent. Where it is necessary to exclude the child being affected, the
report will not report the genotype but simply “unaffected” if the child is a carrier
or normal. The results will be recorded in the lab and be available to the child
once they are able to consent.
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ARRANGEMENTS FOR MICROBIOLOGY, VIROLOGY
AND IMMUNOLOGY
There are no Microbiology, Virology or Immunology laboratories on site and
these services are provided by Sheffield Teaching Hospitals Trust. Their
handbook can be accessed @
http://nww.sth.nhs.uk/NHS/LaboratoryMedicine/Default.asp?page=1.
All Microbiology/Virology services are now provided from the NGH site only.
MICROBIOLOGY
Clinical Microbiology Advice
There is a Consultant Microbiologist based full time at Sheffield Children’s
Hospital (Room E70, Top Floor Orange Wing) who can provide clinical advice.
Office extension 17579, Bleep 255.
Laboratory Queries
For laboratory queries please contact the laboratory at the NGH ext 14777
between the hours of 08:00 –20:00 weekdays, or 08:30 – 16:00 on weekends
and bank holidays.
NB: Please remember that microbiology specimens can take a considerable
length of time to process and if possible be delivered well BEFORE the end of a
normal working day, ideally before 16.00 hrs
On Call Service
Weekdays 20:00 - 08:00 hrs
Weekends 16:00 - 08:00 hrs
Bank Holidays 16:00 – 08:00 hrs
Outside normal working hours a single Biomedical Scientist is available to
process emergency and urgent specimens. Contact must be made with the
person on call before sending any urgent specimens for analysis. There is no
guarantee that any non urgent work will be processed outside normal working
hours. NGH switchboard has a copy of the current out of hours rota.
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 76 of 168
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Sample Transport to Microbiology (NGH Laboratory Medicine Building)
Weekdays 09.00 – 17.00 hrs
Where from
Routine
Weekdays
(09.00-17.00)
Urgent
SCH Clinical
Chemistry
Time
09.40, 11.10, 13.10, 14.40,
16.00, 17.10
Taxi arranged via SCH
Clinical Chemistry if outside
routine pickup times
Notes for urgent samples
• Prior to sending, SCH Clinical Chemistry should be alerted that an urgent
sample is being sent so that the urgency of the request can be discussed
and it can be established whether the sample may be sent by a scheduled
taxi or whether an urgent taxi needs to be booked. The sample should
then be sent by vacuum tube (clearly labelled as urgent) or by hand to
SCH Clinical Chemistry reception (see Sample Transportation section).
• The Microbiology department at NGH must be informed by requestors that
the sample is being sent so they can ensure it is dealt with promptly on
arrival.
• For any enquiries please contact the Microbiology laboratory ext 14777.
Out of hours service (including weekday evenings, Saturday, Sunday and
Bank Holiday)
Where from
Routine
A&E
Reception
Urgent
A&E
Reception
Out of hours
Time
08.30, 11.30,
Sat./Sun./Bank
14.30, 17.30,
holidays
20.30, 22.30
17.15, 18.30,
Week nights
20.30, 22.30
Urgent transport booked via
switchboard (if no routine
transport within 30 minutes)
Notes for urgent samples
• Urgent samples should be clearly identified as urgent on the request form.
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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MICROBIOLOGY
**Clinical Chemistry are NOT responsible for out of hours transportation
arrangements**
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Laboratory Handbook
•
Contact the on-call Microbiology Biomedical Scientist (via the NGH
switchboard) at the same time as sending urgent samples.
Results
Authorised Microbiology results are electronically accessible via ward/office
computers through the hospital network or directly from the PC desktop ‘ICE’
icon. Passwords can be obtained by contacting the IT helpdesk. Please refer to
page 18 for instructions on how to access results.
Microbiology specimens over ‘long’ weekends
Please ensure that on long bank holiday weekends that sample fridges/boxes on
wards/units are regularly inspected, and samples transported as above, to avoid
sample deterioration leading to potentially misleading results. Any concerns or
comments should be communicated to Michael Bell, Microbiology Departmental
Manager (Ext 14528).
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Review date: March 2017
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Laboratory Handbook
ANTIBIOTIC ASSAYS
(Tests carried out in Microbiology NGH)
1. Gentamicin and Tobramycin
In most clinical situations these agents are given once daily.
Oncology/Haematology (gentamicin) and Cystic Fibrosis (tobramycin) use
approved protocols. The gentamicin dosing guidance can be applied to any
group of patients but the tobramycin guidance applies to CF patients only.
If three times daily dosage is used then pre and one hour post levels must be
taken. Therapeutic range pre: <2цg/mL. One hour post: 5-10цg/mL
Optimum sample size: Venous blood. 1ml-clotted blood in a plain tube
Capillary blood. 1ml-clotted blood in microtubes
Venous blood is required for CF patient levels.
During normal laboratory hours send samples to Clinical Chemistry at SCH for
despatch to NGH Microbiology. "On-call" contact the on-call STH Clinical
Chemistry Biomedical Scientist via NGH switchboard and send sample direct to
NGH (see page 77 for specimen transport guidance). Please time levels to
avoid middle of night calls.
st
th
2. Vancomycin - pre-dose level 24 hours after 1 dose (i.e. pre 4 dose if TDS
th
dosing, pre 5 dose if QDS dosing). Sample size and destination as per
gentamicin. Pre-dose level should be 10-15 цg/mL, unless otherwise specified
by Consultant Microbiologist or Pharmacist.
3. Other antibiotic levels - please contact Microbiologist.
See following protocols for further information.
Guidelines for Once Daily Gentamicin in Infants and Children
Available @ http://nww.sch.nhs.uk/Health%20Services%20Management%20%20SCH/cec/index.asp
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MICROBIOLOGY
Samples for antibiotic assay will be collected (by laboratory staff) only if they
coincide with the scheduled capillary phlebotomy ward rounds during weekdays
only.
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TOBRAMYCIN DOSES AND LEVELS INCYSTIC FIBROSIS PATIENTS
(A guide for Medical and Nursing Staff)
Venous blood samples are required
Check U&E before commencing tobramycin and weekly while on treatment
Once daily regimen:
10 mg/kg once daily over 30 minutes
(MAXIMUM DOSE 660mg)
Take blood 18 hours after start of first dose.
Note on request form time of dose and time of
blood sample (exact timing is not critical as
long as it is noted on the form).
Level MUST be less than 1 mg/L.
If level is satisfactory and renal function is normal a further level needs to be
done at the start of each further week of treatment.
Ensure that dose and level are timed for maximum convenience to patient, staff
and laboratory. Levels outside the range MUST be discussed with a senior
member of the CF team and/or the pharmacist and/or the microbiologist.
Three times daily regimen:
4 mg/kg three times daily
Maximum starting dose 160mg TDS until levels
checked
Start on dose that achieved therapeutic levels
last time
rd
th
Measure levels around 3 or 4 dose
Note on request form time of dose and times of
blood samples
Pre level just before dose given
Post level 1 hour after dose given (timing is
critical)
Aim for:
• pre less than 2mg/L
• post 8 -12 mg/L
If level is satisfactory and renal function is normal a further level needs to be
done at the start of each further week of treatment.
Ensure that dose and levels are timed for maximum convenience to patient, staff
and laboratory. Levels outside the range MUST be discussed with a senior
member of the CF team and or the pharmacist and or the microbiologist.
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Review date: March 2017
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Laboratory Handbook
VIROLOGY SERVICES
The Virology Department is based within Microbiology at the Northern General
Hospital.
Department Staff and General Information
Professor Goura Kudesia (Consultant Virologist) Ext 14804, NGH
Dr Mohammed Raza (Consultant Virologist) Ext 14526, NGH
Dr Alison Cope (Consultant Virologist) Ext 14526, NGH
Duncan Whittaker (Virology Department Manager) Ext 14056, NGH
Miss Geraldine Ball (Serology Manager) Ext 14531/14056, NGH
Virology SpR Office Ext 66477, NGH
Laboratory Hours
Weekdays 9am - 5.20 pm
Saturdays 9am - 12.30 pm
Emergency Requests via Virology SpR Ext 66477, NGH or NGH Bleep 537
General Enquiries/ Results Enquiries Ext 14777, NGH
On-Call Service
Consultant Virologist (via NGH switchboard) provides an advice-only on call
service.
Urgent out of hours virology requests other than rapid RSV must be
phoned to the on call Consultant Virologist (See above)
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VIROLOGY
Please consult annually updated bronchiolitis flow chart for details of RSV
testing service. Rapid tests for RSV are carried out by the SCH Haematology
Department. Tests are carried out in batches throughout the day, the times of
which are published at the start of each RSV season.
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IMMUNOLOGY SERVICES
The Immunology Department is based at the Northern General Hospital.
Transport to the NGH Immunology department is by STH-arranged van
collections organised by the NGH Transport Manager (Ext 14701) and
Campuslink. The van visits various laboratories and GP surgeries and calls for
samples to the NGH at approximately 10:30 am and 2:30 pm, Monday to Friday.
Outside of these times Monday to Friday, samples can also be transported by
the CampusLink taxi sample shuttle at 09:40, 11:10, 13:10, 14:40, 15:40 and
16:00.
Also see section 6.2 of the Paediatric Medicine pages in the Guidelines for
SC(NHS)FT Medical Staff Combined Book for immunology investigations’
http://nww.sch.nhs.uk/Health%20Services%20Management%20%20SCH/documents/GUIDELINES_HANDBOOK/2007/index.htm
Department Staff and General Information
Dr William Egner (Consultant) Ext 15701, NGH
Dr Egner’s secretary Ext 15705
Kevin Green (Department Manager) Ext 15707, NGH
Mr Green’s secretary Ext 15706
Immunology enquiries Ext 15552
Laboratory Hours
Weekdays 9.00am - 5.00 pm
Results, from April 2012 no printed reports will be sent out. Authorised
Immunology results are electronically accessible via ward/office computers
through the hospital network or directly from the PC desktop ‘ICE’ icon.
Passwords can be obtained by contacting the ICE Administrator (Ext 53268).
Please refer to page 18 for instructions on how to access results.
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Review date: March 2017
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Laboratory Handbook
CSF SAMPLES
Volume of CSF required for specific tests (paediatric samples)
1
BEFORE you take the CSF · Decide which test you require
· Calculate the volume of CSF this will need.
· Work out the number of drops that this will be.
Regardless of the size of needle used, 1ml of CSF is equivalent to 20 drops.
Remember that all volumes given are the minimum required, so extra drops are
always useful.
2
For MICROBIOLOGY investigations - See table for volumes required.
·If the CSF is bloodstained, take the volume you require into three
screw-topped universal containers (these have a conical bottom).
Number them 1,2,3.
·If the CSF is clear, take the volume into a single universal container.
DO NOT use the flat bottomed sputum pots for collecting CSF as they
cannot be centrifuged and fluid will be lost transferring to a universal
container.
3
For CLINICAL CHEMISTRY INVESTIGATIONS -
·Protein: take 4-5 drops into a paediatric 1ml plain tube/universal 25mL.
Blood stained samples will elevate results!
·Serine and glycine 8-10 drops into paed 1mL plain tube.
*Please label these tubes by hand
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CSF SAMPLES
·Glucose and/or Lactate: take 4-5 drops into a paediatric fluorideheparin tube.
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4
Put the tests that you require in ORDER OF PRIORITY on the request
form, so that we can allocate CSF accordingly. This is VERY important
for very small volumes.
5
Transport specimens to the laboratory without delay: Protein, glucose
and lactate to the Clinical Chemistry at SCH, all other bottles via the
vacuum tube to Microbiology at RHH. Please ensure that porters and
nurses etc are instructed to not send the sample for protein/glucose to
the NGH along with the sample for C&S
6
If the specimen is to be examined out of normal working hours,
ALWAYS inform the relevant biomedical scientists on duty.
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All volumes given are the minimum required
INVESTIGATION
Volume of
CSF
Number of
Drops
Additional blood
sample required
0.5ml
minimum
10
NO
0.5ml
minimum
10
NO
0.5 ml
10
YES
0.25 ml
minimum
5
YES
0.5 ml
10
YES
0.25ml for
each test
5 for each
test
YES
Glucose
0.25 ml
4-5
YES
Protein
0.25 ml
4-5
NO
Lactate
0.25 ml
4-5
NO
Serine Glycine
0.25 ml
4-5
YES
Microbiology
Culture (bacterial/fungal)
Cell count
Gram film
Indian ink film
(if indicated)
Z-N film Mycobacterial
culture
Cryptococcal antigen
PCR
Virology
Syphilis
Borrelia
Leptosspira
Toxoplasma
NB The plain 1 ml bottles issued by the laboratory for sending CSF samples for
protein estimation must only be used for this purpose. These bottles are nonsterile and are not suitable for M, C & S requests. They should also not be used
for blood samples as this results in insufficient sample being collected - please
use the 1ml or 5ml labelled bottles supplied to the ward.
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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CSF SAMPLES
Clinical Chemistry
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SPECIMEN CONTAINERS
Please refer to the A-Z Laboratory test listing table for details of the type of specimen required for each test.
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Laboratory Handbook
PINK
Paediatric
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SPECIMEN CONTAINERS
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Review date: March 2017
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A-Z LABORATORY TEST/CONDITIONS LIST
The table on the following pages gives an alphabetical list of analyses provided by either the laboratories at SCH or related laboratories giving
details of specific sample requirements and where they are analysed. For tests carried out by ISO 15189 accredited laboratories at SCH, the tests
listed are included in the accreditation schedule unless otherwise stated. For all tests analysed at SCH, the table also shows the expected
turnaround time (TAT) in routine situations. Turnaround times for histology samples can be found in the Histopathology section. Further
information on analyses referred to STH can be found in the STH Laboratory Medicine Handbook @
http://nww.sth.nhs.uk/NHS/LaboratoryMedicine/Default.asp?page=1.
Lab to send to codes
CC
Clinical Chemistry
CCM
Clinical Chemistry Metabolic Laboratory
H
Haematology and Blood Bank
HP
POCT
SDGS
Histopathology
Point of care test (for CC in exceptional circumstances)
Sheffield Diagnostic Genetics Service
Referral lab codes
BCH
Birmingham Children’s Hospital
BUH
Birmingham University Hospital
CCFE
Chalfont Centre For Epilepsy
CHILD
University College London, Institute of Child Health
CHURCH
Churchill Hospital, Oxford
GEOR
St George’s Hospital, London
GRI
Glasgow Royal Infirmary
GUY
Guy’s and St Thomas’ Hospital, London
JAMES
St James’s University Hospital, Leeds
KING
King’s College Hospital, London
LRI
Leicester Royal Infirmary
MCH
Manchester Children’s Hospital
NAT
National Hospital Neurology and Neurosurgery
NEURO
University College London, Institute of Neurology
NGH
NHSBT
NRVI
PRU
RBH
RDGH
RHH
SAS centre
SGH
SOUTH
SRH
TROP
UHSM
WILL
Northern General Hospital
NHS Blood and Transplant
Newcastle Royal Victoria Infirmary
Protein Reference Unit, Sheffield
Royal Brompton Hospital
Rotherham District General Hospital
Royal Hallamshire Hospital
Supra – Regional Assay Centre
Southampton General Hospital
Southmead Hospital, Bristol
Salford Royal Hospital
Centre for Tropical Medicine and Global Health, Oxford
University Hospital of South Manchester
Willink BGU, Central Manchester University Hospitals
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Laboratory Handbook
Test
Acid-base (blood gas)
Specimen
type
Blood
Acid-base (blood gas)
Blood
Acid Lipase /Esterase
-
Collection Tube
Volume TAT
Notes/Comments
type
0.3mL <30min Do not use nonArterial
PICO or
Radiometer
heparinised
heparinised
Plastipaks!
syringe
Capillary
Heparinised 0.10mL <10min See pH, pCO2,
pO2, base excess
capillary
and bicarbonate.
Mix thoroughly
-
-
-
-
Acid Glycoprotein (Orosomucoid)
Blood
Venous
S. Gel
2ml
-
ACTH (Adrenocorticotrophic hormone)
Blood
Venous
EDTA
5ml
(1ml
min)
-
Acute Lymphoblastic Leukaemia (ALL)/BCR- Blood/Bone
ABL
marrow
-
EDTA
Acute Lymphoblastic Leukaemia (ALL) (+/- Bone marrow
FISH)
/leukaemic
blood
-
Universal
with 5-10ml
of transport
medium /Li
Hep tube
Lab to Referred to
send to
CC
(POCT)
CC
(POCT)
Refer to White cell
enzyme
CC
Bleep
duty CC
=
biochemist prior to
collection
095.
