St Helens and Knowsley Teaching Hospitals
Pathology Services
Laboratory Handbook
2014
Version 14.01e
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Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
PATHOLOGY SERVICES
BLOOD SCIENCES
CLINICAL BIOCHEMISTRY / HAEMATOLOGY &
BLOOD TRANSFUSION DEPARTMENTS
ROUTINE SERVICE
24 HOURS PER DAY
For Results: Please check OCS or Telepath first
All enquiries*: (0151 430) 1822 or 1826
Automated System: When the automated system speaks:
press 2 for results, or 3 then 1 for Biochemistry or 3 then 2 for
Haematology
*FOR ALL TRANSFUSION REQUESTS 24 HOURS CONTACT
(0151 430) 1584
MICROBIOLOGY DEPARTMENT
ROUTINE SERVICE
Monday – Friday
8.00am – 8.00pm
Saturday / Sunday / Bank Holidays 9.00am – 5.00pm
All enquiries: Ext 1837(01514301837)
(Please notify Microbiology Laboratory staff of any urgent work sent)
For results please check Telepath, OCS (Order Comms
System) or ICE first
ON CALL EMERGENCY SERVICE
Monday – Friday
after
Saturday
after
Sunday/Bank Holidays after
Christmas day
after
8.00 pm
5.00 pm
5.00 pm
1.00pm
NB. the on call Biomedical Scientist (BMS) is on call from
home during the emergency service hours and must be
informed via switchboard (01514261600 or dial 0 from with the
Trust) of all urgent requests.
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Pathology Services
CONTENTS
PATHOLOGY SERVICES ......................................................................................... 2
CONTENTS ............................................................................................................... 3
1 SECTION ONE - GENERAL INFORMATION ....................................................... 10
1.1 CONTACT NUMBERS .................................................................................. 10
1.1.1 KEY PERSONNEL ................................................................................................. 10
1.1.2 DEPARTMENT NUMBERS ................................................................................... 11
1.2 ABOUT PATHOLOGY SERVICES................................................................ 11
1.3 PHLEBOTOMY SERVICES........................................................................... 12
1.3.1 HOSPITAL IN-PATIENTS ...................................................................................... 12
1.3.2 HOSPITAL OUT-PATIENTS .................................................................................. 12
1.3.3 GENERAL PRACTICE........................................................................................... 12
1.3.4 COMMUNITY PHLEBOTOMY SERVICE .............................................................. 12
1.4 GP COLLECTION/DELIVERY SERVICE ...................................................... 14
1.5 PATHOLOGY OPENING HOURS (ROUTINE WORK).................................. 14
1.5.1 NORMAL HOURS .................................................................................................. 14
1.5.2 LIMITED SERVICE ................................................................................................ 14
1.6 URGENT TESTS ........................................................................................... 14
1.6.1 DURING NORMAL WORKING HOURS................................................................ 14
1.6.2 OUT OF NORMAL WORKING HOURS ................................................................ 14
1.7 REQUESTING PATHOLOGY TESTS ........................................................... 15
1.7.1 MINIMUM REQUIREMENTS FOR ACCEPTANCE OF SAMPLES ...................... 15
1.7.2 REQUEST FORMS.............................................................................................. 16
1.8 SAMPLE COLLECTION................................................................................ 16
1.8.1 ADULT BLOODS ................................................................................................... 16
1.8.2 PAEDIATRIC BLOODS ....................................................................................... 17
1.8.3 OTHER SAMPLE CONTAINERS ........................................................................ 17
1.9 HIGH RISK SPECIMENS .............................................................................. 17
1.10 TRANSPORT TO THE LABORATORY....................................................... 17
1.10.1 PACKAGING ........................................................................................................ 17
1.10.2 TRANSPORT ....................................................................................................... 18
1.11 CYTOGENETIC SAMPLES ......................................................................... 18
1.12 ADD ON TESTS FOR SAMPLE ALREADY IN LABORATORY.................. 18
1.13 SPECIMENS FROM STAFF ........................................................................ 21
1.14 REPORT DELIVERIES TO WARDS ........................................................... 21
1.15 POINT OF CARE TESTING ........................................................................ 21
1.15.1 USE OF POCT .................................................................................................... 21
1.15.2 POCT COMMITTEE ............................................................................................ 22
1.15.3 SERVICES AVAILABLE ...................................................................................... 22
1.15.4 ADVICE ................................................................................................................ 22
1.16 REMOTE ENQUIRY FOR PATHOLOGY RESULTS – TELEPATH/OCS .... 22
1.16.1 REGISTRATION AND DATA PROTECTION ...................................................... 22
1.16.2 LOGIN .................................................................................................................. 23
1.16.3 TO FIND RESULTS ............................................................................................. 24
1.16.4 VIEWING MICROBIOLOGY RESULTS .............................................................. 24
1.16.5 TROUBLESHOOTING ......................................................................................... 25
1.17 ICE DESKTOP GP ORDER COMMUNICATIONS SOLUTION ................... 25
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Pathology Services
1.18 TELEPHONED RESULTS ........................................................................... 25
2 SECTION TWO – BIOCHEMISTRY (INCLUDING IMMUNOLOGY) ..................... 26
2.1
CONTACT NUMBERS (INCLUDING CLINICAL ADVICE) ........................ 26
2.1.1 DURING NORMAL WORKING HOURS.............................................................. 26
2.1.2 OUT OF NORMAL WORKING HOURS .............................................................. 26
2.1.3 TELEPHONED RESULTS ................................................................................... 26
2.2
ABOUT BIOCHEMISTRY ........................................................................... 26
2.3
REQUEST FORM AND SAMPLE ACCEPTANCE CRITERIA................. 26
2.4
COMPLEX BIOCHEMISTRY TESTS....................................................... 26
2.5
SPECIMEN REQUIREMENTS (CLICK TO VIEW ‘SPECIMEN
COLLECTION AND HANDLING’) ....................................................................... 27
2.5.1
2.5.2
2.5.3
2.5.4
2.5.5
BLOOD PROFILES.............................................................................................. 27
CSF ...................................................................................................................... 27
FLUIDS ................................................................................................................ 27
URINES ............................................................................................................... 27
SPURIOUS RESULTS DUE TO INAPPROPRIATE COLLECTION ................... 28
2.6
REFERENCE RANGES........................................................................... 28
2.7
SPECIFIC AREAS ................................................................................... 28
2.7.1 THERAPEUTIC DRUG MONITORING ............................................................... 28
2.7.2 TUMOUR MARKERS .......................................................................................... 28
2.7.3 GUIDELINES FOR REQUESTING THYROID FUNCTION TEST. CLICK HERE
28
2.7.4 GUIDELINES FOR REQUESTING LIVER FUNCTION TESTS.CLICK HERE ... 28
2.8
TURNAROUND TIMES FOR URGENT/ROUTINE/GP/OUTPATIENT..... 29
REQUESTS ......................................................................................................... 29
2.9
REFERRAL TESTS ................................................................................. 29
2.10
SPECIMEN INFORMATION .................................................................... 30
2.11
REFERRAL LABORATORIES ................................................................ 36
3
SECTION THREE - HAEMATOLOGY ..................................................... 43
3.1
CONTACT NUMBERS ............................................................................ 43
3.1.1 DURING NORMAL WORKING HOURS.............................................................. 43
3.1.2 OUT OF NORMAL WORKING HOURS .............................................................. 43
3.2
ROUTINE TESTS (CLICK TO VIEW ‘SPECIMEN COLLECTION AND
HANDLING’) ....................................................................................................... 43
3.2.1 FULL BLOOD COUNT ......................................................................................... 43
3.2.2 OTHER TESTS AVAILABLE USING THE SAME SPECIMEN ........................... 43
3.3
COAGULATION TESTS .......................................................................... 43
3.4
CONTROL OF ANTICOAGULANT THERAPY ....................................... 44
3.5
SPECIAL TESTS ..................................................................................... 44
3.6
HIGH RISK SPECIMENS ........................................................................ 45
3.7
HAEMATOLOGY REFERENCE RANGES .............................................. 45
RED CELL COUNT ................................................................................................. 45
HAEMOGLOBIN ..................................................................................................... 45
LEUCOCYTE COUNT ............................................................................................. 46
DIFFERENTIAL LEUCOCYTES COUNT ................................................................ 46
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3.8 SPECIMEN INFORMATION ......................................................................... 47
3.9
REFERRAL LABORATORIES ................................................................ 50
4
SECTION FOUR - BLOOD TRANSFUSION ........................................... 51
4.1.1
CONTACT NUMBERS ............................................................................ 51
4.1.2 DURING NORMAL WORKING HOURS.............................................................. 51
4.2
TRANSFUSION POLICY ......................................................................... 51
4.3
IMPORTANT FACTS FOR TRANSFUSIONS ......................................... 51
4.4
TRANSFUSION REQUESTS .................................................................. 51