Needs
to
be
received by lab
within
4hrs
of
collection.
0.5-5ml 2-4
Must be sent to the SDGS
weeks laboratory
immediately
0.25-1ml 10 days
SDGS
/5-10ml
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-
NGH
RHH
-
-
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Laboratory Handbook
Acute Myeloid Leukaemia (AML) (+/- FISH)
Acute Myeloid
M2/AML-17
Leukaemia
/AML/
Bone marrow
/leukaemic
blood
-
AML- Blood/Bone
marrow
-
Acute Myeloid Leukaemia /AML/ Flt3/NPM1 Blood/Bone
mutation screen
marrow
Acute phase reactants
Blood
Acute Promyeloic Leukaemia (APL)/AML Blood/Bone
M3/AML-17
marrow
Venous
-
ADAMTS13 deficiency (thrombotic
thrombocytopenic purpura)
Blood
Venous
Adrenoleukodystrophy (ALD) (X-linked)
Blood
Acyl carnitine profile
Bile
Acyl carnitine profile
Blood
Venous
Acyl carnitine profile
Blood Spots
Venous
Acyl carnitine profile
CSF
Venous
-
-
Universal
SDGS
0.25-1ml 10 days
with 5-10ml /5-10ml
of transport
medium
/Li
Hep tube
EDTA
0.5-5ml 2-4
Must be sent to the SDGS
weeks laboratory
immediately
EDTA
0.5-5ml 2 weeks
SDGS
S. Gel
EDTA
EDTA
EDTA
2ml
0.5-5ml 2-4
weeks
CC
Must be sent to the SDGS
laboratory
immediately
0.5-5ml 8 weeks SDGS
0.5-5ml 2-8
weeks
Guthrie card Two
4-6
spots
weeks
Li Hep
0.5ml
5-14
plasma
days
Serum
Guthrie card Two
5-14
(Li Hep - spots
days
whole blood)
Plain tube
0.1ml
4-6
weeks
-
-
-
NGH
-
-
SDGS
-
CCM
-
- CCM
-
Not EDTA
CCM
-
PM samples
CCM
-
PM samples
(PM samples
month TAT)
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Test
Acyl carnitine profile
Specimen
type
Fibroblasts
Adenosine Deaminase
Blood
Collection Tube
type
Culture
meduim
Venous
EDTA
Adrenal cortical antibodies
Blood
Venous
S. Gel
Adrenalin / Noradrenalin
Blood
Venous
Adrenalin
Urine
24 hrs
Li Hep
2ml
2-4
plasma
weeks
Bottle
10ml
contains 1030 mls
H2SO4
EDTA
0.5-5ml 2-8
weeks
Li Hep
0.5ml
4h
plasma
Li Hep
0.5ml
4h
plasma
Fluoride Hep
4h
Adrenoleucodystrophy (ALD) gene mutation Blood
Venous
Alanine aminotransferase ALT, SGPT
Blood
Albumin
Blood
Alcohol (Ethanol)
Blood
Venous
/capillary
Venous
/capillary
Venous
Aldosterone
Blood
Venous
Alkaline phosphatase (ALP)
Blood
Alkaline phosphatase (ALP) isoenzymes
Blood
ALK Breakapart (2p23)
Paraffin
embedded
Venous
/capillary
Venous
/capillary
-
Li Hep
plasma
Li Hep
plasma
S. Gel
-
Volume TAT
5ml
2ml
Notes/Comments Lab to Referred to
send to
2
Refer
to
Skin CCM
months Biopsies
H
GUY
-
2ml
-
0.5ml
4h
0.5ml
4h
-
1-2
weeks
Send
on
immediately
-
CC
NGH
ice CC
RBH
CC
NGH
-
SDGS
-
-
CC
-
-
CC
-
Contact
lab
to CC
arrange analysis
Send to lab within CC
2h of collection
CC
-
Only send if total CC
ALP elevated
Contact lab prior to SDGS
referral
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SAS centre
RHH
-
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tissue biopsy
Alpha-1-antichymotrypsin
-
-
-
-
-
Alpha-1-antitrypsin
-
-
-
-
-
Alpha fetoprotein (AFP)
Blood
Venous
S. Gel
0.5ml
-
Alpha Subunit
Blood
Venous
S Gel
0.5ml
-
Alpha-thalassaemia
Blood
Venous
EDTA
Aluminium
Blood
Venous
Alveolar rhabdomyosarcoma
-
Amino Acids
PETS 2x4u
sections on
slides
Blood
Amino Acids
Blood Spots
Amino Acids
CSF
0.5-5ml 2-8
weeks
Acid washed 2ml
plain tube
-
Venous or
capillary
Venous or
capillary
-
-
Li Hep
1ml
plasma
(serum /
fluoride OK)
Guthrie card Two
(Li Hep - spots
whole blood)
Plain
tube 0.2ml
(fluoride OK)
See acute phase CC
reactants
See acute phase CC
reactants
CC
-
CC
-
SDGS
Contact lab prior to CC
collection. Do not
separate.
14 days
SDGS
NGH
BUH
NGH
-
2 weeks
-
CCM
-
1 week
-
CCM
-
CCM
-
1 week Paired plasma
required
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Test
Specimen
type
Collection Tube
type
Amino Acids
Hair
Amino Acids
Urine
Aminophyline (Theophylline)
Blood
5 Aminosalicylic Acid
Blood
Random /
24 hrs
Venous /
capillary
Venous
Amiodarone + Desethylamiodarone
Blood
Venous
Ammonia
Blood
Amylase
Blood
Venous /
Arterial
Venous /
capillary
Venous
-
AMylotrophic Lateral Sclerosis and Dementia Blood
Next Generation Sequencing Panel
Anaplastic large cell lymphoma ALK positive PETS 2x4µm
sections on
slides
Androgen Insensitivity Syndrome (Testicular Blood
Venous
Feminisation)
Volume TAT
Plain
universal /
specimen
bag
Plain
10ml
universal
Li
Hep 0.5ml
plasma
S Gel
2 ml
Notes/Comments Lab to Referred to
send to
2
Contact lab prior to CCM
months
collection
-
5 - 14
days
-
-
-
CCM
-
CC
RHH
-
-
CC
NGH
S Gel or Li 1 -2 ml
Hep plasma
Li Hep
0.5ml
<1hr
-
CC
LRI
Li Hep
plasma
EDTA
-
EDTA
0.5ml
4h
0.5-5ml 16
weeks
14 days
0.5-5ml 2-8
weeks
Send on ice. No
serum
-
CC
-
CC
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
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Review date: March 2017
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Androgen metabolites
Urine
24hr
Plain bottle
Aneuploidy FISH test
Sterile
Universal
S. Gel
2-5ml
ANF (Anti Nuclear Factor)
Amniotic Fluid Sample
Blood
Venous
2ml
2-3
days
-
Angiotensin converting enzyme (ACE)
Blood
S. Gel
2ml
-
Anti-phospholipid antibodies
Blood
Anti-phospholipid antibodies
Blood
Anticonvulsants
Blood
Anti -DNA antibodies
Blood
Venous
S. Gel
2ml
-
Anti Diuretic Hormone (ADH)
Blood
Venous
2ml
-
Anti-Gliadin antibodies
Blood
Venous
2ml
-
Antimicrosomal antibodies
Blood
Venous
Li Hep
plasma
Plain tube
serum
S. Gel
2ml
-
Venous
Venous
-
Citrate or
plain
-
-
-
-
-
-
-
-
-
CC
24hr collection
preferred but will
accept 20ml spot
samples, absolute
min volume 2 ml.
SDGS
KING
-
-
CC
NGH
-
CC
RHH
See Auto immune CC
antibodies
See coagulation
H
studies. This test is
for Haematology
patients only unless
previously
approved by the
Haematology
Consultants.
See individual
CC
drugs
CC
NGH
Separate freeze
within 30 mins
-
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Review date: March 2017
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RHH
NGH
CC
SAS centre
CC
NGH
CC
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Collection Tube
type
Venous
Plain tube
Volume
Anti-mullerian hormone
Specimen
type
Blood
TAT
2ml
-
Anti-neutrophil abs (not ANCA)
Blood
Venous
S. Gel
1ml
-
Anti nuclear factor(ANF)
Blood
Venous
S Gel
2ml
-
Antithrombin Deficiency
Blood
Venous
EDTA
Anti-thrombin III
Blood
Venous
Citrate
Anti-Xa (for low molecular weight heparin
control)
Blood
Venous
Citrate
Notes/Comments Lab to Referred to
send to
CC
RHH
By arrangement
H
with NHSBT Bristol
only
CC
Apolipoprotein E (APOE)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
2.5ml
Discuss See coagulation
studies
1.0ml
Discuss Contact Haem
Consultant. See
Coag studies.
0.5-5ml 6 weeks -
APTT Ratio (for unfractionated heparin
control)
Blood
Venous
Citrate
1.0ml
Venous
EDTA
Plain
universal
EDTA
5ml
S.Gel
2ml
Array CGH (see CGH)
Arsenic
Blood
-
Arsenic
Urine
Ascorbic Acid in leucocytes
Blood
Early
morning
Venous
ASOT (Anti-Streptolycin O Titre)
Blood
Venous
-
5ml
-
Discuss Contact Haem
Consultant. See
Coag studies.
Exclude fish from
diet 5d prior to test
Exclude fish from
diet 5d prior to test
Bleep duty
biochemist prior to
collection 095
-
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NHSBT
Bristol
NGH
SDGS
H
RHH
H
-
SDGS
-
H
-
-
CC
SAS centre,
Guildford
SAS centre,
Guildford
RHH
CC
NGH
CC
CC
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Aspartate amino transferase (AST)
Blood
Blood
Venous
/capillary
Venous
Li Hep
0.5ml
plasma
Li Hep Tube 2-3ml
Ataxia Telangiectasia
Autoimmune Antibodies
Blood
Venous
S. Gel
B12 - vitamin
-
Barbiturates (overdose) Phenobarbitone
Blood /random Venous
urine
Barbiturates (Theraputic)
Blood
Batten’s Disease
Blood
Base Excess (calculated)
Blood
Arterial /
Venous
Base Excess (calculated)
Blood
Capillary
Bernard-Soulier syndrome (GP1BA, GB1BB, Blood
GP9)
Beta HCG (? pregnant)
Blood
Venous
/capillary
Venous
Venous
Venous
/capillary
2-3ml
-
-
Li Hep
2ml
plasma/ plain
universal
Li Hep
1ml
EDTA
2mls
4h
-
28 days Please inform the
laboratory prior to
sample dispatch
-
See Haematinic
assay
-
CC
-
SDGS
-
CC
NGH
CC
-
CC
NGH
Trough after 14d of CC
constant therapy
6 weeks
HP
RHH
-
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
Plastipaks.
heparinised
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
EDTA
0.5-5ml 2-8
weeks
S. Gel
1ml
Min 200 µl serum
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Review date: March 2017
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RHH
POCT
(CC)
-
POCT
(CC)
-
SDGS
-
CC
RHH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Beta HCG (? Tumour marker)
Specimen
type
Blood
Collection
type
Venous /
capillary /
arterial
Venous
Beta-thalassaemia
Blood
Bicarbonate (calculated)
– blood gas analyser
Blood
Arterial /
Venous
Bicarbonate (calculated)
– blood gas analyser
Blood
Capillary
Bicarbonate (total carbon dioxide)
Blood
Bile Pigments (bilirubin, urobilinogen, urobilin) Urine
Venous
/capillary
Random
Bile Salts / Acids
Blood
Venous
Bile Salts/Acids
Urine
Random
Bilirubin (conjugated including total
paediatric)
Blood
Venous
/capillary
Tube
Volume
S. Gel or
plain
1ml
TAT
-
Notes/Comments Lab to Referred to
send to
Send with AFP and CC
NGH
placental ALP
EDTA
0.5-5ml 2-8
weeks
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
heparinised
Plastipaks.
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
Li Hep
0.5ml
4h
(Plasma)
Plain
universal
Li Hep
plasma
Plain
universal
Li Hep
plasma
SDGS
-
POCT
(CC)
-
POCT
(CC)
-
CC
-
10ml
1 week Keep in Dark
CCM
-
1ml
4 weeks Not for cholestasis CCM
in pregnancy
4 weeks Not for cholestasis CCM
in pregnancy
4h
CC
-
5ml
0.5ml
Biotin
-
-
-
-
-
See vitamins
CC
Biopterins
-
-
-
-
-
Bleep duty
biochemist 095
CC
Biotinidase
Blood
Venous
Li Hep
plasma
1ml
5-14
days
-
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CCM
BCH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Bladder cancer
PETS 2x4µm
sections on
slides
-
Blood count
Blood gases
-
-
-
-
-
-
-
-
-
-
Blood group & crossmatch
Blood
Venous
EDTA
2.5ml
Blooms syndrome
Blood
Venous
Li Hep
2-3ml
Bone Biopsy for bone diseases
Bone biopsy
Bone markers (Bone Specific Alkaline
Phosphatase)
Blood
Venous
Random urine
-
-
-
S. Gel/ plain 2ml
universal
blood
10ml
urine
14 days
10-30
mins
-
SDGS
-
See FBC
H
-
See Acid -base
POCT
(CC)
-
H
Telephone the
laboratory where
request is urgent.
Must use blood
bank form. Sample
must be fully
labelled. See
detailed section
describing infant
requests and
special needs
28 days Please inform the SDGS
laboratory prior to
sample dispatch
See
Send direct to Histo Histo
Histo
RHH
RHH
section
Allow to clot.
CC
Separate within 4
hrs of collection
Depend
ent on
clinical
need.
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Difficult
cases
referred to
NHSBT,
Sheffield
-
RHH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Bone marrow investigations
Specimen
Collection Tube
Volume TAT
type
type
Formalin fixed
See
See
Histopath
Histo
section for
section
further details
Bone marrow Discuss
Discuss
Discuss Discuss
Bone profile
Blood
Bone marrow biopsy
BRAF (V-raf murine sarcoma viral oncogenes PETS 8x10µm
homolog B1) p.Val600Glu mutation
sections in
universal
Brain Biopsy
Brain biopsy
Breast Cancer - HER2 FISH
Bromide
Bruck Syndrome (PLOD2)
Venous /
capillary
Li Hep
plasma
0.5ml
4h
Notes/Comments Lab to Referred to
send to
Use formalin safety HP
specimen bag
Contact cons
H
Haem. See detailed
section
-
Calcium, albumin, CC
phosphate, alkaline
phosphatase
SDGS
-
-
-
-
-
1-2
weeks
-
-
-
-
-
See
Send direct to Histo
RHH. If fresh must
Histo
section be delivered by
hand.
14 days
SDGS
PETS 2x4µm
sections on
slides
Blood
Venous/
capillary
Lith hep/ S
Gel
1 ml
Blood
EDTA
0.5 -5ml 2-8
weeks
Venous
-
-
CC
-
SDGS
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Review date: March 2017
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-
RHH
-
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Burkitt lymphoma
C peptide
PETS 2x4µm
sections on
slides
Blood
C- reactive protein CRP
Blood
C1 esterase inhibitor
C3 conversion
C3 nephrotic factor
Blood
Blood
Blood
C4
Blood
Caeruloplasmin
Caffeine
Blood
Blood
CA125
Blood
Calcitonin
-
-
-
14 days
-
-
-
-
Venous /
capillary
Venous
Venous
Venous /
capillary
Venous /
capillary
Venous
Venous /
capillary
0.5ml
4h
-
SDGS
-
CC
-
-
CC
-
See Insulin
Li Hep
plasma
S. Gel
EDTA
S. Gel
2ml
2ml
2ml
-
-
CC
CC
CC
NGH
NGH
NGH
S. Gel
2ml
-
-
CC
NGH
S. Gel
Li Hep
plasma
2ml
0.5ml
Min 200µl serum
CC
7 days Assayed weekly on CC
Tuesday
NGH
NGH
Venous
S Gel
2ml
-
Blood
Venous
EDTA or
serum
3-5ml
-
Calcium (ionized)
Blood
Arterial /
Venous
Calcium (ionized)
Blood
Capillary
Calcium (total)
Blood
Venous /
capillary
-
Bleep duty
biochemist prior to
collection 095
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
heparinised
Plastipaks.