4.4.1 REQUEST FORMS.............................................................................................. 51
4.4.2 SAMPLES (CLICK TO VIEW ‘SPECIMEN COLLECTION AND HANDLING’) .... 52
4.5
ROUTINE CROSSMATCHING ................................................................ 52
4.5.1 ROUTINE REQUESTS ........................................................................................ 52
4.5.2 SURGICAL REQUESTS (FAST ISSUE) ............................................................. 52
4.6
EMERGENCY CROSSMATCHING ......................................................... 52
4.6.1 RESPONSIBILITY ............................................................................................... 53
4.6.2 BLOOD SUPPLIED BY THE LABORATORY ...................................................... 53
4.6.3 EMERGENCY O NEGATIVE BLOOD ................................................................. 53
4.7
CONSERVATION OF BLOOD ................................................................ 53
4.7.1 GROUP AND SAVE............................................................................................. 53
4.7.2 UNUSED BLOOD ................................................................................................ 54
4.8
COLLECTION OF CROSSMATCHED BLOOD....................................... 54
4.8.1 LOCATION OF CROSS-MATCHED BLOOD ...................................................... 54
4.8.2 COLLECTION ...................................................................................................... 54
4.9
RETURN OF UNUSED BLOOD .............................................................. 54
4.9.1 WITHIN 30 MINUTES OF REMOVAL ................................................................. 54
4.9.2 MORE THAN 30 MINUTES AFTER REMOVAL ................................................. 54
4.10 ADMINISTRATION OF BLOOD TO A PATIENT INCLUDING SPECIAL
REQUIREMENTS FOR A PATIENT .................................................................... 54
4.11
TRANSFUSION REACTIONS ................................................................. 55
4.11.1 PROCEDURE ...................................................................................................... 55
4.11.2 NOTIFICATION.................................................................................................... 55
4.11.3 PLASMA PRODUCTS ......................................................................................... 55
4.11.4 FROZEN PLASMA............................................................................................... 56
4.11.5 PLATELET CONCENTRATES ............................................................................ 56
4.12
SAMPLE REQUIREMENTS .................................................................... 56
4.13
TRANSFUSION RECORDS .................................................................... 56
4.14
TRAINING IN TRANSFUSION ................................................................ 57
5
SECTION FIVE - MICROBIOLOGY ......................................................... 60
5.1
CONTACT NUMBERS ............................................................................ 60
5.1.1 DURING NORMAL WORKING HOURS.............................................................. 60
DR M S VARDHAN ......................................................................................................... 60
5.2
ABOUT MICROBIOLOGY ....................................................................... 60
5.3
ANTIBIOTIC PRESCRIBING ................................................................... 61
5.4
INFECTION PREVENTION AND CONTROL ADVICE ............................ 61
5.5
DIAGNOSTIC MICROBIOLOGY ............................................................. 61
5.6
MICROBIOLOGY SPECIMENS (CLICK TO VIEW ‘SPECIMEN
COLLECTION AND HANDLING’) ....................................................................... 61
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5.7
ANTIBIOTIC ASSAYS ............................................................................. 61
5.8
BLOOD CULTURES ............................................................................... 62
5.9
ASCITIC FLUID ....................................................................................... 63
5.10
A.S.O.T.................................................................................................... 63
5.11 CHLAMYDIA/ NEISSERIA NUCLEIC ACID AMPLIFICATION TEST
(NAAT) ................................................................................................................ 63
5.12
CSF ......................................................................................................... 63
5.13
FAECES .................................................................................................. 64
5.14
GENITAL TRACT SWABS ...................................................................... 64
5.17 PLEURAL FLUID ........................................................................................ 65
5.18
PUS ......................................................................................................... 65
5.19 SPUTUM ..................................................................................................... 65
5.20 SWABS ....................................................................................................... 65
5.21 ROUTINE SEROLOGY BROWN GEL TUBE, RED TOPPED EDTA
SAMPLE FOR PCR............................................................................................. 65
5.22 SEMEN ANALYSIS ..................................................................................... 66
5.22.1 POST-VASECTOMY SPECIMENS ..................................................................... 66
5.22.2 INFERTILITY SPECIMENS ................................................................................. 66
5.23 THREADWORM .......................................................................................... 66
5.24 TISSUE........................................................................................................ 67
5.25 URINE ......................................................................................................... 67
5.25.1 CSU...................................................................................................................... 67
5.25.2 MSSU ................................................................................................................... 67
5.25.3 TB CULTURE ...................................................................................................... 67
5.26 VIROLOGY/SEROLOGY............................................................................. 67
5.26.1 DETECTION OF VIRUS BY POLYMERASE CHAIN REACTION (PCR) ........... 68
5.26.2 DETECTION OF ANTIBODY E.G. IN BLOOD. ................................................... 68
5.27 TURN-AROUND TIMES FOR MICROBIOLOGY SPECIMENS ................... 68
5.27.1 MICROBIOLOGY PROCESSED AT WHISTON ................................................. 68
5.27.3 REFERRAL LABORATORIES ............................................................... 70
6
SECTION SIX - HISTOPATHOLOGY AND CYTOLOGY ........................ 72
6.1
CONTACT NUMBERS ............................................................................ 72
6.1.1 DURING NORMAL WORKING HOURS.............................................................. 72
6.1.2 OUT OF NORMAL WORKING HOURS .............................................................. 72
6.2
DEPARTMENTAL NORMAL WORKING HOURS................................... 72
6.3
HISTOPATHOLOGY SAMPLES (CLICK TO VIEW ‘SPECIMEN
COLLECTION AND HANDLING’) ....................................................................... 73
6.3.1 REQUESTS ......................................................................................................... 73
6.3.2 SPECIMEN FIXATION......................................................................................... 74
6.3.3 SUPPLIES ........................................................................................................... 74
6.3.4 FROZEN SECTIONS ........................................................................................... 74
6.3.5 IMMUNOFLUORESCENCE STUDIES................................................................ 74
6.3.6 PREGNANCY LOSS SPECIMENS AND NON-VIABLE FETUSES (UP TO END
OF 15 WEEKS GESTATION) ......................................................................................... 74
6.3.7 REVIEW OF ARCHIVAL MATERIAL ................................................................... 75
6.4
NON-GYNAE CYTOLOGY ...................................................................... 75
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Pathology Services
6.4.1 REQUESTS (CLICK TO VIEW ‘SPECIMEN COLLECTION AND HANDLING).. 75
6.4.2 ALL SPECIMENS MUST BE APPROPRIATELY IDENTIFIED AND
ACCOMPANIED BY A COMPLETED REQUEST FORM (SEE ABOVE). ..................... 75
6.4.3 FINE NEEDLE ASPIRATION CYTOLOGY ......................................................... 75
6.4.4 BODY FLUID CYTOLOGY .................................................................................. 75
6.4.5 URINE CYTOLOGY ............................................................................................. 75
6.4.6 SPUTUM CYTOLOGY ......................................................................................... 75
6.4.7 JOINT FLUIDS ..................................................................................................... 76
6.4.8 ENDOSCOPIC BRUSHINGS .............................................................................. 76
6.4.9 ENDOSCOPIC WASHINGS ................................................................................ 76
6.4.10 FNA ADEQUACY ASSESSMENT SERVICE ...................................................... 76
6.4.11 TURN AROUND TIMES FOR NON GYNAE CYTOLOGY .................................. 76
6.5
6.5.1
6.5.2
6.5.3
6.5.4
6.5.5
6.5.6
6.6
GYNAECOLOGICAL CYTOLOGY .......................................................... 76
SERVICE OVERVIEW ......................................................................................... 76
SAMPLES AND REQUEST FORMS ................................................................... 77
LBC CERVICAL SAMPLING/SMEAR TAKING AND TRANSPORT ................... 78
TURN AROUND TIMES FOR CERVICAL LBC SAMPLES ................................ 79
SUPPLIES ........................................................................................................... 79
CLINICAL ADVICE FOR CERVICAL CYTOLOGY ............................................. 79
POST MORTEMS .................................................................................... 79
6.6.1 CONTACT NUMBERS......................................................................................... 79
6.6.2 HOSPITAL POST MORTEMS ............................................................................. 79
6.6.3 CORONER’S POST MORTEMS ......................................................................... 79
6.7
REFERRAL LABORATORIES ................................................................ 80
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Pathology Services
Introduction
Welcome to the 2014 edition of the Laboratory Handbook issued by St Helens
and Knowsley Teaching Hospitals NHS Trust Pathology Services.
We hope that you will find this information useful, however if there is anything
that needs clarification, please do not hesitate to contact the department
concerned.
Modern Laboratory Medicine is subject to continual improvement and this
document will require regular revision. However, due to the difficulties in
constantly updating printed versions, the electronic version available on the
intranet will be the most up to date. Major changes in policies and procedures
occurring between reprints will also be notified through the Trust Team Brief
and global e mail system and to Primary Care as appropriate.
Duplicate requesting: Pathology requests have increased year on year.
Audits have shown that there are numerous unnecessary duplicate requests
received (FBC, LFT, Troponin, TFT etc) from both inpatients and primary care
contributing to this rise. Before requesting any test ensure that it has not
already been done by enquiring in the Laboratory Information Systems (LIMS)
/ Telepath or in the patients notes, also ensure all tests requested are to
answer a specific question and are of immediate value to the patient, ‘routine’
or ‘daily’ FBC, UE, LFT etc on a stable patient are of no value. Unnecessary
duplicate requesting results in a decrease turnaround time for other patient
samples and are a waste of resources for all members of staff including that of
the patient.
The Biochemistry and Haematology Departments contain guidelines on retest
intervals for some of the more common tests and each laboratory can be
contacted for a copy of these. Alternatively individual patients can be
discussed by contacting a member of the clinical staff.
We extend our thanks to the clinical staff who assisted in the production of this
edition by reading the draft version and offering suggestions for improvement.
We hope that you, as users of our service, will help us to ensure that the
services we provide, and this document describing them, will continue to meet
your needs by informing us of any changes that would help us to improve the
care we give to our patients.
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Laboratory Handbook
SITE MAP OF WHISTON HOSPITAL
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1 SECTION ONE - GENERAL INFORMATION
1.1 CONTACT NUMBERS
1.1.1 Key Personnel
Clinical Director/Consultant
Chemical Pathologist:
Dr. M.A.J. Al-Jubouri
0151-430-1833
Pathology Manager:
Mr. C. Westcott
0151-290-4122
Admin. Manager/
PA to Clinical Director &
Pathology Manager:
Mrs B. Taylor
0151-430-1831
Clinical Biochemist:
Biochemistry Service Manager:
Contact for Immunology:
Dr. L Hassall
0151-290-4141
Mr. D. Ames
0151-430-2180
Dr. A Rowbottom
(Contact either Dr Al-Jubourior Dr Hassall)
Consultant Microbiologists:
Dr. K.D. Allen
Dr. M.S. Vardhan
Dr. K. Mortimer
Mr.K. McLachlan
Secretary
0151-430-1834
0151-430-1836
0151-430-1622
0151-290-4140
0151-290-4123
Dr. N. Hasan
Dr. S. A. Kelly
Dr. M. Pinto
Dr. L. Forsyth
Dr. N Sharma
Dr. D Barker
Mr. D. Walsh
Mr. I. Young
Secretaries
Ms S. Montgomery
0151-430-1190
0151-430-1839
0151-430-1731
0151-430-1835
0151-430-2759
0151-430-1620
0151-290-4319
0151-430-1916
0151-430-1824
0151-430-1816
Consultant Haematologists:
Dr. J.A.T. Nicholson
Dr. M. Gharib
Dr. J. A. Tappin
0151-430-2366
0151-430-1315
0151-430-1825
Haem/Trans Service Manager:
Mr. D. Nixon
Secretaries
0151-430-1886
0151-430-1825
Chief Phlebotomist:
Mrs. D Lamb
0151-290-4318
Microbiology Service Manager:
Consultant Histopathologists:
Cell Path Service Manager:
Assistant Manager:
Consultant BMS Cervical:
Cytology (clinical advice)
Blood Room Whiston Hospital:
Blood Room St Helens Hospital:
0151-430-1947
01744-646-080
I.T. Co-ordinator:
Mr. A. Powell
0151-430-2365
Pathology Quality Manager:
Mr. S. Beckett
0151-290-4215
Hospital Based Cytology
Co-ordinator:
Mrs. M. Middleton
0151-430-1770
Transfusion Co-ordinator:
Miss H. Buchanan
0151-290-4214
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Pathology Services
Point of Care Testing
Co-ordinator:
Mrs. S. Roberts
0151-290-4317
Mortuary:
Mr. S. Pimblett
0151-430-1954
1.1.2 Department Numbers
General Enquiries
Fax number
Biochemistry
Haematology
Coagulation
Transfusion
St Helens Laboratory (Haematology)
Cytology
Microbiology Specialist Trainees
Microbiology
Histopathology
Specialist Registrar Histology
Mortuary
0151-430-1826/1305
0151-430-1823
0151-430-1832
0151-430-1838
0151-430-1830
0151-430-1584
01744- 646079
0151-430-1770
0151-430-2367/2459/7505
0151-430-1837
0151-430-1828
0151-290-4124
0151-430-1954 (fax 1290)
Please note:
Calls from within Whiston or St Helens Hospitals. Dial only the last 4 digits
for numbers prefixed with 430 or 290, and dial only the extension number for
those prefixed with the main hospital switchboard number of 426 1600.
Calls from external lines.Numbers prefixed with 430 or 290 are direct lines,
those prefixed with the main hospital switchboard number of 426 1600 will need
to be put through to the extension number by the operator.
1.2 ABOUT PATHOLOGY SERVICES
The Pathology Laboratory at Whiston Hospital is located in Nightingale House.
See the Site Map on page 9
Each year Whiston Laboratory performs over 4.5 million tests which are dealt
with by medical, scientific, clerical and support staff in 6 departments:
Biochemistry
Microbiology
Haematology
Histopathology
Transfusion
Cytology
Each department provides an up to date comprehensive range of diagnostic
tests detailed in this handbook. The laboratory provides an efficient, high
quality, cost effective, clinically based diagnostic service.
We participate in both national (external) and internal quality control schemes,
with consistently high performance. All departments have full accreditation by
Clinical Pathology Accreditation (UK) Ltd, by peer reviewed assessment of the
quality of our service.
In addition to the main departments, Point of Care Testing (POCT) covering
laboratory tests undertaken within the acute Trust but outside the laboratory
area, are under the direction of a Pathology based BMS POCT Co-ordinator.
See section 1.4 for further information.
We also have a small laboratory facility at St Helens staffed Monday to Friday
mornings providing urgent Haematology and Coagulation tests for the hospital.