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
Li Hep
0.5ml
4h
plasma
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CC
NGH
CC
NGH or
SAS centre
POCT
(CC)
-
POCT
(CC)
-
CC
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Collection
type
Tube
Volume
TAT
-
-
-
-
Calculi (stones)
Stones
CALR Exon 9 mutation screen (?PMF and
?ET)
Blood/Bone
Marrow
Venous
EDTA
Carbamezapine (Tegretol)
Blood
Carbon dioxide (total)
Carbon monoxide
Blood
Blood
Venous /
capillary
Venous /
capillary
Carboxyhaemoglobin (COHb; reported as
%Hb) – blood gas analyser
Blood
Arterial /
Venous
Carboxyhaemoglobin (COHb; reported as
%Hb) – blood gas analyser
Blood
Capillary
Cardiolipin
Blood
Venous
Li Hep
0.5 ml
plasma
See bicarbonate
Heparinised
syringe/capill
ary
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
heparinised
Plastipaks.
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
S. Gel
2 ml
-
Carotene
Bllood
Venous
Li Hep /S Gel
5ml
Carnitine
Blood
Venous
Li Hep
plasma
(serum /
fluoride OK)
1ml
0.5-5ml 2 weeks
5-14
days
Notes/Comments Lab to Referred to
send to
-
CC
-
SDGS
CC
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Review date: March 2017
© SC(NHS)FT 2016.
Page 102 of 168
RHH
CC
POCT
(CC
-
POCT
(CC)
-
POCT
(CC)
-
CC
Protect from light CC
-
LRI
CCM
NGH
RDGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Carnitine
Urine
Carnitine Acylcarnitine Translocase (CACT)
Deficiency
Carnitine Palmitoyl Transferase Type2
(CPT2) Deficiency
Carnitine Palmitoyl Transferase Type2
Blood or
Fibroblasts
Blood or
Fibroblasts
Fibroblasts
Carotenoids
-
Cartilage-associated protein (CRTAP) –
autosomal recessive OI
Catecholamine metabolites
Blood
Urine
Catecholamines
-
CEA (carcinoembryonic antigen )
Blood
CBCL/CTCL / Skin lymphoma/ mycosis
fungoides (IgH or T cell gene
rearrangements)
Paraffin
embedded
tissue biopsy
CD34+ cell count
Blood
Random /
24 hrs
Venous
Plain
universal
EDTA
Venous
EDTA
-
5-14
days
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
6-8
weeks
-
-
-
0.5-5ml 2-8
weeks
-
-
-
-
-
Venous
Venous
-
Venous
Cerebral AD Arteriopathy with Subcortical
Blood
Venous
Infarcts & Leukoencephalopathy - CADASIL
CGH/microarray
Blood Sample Venous
EDTA
S Gel
10ml
-
-
2 ml
-
-
CCM
-
-
SDGS
-
-
SDGS
-
-
CCM
-
See Vitamin A
-
CC
-
SDGS
-
See VMA & VHA
CCM
See adrenaline &
nor-adrenaline
CC
NGH
CC
NGH
-
5 micron 2-8
unmount weeks
ed
sections
EDTA
2.5ml
Discuss Contact consultant
haematologist prior
to collection
EDTA
0.5-5ml 2-8
weeks
EDTA/Li Hep 2-3ml 6-12
months
-
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-
SDGS
-
H
-
SDGS
-
SDGS
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Chimerism/pre or post bone marrow/stem cell Blood/Bone
transplant (BMT/SCT)/donor for
marrow
BMT/SCT/matched unrelated donor (MUD) –
Sex matched (Powerplex)
Chimerism/pre or post bone marrow/stem cell Blood/Bone
transplant (BMT/SCT)/donor for
marrow
BMT/SCT/matched unrelated donor (MUD) –
Sex mis- matched (FISH)
Chitotriosidase
Blood
Collection Tube
type
EDTA
-
EDTA
Volume TAT
Notes/Comments Lab to Referred to
send to
0.5-5ml 2 weeks
SDGS
-
0.5-5ml 2 weeks
-
SDGS
-
Venous
EDTA
2-5ml
-
-
CC
Venous /
capillary
Arterial /
Venous /
Capillary
Li Hep
plasma
Radiometer
hep. syringes
or capillary
with flea,
ends,magnet
-
0.5ml
4h
-
CC
<30min Do not use nonPOCT
syr.
heparinised
(CC)
containers. Keep
0.10mL <10min well mixed right up
cap.
cap. until analysis.
See sweat test
CC
-
1ml
4 weeks
CCM
-
0.5ml
4h
CC
-
Blood
Venous /
capillary
Venous
Li Hep or
serum
Li Hep or
serum
EDTA
2-5ml
-
Blood
Venous
S. Gel
2-3ml
-
Blood
Venous /
capillary
Li Hep
2-3ml
Chloride
Blood
Chloride (blood gas analyser)
Blood
Chloride
Sweat
Cholestanol
Blood
Venous
Cholesterol
Blood
Cholinesterase
Chromogranin A
Chromosome – Adult (with or without FISH)
-
WILL
-
0.3mL
syr.
Fasting sample
-
CC
Part of standard gut CC
hormone profile
28 days
SDGS
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-
SOUTH
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Chromosome –Child (with or without FISH)
Blood
Chromosome –Neonate
Blood
Chromosome (with or without FISH)
PRENATAL
Chromosome (with or without FISH)
PRENATAL
Chromosome (with or without FISH)
PRENATAL
Chromosome (with or without FISH)
POSTNATAL
Chromosome (with or without FISH)
FETAL LOSS
Amniotic Fluid
sample
CVS
Chromosome (with or without FISH)
Chromosome (with or without FISH)
Venous /
capillary
Venous /
capillary
1-2ml
SDGS
-
Li Hep
0.5 –
1ml*
10 days * smaller samples SDGS
can be attempted
but may reduce the
likelihood of a
successful result
10-20ml 14 days
SDGS
-
3-4
14 days
fronds
0.5-1ml 10 days
-
SDGS
-
-
SDGS
-
1-3ml
10 days
-
SDGS
-
2-3
weeks
-
SDGS
-
1-2mm 2-3
cubed weeks
-
SDGS
-
<1cm
cubed
-
SDGS
-
Fetal blood
cordocentesis
Cord blood
-
Sterile
universal
Sterile
universal
Li Hep
-
Li Hep
Placental, fetal
membrane
and cord
biopsies
Skin biopsy
-
Sterile tissue <1cm
culture
cubed
medium pots
-
Sterile tissue
culture
medium pots
Universal
with 5-10ml
of transport
medium
Solid Tumour
Biopsy
-
Li Hep
-
-
28 days
2-3
weeks
-
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-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Chronic Lymphoproliferative Leukaemia
(CLL) - FISH
Chronic Myeloid Disease (CML) (+/- FISH)
Specimen
type
Bone marrow
Bone marrow
/leukaemia
blood
Chronic Myeloid Leukaemia (CML)/BCR-ABL Blood/Bone
marrow
Collection Tube
type
Universal
with 5-10ml
of transport
medium
Universal
with 5-10ml
of transport
medium /Li
Hep tube
EDTA
Cleido Cranial Dysplasia
Blood
Venous
EDTA
Clonazepam
Blood
Venous
Fluoride
Coagulation factor assay/other studies
Blood
Venous.
Citrate
Coagulation screen
Blood
Venous. NB Citrate
not
capillary
Volume TAT
-
Notes/Comments Lab to Referred to
send to
28 days
SDGS
-
0.25-1ml 28 days Urgent samples
/5-10ml
have a TAT of 10
days. See SDGS
section
0.5-5ml 2-4
weeks
0.5-5ml 2-8
weeks
1ml
-
SDGS
-
Must be sent to the SDGS
laboratory
immediately
SDGS
-
-
CC
Contact Discuss Fill level is crucial. H
lab
See detailed
section for
description of tests
available
1.0ml
2h
Fill level is crucial. H
See detailed
section for
description of tests,
anticoagulation
therapy control and
D-Dimers in ?DVT
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RHH
Some to
RHH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Coeliac screen
-
Cold Agglutinins
Blood
Venous
-
-
1 day
See anti-glyadin
CC
antibodies
Samples must be H
transported to the
laboratory while
still warm
-
Collagen screen
Blood
Venous
EDTA & plain 1ml
tube
EDTA
plus
>2ml
plain
tube
S. Gel
2ml
Colorectal Cancer (HNPCC/FAP) Extended
Gene Panel
Complement C3, C4 only
Venous
EDTA
0.5-5ml
Blood
Venous
12
weeks
EDTA/ S. Gel 2-3ml
Complement CH50, APCH50 functional
activity of either pathway
Blood
Venous
S. Gel
2-3ml
Congenital Bilateral Absence of Vas Deferens Blood
(CBAVD)
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Congenital thrombotic thrombocytopenic
purpura (ADAMTS13 deficiency)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Copper
Blood
Venous /
capillary
Li Hep
plasma
0.75ml
-
-
-
-
-
CC
-
SDGS
State on form
CC
whether plasma or
serum. If left for
longer than 1 night freeze
Send within 2hrs of CC
collection.
2ml venous sample CC
required for zinc,
caeruloplasmin
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Review date: March 2017
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-
NGH
NGH
NGH
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Collection Tube
type
Copper Liver biopsy
Fresh
Cortisol
Blood
Venous
/capillary
Li Hep,
Creatinine
Blood
Venous /
capillary
Creatine kinase CK (or Creatine
phosphokinase CPK)
Blood
Cri-du-chat syndrome
-
-
Volume
TAT
-
-
See Histopathology HP
section
-
4-24 h
-
CC
-
Li Hep, S.Gel 0.5ml
plasma
4h
-
CC
-
Venous /
capillary
Li Hep
plasma
0.5ml
4h
-
CC
-
Blood
Venous
Li Hep
2-3ml
28 days
-
SDGS
-
Crigler-Najjar Syndrome types I and II
Blood
Venous
EDTA
-
SDGS
-
Cryoglobulins
Blood
Venous
Crossmatch
Blood
EDTA and
S.Gel
-
0.5-5ml 2-8
weeks
2ml of
each
-
CRTAP (autosomal recessive OI)
Blood
CSF cytology
CSF
-
Plain
Universal
CSF cell count
CSF
-
Plain x 3
CSF glucose
CSF
-
Fluoride
0.5ml
4h
CSF protein
CSF
-
Plain
0.5ml
4h
Venous
EDTA
0.5 ml
min
Notes/Comments Lab to Referred to
send to
0.5-5ml 2-8
weeks
See
Histo
section
15 drops 24h
x3
Contact CC Lab.
CC
Keep at 37°C
See Blood group & H
crossmatch
SDGS
-
Send direct to Histo
RHH
Haemic cell count. H
Ensure 3 vials are
labelled 1,2 & 3
CC
-
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Review date: March 2017
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CC
NGH
RHH
-
-
CAEC Registration Identifier: 1043
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Laboratory Handbook
Cyanide
Blood
Venous
Fluoride
1ml
Whole blood
Cyclosporine (Ciclosporin)
Blood
Venous /
capillary
EDTA
0.5ml
CYP2C19
Blood
Venous
EDTA
CYP3A4
Blood
Venous
EDTA
Cystic fibrosis
Blood or
Venous
Guthrie spots
Urine
Random /
24 hrs
Blood
-
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 1-8
weeks
10ml
5-14
days
3ml
-
Cystine
Cystine in leucocytes
D-Dimers
7-Dehydrocholesterol
Blood
Venous
7-Dehydrocholesterol (Prenatal test for Smith Amniotic fluid
Lemli Optiz Syndrome)
8-Dehydrocholesterol
Blood
Delta F508
-
-
Venous
-
EDTA
Plain
universal
Li Hep
Li Hep
plasma
-
2-24h
-
CC
Analysed Tue and CC
Fri, urgent requests
only at other times.
Must be received
before 15.00 for
analysis that day
SDGS
-
SDGS
-
-
CCM
-
5 days
-
1ml
4 weeks
-
-
-
10mls
-
-
SDGS
1ml
-
NGH
-
Please contact Duty CC
Biochemist
See Coagulation
H
screen
4 weeks
CCM
Li Hep
plasma
-
CCM
See Cystic Fibrosis SDGS
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Review date: March 2017
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JAMES
-
-
CAEC Registration Identifier: 1043
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Laboratory Handbook
Test
Specimen
type
Dentatorubral pallidoluysian atrophy (DRPLA) Blood
Dermatofibrosarcoma protuberans
DHEAS
Collection Tube
type
Volume TAT
Venous
0.5-5ml 2-6
weeks
PETS 2x4µm
sections on
slides
Blood
Venous/
capillary
EDTA
Notes/Comments Lab to Referred to
send to
-
SDGS
-
14 days
-
SDGS
-
200µl
-
-
CC
RHH
EDTA whole 0.5ml
blood
Li Hep/S.Gel 500µl
-
CC
NGH
CC
SAS centre
-
Serum/
plasma
-
Plus 0.5ml EDTA
Control patient
-
DHR
Blood
Venous
DHT ( Di hydrotestosterone )
Blood
Venous
Diamond Blackfan Anaemia (RPS19)
Blood
-
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Diamond Blackfan Anaemia (dosage testing Blood
by MPLA)
-
EDTA
0.5-5ml 8
weeks
-
SDGS
-
Diazepam (with nordiazepam)
Blood
Venous
-
Li Hep/S. Gel 2ml
-
-
CC
RHH
Dibucaine number
-
-
-
-
-
See
pseudocholin’ase
CC
-
Differential WBC
-
-
-
-
-
See FBC
H
-
-
Ideally 6-8hrs post CC
dose
Digoxin
Blood
Venous /
capillary
S. Gel
1 ml
Dimethylglycine
Blood
Venous
Li Hep
plasma
1ml
4-6
weeks
-
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CCM
RHH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Dimethylglycine
Urine
Random
Direct anti-globulin test (DAT, DCT)
Blood
Venous
/capillary
-
Dopamine
-
Dopa-responsive dystonia (Segawa
syndrome), dominant
Dopa-responsive dystonia, recessive
Tyrosine hydroxylase deficient
Down syndrome – PRENATAL (with or
without FISH)
Plain
universal
EDTA
Venous
EDTA
Blood
Venous
EDTA
Down syndrome – POSTNATAL
-
-
Sterile
universal
-
-
Venous
EDTA
Venous
EDTA
Venous
EBV or CMV PCR
Blood
Venous
EGFR (exons 18-21)
PETS 8x10µ
sections in
universal
Blood
4-6
weeks
24hours Use blood bank
form.
See Adrenalin
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
10-20ml 10-14
days*
-
Dystonia 1 or Idiopathic Torsion Dystonia,
Blood
dominant
Dystonia and parkinsonism Next Generation Blood
Sequencing Panel
Dystrophia myotonica (DM)
Blood
Ehlers-Danlos Classical (COL5A1 and
COL5A2)
Ehlers Danlos Next Generation Sequencing Blood
Panels (Vascular, Classic and Kyphoscoliotic)
0.5ml
-
Blood
Amniotic fluid
2ml
-
-
EDTA
0.5-5ml 2-6
weeks
0.5-5ml 16
weeks
0.5-5ml 2 weeks
EDTA
2ml
-
-
Venous
EDTA
Venous
EDTA
-
CCM
-
H
-
CC
RHH
-
SDGS
-
-
SDGS
-
*Rapid FISH test SDGS
usually reported the
next working day
See chromosome
-
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
CC
-
5 days EGFR testing from SGDS
required, please
contact laboratory
0.5-5ml 2-8
SDGS
weeks
0.5-5ml 12
SDGS
weeks
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Date of Issue: April 2016
Review date: March 2017
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Page 111 of 168
NGH
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Ehlers-Danlos Syndrome Classical
(COL5A1)- Null allele
Ehlers-Danlos Syndrome-hypermobile
(TNXB)
Ehlers-Danlos Syndrome-KMH (FKBP14)
Ehlers-Danlos Syndrome-Kyphoscoliotic
(PLOD1)
Ehlers-Danlos Syndromemusculocontractural (CHST14)
Ehlers-Danlos Syndrome – vascular
(COL3A1)
Ehlers-Danlos Syndrome arthrochalasic
(COL1A1 and COL1A2)
Electrolytes
Specimen
Collection
type
type
Skin
biopsy/culture
d fibroblasts
Blood
Venous
EDTA
Blood
EDTA
Venous
Tube
-
Volume TAT
-
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5mn 2-8
weeks
0.5ml
4h
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous/
capillary
Li Hep
plasma
Electron Microscopy
Various
Biopsy
Endomysial Antibodies
Blood
Venous/
capillary
-
Tube
Small
containing
biopsy
gluteraldehyd
e fixative
(available
from Histo)
S Gel
2ml
Enzymes
-
-
2-8
weeks
-
6 wks
-
Notes/Comments Lab to Referred to
send to
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
See potassium,
CC
sodium , chloride,
bicarbonate
Fixative should be HP
stored at 4ºC and
applied within 5
mins. Deliver
promptly to Lab.
See individual
enzymes
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CC
CC
-
RHH
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Episodic ataxia type 1
Blood
Venous
EDTA
Episodic ataxia type 2
Blood
Venous
EDTA
Epoxy Carbemazepine
Blood
S Gel
ESR
Blood
EDTA
0.5ml
Ethosuximide
Blood
Li Hep
1ml
Extended lymphocyte markers
Blood
Venous /
Capillary
Venous/
capillary
Venous/
capillary
Venous/
capillary
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
2ml
-
EDTA
1.0ml
Ewings sarcoma and rearrangement of
EWSR1 associated with clear cell sarcoma,
extraskeletal myxoid chondrosarcoma and
desmoplastic small round cell tumour
Factor V deficiency (F5)
PETS 2x4µm
sections on
slides
Blood
Venous
EDTA
0.5-5ml 8 weeks -
Factor XI Deficiency (Haemophilia C)
molecular test
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
-
24h
-
-
-
SDGS
-
-
SDGS
-
-
CC
Can be performed H
along with FBC
Store 4°C
CC
H
By special
arrangement RHH,
Immunology NGH
or Immunology
Newcastle
dependant on
clinical situation.
14 days
SDGS
-
NGH
NGH
RHH, NGH
or NRVI
-
SDGS
-
For advice on
SDGS
Haematology
specialist
coagulation
assays/studies
please see page 57
-
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Laboratory Handbook
Test
Factor XIII Deficiency molecular test
Specimen
type
Blood
Collection Tube
type
Venous
EDTA
Faecal fat
Faeces
-
Faecal Occult Blood
Faeces
-
Volume TAT
0.5-5ml 2-8
weeks
-
Faeces pot
Familial Adenomatous Polypsis Coli (FAP)
Blood
(APC sequencing and MLPA)
Familial Adenomatous Polypsis Coli (FAP) & Blood
MUTYH Gene Panel (APC & MUTYH
sequencing and MLPA)
Familial hemiplegic migraine type 1
Blood
Venous
EDTA
Venous
EDTA
Venous
EDTA
Familial hypercholesterolaemia (LDLR
Blood
sequencing and MLPA ApoB p.(Arg3527Gln)
mutation analysis; PCSK9 p.(Asp374Tyr)
mutation analysis)
Familial motor neurone disease / amyotrophic Blood
lateral sclerosis with or without frontotemporal
dementia (ALS/FTD) C9orf72 gene
Venous
EDTA
Venous
EDTA
-
-
-
-
Notes/Comments Lab to Referred to
send to
SDGS
For advice on
Haematology
specialist
coagulation
assays/studies
please see page 57
NGH
Fat globule
microscopy
recommended.
Contact Clin Chem
duty biochemist
bleep 095
CC
BCH
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
-
SDGS
-
-
SGDS
-
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
-
SDGS
-
-
SDGS
-
0.5-5ml 2-8
weeks
-
SDGS
-
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Date of Issue: April 2016
Review date: March 2017
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Laboratory Handbook
Familial motor neurone disease / amyotrophic Blood
lateral sclerosis (ALS) SOD1 gene
Familial motor neurone disease / amyotrophic Blood
lateral sclerosis (ALS) TARDBP gene
Familial Porencephaly (COL4A1 & COL4A2) Blood
Venous
EDTA
Venous
EDTA
Venous
EDTA
Familial Porencephaly (COL4A1 & COL4A2) Blood
by Next generation Sequencing
Familial Thoracic Aortic Aneurysms Next
Blood
Generation Sequencing Panel
Fanconi anaemia
Blood
Venous
EDTA
Venous
EDTA
Venous
Li Hep
Fanconi Anaemia (FANCA, FANCC, FANCG) Blood
Venous
EDTA
Faecal alpha 1 antitripsin
Faeces
Faecal pot
Faecal elastase
Faeces
FBC (full blood count)
Blood
Random
faeces
Formed
faeces
Venous /
capillary
EDTA
1ml
Ferritin
Blood
Venous /
arterial
-
Plain or Li
Hep
-
0.5ml
Fibrinogen
-
0.5-5ml 2-8
SDGS
weeks
0.5-5ml 2-8
SDGS
weeks
SDGS
0.5-5ml 2-8
weeks
0.5-5ml 12
SDGS
weeks
0.5-5ml 12
SDGS
weeks
2-3ml 28 days Please inform the SDGS
laboratory prior to
sample dispatch
0.5-5ml 2-8
SDGS
weeks
10g
Freeze immediately CC
Faecal pot
-
-
-
Not suitable for
CC
patients < 2 wks old
24hours 1ml suff for film,
H
ESR, GF test and
retics also. See
detailed section for
tests included
2-72 hrs
H
-
See Coagulation
screen
.
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Review date: March 2017
© SC(NHS)FT 2016.
Page 115 of 168
H
-
PRU
RHH
-
CC
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Collection Tube
type
Volume TAT
Fibrinogen disorders (FGA, FGB, FGG)
Film for blood cell morphology
Blood
Venous
EDTA
0.5-5ml 8 weeks
Blood
Venous /
capillary
EDTA
Venous
Li Hep
FISH Constitutional Tests – see table below Blood
for list of tests
CONSTITUTIONAL FISH TEST
In Chromosome Order 1-22,X,Y
1p36.33 microdeletion syndrome (inc.
hypertrichotic osteochondrodysplasia)
2q37.3 Brachydactyly-mental retardation
microdeletion
syndrome (inc. Albright
hereditary osteodystrophy (AHO)-like
metacarpal/metatarsal shortening)
4p16.3 Wolf-Hirschhorn microdeletion syndrome
5p15.3 Isolated Cat Cry microdeletion syndrome
(ICS) and 5p15.2 Cri Du Chat microdeletion
syndrome (CDC)
5q35 Sotos microdeletion syndrome
7q11.23 Williams microdeletion syndrome
7q11.23 microduplication syndrome (inc. speech
delay, ADHD)
-
CEB108/T7 and D1Z2
-
-
2-3ml
Gene
Notes/Comments Lab to Referred to
send to
Performed only if
FBC findings or
clinical details
indicates
appropriate
Depend
ent on
urgency
SDGS
-
H
-
SDGS
-
Comments
Terminal and interstitial deletions detected
D2S447
WHSC1
FLJ25076 (ICS) and
CTNND2 (CDC) respectively
NSD1
ELN
ELN
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Laboratory Handbook
8q12.1-12.2 CHARGE microdeletion syndrome
(inc.ocular coloboma, heart defects of any type,
atresia of the choaneae, retardation, genital and
ear anomolies)
8q23.3-8q24.1 Langer-Giedion microdeletion
syndrome (inc. trichorhinophalangeal syndrome
type 1 and multiple cartilaginous exostoses)
9q34.3 Kleefstra microdeletion syndrome (inc.
craniofacial features, hypotonia, obesity,
microcephaly and speech delay)
15q11.2 Prader-Willi microdeletion/
microduplication syndrome
15q11.2 Angelman microdeletion syndrome
16p13.3 Rubenstein-Taybi microdeletion
syndrome (inc. short stature, talon cusps, patellar
dislocation, broad thumbs and big toes)
17p13.3 Miller-Dieker microdeletion syndrome
17p11.2 Smith-Magenis microdeletion syndrome
17p11.2 Potocki-Lupski microduplication
syndrome (inc. neonatal hypotonia, sleep apnea,
hyperactivity, structural cardiovascular
abnormalities)
17q11.2 NF1 (Von Recklinghausen) microdeletion
syndrome
17q21.31 microdeletion syndrome (inc. neonatal
hypotonia, developmental delay and speech
delay)
22q11.2 DiGeorge/VCFS microdeletion or
microduplication syndrome
CHD7
TRPS1 and EXT1
respectively
D9S325
SNRPN
For 1st line test see molecular genetic referral
D15S10/UBE3A
For 1st line test see molecular genetic referral
CREBBP
LIS1 (PAFAH1B1)
RAI1
RAI1
NF1 (RP1-4C23)
Home grown
MAPT
TBX1
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Review date: March 2017
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Laboratory Handbook
CONSTITUTIONAL FISH TEST
In Chromosome Order 1-22,X,Y
22q13.3 Phelan-McDermid microdeletion
syndrome (inc. neonatal hypotonia, absent or
delayed speech)
Xp22.3 or Yp11.32 Leri-Weill Dyschondrosteosis
inc. short stature and madelung deformity
(heterozygous microdeletion syndrome) or Langer
Mesomelic Dysplasia inc. severe short stature
and skeletal abnormalities (homozygous
microdeletion syndrome)
Xp22.3 Kallmann microdeletion syndrome (inc.
hypogonadotrophic hypogonadism and anosmia)
Xp22.3 Steroid Sulphatase Deficiency
microdeletion syndrome inc. X-Linked Ichthyosis
Xq13.2 X inactivation centre deletion
Yp11 Swyer microdeletion syndrome (XY female)
and detection of unbalanced t(X;Y) leading to XX
with male phenotype
XCEN/YCEN/18CEN/13q14/21q22.13-q22.2 Sex
chromosome aneuploidy, Edward, Patau and
Down syndrome
Gene
N85A3
SHOX
Comments
N85A3 is the control sequence for TBX1
Located in the PAR1 pseudoautosomal regions
of both X and Y chromosomes
KAL1
STS
XIST
Critical for the determination of phenotypic
severity of abnormal X chromosomes
SRY
Sex determining region
DXZ1/DYZ3/D18Z1/RB1/D21
S342,
D21S341,D21S259
Common aneuploidy detection
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Laboratory Handbook
Test
Specimen
type
FISH Oncology Tests – see table below for
list of tests
Blood/Bone
marrow
Collection Tube
type
-
Universal with
5 – 10mls of
transport
medium/Li
Hep tube
ONCOLOGY FISH TEST
A – Z by gene name
AFF1 (MLLT2)/MLL dual fusion
ALK Breakapart
ALK/EML4 Dual Fusion
BCL2 Breakapart
BCL6 Breakapart
4q21-22/11q23
2p23
inv(2)(p21p23)
18q21
3q26.2
BCR/ABL1/ASS Dual Fusion
t(9;22)(q34;q11)
BLADDER PANEL- Single locus probes
D3Z1/D7Z1/p16/D17Z1
CBFB Breakapart
CBFB/MYH11 Dual Fusion
CCND1 Breakapart
CCND1/D11Z1 Single locus probes
CDKN2C(p18)/CKS1B amplification in MM single
locus probes
CERVICAL PANEL Single locus probes
hTERC/MYC/D7Z1
CHD5/1qter single locus probes
Volume TAT
-
Depend
ent on
urgency
Gene
3CEN/7CEN/9p21/17CEN
16q22
inv(16)(p13q22) and
t(16;16)(p13;q22)
11q13
11q13/11CEN
1p32.3/1q21
3q26.2/8q24/7CEN
1p36
Notes/Comments Lab to Referred to
send to
-
SDGS
Comments
All variants
All variants
All variants
Tricolour –Complex deletion rearrangement
pattern monitoring possible
3, 7 and 17 aneuploidy detection and 9 short
arm deletion detection
All variants
All variants
CCND1 amplification detection
CDKN2C deletion / CKS1B
Detection of hTERC and/or MYC gain
Short arm deletion detection
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Review date: March 2017
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-
CAEC Registration Identifier: 1043
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Laboratory Handbook
ONCOLOGY FISH TEST
A – Z by gene name
CLL PANEL Single locus probes
MIX 1 - ATM/TP53
MIX 2 – D12Z3/D13S319/13q34
Gene
11q22.3/17p13.1
12CEN/13q14.3/13q34
D1Z2 Single locus probe
D8Z2 Single locus probe
D12Z3 Single locus probe
D7S522/D7Z1 Single locus probes
D13S25 Single locus probe
D13S319 Single locus probe
D20S108 Single locus probe
DDIT3 Breakapart
DEK/NUP214 Dual Fusion
Dermatofibrosarcoma protruberans panel
chromosomes COL1A1 and PDGFB – breakapart
probes
DXZ1/DYZ3 Single locus probes
EGR1/D5S23,D5S721
EML4 Breakapart
ETV6 Breakapart
ETV6/RUNX1 Dual Fusion
1p36
8CEN
12CEN
7q31/7CEN
13q14
13q14
20q12
12q13
t(6;9)(p22;q34)
EVI1 (D3S1243/hTERC/RH123089) Breakapart
3q26.2
EWSR1 Breakapart
EWSR1/FLI1 Dual Fusion
22q12
t(11;22)(q24;q12)
17q22 and 22q13
XCEN/YCEN
5q31/5p15.2
2p21
12p13
t(12;21)(p13;q22)
Comments
Deletion detection
Aneusomy 12 and aneusomy 13 or
heter/homozygous long arm deletion detection
Short arm deletion detection
Aneusomy 8 detection
Aneusomy 12 detection
Monosomy or long arm deletion detection
Monosomy or long arm deletion detection
Monosomy or long arm deletion detection
Monosomy or long arm deletion detection
All variants formerly CHOP
Detection of t(17;22)(q22;q13) and amplification
in supernumerary ring
Sex mismatched monitoring
Monosomy or long arm deletion detection
All variants
All variants
Formerly TEL/AML1
Tricolour
All variants
All variants
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
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Laboratory Handbook
FGFR1/D8Z2 Breakapart and single locus probe
8p11/8CEN
FOXO1 Breakapart
13q14
FUS Breakapart
16p11
GLIOMA PANEL Single locus probes
Mix 1 –
EGFL3,TP73/ANGPTL1,ABL2
Mix 2 - ZNF44,ZK1,MAN2B1/GLTSCR1+2,CRX
1p36/1q25
HER2/D17Z1 Single locus probes
HER2/TOP2A/D17Z1 Single locus probes
IGH Breakapart
IGH/BCL2 Dual Fusion
IGH/CCND1,MYEOV Dual Fusion
IGH/FGFR3 Dual Fusion
IGH/MAF Dual Fusion
IGH/MAFB Dual Fusion
IGH/MYC/D8Z2 Dual Fusion
IGK Breakapart
IGL Breakapart
MALT Breakapart
MDM2/D12Z1 Single locus probes
MELANOMA PANEL Single locus probes
D6Z1/RREB1/MYB/CCND1
MLL Breakapart
MYB Single locus probe
MYC Breakapart
MYC/D8Z2 Single locus probes
All variants and FGFR1 amplification
All variants Formerly FKHR
See also PAX3
All variants
Loss of 1p relative to 1q and loss of 19q
relative to 19p
19p13/19q13
17q11.2-q12
17q11.2-q12/
17q21-22/17CEN
14q32
t(14;18)(q32;q21)
t(11;14)(q13;q32)
t(4;14)(p16;q32)
t(14;16)(q32;q23)
T(14;20)(q32.33;q11.1-q13.1)
t(8;14)(q24;q32)
2p12
22q11
18q21
12q14.3-q15/12CEN
MM
Aneusomy 8 also detected
All variants
All variants
All variants
MDM2 amplification detection
6CEN/6p25/6q23/11q13
11q23
6q23
8q24
8q24/8CEN
All variants
Long arm deletion detection
All variants
Detection of gain of 8q24 relative to 8CEN
HER2 amplification detection
HER2 amplification detection and TOP2A
deletion
All variants
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 121 of 168
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Laboratory Handbook
ONCOLOGY FISH TEST
A – Z by gene name
N-MYC/D2Z1 Single locus probes
NUP98 breakapart
p16(D9S1749-D9S1752)/CEP9 Single locus
probes
Gene
2p24/2CEN
11p15
9p21/9CEN
PAX3 Breakapart
2q35
PBX1/TCF3 dual fusion probe
t(1;19)(q23;p13.3)
4q12
FIP1L1/CHIC2/PDGFRA
rearrangement
5q32
3q26.32
t(15;17)(q22;q21)
PDGFRA /LNX/ SCFD2 Breakapart
PDGFRB Breakapart
PIK3CA Single locus probe
PML/RARA Dual Fusion
PROSTATE PANEL
Mix 1 – TMPRSS2/ERG Breakapart
Mix 2 - PTEN/CEP10 Single locus probes
PTEN/CEP10 Single locus probes
RARA Breakapart
RB1
ROS1 Breakapart
RUNX1/RUNX1T1 Dual Fusion
SEC63/D6Z1
SS18 Breakapart
TCF3 Breakapart
TCR a/d Breakapart
21q22
10q23/10CEN
10q23/10CEN
17q21
13q14
6q22
t(8;21)(q22;q22)
6q21/6CEN
18q11.2
19p13.3
14q11.2
Comments
N-MYC amplification detection
AML, ALL, CML-bc
Short arm deletion detection
All variants
See also FOXO1
ALL
Tricolour
All variants
All variants
PIK3CA amplification detection
Mix 1 – Tricolour, all variants
Mix 2 - Long arm deletion detection
Long arm deletion detection
All variants
Monosomy or long arm deletion detection
All variants
Formerly AML1/ETO
Long arm deletion detection
All variants Formerly SYT
All variants, formerly E2A
All variants
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
TP53/D17Z1 Single locus probes
TP53/MPO Single locus probes
Uveal Melanoma Single Locus Probes
D3Z1/D8Z2
ZNF217
17p13.1/17CEN
17p13.1/17q22
3 centromere and 8
centromere
20q13.2
Test
Specimen
type
Fish Odour Syndrome
Urine
Fish Odour Syndrome (Molecular Genetic
testing)
-
Fk506 (tacrolimus )
Blood
Fluoride number
Blood
Folate
Short arm deletion detection
i(17q) detection
Aneuploidy detection
ZNF217 amplification detection
Collection Tube
type
Volume TAT
Notes/Comments Lab to Referred to
send to
-
-
-
-
See Trimethylamine CCM
& Dimethyglycine
-
-
-
-
-
See
Trimethylaminuria
-
Venous /
capillary
-
EDTA whole 0.5ml
blood
-
-
Follicle stimulating Hormone FSH
Blood
Venous
Follicular lymphoma / DLBCL
Fragile X syndrome
PETS 2x4µm
sections on
slides
Blood
Venous
Free fatty acids
Blood
-
-
-
1 day
-
Li Hep / S.