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The laboratories provide training for junior medical staff, Biomedical Scientists
(BMS) and medical students. Medical and BMS staff actively participate in
research and development, both internally and in conjunction with hospital
colleagues. Pathology staff are all actively involved in audit in order to improve
the quality of the service provided.
We value any comments from the users of our services as this will help us to
monitor and improve the service we offer.
1.3 PHLEBOTOMY SERVICES
1.3.1 Hospital In-patients
Phlebotomy services are provided for hospital in-patients daily in the morning at
Whiston, and Monday to Friday mornings at St. Helens Hospital.
1.3.2 Hospital Out-patients
Services for hospital out patients are provided on both sites.
Opening hours for Hospital Clinic Patients Only
Whiston
8:30 am–5:00 pm Mon – Thurs, Fri 8.30 am–4.30 pm.
No service at weekends.
St Helens
8.00 am – 5.00 pm weekdays
No service at weekends
Newton Community (OPD)
Mon – Fri 8.30 am – 11:15 am
1.3.3 General Practice
Direct access to General Practice is restricted within the times above to those
days that generally have a lighter clinic attendance. Please refer to current
opening hours as per latest memo, which are designed to reduce patient waiting
times. We are able to offer a limited booked service for patients requiring a
Glucose Tolerance Test, and anticipate that this service will also be offered
within Primary Care.
1.3.4 Community Phlebotomy Service
For information on the existing phlebotomy community sessions please refer to
the table below for the following available services:Halton& St Helens CCG
Knowsley CCG
Whiston Community
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Whiston Community Phlebotomy Service
Fri
Type of
Service
Patients
per
Session
8:30am
11:30am
By Appt
40
7.00am9.00am
7.00am9.00am
walk In
25-30
8:30am
11:30am
8:30am
11:30am
By Appt
30
8:30am
11:30am
8:30am
11:30am
walk In
40
8:30am 11:30am
8:30am
11:30am
Walk In
40
10:00am 12:00pm
8:45am
9:30am
By Appt
25
8:30am
11:30am
Walk In
40
10:00am
11:00am
By Appt
18
Alternative
Wed
8:45am 9:30am
By Appt
12
Alternative
Wed
8:45am 9:30am
By Appt
12 - 15
8.30am11.30am
Walk In
40-50
Phlebotomy Clinics
Mon
Tues
Peelhouse Lane Plaza (own patients only)
1, PeelhouseLane,Widnes WA8 6TN
Tel: 0151 424 6221
Widnes HCRC ( NO Anti-coag)
oaks Place, Caldwell Road, Widnes WA8
7GD
Tel 0151-495-5000
Widnes HCRC A.CoagWalkin Tue 8:30 -
8:30am
11:30am
8:30am
11:30am
7.00am9.00am
7.00am9.00am
7.00am9.00am
10:30am
8:30am
11:30am
10:30am
11:30am
8:30am 11:30am
8:30am
11:30am
8:30am
11:30am
Oaks Place, Caldwell Road, Widnes WA8
7GD
Tel: 0151-495-5000
Rainhill Clinic
View Road, Prescot L35 0LE
Tel: 0151 289 2021
Bowery Health Centre
Elephant Lane
St Helens WA9 5PR 01744-816831
Haydock Health Centre
Station Road, Haydock, WA11 0JN
Tel: 0844 477 6826
Whiston Health Centre
Old Colliery Road, Whiston,L35 35X
Tel:
Patterdale Lodge Medical Centre
Leigh Street, Newton Le Willows WA12 9NE
Tel: 01925 227111
Dr Lowe Clay Lane
1a Clay Lane, Burtonwood, Warrington WA5
4HH
Tel: 01925 223254
Dr Lowe High Street
87 High Street, Newton Le Willows, WA12
9SL
Tel:01925 290311
Newton Cottage Hospital (Clinic)
Bradlegh road, newton le willows
0151 290 4834/4780
Knowsley Medical Centre
Frederick Lunt Avenue, Knowsley
Tel:0151-546 3458
Gresford Medical Centre
Pilch Lane
Tel:0151 489 2020
Beaconsfield Primary Care Centre
Bevan Way, Widnes
Tel; 0151-424-3986
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Laboratory Handbook
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Pathology Services
1.4 GP COLLECTION/DELIVERY SERVICE
Practices using our services have a specimen collection and a printed report
delivery each weekday. Blood test and microbiology reports are transmitted
electronically at 6.30 am, 12 noon and thereafter every half hour until 6.30 pm.
Cervical cytology reports are sent electronically to all practices on request.
Histopathology reports are not transmitted electronically.If you would like to stop
receiving
paper
reports
in
your
surgery
then
please
contactpathology.support@sthk.nhs.uk
1.5 PATHOLOGY OPENING HOURS (ROUTINE WORK)
1.5.1 Normal hours
Monday-Friday
9.00 am - 5.30 pm
1.5.2 Limited Service
Please see page 2 for details of limited service times.
1.6 URGENT TESTS
1.6.1 During Normal Working Hours
These must be clearly marked "URGENT" on the request form and given to a
receptionist at the laboratory reception. Unusual or exceptional requests are
facilitated by telephone discussion with the appropriate laboratory staff.
Urgent requests for Crossmatchingblood,must be telephoned to 1584 and
samples delivered straight to the Transfusion department for checking.
Microbiologyshould be contacted for all urgent requests for urine microscopy
and CSFs ext 1652
ACCESS TO PATHOLOGY RESULTS
Results of completed and authorised tests are available via ward terminals,
within the acute Trust and via ICE within the community, telephone enquires for
results will not be accepted from these departments. The method to obtain
results is outlined in section 1.15.
1.6.2 Out of Normal Working Hours
Please use this service sensibly. If it is abused there will be delays in the
reporting of truly urgent results. Outside of routine hours a reduced level of
staffing will be on duty but will continue carrying out all routine and emergency
work for Biochemistry and Haematology/Blood Transfusion and Microbiology.
Please remember a request for Microbiology test out of hours will continue to
be requested through Switchboard (see page 2 for details).
When sending requests for Biochemistry or Haematology you will only need to
contact the laboratory if the request is very urgent. All urgent and routine work
will still be processed without the requirement to contact Pathology
Where a request is clinically very urgent and is required as soon as possible, a
call to the Pathology Hotline is required and “URGENT” appropriately identified
on the form.
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Pathology Hotline Ext 1826(0151-430-1826)
The Pathology Hotline is available 24 hours a day 7 days a week.
If an Emergency Cross-Match is required you MUST contact the Blood
Transfusion Department directly
Transfusion Hotline Ext 1584 (0151-430-1584)
The Transfusion Hotline is available 24 hours a day 7 days a week.
Full cross match 45 mins, Emergency cross match 30 mins, Uncross matched
15 mins. Electronic Issue 5 minutes– times are dependant on complexity and
volume of workload.
1.7 REQUESTING PATHOLOGY TESTS
1.7.1 Minimum Requirements for Acceptance of Samples
In the interests of patient safety and compliance with Clinical Governance there
is a separate policy, available on the intranet, for the minimum criteria for
request form and sample acceptance. This is designed to ensure that each
patient is positively identified before collection of the sample and that results are
provided for the right patient in a timely manner.
Handwrittenrequest forms must be completed with at least three identifiers, as
follows:
Full Name
and Date of Birth
and NHS number/Hospital number/A&E number/Address
The name of Consultant, location for report, signature of requestor and tests
required must also be indicated. It is essential to include relevant clinical details
for the correct interpretation of results and to perform further tests based on the
results. For Microbiology requests, details of current or recent antimicrobial
treatment must also be provided.
Handwrittensamples must be completed with two of the same patient
identifiers as on the request form as follows:
and
Full Name
Date of Birth
In addition the date and time of sample collection should be included.
Samples received in Pathology can be;
 Handwritten
 Order Comms System (hospital) labelled with an ID label produced via
system
 Sunquest ICE Order Communications labelled with an ID label
produced via system for GP and community only,
 Blood track labels produced directly from the wristband
 Emergency Department blood tube label
Sample labelling must comply with the following;
 Contain a minimum of three of the identifiers present on the request
form. Except for Transfusion requests, two identifiers are acceptable for
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

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handwritten tubes if space is restricted. Transfusion must have a
minimum of three identifiers.