Gel
-
2ml
EDTA
0.5-5ml 2-8
weeks
-
-
-
14 days
See
pseudocholin’ase
See Haematinic
assay
-
CC
-
CC
-
CC
-
CC
RHH
-
SDGS
-
-
SDGS
-
CCM
-
See Intermediary
metabolites
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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CAEC Registration Identifier: 1043
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Laboratory Handbook
Test
Free T3, T4
Specimen
type
Blood
Collection Tube
type
Venous
Li Hep
Friedreich Ataxia
Blood
Venous
EDTA
Fructose-1,6-bisphosphatase deficiency
Blood
Venous
EDTA
Fumarate hydratase
Amniotic Fluid
-
Plain
universal
Fumarate hydratase
Fibroblasts
-
Fumarate Hydratase Deficiency (FH
sequencing and MPLA)
Fumaric Acid
Blood or
Venous
Fibroblasts
Amniotic Fluid
-
Culture
medium
EDTA
Galactitol
Urine
Random
Galactokinase
Blood
Venous
Galactosaemia screen
Blood
Venous or
capillary
Plain
universal
Volume TAT
1ml
1-3
days
0.5-5ml 2-6
weeks
0.5-5ml 2-8
weeks
5ml
ASAP
Notes/Comments Lab to Referred to
send to
CC
-
SDGS
-
-
SDGS
-
Please contact the CCM
metabolic lab prior
to collection
1-2 mm 2
Refer to Skin
CCM
months Biopsies
SDGS
0.5-5ml 2-8
weeks
5ml
ASAP Prenatal diagnosis CCM
of Fumarate
hydratase
deficiency.
Metabolic lab
MUST be contacted
5ml
5-14
Please contact the CCM
days
duty biochemist
Send on ICE
1 ml
CC
-
Plain
universal
Lith Hep
Whole blood
Li Hep whole 0.5ml
blood
2 days Not EDTA
QPulse Document Reference: 999-0018
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 124 of 168
CCM
-
SOUTH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Galactosaemia screen
Blood Spots
Venous or
capillary
Galactose-1-phosphate
Blood
Venous
Galactose-1-phosphate uridyl transferase
Blood
Gamma glutamyl transferase GGT
Blood
Gastrin
-
-
GATA2
Gentamicin
Blood/Bone
Marrow
Blood
Gilbert syndrome
Blood
Glandular fever screen
Glanzmann Thrombasthaemia
Blood
Glioma
Gliadin antibodies
-
Guthrie card Two
(Li Hep spots
whole blood)
Li Hep whole 5ml
blood
-
Venous
/capillary
-
Li Hep
plasma
-
Venous
EDTA
Venous /
capillary
Venous
S. Gel / plain 1ml
EDTA
Venous
EDTA
PETS 2x2µm
and 2x4µm
sections on
slides
Blood
Venous/
capilary
-
-
S Gel
0.5ml
-
1 week
Send
away
4h
-
CCM
-
Please contact the CCM
duty biochemist
See Galactosaemia CCM
screen
CC
-
-
Bleep duty
CC
biochemist prior to
collection 095
0.5-5ml 8 weeks
SDGS
-
-
CC
0.5-5ml 6-8
weeks
See I.M screen
0.5-5ml 2-8
weeks
14 days
-
2 ml
CC
-
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 125 of 168
SAS centre
NGH
SDGS
-
H
SDGS
-
SDGS
-
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Globulin
-
Collection Tube
type
-
Volume
TAT
-
-
-
See
CC
Immunoglobulins
Send on ice
CC
immediately
Li Hep acceptable CC
only if <60 mins old
NGH
Glucagon
Blood
Venous
EDTA
1ml
Glucose
Blood
Venous /
capillary
Fluoride/Li
Hep
0.5ml
Glucose (blood gas analyser)
Blood
Arterial /
Venous /
Capillary
0.3mL
syr.
CSF
<30min Do not use nonPOCT
syr.
heparinised
(CC)
containers. Keep
0.10mL <10min well mixed right up
cap.
cap.
until analysis.
0.1ml
4h
CC
-
Glucose
Radiometer
hep. syringes
or capillary
with flea,
ends,magnet
Fluoride hep
Glucose
Glucose-6-phosphate dehydrogenase
(G6PD)
Urine
Blood
Plain bottle
EDTA
1.0ml
4h
10 ml aliquot
Discuss Screen performed
at SCH. Assay
performed if screen
is abnormal and is
referred to Haem
RHH
0.5-5ml 2-8
weeks
10ml
2 weeks Contact lab prior to
amniocentesis
0.5-5ml 2-8
weeks
6-8
weeks
CC
H
-
SDGS
-
CCM
-
SDGS
-
CCM
-
Glucose Transporter 1 (GLUT1) deficiency
Blood
syndrome (SLC2A1 sequencing and MLPA)
Glutaric acid
Amniotic Fluid
Glutaric AciduriaType 1 (GA1)
Blood
Glutaric Aciduria Type 1
Fibroblasts
24 hr
Venous /
capillary
Venous
Venous
-
EDTA
Plain
universal
EDTA
-
-
Notes/Comments Lab to Referred to
send to
4h
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 126 of 168
SAS centre
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Glutathione peroxidase
Glycated haemaglobin
-
-
Glyceric Acid chirality (D or L)
Urine
Random
Glycine
Blood
Venous
Glycine
CSF
-
-
-
Plain
universal
Li Hep
plasma
Plain tube
5ml
0.5ml
0.2ml
-
See selenium
See HbA1c
CC
GRI
-
-
-
CCM
-
-
CCM
-
1 week Must be paired with CCM
a plasma sample
-
4-6
weeks
1 week
Glycogen Storage Disease Next Generation Blood
Sequencing Panels: Liver, Muscle, Heart,
Generalised Panel
Glycogen Storage Disease Type 0 (GYS2 – Blood
liver, GYS1-muscle)
Venous
EDTA
0.5-5ml 8 weeks
-
SDGS
-
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type 1a (von
Gierke disease) (G6PC)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type 1 non-a
(SLC37A4)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type II (Pompe
disease) (GAA)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type III (AGL)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type IV
(Andersen disease) (GBE1)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type V (McArdle Blood
disease) (PYGM)
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 127 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Glycogen Storage Disease Type VI (Hers
Disease)(PYGL)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type VII (Tarui
disease)(PFKM)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type IX (X-linked) Blood
(PHKA2-liver, PHKA1-muscle)
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type IX
(autosomal) (PHKB, PHKG2)
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disease Type X (PGAM2) Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Glycogen Storage Disorder Enzymes
Blood
Venous
Li Hep whole 5ml
blood
Glycosaminoglycans
Urine
Random /
24 hrs
Plain
universal
Gonadotrophins
-
Collection Tube
type
Volume TAT
-
10ml
4-6
weeks
Notes/Comments Lab to Referred to
send to
Please contact the CCM
duty biochemist
prior to collection
CCM
-
-
-
-
-
-
See FSH and LH
-
CC
Group
Blood
-
-
-
-
See Blood group & H
crossmatch
-
Group and save
Blood
-
-
-
-
See Blood group & H
crossmatch
-
Growth hormone
Blood
Venous
Li Hep
plasma
2ml
-
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 128 of 168
CC
RHH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Growth hormone antibodies
Blood
Venous
5ml
Venous
S. Gel / Li
Hep
EDTA
Gut hormone profile
Blood
Haemochromatosis
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
Haemoglobin
Blood
Haematinic Assay
Blood
Haemoglobin (total, tHb; g/L)
- blood gas analyser
Blood
Haemoglobin (total, tHb; g/L)
- blood gas analyser
Blood
Capillary
Haemoglobin studies
Blood
Venous /
capillary
Haemolysis tests
Blood
Venous
Haemophilia A/Factor VIII deficiency
molecular test
Blood
Venous
Venous /
capillary
Arterial /
Venous
S. Gel
10ml
1ml
-
-
3 weeks Transport on ice
5 days
See FBC
-
CC
NGH
CC
SAS centre
SDGS
-
H
-
CC
-
PICO or
0.3mL <30min Do not use nonPOCT
(CC)
Radiometer
heparinised
Plastipaks.
heparinised
Don’t let sediment
syringe
Heparinised 0.10mL <10min Use flea, ends &
POCT
capillary
magnet to mix, up (CC)
until analysis
EDTA
2ml
10 days Hb HPLC and
H
HbA2, F, S
quantitation
H
EDTA
Discuss 10 days Discuss with
consultant
haematologist to
determine choice of
tests.
For advice on
EDTA
0.5-5ml 2-8
SDGS
weeks Haematology
specialist
coagulation
assays/studies
please see page 57
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 129 of 168
-
-
-
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Haemophilia B/Factor IX deficiency molecular Blood
test
Collection Tube
type
Venous
EDTA
Volume TAT
Haemophilia C/ Factor XI Deficiency
molecular test
Blood
Venous
0.5-5ml 2-8
weeks
Haemosiderin
Discuss with Discuss 3 days
lab
Haemosiderin
Bone marrow Bone
marrow
aspirate
Urine
Urine
Haptoglobin
Blood
Venous
Plain / S. Gel 2ml
10 days
HbA1C
Blood
EDTA
4h
HDL cholesterol
Helicobacter- pylori
Heparin control
Blood
Blood
Blood
Venous /
capillary
Venous
Venous
Venous
EDTA
Plain
S. Gel
S. Gel
Citrate
0.5-5ml 2-8
weeks
10ml
0.10.5ml
1ml
1ml
1.0ml
3 days
4h
Discuss
Notes/Comments Lab to Referred to
send to
SDGS
For advice on
Haematology
specialist
coagulation
assays/studies
please see page 57
For advice on
SDGS
Haematology
specialist
coagulation
assays/studies
please see page 57
Discuss with
H
consultant
haematologist.
Discuss with
H
consultant
haematologist
Discuss with
H
RHH
consultant
haematologist
POCT
CC
CC
CC
NGH
See also anti-Xa. H
Contact Haem
Consultant.
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Hepatitis B PCR
Blood
Venous
S. Gel/EDTA 2ml
-
Label as “high risk” CC
NGH
Hepatitis C PCR
Blood
Venous
S. Gel/EDTA 2 x 2ml
-
Label as “high risk” CC
NGH
Hepatitis B or C serology
Blood
Venous
S. Gel
-
Her2
Paraffin
embedded
tissue biopsy
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous
EDTA
Blood
Venous
Blood
Venous
Hereditary Ataxia and Migraine Next
Generation Sequencing Panel
Hereditary Breast and Ovarian Cancer
(BRCA1 & BRCA2)
Hereditary Breast and Ovarian Cancer
Extended Gene Panel
Hereditary Leiomyomatosis with renal cell
carcinoma (HLRCC/MCUL) (FH sequencing
and MLPA)
Hereditary Non Polyposis Colorectal Cancer
(HNPCC)
Hereditary Non Polyposis Colorectal Cancer
(HNPCC) Gene Panel (including MLPA)
-
2ml
-
-
Ask for Hep B s Ag, CC
CoreAb and SAb.
Label as “high risk”
1-2 Contact lab prior to SDGS
weeks referral
0.5-5ml
NGH
-
16
weeks
0.5-5ml 8 weeks Performed by Next
full Generation
screen Sequencing &
2 weeks MLPA
predictiv
e
0.5-5ml
12
weeks
0.5-5ml
2-8
weeks
SDGS
-
SDGS
-
SDGS
-
SDGS
-
EDTA
0.5-5ml
-
SDGS
-
EDTA
0.5-5ml
-
SDGS
-
2-8
weeks
2-8
weeks
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 131 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
Collection Tube
type
type
Hereditary Non Polyposis Colorectal Cancer Blood and
Venous
EDTA
(HNPCC) Tumour Microsatellite Instability
PETS 8X10um
Analysis (MSI)
sections in
universal
Hereditary Spastic Paraparesis (dominant,
Blood
Venous
EDTA
pure) SPAST gene
Hereditary Spastic Paraparesis (dominant,
Blood
Venous
EDTA
pure) ATL1 gene
Hereditary Spastic Paraparesis (dominant,
Blood
Venous
EDTA
pure) REEP1 gene
Hereditary Spastic Paraparesis (HSP) Next Blood
Venous
EDTA
Generation Sequencing Panel
Hexanoylglycine
Amniotic Fluid
Plain
universal
Hexanoylglycine
Urine
Random
5 HIAA
Urine
24 hr
High density lipoprotein (HDL)
High Sensitivity Troponin T
Histamine
Blood
-
Venous
/capillary
-
Volume TAT
Notes/Comments Lab to Referred to
send to
SDGS
0.5-5ml 8 weeks
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
0.5-5ml 16
weeks
5ml
ASAP
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
Prenatal diagnosis CCM
of MCADD.
Metabolic lab
MUST be contacted
4weeks
CCM
Plain
universal
10ml 10%
H2SO4
-
2ml
S. Gel
0.5ml
-
-
10ml
-
-
-
-
-
-
-
5 hydroyxindole
acetic acid
See HDL
cholesterol
-
CC
CC
RHH
Contact
Immunology ext
15552
CC
NGH
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 132 of 168
NGH
CC
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Histopathology acetylcholinesterase
Rectal biopsy
Unfixed rectal Moist
biopsy
See Histo
section for
further details
-
Histopathology fixed samples
Formalin fixed -
See Histo
section for
further details
-
See
By prior
HP
Histo
arrangement, must
section include phone
number for report,
must indicate
urgency, for same
day result the
sample must be
received before
1.30pm
See
Use formalin safety HP
Histo
specimen bag
section
-
See
By prior
HP
Histo
arrangement, must
section include phone
number for report
HP
See
Indicate if dry
copper estimation is
Histo
section required
-
-
Histopathology inter-operative frozen section Unfixed
Moist
See Histo
section for
further details
-
Histopathology liver biopsy
Unfixed
Moist if
small
sample
See Histo
section for
further details
-
Histopathology Lymph node or tumour
Unfixed
Moist if
small
sample
See Histo
section for
further details
-
See
By prior
Histo
arrangement
section
HP
-
Histopathology needle muscle biopsy
Unfixed
Moist
See Histo
section for
further details
-
See
By prior
Histo
arrangement
section
HP
-
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
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-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Histopathology open muscle biopsy
Specimen Collection
type
type
Unfixed needle In Hams
biopsy
F10, from
Histopath
lab
Unfixed
Moist
HIV DNA
Blood
Venous
See
Histopath
section for
further details
See
Histopath
section for
further details
EDTA
2ml
HIV Viral load (RNA)
Blood
Venous
EDTA
HLA / tissue typing
Blood
Venous
EDTA
Histopathology needle or trucut ? tumour
Tube
Volume
TAT
See
Histo
section
Notes/Comments Lab to Referred to
send to
By prior
HP
arrangement
See
By prior
Histo
arrangement
section
-
HP
Test used to
CC
monitor infants born
to infected mothers.
Plasma must be
separated within 6
hrs.
Label as “high risk”
2ml
Test used to
CC
monitor infected
patients.
Plasma must be
separated within 6
hrs.
Label as “high risk”
2.5ml. If 10 days Dedicated form
H
leucorequired - obtain
penic
from blood bank lab
then 5ml
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Review date: March 2017
© SC(NHS)FT 2016.
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-
NGH
NGH
NHSBT
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Venous
Dedicated form
required - obtain
from blood bank
lab. Discuss with
consultant
haematologist
H
See VMA
CCM
-
2 weeks Must be separated CCM
within 30 mins
-
Blood
HMMA
Urine
Homocysteine
Blood
Venous
fasting
Li Hep or
EDTA
2ml
Homocysteine (free)
Urine
Random /
24 hrs
Plain
universal
5ml
7 - 10
days
-
-
Homovanillic acid
Urine
Human chorionic gonadotrophin
Blood
Venous
-
Huntington disease
Blood
Venous
HVA
Urine
Random /
24 hrs
Hydrogen ion concentration (H+)
Blood
– blood gas analyser, see also pH
Arterial /
Venous
Hydrogen ion concentration (H+)
Blood
– blood gas analyser, see also pH
Capillary
EDTA + plain 5ml
10 days
EDTA +
2ml
plain
NHSBT
HLA antibody/platelet antibody
-
S. Gel/ Li
Hep
EDTA
-
-
Please note Plasma CCM
is preferred sample
for total
homocysteine
-
-
See HVA
CCM
3 ml
-
S. Gel preferred
CC
0.5-5ml 2 weeks
24 hr
10ml
1 week
collected into
10 ml HCL
PICO or
0.3mL <30min
Radiometer
heparinised
syringe
Heparinised 0.10mL <10min
capillary
RHH
-
SDGS
-
-
CCM
-
POCT
(CC)
-
POCT
(CC)
-
Do not use nonheparinised
Plastipaks.
Don’t let sediment
Use flea, ends &
magnet to mix, up
until analysis
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Review date: March 2017
© SC(NHS)FT 2016.
Page 135 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
3-Hydroxy Butyrate
Specimen
type
Blood
Collection
type
-
4-Hydroxy Butyrate
Amniotic Fluid
4-Hydroxy Butyrate
CSF
4-Hydroxy Butyrate
Urine
2-Hydroxy Glutaric Acid Chirality (D or L)
Urine
Random
17 α Hydroxyprogesterone
Blood
Venous
1,25 Hydroxyvitamin D
Blood
Venous
-
Tube
Volume
-
-
TAT
Notes/Comments Lab to Referred to
send to
See Intermediary CCM
metabolites
ASAP Prenatal diagnosis CCM
of Succinic Semi
aldehyde
dehydrogenase
deficiency.
Metabolic Lab
MUST be
contacted.
4 weeks
CCM
-
Plain
universal
5ml
-
Plain tube
0.5ml
Random
Plain
2ml
universal
Plain
5ml
universal
Li Hep
1ml
plasma/S Gel
S. Gel
3ml
4 weeks
-
CCM
-
4 weeks
-
CCM
-
-
-
CC
3 weeks Protect from light CC
25 Hydroxyvitamin D
Blood
Venous
S. Gel serum 3ml
Hypochromic red cells
Blood
EDTA
Hypophosphatasia (ALPL)
Blood
Venous /
capillary
Venous
EDTA
3 weeks Protect from light CC
Within 1 day
FBC
0.5-5ml 2-8
weeks
RHH
-
-
H
-
-
SDGS
-
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 136 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
IgG subclasses
Blood
Venous
S. Gel
2ml
-
IGF-1
IGF-BP3
Blood
Blood
Venous
Venous
S. Gel
S. Gel
1ml
1ml
-
Immunoglobulin heavy chain gene
rearrangement (IgH)/B cell lymphoctyosis/B
cell gene rearrangement
Immunoglobulins (IgG, IgA, IgM, IgE)
Infectious mononucleosis (I.M.) screen
Blood / Bone
Marrow
EDTA
0.5-5ml 2 weeks
Blood
Blood
Venous
Venous /
capillary
S. Gel
EDTA
1ml
0.5ml
INR
Blood
Venous /
capillary
Citrate
1ml
Inhibin
Blood
S Gel
1ml
Insulin
Blood
Venous/
capillary
Venous
Li Hep
plasma
5ml
-
Insulin antibodies
Blood
Venous
S. Gel
2ml
-
-
CC
Responses to
vaccinations are a
more useful initial
test of immune
fraction than IgG
subclasses.
CC
CC
-
SDGS
CC
1 day Can perform along H
with FBC with 1ml
total
1day See coagulation
H
screen. Restrictions
apply If capillary
CC
Additional 2ml
fluoride for
intermediate
metabolites
-
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 137 of 168
NGH
RHH
SAS centre,
Guildford
-
NGH
-
-
NGH
CC
RHH
CC
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Collection Tube
type
Interferon
CSF
Intermediary Metabolites
Blood
Venous or
capillary
Fluoride
plasma
Intracellular Magnesium
Blood
Venous
Lith hep
2ml
Whole blood 0.5ml
-
Iodine
Urine
Random
Universal
-
Iron
Blood
Venous/
capillary
Li Hep
plasma
0.5ml
Islet cell antibodies
Blood
Venous
S. Gel
2ml
-
Isoelectric focusing of Transferrin
Blood
S Gel
1ml
-
Isohaemagglutinins (anti A, anti B, IgM)
Blood
Venous/
capillary
Venous
S. Gel
1ml
JAK2 (V617F mutation)
Blood/Bone
marrow
Venous
EDTA
-
Volume TAT
Sterile
universal
-
2ml
-
1-5
days
-
4h
Notes/Comments Lab to Referred to
send to
Freeze within 2hrs CC
of collection.
Please contact the
Duty Biochemist
Includes Glucose, CCM
Lactate, 3-Hydroxy
Butyrate and Free
fatty acids
CC
-
CC
Suspected
CC
overdose measure
at 4h
CC
-
24h
CC
Ask for quantitative H
titres. Needs blood
bank form filled
appropriately
0.5-5ml 2 weeks SDGS
QPulse Document Reference: 999-0018
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 138 of 168
France
-
RHH
SGH
-
NGH
NEURO
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
JAK2 Exon 12 mutation screen
(polycythaemia rubra vera/PRV)
Kallmann syndrome
Blood/Bone
marrow
Blood
Karyotype
-
KIT-D816V
Blood/Bone
marrow
KRAS ( v-Ki-ras2 Kirsten rat sarcoma viral
Paraffin
oncogene homolog) for CRC and NSCLC and embedded
other
tissue biopsy
Lactate
Blood
Lactate (blood gas analyser)
Blood
Lactate
CSF
Lactate dehydrogenase LDH
Blood
Lactose tolerance test
Blood
Lamotrigine
Blood
Latex fixation test
Blood
Venous
EDTA
0.5-5ml 2 weeks
-
SDGS
-
Venous
Li Hep
2-3ml
-
SDGS
-
Venous
Biopsy
Venous or
capillary
Arterial /
Venous /
Capillary
-
-
EDTA
28 days
-
See Chromosome SDGS
-
0.5-5ml 2 weeks -
SDGS
-
-
SDGS
-
Fasting if not part of CC
Hypoglycaemia
screen
Radiometer 0.3mL <30min Do not use nonPOCT
hep. syringes syr.
syr.
heparinised
(CC)
or capillary
containers. Keep
with flea,
0.10mL <10min well mixed right up
ends,magnet cap.
cap.
until analysis.
Fluoride tube 0.2ml
4 days
CCM
-
-
Fluoride
plasma
-
0.5ml
Venous /
capillary
-
Li Hep
plasma
-
0.5ml
Venous/
capillary
Venous
Lith Hep/
S Gel
S Gel
1ml
-
1-2
weeks
4h
4h
-
Bleep duty
biochemist 095
-
-
-
-
3 ml
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 139 of 168
-
-
CC
-
CC
-
CC
NGH
CC
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Laxative screen
Specimen
type
Urine
Lead
Blood
Leber Hereditary Optic Neuropathy (LHON)
Blood
Collection
Tube
type
Random
Plain
universal
Venous
Li Hep /
EDTA whole
blood
Venous
EDTA
Leucine Proline-Enriched Proteoglycan
(LEPRE1) (autosomal recessive OI)
Blood
Venous
Leucocyte enzyme
-
Leukaemia cytochemistry
Levetiracetam (Keppra)
Blood
Li Fraumeni (TP53 gene sequencing and
MLPA)
Lipase
Blood
Lipids
Blood
Lipoprotein (a) Lp (a)
Blood
Lithium
Blood
Blood
EDTA
-
Volume TAT
10ml
1ml
-
Notes/Comments Lab to Referred to
send to
CC
NGH
-
CC
0.5-5ml 2-8
weeks
-
SDGS
-
0.5-5ml 2-8
weeks
-
SDGS
-
CC
-
H
CC
CCFE
-
-
-
-
-
-
Venous/
capillary
Venous
Li Hep/
S Gel
EDTA
Venous/
Capillary
Venous /
capillary
Lith Hep/ S
Gel
Li Hep / S.
Gel
Venous /
capillary
Venous
Li Hep
1m
-
S Gel
3ml
-
1ml
0.5-5ml 2-8
weeks
0.5ml
1-2
weeks
0.5ml
4h
See white cell
enzyme
See bone marrow
-
SDGS
-
CC
See cholesterol,
HDL and
triglyceride
-
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 140 of 168
NGH
-
CC
-
CC
GEOR
CC
RHH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Liver function tests
LFT
Blood
Venous /
capillary
Li Hep
LLMI
BAL
Long Chain 3- Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHAD)
Long Chain Fatty Acids
Blood or
Guthrie spots
Blood
Bronchial
aspirate
Venous
Sterile
universal
EDTA
Lupus inhibitor / anticoagulant
Luteinising hormone
Lymphocyte subsets
LH
-
0.5ml
-
-
-
-
Blood
Venous
Blood
Venous
Li Hep
plasma / S.
Gel
EDTA
See bilirubin, ALP,
ALT, GGT, total
protein albumin
>2mls 5 days Macrophage lipid
content analysis
0.5-5ml 2 weeks Common mutation
only
See Very Long
Chain Fatty Acids
See coagulation
studies
2ml
-
1ml
4h
CC
-
HP
-
SDGS
-
CCM
-
H
-
CC
3 days. Not for first line
H
Note: investigation.
samples Requires approval
are
from Immunology
batched consultant before
and this requesting assay.
TAT
may be
longer if
the
sample
is
received
Fri pm.
QPulse Document Reference: 999-0018
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 141 of 168
RHH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Collection Tube
type
Volume
Lysosomal Enzymes
Blood
Venous
EDTA whole 5ml
blood
-
Macroglobulins
Blood
Venous
S Gel
4ml
Magnesium
Blood
Blood
Li Hep
plasma
-
0.5ml
Malarial parasites
Venous /
capillary
-
Malt lymphoma
PETS 2x2µm
and 2x4µm
sections on
slides
Capillary
Blood
only
Manganese
Mannan binding protein
Mantle cell lymphoma
Medium Chain Acyl CoA-dehydrogenase
Deficiency
Blood
Venous
PETS 2x2µm
and 2x4µm
sections on
slides
Blood or
Venous
Guthrie spots
EDTA
-
0.5ml
S. Gel
1ml
-
EDTA
-
-
-
TAT
-
4h
Notes/Comments Lab to Referred to
send to
Please contact the CCM
duty biochemist
Avoid haemolysis
CC
-
Bleep duty
CC
biochemist prior to
collection 095
CC
14 days
SDGS
-
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 142 of 168
NGH
CC
Discuss Can perform along H
with FBC
14 days
SDGS
0.5-5ml 2-8
weeks
MCH
SDGS
TROP
-
SAS centre,
Guildford
NGH
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Meningococcal PCR
Blood
Venous
EDTA
0.5ml
-
Mercury
Blood
Urine
Venous/
Capillary
EDTA
1ml
-
Metanephrine (Metadrenaline)
Blood
Venous
EDTA
3ml
Venous
3-4
Send on ice
CC
weeks immediately.
PICO or
0.3mL <30min Do not use nonPOCT
Radiometer
(CC)
heparinised
heparinised
Plastipaks.
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
POCT
capillary
magnet to mix, up (CC)
until analysis
Li Hep
0.75ml <12hrs Send first sample CC
plasma
48hr post dose
Plain
10ml
Discuss Prenatal diagnosis CCM
universal
of Proprionic
Acidaemia.
Metabolic lab
MUST be contacted
EDTA
0.5-5ml 8 weeks
SDGS
Venous
EDTA
Methaemaglobin (MetHb; reported as %Hb) Blood
– blood gas analyser
Arterial /
Venous
Methaemaglobin (MetHb; reported as %Hb) Blood
– blood gas analyser
Capillary
Methotrexate
Blood
Venous/
capillary
Amniotic Fluid -
Methylcitric Acid
Microsatellite Instability Analysis (MSI)
MTHFR (Methylene Tetra Hydra Folate
Reductase deficiency)
Blood and
Paraffin
embedded
tissue biopsy
Blood
Take as early as
CC
possible after
presentation
Early morning Urine CC
10ml min
0.5-5ml 2-8
weeks
-
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 143 of 168
SDGS
NGH
SAS centre
SRH
-
-
-
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Methylmalonic Acid
Methylmalonic Acid
Specimen
Collection Tube
type
type
Amniotic Fluid
Plain
universal
Volume TAT
Urine
Plain
universal
-
5ml
EDTA
0.5-5ml 2-8
weeks
Microarray (see CGH)
Random
-
Mitochondrial Disorder, Leber Hereditary
Blood
Optic Neuropathy, MELAS, MERRF, NARP.
Mitochondrial DNA
Venous
Blood
Monospot
-
MPL Exon 10 mutation screen (?PMF and
?ET)
Mucopolysaccharides
-
Blood/Bone
Marrow
Urine
Multiple Endocrine Neoplasia Type 1 (MEN1 Blood
gene sequencing & MLPA)
Multiple Endocrine Neoplasia Type 2 (MEN2) Blood
and Hirschsprung disease (RET gene)
Muscle Biopsy
-
Notes/Comments Lab to Referred to
send to
Discuss Prenatal diagnosis CCM
of Methylmalonic
Acidaemia.