All labelling must be done at the patients side
Addressograph labels are NOT acceptable on blood tubes.
Blood Transfusion- only handwritten or blood track produced
labels are acceptable on blood transfusion samples
Request forms




Date and time of sample collection. This is a requirement for
Pathology and provides important information around sample quality.
Addressograph labels can be used for request forms.
Please affix identification labels to all layers of the forms.
Transfusion forms must be signed by the Medical Officer or authorised
Midwife/Nurse who has received specific training in transfusion.
Pathology staff are unable to accept inadequately completed forms or
samples for testing. It is rare but on occasions we do not process such
samples which results in a delay to the patient’s treatment or the patient
needing to provide another sample.
1.7.2
Request Forms
These are colour coded according to the department performing the test
BIOCHEMISTRY
HAEMATOLOGY
Combined request form
TRANSFUSION
MICROBIOLOGY/VIROLOGY
HISTOPATHOLOGY
(including non-gynae Cytology)
GREEN SECTION
RED SECTION
RED
BLUE
WHITE
Request forms for General Practitioner use are combined
BIOCHEMISTRY, HAEMATOLOGY AND MICROBIOLOGY for handwritten
requests with sections colour coded as above or an A4 ICE generic pathology
request form can be used. GYNAECOLOGICAL (cervical LBC) requests can be
made using the HMR101 green form for handwritten requests or an A4 ICE
generic pathology request form can be used.
1.8 SAMPLE COLLECTION
Always ensure that the specimen is placed in the correct container and clearly
labelled. See the appropriate department sections for lists of containers to be
used for the various tests. When in doubt, contact the laboratory for advice or
view using the Intranet.
1.8.1 Adult Bloods
SARSTEDT BLOOD COLLECTION SYSTEM
Code
Colour
Volume
Main use
B5
Brown
4.9 ml
Y5
K3
Yellow
Pink
4.9 ml
3.0 ml
Biochemistry/Viral
Serology/Microbiology
Biochemistry
Haematology/Biochemistry (BNP)
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G3
G9
R8
05
1.8.2
Green
Green
Red
Orange
Pathology Services
3.0 ml
10.0 ml
7.5 ml
5.5 ml
Coagulation
Accurate fill
Coagulation special
essential
Transfusion (Viral/ Micro PCR tests)
Biochemistry special
Paediatric Bloods
Smaller volume colour coded bottles as above are supplied for paediatric use.
Please use separate yellow blood bottles when requesting glucose. Paediatric
bottles must not be used routinely for adult samples.
PLEASE NOTE: transfusion will accept a paediatric 2.7ml EDTA red top
sample with a minimum volume of 1ml of blood
1.8.3
Other Sample Containers
Containers
Common name
Main use
30 ml clear plastic sterile
Universal
CSF, Urine BJP, Urine
Amino Acids, Organic Acids
Cytology and microbiology
Body Fluids e.g. pus, joint
fluids
For all other Biochemistry
Urine and fluid tests
10 ml Urine Monovette Tube Yellow urine tube
10 ml boric acid Green Monovette
30ml or 60 ml clear plastic sterile
30 ml blue/brown top
Urine Pot
Urine Microbiology tests
Sputum pot Sputum
Faeces container
Faeces
1.9 HIGH RISK SPECIMENS
These include all specimens from patients with known or suspected carriage of
Hepatitis A, B,C or HIV. It also includes sputum specimens from patients with
known or suspected pulmonary tuberculosis and cerebrospinal fluid (CSF) from
patients with confirmed or suspected Creutzfeldt Jacob disease (CJD),
specimens from suspected anthrax cases, suspected viral haemorrhagic fevers.
USE OF THE AIRTUBE IS COUNTER-INDICATED FOR THESE SPECIMENS.
To help identify these samples to pathology staff MUST affix "DANGER OF
INFECTION" stickers on both the request form (all layers) and the specimen.
Stickers must be used for every request and on all specimens from high risk
patients.
1.10 TRANSPORT TO THE LABORATORY
1.10.1 Packaging
All samples e.g. blood, faeces, urine, swabs etc are potential infection hazards.
Always ensure that the sample container is tightly sealed to avoid leakage in
transit. Place the container in the plastic bag attached to the request form and
seal the bag carefully. This will ensure that in the event of breakage or spillage
the infection risk to staff is minimised. Never place the request form in the
plastic bag with the sample.
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1.10.2
Pathology Services
Transport
Samples should normally be transported to the laboratory without delay, unless
it is appropriate to store them in a safe manner. Urine samples for culture, for
example, should be stored in a refrigerator if there is a delay in transport.
All Histology and Cytology samples from St Helens DTC are transported to
Pathology in either a small grey/blue transport bag (clinics) or a large green
transport bag (theatres). The specimen books must also be sent with the
samples.
Specimens may be transported to the laboratory using the pneumatic tube
system (Air tube). Please refer to the Trust Policy – ‘Air Tube System’ for
information relating to the appropriate use of this system in respect to samples.
Please ensure you have trained to use the Air Tube prior to use. Blood culture
bottles must only be transported in the air tube when enclosed in the
appropriate carrier.
The following samples MUST NOT be transported via the air tube system:








CSF samples, Samples from patients with Rural African Risks (Viral
haemorrhagic fever), suspected CJD, Anthrax or multi drug resistant
TB.
Transfusion blood and blood products
Clinical waste, including empty blood bags
Any Histology samples in formalin.
Frozen sections for Histology
Cytology samples.
Items over 1.0 Kg (if in doubt, do not send) o
Flammable substances
Any sharps
Please see individual department information for details of special transport
requirements such as samples to be sent on ice.
1.11 CYTOGENETIC SAMPLES
DO NOT PLACE IN FORMALIN
TISSUE FOR CYTOGENETIC STUDIES MUST BE PLACED INTO
TRANSPORT
MEDIUM
SUPPLIED
BY
CYTOGENETICS
DEPT
IMMEDIATELY, OR PLACED IN A STERILE UNIVERSAL AND STORED IN A
REFRIGERATOR.
The Histopathology Department does not process these samples but they will
be delivered to the Liverpool Women’s Hospital via hospital transport daily at
midday Specimens must be delivered to Pathology specimen reception in the
morning, Monday to Friday, where a signature will be obtained.
DO NOT LEAVE AT SPECIMEN RECEPTION WITHOUT ALERTING A
MEMBER OF STAFF.
1.12 ADD ON TESTS FOR SAMPLE ALREADY IN LABORATORY
Please do not ring the laboratory to request further tests – send additional
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request form stating that sample has already been sent. Note for Biochemistry
Department, specimens are kept for a minimum of 48 hours after final report has
been issued by the laboratory.
Samples for Haematology are kept for a
minimum of 24 hours after final report has been issued by the laboratory.
Serology samples are stored for 2 years, contact serology staff on ext. 1695 for
any additional requests. A request form is required for add on requests for HIV.
For guidelines for sample stability, please refer to the tables below:-
Guide to Add-On Test Stability (for samples already centrifuged)
Note: Table 1 below is a guide to the maximum sample age for which “add-on” test requests
can safely be accepted without prior discussion with a senior member of staff (Louise Hassall
Clinical Biochemist Ext. 4141 or Consultant Pathologist Dr Al Jubouri Ext.1822) and will not
present a risk to the patient. Clinical circumstances may arise where tests may be added-on
outside these limits, but only after discussion with a senior member of staff. Any test not
included in table 1 below must be approved by a senior member of staff before analysis. For
Chemistry tests the stability data quoted assumes that samples were promptly centrifuged
after collection and have been stored refrigerated.