Metabolic lab
MUST be contacted
2 weeks
CCM
-
5ml
-
-
-
-
-
-
-
-
Please contact lab SDGS
to discuss sample
type
See SDGS section CC
-
-
-
-
See I.M screen
Venous
EDTA
0.5-5ml
2-8
weeks
4 weeks
Random
Venous
Plain
universal
EDTA
Venous
EDTA
-
-
5ml
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
-
-
-
H
-
-
SDGS
-
-
CCM
-
-
SDGS
-
-
SDGS
-
Metabolic lab
CCM
MUST be
contacted to
arrange ext 17445
QPulse Document Reference: 999-0018
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 144 of 168
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Muscle Biopsy for Histopathology
Fresh
Muscle enzymes
Blood
MutYH-associated polyposis (MAP) (MUTYH Blood
gene) UK common mutation screen/carrier
testing
Mycophenolate
Blood
Myelin basic Protein
CSF
Myelodysplastic syndromes (MDS)
Bone marrow
Myeloperoxidase (cytochemical qualitative)
Blood
Myeloproliferative disease (MPD)
Bone marrow
-
Venous or
capillary
Venous
Venous/
capillary
-
See
Histopath
section for
further details
Li Hep
0.5ml
plasma
EDTA
0.5-5ml
Li hep
EDTA
-
-
Universal
with 5-10ml
of transport
medium
Venous/capi EDTA
llary
-
Universal
with 5-10ml
of transport
medium
Histopath lab
See
HP
MUST be
Histo
section contacted to
arrange
4h
See CK, LDH, AST CC
2-4
weeks
-
-
Separate quickly
0.2ml
-
Freeze immediately CC
-
-
SDGS
0.5ml
0.25-1ml 28 days
-
CC
-
RBH
CHURCH
SDGS
-
Discuss Can perform along H
with FBC
depending upon
clinical setting
0.25-1ml 28 days
SDGS
-
0.5ml
QPulse Document Reference: 999-0018
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Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 145 of 168
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Myeloproliferative disorder/essential
Blood / Bone
thrombocythaemia(ET)/polycythaemia rurbra marrow
vera (PRV)/ myelofibrosis (MF) - JAK2
Collection Tube
type
EDTA
Volume TAT
Notes/Comments Lab to Referred to
send to
0.5-5ml 2 weeks
SDGS
-
MYH9-related disorders (GATA2, SBDS,
RUNX1)
MutYH
Blood
Venous
EDTA
0.5-5ml 8 weeks
-
SDGS
-
Blood
Venous
EDTA
-
SDGS
-
Myoadenylate Deaminase deficiency
(AMPD1)
Myoglobin
Myoglobin
Blood
Venous
EDTA
-
SDGS
-
Blood
Urine
Venous
Random
Preferred
CC
CC
NGH
NGH
N acetylaminoglucoaminidase
Urine
2ml
Store frozen
CC
CHILD
Neonatal Alloimmune Thrombocytopenia
(NAIT)
Neuroblastoma
Blood
Fresh
Random
Venous
S. Gel
Plain
universal
Universal
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
2ml
10ml
-
Neuroblastoma Biopsy & resection
PETS 2x2µm
and 2x4µm
sections on
slides
Fresh
Neurone Specific Enolase
Blood
EDTA
-
0.5-5ml
-
-
-
-
See Histo
section for
further details
-
Venous
S. Gel
2-3ml
2-8
weeks
14 days
-
SDGS
-
-
SDGS
-
See
Histo
section
-
HP
-
-
-
CC
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 146 of 168
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Neurotransmitters
CSF
Neutrophil adhesion molecules
Blood
Venous
EDTA
1ml
Noradrenaline
Blood
Venous
Li Hep
plasma
2ml
Noradrenaline
Urine
24 hr
Normetanephrine (Nor-adrenaline)
Blood
Venous
Bottle +10ml 20ml
H2SO4
EDTA
1ml
Oestradiol
Blood
Venous
Oestrogen
-
Urine
24hr
Oligosaccharides
Urine
-
Oligoclonal bands
CSF
Blood
Urine
-
Organic Acids
Orosomucoid
Orotic Acid
Urine
Special
requirements
-
-
2-4
weeks
Li Hep
2ml
plasma
Plain bottle / 10 ml
few drops of
chloroform
Random
10ml
Random /
24 hrs
-
S Gel
Plain
universal
-
Random /
24 hrs
Plain
universal
-
0.5ml
5ml
10ml
10ml
3-4
weeks
Metabolic lab
MUST be
contacted to
arrange
By arrangement
with Imm lab
Newcastle only
Send on ice
immediately
Send on ice
immediately.
-
-
-
-
-
-
2 weeks Not Boric Acid
-
See Acid
Glycoprotein
2 weeks
-
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Review date: March 2017
© SC(NHS)FT 2016.
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CCM
-
H
NRVI
CC
RBH
CC
NGH
CC
SRH
CC
RHH
CC
RHH
CC
WILL
CC
NGH
CCM
CC
CCM
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Osmolality
Specimen
type
Blood
Osmolality
Urine
Osteocalcin
Blood
Collection
type
Venous/
capillary
Random
urine
Venous
Osteogenesis Imperfecta
Blood
Venous
Osteogenesis Imperfecta – autosomal
dominant Next generation Sequencing Panel
Osteogenesis Imperfecta – autosomal
recessive (CRTAP, LEPRE1, PPIB)
Osteogenesis Imperfecta – autosomal
recessive Next generation Sequencing Panel
Osteogenesis Imperfecta Type V (IFITM5)
Blood
Venous
Blood
Venous
Blood
Venous
Blood
Venous
Osteoporosis and osteoporosis pseudoglioma Blood
syndrome (LRP5)
Oxalate
Urine
Venous
Oxcarbazepine and 10 hydroxycarbazepine
Blood
5-Oxoproline
Amniotic Fluid
Random
urine
Venous
-
Tube
Volume TAT
Li Hep
plasma
Plain
universal
EDTA
0.5ml
4h
1ml
4h
EDTA
5ml
Notes/Comments Lab to Referred to
send to
CC
-
-
0.5-5ml 2-8
weeks
EDTA
0.5-5ml 2-8
weeks
EDTA
0.5-5ml 2-8
weeks
EDTA
0.5-5ml 2-8
weeks
EDTA
0.5-5ml 2-8
weeks
EDTA
0.5-5ml 2-8
weeks
Bottle+10ml 25ml
HCL
Li hep/
0.2ml
S Gel
min
-
CC
Bleep duty
CC
biochemist prior to
collection 095
SDGS
RHH
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
CARE -store at
room temp
-
CC
BCH
CC
CCFE
See Pyroglutamic
acid
CCM
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Review date: March 2017
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-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Oxygen saturation (sO2 ; reported as %)
– blood gas analyser
Blood
Arterial /
Venous
Oxygen saturation (sO2 ; reported as %)
– blood gas analyser
Blood
Capillary
Oxyhaemoglobin (O2Hb ; reported as %Hb)
– blood gas analyser
Blood
Arterial /
Venous
Oxyhaemoglobin (O2Hb ; reported as %Hb)
– blood gas analyser
Blood
Capillary
Pancreatic polypeptide
Blood
Venous
Paracetamol
Blood
Venous /
capillary
Paraquat
Blood
Venous
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
heparinised
Plastipaks.
Don’t let sediment
syringe
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
PICO or
0.3mL <30min Do not use nonRadiometer
heparinised
Plastipaks.
heparinised
syringe
Don’t let sediment
Heparinised 0.10mL <10min Use flea, ends &
capillary
magnet to mix, up
until analysis
EDTA
1ml
ICE
- ON
SEP WITHIN
15MINS
Li Hep
0.5ml
4h
Overdose; sample
plasma
taken not less than
4h post OD.
If IV overdose is
suspected contact
the duty biochemist
(bleep 095)
Clin Chem
Li Hep
10ml
- Contact
RHH before
plasma
collection
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Review date: March 2017
© SC(NHS)FT 2016.
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POCT
(CC)
-
POCT
(CC)
-
POCT
(CC)
-
POCT
(CC)
-
CC
SAS centre
CC
-
CC
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Parathyroid hormone PTH
Specimen
type
Blood
pCO2 / pO2 / pH
Blood
– blood gas analyser
pCO2 / pO2 / pH
Blood
– blood gas analyser
Peroxisomal Biogenesis Disorders (PEX1,
PEX6, PEX10, PEX12, PEX26)
pH
Blood
Blood
pH
Urine
PHA response (or other mitogen responses
e.g. candida, tetanus, PPD)
Phenobarbitone (Phenobarbital)
Blood
Phenylalanine
Blood
Collection Tube
type
Venous
EDTA
Volume
TAT
Notes/Comments Lab to Referred to
send to
1ml
0.5ml Li hep CC
- Paired
sample for bone
profile. Analysed
Tue and Fri, urgent
requests only at
other times.
PICO or
0.3mL <30min Do not use nonArterial /
POCT
Venous
Radiometer
(CC)
heparinised
heparinised
Plastipaks.
syringe
Don’t let sediment
Capillary
Heparinised 0.10mL <10min Use flea, ends &
POCT
capillary
magnet to mix, up (CC)
until analysis
Venous
EDTA
0.5-5ml 2-8
SDGS
weeks
See pCO2
POCT
(CC)
Random
Plain
10ml 1 day
CC
universal
Contact G Wild ext CC
NGH
15394
Venous /
Li Hep
0.5ml
CC
RHH
capillary
plasma
Venous or Li Hep
0.5ml
1 week
CCM
capillary
plasma
(serum OK)
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Review date: March 2017
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Phenylalanine
Blood Spots
Venous or
capillary
Phenytoin
Blood
Phosphate
Blood
Phosphate
Urine
Phosphate excretion indices
Blood+urine
Venous /
capillary
Venous /
capillary
24hr /
random
-
Phosphoethanolamine
Urine
Random
Phosphoglycerate Mutase (muscle,
deficiency of)
Phytanate
Blood
Venous
Phytosterols
Blood
PIK3CA (Phosphatidylinositol 3 – kinase,
catalytic, alpha polypeptide)
Pipecolic Acid
PETS 8x10µ
sections in
universal
Blood
Venous
Pipecolic Acid
Pipecolic Acid
CSF
Urine
Random
PLAP Placental ALP
Blood
CSF
Blood
Venous
-
-
Guthrie Card
(Li Hep whole blood)
Li Hep
plasma
Li Hep
plasma
Plain bottle/
universal
-
Two
spots
Plain
universal
EDTA
10ml
-
1 week
0.5 ml
-
0.5ml
4h
10ml
4h
-
1ml
Li Hep
plasma
Plain tube
Plain
universal
-
CCM
-
CC
Avoid haemolysis
2 weeks
RHH
-
CC
-
PEI,TRP,TmP/GFR CC
-
-
CCM
-
-
SDGS
-
CCM
-
CCM
-
See Very Long
Chain Fatty Acids
4 weeks
-
-
-
CC
-
0.5-5ml 2-8
weeks
-
Li Hep
plasma
(serum OK)
-
-
1-2
weeks
-
SDGS
-
1ml
4 weeks
-
CCM
-
0.5ml
5ml
4 weeks
4 weeks
-
CCM
CCM
-
-
-
CC
-
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Author: Laboratory Handbook Group
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Review date: March 2017
© SC(NHS)FT 2016.
Page 151 of 168
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Blood
Plasmalogens
Collection Tube
type
Venous
EDTA
Volume TAT
2ml
Notes/Comments Lab to Referred to
send to
4 weeks Washed packed red CCM
cells
See HLA
H
-
Platelet antibody
-
-
-
-
Platelet count
-
-
-
-
-
Platelet function
-
-
-
-
-
Venous
EDTA
See coagulation
studies. Discuss
with consultant
haematologist
2.5ml. If 14 daysDedicated form
thrombrequired - obtain
ocytofrom blood bank
penic lab. Discuss with
5ml
consultant
haematologist
See pCO2
Platelet specific typing
Blood
pO2
Blood
Polycystic Kidney Disease (autosomal
dominant) PKD1 & PKD2 Full-gene
sequencing and MLPA
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
Polycystic Kidney Disease (autosomal
dominant) PRKCSH & SEC63 gene
sequencing
Blood
Venous
EDTA
1-5ml
-
-
See FBC
2-8
weeks
H
-
H
-
H
NHSBT
POCT
(CC)
-
-
SDGS
-
-
SDGS
-
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Review date: March 2017
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Porphobilinogen screen
Urine
24hr/
random
Porphyrin screen
Urine
Random
Potassium
Blood
Venous /
capillary
Potassium – blood gas analyser
Blood
Arterial /
Venous /
Capillary
Potassium
Urine
PPIB (autosomal recessive OI)
Prednisolone
Plain
bottle/univers
al
Plain
10ml
universal
-
Protect from light
CC
RHH
Protect from light
Contact Duty
Biochemist. EDTA
blood and faeces
samples may also
be appropriate
depending on the
symptoms
Li Hep
0.5ml
4h
Avoid haemolysis.
Use venous blood
plasma
to check result
Radiometer 0.3mL <30min Do not use nonhep. syringes syr.
syr.
heparinised
or capillary
containers. Keep
with flea,
0.10mL <10min well mixed right up
ends,magnet cap.
cap.
until analysis.
CC
RHH
24hr /
random
Plain bottle/
universal
10ml
-
CC
Blood
Venous
EDTA
-
SDGS
Blood
Venous
S Gel
0.5-5ml 2-8
weeks
1 ml
-
-
4h
CC
-
POCT
(CC)
-
Contact lab before CC
sending sample
2-3 hrs POST dose
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Review date: March 2017
© SC(NHS)FT 2016.
Page 153 of 168
RHH
RBH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Pregnanetriol
Specimen
type
Urine
Pristanate
Blood
Prolactin
Blood
Venous
Protein
Protein
CSF
Urine
24hr/
random
Li Hep
2ml
plasma
Plain tube
0.5ml
Plain bottle / 2ml
universal
Protein , Total
Blood
Protein /creatinine ratio
Urine
Venous/
capillary
24hr/
random
-
Li Hep
0.5ml
plasma
Plain bottle / 2ml
universal
-
Protein C and S
Collection Tube
type
24hr
Plain bottle
-
-
-
Protein C Deficiency
Blood
Venous
EDTA
Protein S Deficiency
Blood
Venous
EDTA
Protein selectivity
Blood
Venous
S. Gel
Volume
TAT
10ml
-
-
-
Notes/Comments Lab to Referred to
send to
Serum/plasma
CC
RHH
hydroxyprogest’one
preferred for
management of 21
hydroxylase
deficiency
See Very Long
CCM
chain Fatty Acids
CC
RHH
4h
4h
-
CC
CC
-
4h
-
CC
-
4h
-
CC
-
H
-
SDGS
-
-
SDGS
-
-
CC
-
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
4ml
-
See coagulation
studies. Discuss
with consultant
haematologist
-
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Review date: March 2017
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NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Protein selectivity
Urine
4hr urine
Prothrombin (3' non 20210G>A prothrombin Blood
variants)
Protoporphyrin (erythrocyte)
Pseudoxanthoma Elasticum
Blood
Pseudocholinesterase (scholine sensitivity)
Purines and Pyrimidines
-
Venous
Plain
universal
EDTA
Venous
EDTA
-
-
Urine
Pyroglutamic acid
Random /
24 hrs
Amniotic Fluid
-
Pyruvate
Blood
Pyruvate
CSF
Quantiferon (Gamma interferon for TB)
Blood
Quinine
Blood
Quantitative BCR-ABL (MRD)
Blood/Bone
marrow
Plain
universal
Plain
universal
Venous
0.5-5ml 2-8
weeks
0.5-5ml 2-8
weeks
10ml
10ml
-
CC
-
SDGS
-
-
H
SDGS
-
See ZPP
See Cholinesterase
Send
Please contact the
away
duty biochemist
2 weeks Contact the lab
prior to
amniocentesis
Contact the lab for
special tubes ext
17445
Contact the lab for
special tubes ext
17445
Contact
Microbiologist
(SCH) for special
tubes ext
17579/53158
-
NGH
CCM
-
-
-
Venous/
capillary
Li Hep
plasma
3 ml
total
Venous
S Gel
5ml
EDTA
0.5-5ml 2 weeks Must be sent to the SDGS
laboratory
immediately
-
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 155 of 168
GUY
CCM
-
-
-
-
CC
NRVI
CC
NRVI
CC
NGH
CC
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
RAST (radio allergo-sorbent test for specific Blood
IgE)
Rectal biopsy for acetylcholinesterase
Unfixed rectal
biopsy
Collection Tube
type
Venous
S. Gel
Moist
See Histo
section for
further details
-
Reducing Substances
Faeces
Random
-
Reducing Substances
Urine
Random
5ml
Renin, and Aldosterone
Blood
Venous
Plain
universal
Plain
universal
Li Hep
2ml
-
Reticulin antibodies
Blood
Venous
S Gel
4ml
-
Reticulocyte count (retics)
Blood
Retinoblastoma
Blood
Venous /
capillary
Venous
Retinol, retinoids
Rheumatoid factor
Blood
5ml
Li Hep
Venous
Volume TAT
0.5ml
2-3ml
S. Gel
2ml
-
Notes/Comments Lab to Referred to
send to
CC
NGH
HP
See
By prior
Histo
arrangement, must
section include phone
number for report,
must indicate
urgency, for same
day result the
sample must be
received before
1.30pm
4 days Fresh sample
CCM
-
4 days Fresh sample
-
Bleep duty
biochemist 095
prior to collection
-
-
CCM
CC
SAS centre,
Leeds
CC
NGH
Can perform along H
with FBC
28 days
SDGS
-
1 day
-
See vitamin A
-
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Review date: March 2017
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-
CC
CC
NGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
RUNX1
Salicylate
Blood/Bone
Marrow
Blood
Venous
EDTA
0.5-5ml 8 weeks
Venous /
capillary
Venous /
capillary
Venous
Li Hep
plasma
Li Hep
plasma
EDTA
0.75ml
Salicylate
Blood
SBDS
Selenium
Blood/Bone
Marrow
Blood
Venous
Li Hep
plasma
Serotonin
Blood
Venous
Serotonin Tumour Marker
Blood
Venous
Serotype Specific Pneumococcus Serology
Blood
Venous
Sex Hormone Binding Globule
Blood
Venous
SGOT (Aspartate aminotransferase)
Blood
SGPT (Alanine aminotransferase)
Blood
Sickle cell disease
Sickle cell disease (newborn screening –
transfused babies)
Blood
Dried blood
spot
Venous
/capillary
Venous
/capillary
Venous
Capillary
SDGS
-
2hrs post dose
therapeutic range
0.75ml 4h
4h post dose
overdose
0.5-5ml 8 weeks
-
CC
-
CC
-
SDGS
-
3ml
-
CC
GRI
EDTA +5mg 2ml
Ascorbic acid
EDTA +5mg 1ml
Ascorbic acid
S. Gel
1ml
-
CC
NAT
CC
JAMES
CC
NGH
CC
RHH
Li Hep
plasma
Li Hep
plasma
Li Hep
plasma
EDTA
-
-
4h
-
2ml
-
Includes
erythrocyte
glutathione
peroxidase
Frozen within 10
mins
Frozen within 10
mins
By arrangement
with Immunology
lab only
-
0.5ml
4h
-
CC
-
0.5ml
4h
-
CC
-
0.5-5ml 2 weeks
SDGS
2 weeks Referrals via
SDGS
Newborn screening
only
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Review date: March 2017
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Page 157 of 168
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Blood
Sickle Hb screen
Silver
Urine
Blood
Sirolimus
Blood
Sitosterols
Skin Biopsy – tissue culture
Blood
Skin
Skin – Immunology
Fresh
Sodium
Blood
Sodium – blood gas analyser
Blood
Collection Tube
type
Venous
EDTA
/capillary
-
Venous/
capillary
-
-
Venous/
capillary
Arterial /
Venous /
Capillary
Volume TAT
1ml
Random
Few ml
urine or
whole blood
EDTA
0.2ml
Whole blood
-
1 day
-
Notes/Comments Lab to Referred to
send to
Can perform along H
with FBC 1 ml total
and confirmed by
HPLC
CC
SAS centre,
Guildford
-
-
CC
See phytosterols
CCM
Refer to Skin
CCM
Biopsies under
Clinical Chemistry
See Histo section Send
for further details. direct to
Contact
Imm
Immunology NGH – NGH
ext 15552.
Li Hep
0.5ml
4h
Also blood gas
CC
plasma
analyser
Radiometer 0.3mL <30min Do not use nonPOCT
hep. syringes syr.
syr.
heparinised
(CC)
or capillary
containers. Keep
with flea,
0.10mL <10min well mixed right up
ends,magnet cap.
cap.
until analysis.
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Author: Laboratory Handbook Group
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Review date: March 2017
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UHSM
-
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Sodium
Sweat
Sodium
Urine
Sorbitol
-
-
-
Plain bottle/
universal
-
10ml
Urine
24hr
random
-
Specific gravity
Urine
Random
1ml
Spinal Muscular Atrophy, 5q linked
Blood
Venous
Plain
universal
EDTA
Spinobulbar Muscular Atrophy (Kennedy
Blood
disease X linked)
Spinocerebellar Ataxia types 1-3, 6, 7, 12 and Blood
17
Steroid profile 24 hr
Urine
Venous
EDTA
Venous
EDTA
Sterols
Venous
24hr
Blood
Stones
-
-
-
Sugar Chromatography
Faeces
Random
Sugar Chromatography
Urine
Random
Sulphite
Urine
Random
Li Hep
plasma
Plain
universal
Plain
universal
Plain
universal
4h
-
4h
CC
-
-
CC
-
See Galactitol
CCM
-
Request osmolality CC
0.5-5ml 2-8
weeks
0.5-5ml 2-6
weeks
0.5-5ml 2-6
weeks
-
10ml
Send
away
Send
away
1 week
-
-
SDGS
-
-
SDGS
-
-
SDGS
-
CC
-
CCM
-
CC
-
Bleep duty
biochemist 095
3 weeks -
1ml
2
See sweat test
See calculi
Please contact the CCM
duty biochemist
Please contact the CCM
duty biochemist
Please contact the CCM
duty biochemist.
Must be analysed
within 30 minutes
QPulse Document Reference: 999-0018
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Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 159 of 168
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CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Sulphocysteine
Specimen
type
Urine
Sweat test (sodium &chloride)
Sweat
Synovial sarcoma
PETS 2x4µm
sections on
slides
Blood / Bone marrow
-
PETS 25x5µm
-
-
-
T cell lymphocytosis / T cell receptor gene
rearrangements (TCR)
T cell lymphocytosis / T cell receptor gene
rearrangements (TCR)/CTCL
Tacrolimus (FK506)
Collection Tube
type
Random
Plain
universal
-
Blood
Venous
Thalium
Blood
Venous
Thalium
Urine
Random
Theophylline
Blood
Thiopentone
Blood
Venous /
capillary
Venous/
capillary
Notes/Comments Lab to Referred to
send to
3 weeks
CCM
-
5ml
-
EDTA
Testosterone
Volume TAT
-
-
-
14 days
0.5-5ml 2-4
weeks
Universal
-
-
-
Li Hep
plasma
EDTA
2ml
Sterile
universal
Li Hep
plasma
Li hep/
S Gel
30ml
10ml
0.5ml
1ml
Arrange with lab
CC
-
SDGS
-
Must be sent to the SDGS
laboratory
immediately
SDGS
-
-
2-4
weeks
dependi
ng on
clinical
need
See FK506
-
-
-
CC
-
-
CC
RHH
-
CC
SAS centre
-
CC
SAS centre
-
CC
RHH
-
CC
RHH
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 160 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Thiopurine methyltransferase TPMT
Thiosulphate
Blood
Venous
Urine
Thrombophilia tests
Random
-
Thyroid antibodies
Blood
-
Venous
EDTA whole 2-5ml
blood
Plain
5ml
universal
-
S. Gel
Venous
Thyroid function tests TFT
Blood
Venous
Thyroid stimulating hormone TSH
Blood
Thyroid stimulating hormone TSH
Dried blood
spot
Li Hep
2ml
plasma
Venous
Li Hep
1ml
plasma
Dried blood Guthrie card
spot
Tiagabine
Blood
Venous
Tissue type
Venous
-
-
4 weeks
-
-
S. Gel
-
Blood
Blood
-
2ml
Thyroid binding globulin TBG
Tissue transglutamainse
-
2ml
S Gel
1-3
days
1-3
days
1-5
days
2ml
S. Gel
-
2ml
-
-
-
See coagulation
studies. Discuss
with consultant
haematologist
CC
GUY
CCM
-
H
RHH
-
CC
NGH
-
CC
NGH
TSH first line test
CC
-
CC
-
CC
Not offered as a
separate test
except for TSH
monitoring and for
needle-phobic
patients by
arrangement.
CC
-
CCFE
-
See HLA typing
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 161 of 168
CC
H
NGH
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Tobramycin
Specimen
type
Blood
Topiramate
Blood
Total iron binding capacity TIBC
Blood
Total thyroxine T4
Blood
Collection
type
Venous/
capillary
Venous /
Capillary
Venous /
capillary
Venous
Toxicology screen
Blood
Venous
Toxicology screen
Urine
Random
TPMT Pyrosequencing
Trace elements
Blood or
Venous
Buccal swabs
Blood
Venous/
capillary
-
Transcobalamin II assay
Blood
Venous
Plain
universal
5ml
Transferin
Blood
Venous
S. Gel
Total iron binding capacity TIBC
Blood
Venous /
capillary
Li Hep
plasma
TNF alpha
Tube
Volume TAT
S. Gel
1ml
-
Li hep/
S Gel
Li Hep
plasma
Li Hep
plasma
Li Hep
plasma
Plain
universal
EDTA
1ml
-
S Gel
Notes/Comments Lab to Referred to
send to
CC
NGH
-
CC
CCFE
-
CC
-
-
CC
RHH
-
CC
NGH
-
CC
NGH
0.5-5ml 4 weeks
-
SDGS
1ml
-
CC
PRU
See Cu, Zn, Se, Fe CC
NGH
2ml
4h
1ml
-
5ml
-
10ml
-
-
-
-
-
H
Discuss
2ml
Discuss Discuss with
consultant
haematologist
-
CC
NGH
2ml
4h
CC
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 162 of 168
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Total thyroxine T4
Blood
Venous
Toxicology screen
Blood
Venous
Toxicology screen
Urine
Random
TPMT Pyrosequencing
Trace elements
Transcobalamin II assay
Blood or
Venous
Buccal swabs
Blood
Venous/
capillary
Blood
Venous
Transferin
Blood
Transferrin IEF
Blood
TNF alpha
Transfusion reaction
-
Li Hep
plasma
Li Hep
plasma
Plain
universal
EDTA
-
CC
RHH
-
CC
NGH
-
CC
NGH
0.5-5ml 4 weeks
-
SDGS
S Gel
1ml
-
CC
Plain
universal
5ml
Venous
S. Gel
2ml
Venous
S. Gel
2ml
-
1ml
-
5ml
-
10ml
-
-
-
See Cu, Zn, Se, Fe CC
Discuss Discuss with
H
consultant
haematologist
CC
-
-
Transketolase
Blood
Venous
EDTA
5ml
Triglycerides
Blood
Venous /
capillary
Li Hep
plasma
0.5ml
-
-
4h
-
See detailed
section. Discuss
with consultant
haematologist
By arrangement
only. Store and
send frozen
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 163 of 168
CC
H
PRU
RHH
Discuss
NGH
NAT
-
CC
RDGH
CC
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Urine
Trimethylamine
Trimethylaminuria /Fish Odour Syndrome
(FMO3)
Blood
Triodothyronine T3
Troponin (High Sensitivity Troponin T)
Blood
-
Tryptase
Blood
Tumour markers
-
Tyrosine hydroxylase deficient doparesponsive dystonia (Segawa)
Blood
U/E
Blood
UKALL2003/UKALLR3 MRD TRIALS
Collection Tube
Volume TAT
Notes/Comments Lab to Referred to
type
send to
Random / 24 hr
10ml
4 weeks
CCM
24 hrs
collected into
10 ml 6M
HCL
Venous
EDTA
0.05-5ml 2-8
SDGS
weeks
Venous
/capillary
Venous
S. Gel
EDTA / S.
Gel
Venous
Venous
/capillary
Bone marrow -
-
0.5ml
-
See free T3
-
CC
CC
RHH
2ml
-
For allergy
disorders +mass
cell syndromes
See Alpha feto
protein + BHCG
-
CC
NGH
CC
NGH
-
-
EDTA
0.5-5ml 2-8
weeks
Li Hep
plasma
ACD
0.5ml
-
SDGS
-
See Na, K, Cl,
CC
Bicarb , Urea
2.5-10ml Depend Peripheral blood in SDGS
ant on ACD is acceptable
at diagnosis if the
time
WCC is >
point
20x10^9/l.
Research trials.
-
4h
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 164 of 168
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Uniparental disomy chromosome 7 / Russell Blood
Silver Syndrome
Urea
Blood
Urea
Urine
Urea Cycle Disorders (OTC, CPS1, NAGS,
ASL, ASS, ARG)
Uric acid
Blood
Blood
Uric acid
Urine
Urinary electrolytes
-
Venous
EDTA
Venous
/capillary
24hr
/random
Venous
Li Hep
plasma
Plain bottle/
universal
EDTA
Venous
/capillary
24hr
/random
-
Li Hep
plasma
Plain bottle/
universal
-
24 hr plain
bottle
Random
urine
Random
urine
Aliquot
10ml
-
Plain
universal
Plain
universal
1ml
4h
1ml
4h
Urinary free cortisol
Urine
Urine Amylase/creatinine
Urine
Urine Calcium/creatinine
Urine
Urine copper
Urine
Urine copper Wilson's disease
Urine
24 hr plain Aliquot
bottle
24hr basal
-
Urine copper Wilson's disease
Urine
2nd 24hr
-
0.5-5ml 2-8
weeks
0.5ml
4h
-
SDGS
-
-
CC
-
10ml
-
CC
-
0.5-5ml 2-8
weeks
0.5ml
4h
-
SDGS
-
-
CC
-
10ml
-
CC
-
CC
-
CC
SAS centre,
Leeds
-
4h
4h
-
10 ml
-
-
-
See sodium,
potassium
-
Ratio
CC
µmmol/creatinine
Ratio
CC
µmmol/creatinine.
On second urine
passed during day
CC
-
-
NGH
CC
NGH
2 12hrly doses of CC
penicillamine given
NGH
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 165 of 168
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Specimen
type
Urine
Collection Tube
type
24 hr plain Aliquot
bottle
Volume TAT
Urobilinogen
Vaccination responses (Bacterial, Hib,
Pneumococcus, Tetanus,Men C)
Valproate (Valproic acid)
Urine
Blood
Venous
S. Gel
2-4ml
-
Blood
Li Hep
1ml
-
-
CC
RHH
Vancomycin
Blood
S. Gel
1ml
-
-
CC
NGH
CCM
-
-
CCM
-
CCM
-
SDGS
-
Urine creatinine
-
10ml
Vanilyl Mandelic Acid
Urine
Venous
/capillary
Venous
/capillary
-
Very Long Chain Fatty Acids
Blood
Venous
Very Long Chain Fatty Acids
Fibroblasts
Very-long-chain-acyl-CoA dehydrogenase
(VLCAD) deficiency
Viral serology (e.g. Polio, Measles, Mumps,
Rubella, Varicella)
Vitamin A
Blood or
fibroblasts
Blood
Venous
Li Hep
1ml
plasma
(serum /
fluoride OK)
Culture
medium
EDTA
0.5-5ml
Venous
S. Gel
3-5ml
Blood
Venous
Li Hep
3ml
Vitamin Aand E
Blood
venous
Li Hep
3ml
-
-
-
4h
4 weeks
Notes/Comments Lab to Referred to
send to
For creatinine
CC
clearence Blood +
Complete Urine
collection. Include
child's weight &
height
See Bile pigments CCM
CC
NGH
See VMA
2
Refer to skin
months biopsies
2-8
weeks
Discuss with lab
-
CC
Protect from light CC
at all times
Protect from light CC
at all times
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 166 of 168
NGH
RDGH
RDGH
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Vitamin B1 thiamine
Blood
Venous
EDTA
5ml
-
Vitamin B12
Blood
Venous /
arterial
Plain
2ml
10 days
Vitamin C
Blood
Vitamin D
Blood
VKORC1 gene (Warfarin resistance)
Blood
VMA
Urine
-
-
-
-
Venous/Cap S. Gel/Li Hep 3ml
illary
Venous
EDTA
0.5-5ml 2-8
weeks
24hr
Bottle+10ml
5-14
HCL
days
von Willebrand Disease type 1- 3r molecular Blood
test
Venous
EDTA
0.5-5ml 2-8
weeks
von Willebrand Disease platelet type (GP1BA Blood
gene) molecular test
Venous
EDTA
0.5-5ml 2-8
weeks
Request
transketolase
-
CC
RDGH
CC
-
Contact lab prior to CC
collection
Protect from light CC
at all times
SDGS
-
RDGH
A random urine
CC
sample may be
accepted if urgent
but discuss with
Duty Biochemist
prior to sending For advice on
SDGS
Haematology
specialist
coagulation
assays/studies
please see page 57
For advice on
SDGS
Haematology
specialist
coagulation
assays/studies
please see page 57
-
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 167 of 168
SAS centre
-
-
-
CAEC Registration Identifier: 1043
Sheffield Children’s (NHS) Foundation Trust
Laboratory Handbook
Test
Warfarin resistance (VKORC1 gene) and
combined vitamin K clotting factor deficiency
type 2
WBC white cell count
Specimen
type
Blood
-
Collection Tube
type
Venous
EDTA
-
Volume TAT
0.5-5ml 2-8
weeks
-
-
Li Hep whole 3ml
blood
EDTA whole 5ml
blood
-
See FBC
H
-
White cell cystine
Blood
Venous
White cell enzymes
Blood
Venous
Wilms Tumour, Frasier syndrome, Denys
Drash syndrome, (Wilms Tumour
Suppressor) WT1 Gene sequencing and
MPLA
Wilson disease
Blood
Venous
EDTA
0.5-5ml 2-8
weeks
-
SDGS
-
Blood
Venous
EDTA
-
SDGS
-
Zinc
Blood
Venous
ZPP (Zinc protoporphyrin)
Blood
Venous
/capillary
Li Hep
plasma
EDTA
0.5-5ml 2-8
weeks
1ml
0.5ml
Send
away
Send
away
Notes/Comments Lab to Referred to
send to
SDGS
-
Please contact the CCM
duty biochemist
Please contact the CCM
duty biochemist
2ml if copper
CC
required
10 days Can perform along H
with FBC if 1ml total
QPulse Document Reference: 999-0018
Approved by: Prof J R Bonham
Author: Laboratory Handbook Group
Date of Issue: April 2016
Review date: March 2017
© SC(NHS)FT 2016.
Page 168 of 168
-
NGH
-