Table 1: Biochemistry
Tests
Maximum age of samples for analysis
Tubes with gel (brown top)
Amylase
4 days
AST
4 days
Bicarbonate
1 hour
Calcium
4 days
CK
4 days
Cortisol
2 days
CRP
7 days
Ferritin
2 days
Glucose
2 days (yellow top only)
HbA1c
5 days (yellow top only)
HCG
2 days
Iron
7 days
LDH
4 days
LFT
1 day (bilirubin most unstable)
Lipids
2 days (HDL most unstable)
Magnesium
4 days
Paracetamol
7 days
Phosphate
4 days
PSA
2 days
Salicylate
2 days
TSH
5 days
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Troponin I
12 hours
U&E
3 days
+
U&E (without K )
4 days
Vitamin B12/Folate
1 day
Zinc
2 days
Table 2: Immunology
Tests
Allergy testing
Auto Antibody Screening/ANCA
Immunology specialist assays
ATTG
Maximum age of samples for analysis
7 days
7 days
Discuss directly with laboratory technical
staff
7 days
Additional Biochemistry information for Clinical Biochemist reference ONLY
Test
Maximum age of samples for add-ons
Tubes with gel (brown top)
17-OHP
ACTH
AFP
Albumin
Aldosterone
Alkaline phosphatase
ALPisoenzymes
Alpha-1- acid
glycoprotein
1
Alpha 1-antitrypsin
ALT
Amylase
Androstenedione
Bicarbonate
Bile acids
Bilirubin
BNP
C3/C4
CA-125
CA-153
Carbamazepine
CEA
Cholesterol (total)
Chloride
C-peptide
DHEAS
Digoxin
Down’s Syndrome screen
Ferritin
FSH
FT3/FT4
Gastrin
GGT
Growth hormone
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4 days
Must be separated immediatelyupon receipt and frozen
3 days
6 days
7 days
4 days
7 days
4 days
7 days
4 days
4 days
1 day
1 hour
7 days
1 day
8 hours
4 days
2 days
2 days
7 days
2 days
4 days
1 day
Must be separated immediatelyupon receipt and frozen
1 day
7 days
6 days
2 days
7 days
5 days
1 day
4 days
1 day
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Haptoglobin
HbA1c
HDL
IBC
IGF-1
Immunoglobulins
Insulin
Iron
LDH
LDL
LH
Lithium
Oestradiol
NTD Screen
Osmolality
P1NP
Progesterone
Prolactin
PSA
PTH (EDTA sample)
Renin
SHBG
Testosterone
Theophylline
Transferrin
UIBC
Total protein
Triglycerides
Urate
Vitamin D
Pathology Services
7 days
5 days
2 days
7 days
Must be separated immediately upon receiptand frozen
7 days
Must be separated immediately upon receiptand frozen
7 days
4 days
2 days
3 days
1 day
2 days
6 days
1 day
5 days
2 days
2 days
2 days
24 hours (room temp), if refrigerated stable for 72hrs
Must be separated immediatelyupon receipt and frozen
3 days
1 day
7 days
7 days
7 days
6 days
3 days
7 days
2 days
1.13 SPECIMENS FROM STAFF
These must be sent via the GP or Health Work and Well Being, so that a doctor
can be readily contacted with the results. Members of staff must not view their
own test results.
1.14 REPORT DELIVERIES TO WARDS
WHISTON HOSPITAL. There is one delivery of reports to the wards every day
(Monday – Friday) leaving the laboratory at 14:00hrs .
ST. HELENS HOSPITAL. Reports are delivered to the wards at 11.30 am and
4.30 pm (Monday-Friday) and 12 noon on Saturday.
1.15 POINT OF CARE TESTING
1.15.1 Use of POCT
To ensure that POCT is performed to the highest possible standards and meets
Clinical Governance objectives the Trust has a policy on POCT that can be
accessed via the intranet. Members of the Community who require site of this
document, please contact:pathology.support@sthk.nhs.uk
Some investigations on patient samples need to be performed near the patient,
Point of Care Testing (POCT) or Near Patient Testing (NPT), because of the
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urgency of the clinical situation. In some cases POCT is used as a screening
method to reduce the need for, and cost of, further testing, for example urine
samples that show no abnormalities on dipstick testing should not be sent for
culture. In both cases clinical decisions about patient management are made on
the basis of the results of such investigations, and it is vital that confidence can
be placed on the results obtained and that risks to patients of inaccurate results
are minimised.
1.15.2 POCT Committee
The Trust has a POCT Committee which is responsible for the assessment of
compliance of point of care testing with current best practice. The committee is
chaired by the POCT Co-ordinator and comprises other Pathology staff,
Cardiorespiratory staff, and key representatives from clinical staff who regularly
use this equipment.
The purchasing of equipment intended for point of care testing must only be
done so following recommendation by the Point of Care Committee.
1.15.3 Services Available
The following POCT services are currently available within the trust.







Blood Gas/Electrolytes/Co-oximetry
Blood Glucose
Urinalysis
Pregnancy Testing
HbA1c
Haemoglobin (theatres only)
AntiCoagulation
No member of staff is to use any of this equipment until they have received
adequate and recorded training, and refresher training as necessary. This is to
comply with the Medical Devices Training Policy as well as the policy for POCT.
In addition, some of this equipment is password protected, STAFF MUST NOT
SHARE PASSWORDS.
1.15.4 Advice
For advice about existing POCT services or introduction of new devices please
contact the POCT Co-ordinator on Ext. 4317. From outside the Hospital 0151
290 4317.
1.16 REMOTE ENQUIRY FOR PATHOLOGY RESULTS – TELEPATH/OCS
Results of authorised completed samples will not be given out over the
telephone. It is the ward’s responsibility to ensure that it has adequate staff
coverage who are able to access the pathology computer (Telepath) or OCS 24
hours a day.
1.16.1 Registration and data protection
Only staff who require access to results as part of their role are entitled to
register. To register staff on the pathology computer, an application form must
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be completed by the individual, signed by the ward manager, and sent to the
Path Admin Team. Staff are reminded that they must not view results for
patients unless they are involved in the care of that patient.
If you need a Tpath (Telepath) Application Form or have forgotten your Tpath
password, please contact the Path Admin Team quoting your USERID
[username] and ask for your password to be reset, preferably by emailpathology.support@sthk.nhs.uk or by Telephone 1484 / 1662.
1.16.2 Login
After initial login use the following format for future logins to Telepath system.
From login : enter <tpath><return>
From User ID : enter <user I.D.><return>
From Password : enter individual password ( ****** ) <return>
This will allow you access to the Remote Enquiry section only of the
Pathology Computer system. Only authorised results from Biochemistry,
Haematology and Microbiology will be available.
Type
1 <RETURN> for patient enquiry.
2 <RETURN> to change password.
3 <RETURN> for Laboratory help index (Opening hours, Infection
Control Quiz).
From the main menu type in the number of the option that you require then
press the <RETURN> key. e.g. Option 1 WHO Patient enquiry selecting this
option will display the following screen:
If at any stage you require help enter ?for hints and tips.
Patient Enquiry
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1.16.3 To find results
There are 3 different ways to search the patient database
1. Hospital No.
If given to the
asked for the
these in then
recalled. If no
next stage.
Laboratory please use, you will also be
first two letters of the surname. Type
press return, the patient will then be
patient is found press <Esc>. Move to
2. DOB / Age
Type in the Hospital No. field the letter ‘K’ and press
<RETURN> Type in the date of birth the format is
<ddmmyy> e.g. 301068, there is no need to type in
hyphens or spaces between the numbers. If born
before 1910 use a minus sign between day, month and
year e.g. 10-01-05, for a patient born in 1905, then
press <RETURN>
3. Surname
Type in 'U' for Unknown in the Hospital No. field, press
<RETURN> Once you use the U search care must be
taken that you spell the patient name as supplied to
Pathology. If the name is likely to have been mis-spelt
use only the first few letters. NB Double barrelled
surnames enter the first surname only press
<RETURN>.
Forename
Use the first few letters of the forename for speed.
Sex M/F/U/P
Pathology system has four sexes Male, Female,
Unknown and Pregnant. Leave blank if in doubt. Press
<RETURN> to bypass. (Generally better to leave
blank).
DOB/AGE
NHS NO
Press <RETURN> to bypass
Type ‘K’ at the Hospital No field and press <RETURN>
This action will evoke the secondary key search
function.
Press <RETURN> then enter your Patients NHS No.
1.16.4 Viewing Microbiology Results
Only completed reports that have been authorised by the microbiology medical
staff are available to view.
If the message 'You are not permitted to view this report' is displayed then
this generally means that the report is still in progress and not yet finished with.
Occasionally if there are several comments on the report they may disappear off
the bottom of the screen. To view these comments press the + key then press
<RETURN>, this will move the report up the screen revealing the comments
that were below the bottom of the screen, press the - (minus key) then
<RETURN> to move the screen back up. Similarly if there are several
organisms isolated the antibiotic table data may disappear past the right hand
side of the screen. To see the missing data move the report to the right by
pressing the > sign and then <RETURN> then press < and <RETURN> to move
it back to the left.
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In summary – (+ Plus & - minus keys) enable you to move the report up and
down on the screen (< less than &> greater keys) enable you to move the report
from left to right.
1.16.5 Troubleshooting
Stuck in a loop in
<EARLIEST> fields
<LATEST>
Solution
Press the Shift + 6 keys together to give the “^” character then
press the <RETURN> KEY
If you require further assistance using the Pathology System please e-mail any
of the following people in the Laboratory: Alan Powell, Chris Westcott or
Barbara Taylor.
If you are unable to locate the Pathology System Icon or unable to connect to
the Pathology System on the PC you are using then you will need to contact the
IT Department Helpdesk on Extension 1172.
1.17 ICE DESKTOP GP ORDER COMMUNICATIONS SOLUTION
The GP Order Communications ICE System integrates with your GP Clinical
Systems. Staff at the Surgery now has the ability to generate an electronic
request which the Laboratory can process once in receipt of the specimen.
You can view and print your Patient reports or “download” reports directly into
your GP Clinical System.
This functionality is in addition to GP reporting system which is provided by the
Laboratory to distribute an electronic report directly into your GP Clinical System
from your referral.
The IT Training Team have produced a number of training documents based on
the GP clinical provider and version of the system you use. You can click on the
following links below to access your relevant training document.
Label Trace
On Line Test Requesting for Torex Premiere Synergy
On Line Test Requesting for EMIS LV
On Line Test Requesting for EMIS PCS
On Line Test Requesting for VISION
1.18 TELEPHONED RESULTS
There is a separate policy available on the intranet that details the requirements
for telephoned results. Due to the risk of transcription errors, telephoned results
are kept to a minimum. Results that fall outside limits set by the Consultant
Pathologists in each discipline will be telephoned and ACTION must be taken to
ensure patient safety. ALL telephoned results must be entered into the patient’s
notes, as a timed dated and signed entry. Please see the latest version of the
Policy for Actioning of Pathology Results Communicated by Telephone on the
Trust intranet.
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2 SECTION TWO – BIOCHEMISTRY (INCLUDING
IMMUNOLOGY)
2.1
CONTACT NUMBERS (INCLUDING CLINICAL ADVICE)
2.1.1 During Normal Working Hours
From within the hospitals
Telephone
Fax
1832 (0151-430-1832)
1823
Consultant Chemical
Pathologist
Dr M.A. Al-Jubouri
1833 (0151-430-1833)
Please contact for interpretation & advice.
Clinical Biochemist
Dr L Hassall
4141 (0151-290-4141)
Departmental Manager
Mr D. Ames
2180 (0151-430-2180)
Clinical Advice for Immunology: This is provided by Dr Anthony Rowbottom
Consultant Clinical Scientist and Hon. Senior Lecturer. Dr Rowbottom can be
contacted as required via Dr M.A.Al-Jubouri, Consultant Chemical Pathologist
or Louise Hassall, Principal Clinical Scientist. Dr Rowbottom will respond to at
least 95% of Clinical Enquiries within 48 hours.
2.1.2
Out of Normal Working Hours
For contacting the department to request urgent work please see details on
page 2.
2.1.3
Telephoned Results
For results communicated by telephone for Biochemistry, please refer to
‘Telephoning of Results SOP Biochemistry’CLICK TO VIEW.
2.2
ABOUT BIOCHEMISTRY
The current workload is over 3,000,000 tests/annum. The range of services
offered on site and through regional and supraregional services is
comprehensive. On site we have up to date automated analysers handling basic
chemistry, endocrine, vitamin assays, specific tumour markers and cardiac tests.
We undertake lipid profiling, TDM and the long term monitoring of diseases such
as diabetics via HbA1c and microalbumin assays. More manual methods used
include various types of electrophoresis and autoantibody screening.
2.3 REQUEST FORM AND SAMPLE ACCEPTANCE CRITERIA
Request forms MUST be correctly filled out including clinical details. Please see
section 1.7 for details
2.4 COMPLEX BIOCHEMISTRY TESTS
Please contact the laboratory for details of complex tests such as Synacthen,
overnight dexamethasone suppression and water deprivation tests.
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St Helens and Knowsley Teaching Hospitals
Pathology Services
2.5 SPECIMEN REQUIREMENTS (click to view ‘SPECIMEN COLLECTION AND
HANDLING’)
The table in section 2.8 lists specimen requirements, turnaround times and
reference ranges. Some tests are performed as part of a combined profile from
the same sample as indicated.
NOTE:
Cardiac Troponin I Report TnI + 0.57 ug/L Interpretative guide applies to
samples > 12 h post-event. <0.05 No detectable myocardial damage > 0.05
Detectable myocardial damage, the aetiology of which depends on clinical
setting and ECG findings Raised TnI can be due to ischaemic cardiac events or
non ischaemic cardiac causes such as peri/myocarditis, heart failure & drug
cardiotoxicity. It can also be due to non cardiac causes such as pulmonary
embolism, critical illness, renal failure, sepsis, stroke & subarachnoid
haemorrhage. If acute MI is suspected, refer to Cardiology Team please on ext.
1917
2.5.1
Blood profiles
The majority of profiles can be provided from one correctly filled 4.7 ml brown
gel blood bottle. If the request includes some tests sent to other laboratories
then a second sample is required.
2.5.2
CSF
CSF collection kits are available on many wards and can also be obtained from
Pathology Reception when required. These kits are to be used when
investigating Subarachnoid Haemorrhage and/or Meningitis and contain the
appropriate sampling bottles, request forms and instructions. The instructions
are reproduced in the Microbiology Section 5.12.
PLEASE NOTE – When investigating possible SAH/Xanthochromia:
1. Only do an LP in CT Negative or CT equivocal patients.
2. Collect CSF samples at least 12 hours post event and up to 3 weeks after
an event.
3. Take the blood samples either immediately before or after the LP and send
with the CSF samples.
4. Transport the CSF samples for Biochemistry by hand within 30 minutes of
collection. DO NOT USE THE PNEUMATIC TUBE as this may invalidate
the test.
5. If LP fails, do not attempt repeat LP next day or thereafter, as false
xanthochromia may be obtained.
2.5.3
Fluids
All fluid samples e.g. ascitic, pleural, synovial, gastric, CSF and wound
specimens should be received in both a plain container and a yellow Y5 blood
bottle. Do not use sputum pots for fluids as they are liable to leak.
2.5.4
Urines
Please see the table in section 2.8 for details of tests, sample volumes and
preservatives required.
Version 14.01e
Page 27 of 82
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
2.5.5
Pathology Services
Spurious results due to inappropriate collection
Problem
Common Causes
Consequences
+
Delay in
separation of
serum
Storage
overnight storage
delay in transit
Increased K , PO4, ALT, LDH
+
Decreased HCO3, (Na occasionally)
Haemolysis
expelling blood through needle into tube
over vigorous mixing of specimen
o
storing specimen in freezer (-20 C)
excessive delay in transit
leaving specimen in hot environment
o
+
storing at 4 C
Increased K
Decreased HCO3
For haemolysed samples the following tests will NOT be
reported: Folate, potassium, direct bilirubin, CK, IgM and
LDH and zinc
For grossly haemolysed samples the following tests will
NOT be reported: Folate, potassium, phosphate,
magnesium, lithium, ALP, direct bilirubin, CK, LDH, IgM ,
triglyceride, urea and zinc.
For very grossly haemolysed samples no results will be
reported
+
2+
Inappropriate
sampling site
Incorrect
container or
anticoagulant
specimen taken from drip arm
no enzyme inhibitor
EDTA tube (red or yellow) or transferring
blood form one tube to another
Increased drip analyte, e.g. glucose, K , Mg
Dilutional effect
Low glucose
+
Increased K
2+
2+
Decreased Ca , ALP, Mg
Lipaemia
specimen taken after a fatty meal
Decreased Na+
2.6 REFERENCE RANGES
References ranges for the majority of tests are listed in section 2.10they are
also quoted on reports where appropriate and abnormal results highlighted.
Section 2.10 is not an exhaustive list and for any information on a test not in
section 2.10 please contact the laboratory.
2.7 SPECIFIC AREAS
2.7.1
Therapeutic drug monitoring
The measurement of a limited amount of therapeutic drugs is available. Many
of these samples require to be taken at a specific time pre or post dose.
Ensure the timing of the sample is appropriate and the request is also
appropriate (i.e. possible patient toxicity or non-compliance). If required
please contact the laboratory to discuss.
2.7.2
Tumour markers
The measurement of some tumour markers are available however they are
not to be used for primary diagnosis of cancers, their main use is for
monitoring therapeutic response and early detection of relapse.
2.7.3
Guidelines for Requesting Thyroid Function Test. Click here
2.7.4
Guidelines for Requesting Liver Function Tests.Click here
Version 14.01e
Page 28 of 82
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
2.8 TURNAROUND TIMES FOR URGENT/ROUTINE/GP/OUTPATIENT
REQUESTS
For urgent requests the Biochemistry Department aim to process the results
within 2 hours of receipt.
For routine requests from wards the Biochemistry Department aim to process
the results within 4 hours of receipt.
For turnaround times for requests from GP/Out-Patients, please refer to section
2.10 Specimen information.
2.9 REFERRAL TESTS
There are over 100 different tests that are sent to a referral laboratory. For the
most commonly requested referral tests please refer to Section 2.10 Specimen
Information.
For the name and address of referral laboratories please refer to Section 2.11.
If a referral test is not available in the User Handbook please contact the
Biochemistry Department for advice.
Version 14.01e
Page 29 of 82
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
2.10
Pathology Services
SPECIMEN INFORMATION
Please see the following link to the ‘World Health Organisation Use Of Anticoagulants In Diagnostic laboratory Investigations’. This document
has utility in telling users the time that analytes could be expected to be stable for in serum. Click to view
TEST (BLOOD)
PROFILE
ACTH
Albumin
LFT, Calc,
Prot, Elec
Alcohol
BLOOD BOTTLE
TURNAROUND
REFERENCE RANGES
COMMENT
K3
2 weeks
See report
Send to lab ON ICE within 10 mins of
collection. Contact lab first.
B5
< 24 hrs
35 – 50 g/L
Y5
< 24 hrs
<5 mg/dl: See report
Aldosterone/Renin
K3
Alkaline Phosphatase (adult)
Alkaline Phosphatase (paediatric)
Alkaline Phosphatase isoenzymes
Alpha 1 Antitrypsin
Alpha Fetoprotein
ALT
Amino Acids
Ammonia
Amylase
Angiotensin converting enzyme( serum)
Anti TissueTransglutaminase (ATTG)
AST
Autoantibodies (ANA, AMA, SMA, GPC
and ANCA screening.)
B12
Bicarbonate
Bile Acids
Version 14.01e
LFT
AFP
LFT
ACE
Bica
<3 weeks
See report
Patient on adequate Na & K diet. No drugs.
Collect K3 and O5 samples at room
temperature from overnight recumbent patient.
Send to lab immediately. Repeat renin on K3
after 30 minutes mobility. Send to lab
immediately. Contact lab before doing test.
Sent away to South Manchester Pathology
Services
< 24 hrs
14 days
< 24 hrs
< 24 hrs
< 24 hrs
3 weeks
Male 30-135 iU/L
Female 30-120 iU/L
See report
See report
See report
non pregnant < 7 ug /L
<40 U/L
See report
< 24 hrs
20 – 70 umol/L
Send sample to lab on ice <10 mins
< 24 hrs
7 days
10 days
< 24 hrs
20 – 105 IU/L
15 - 55 IU/L
<10 U/ml
< 40 U/L
Pancreatitis typically > 280
B5
< 4 days
See report
B5
B5
B5 (also EDTA
< 24 hrs
< 24 hrs
< 24 hrs
180 - 910 pg/ml
22 – 30 mmol/L
<14 umol/L
B5
B5
B5
B5
B5
Serum/plasma
O5 or K3 (min
0.5ml)
B5
B5
B5
B5
Page 30 of 82
< 24 hrs
Laboratory Handbook
Increases in pregnancy and old age
Referral test to Southampton
Investigation of testicular and hepatic tumours
Equivocal/Positives sent for confirmation &
further typing. Reported in < 3 weeks
St Helens and Knowsley Teaching Hospitals
Bilirubin
BNP B – Natriuretic Peptide
Pathology Services
LFT, SBR
plasma)
B5
K3 – if you also
want FBC from
Haematology 2
tubes must be sent
< 24 hrs
< 17 μmol/L
< 24 hrs
A high BNP result greater
than 400 ng/L has a high
probability for heart failure.
C3
C4
Ca 125
B5
B5
< 24 hrs
< 24 hrs
0.7 – 1.7 g/L
0.18 – 0.58 g/L
B5
< 24 hrs
0 – 35 KU/L
CA 19-9
6-Thioguanine Nucleotides (6-TGN)
(6-MPP is performed along with this
analysis)
6-Methyl Mercaptopurine (6-MPP)
(this is performed along with 6-TGN
analysis)
B5
2 weeks
0 – 35 KU/L
K3
1 week
See report
K3
1 week
See report
BLOOD BOTTLE
TURNAROUND
REFERENCE RANGES
B5
2 weeks
TEST
Caeruloplasmin*
PROFILE
Calcium
Carbamazepine
Calc
Carb
B5
B5
< 24 hrs
< 24 hrs
Male 0.18 – 0.34 g/L
Female 0.14 – 0.46 g/L
2.15 – 2.60 mmol/L
4.0 – 10.0 mg/L
Carboxyhaemoglobin
COHb
O5 or K3
< 24 hrs
< 2% COHb
CEA
Cholesterol
Chloride
CK (male)
CK (female)
CKMB Mass
CEA
Chol
Chlo
B5
B5
B5
B5
B5
B5
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
<4 microg/L
< 5.0 mmol/L
95 – 105 mmol/L
Male 23 – 190 U/L
Female 22 – 170 U/L
< 5.0 ug /L
MHRA Guidelines state
should be less than 119
nmol/L
MHRA Guidelines state
should be less than 134
nmol/L
Male 12.1- 20.9 umol/L
Female 12.8 – 24.2umol/L
Cobalt
Does not
apply
K3
2 weeks
Chromium
Does not
apply
K3
2 weeks
B5
B5
2 weeks
2 weeks
Copper (Male)
Copper (Female)
Version 14.01e
Page 31 of 82
Laboratory Handbook
In a breathless patient with or without
peripheral oedema, a normal BNP test can be
used to rule out heart failure as the underlying
cause. A positive BNP test does not confirm
heart failure and echocardiography is indicated.
Increases in ovarian carcinoma, ascites and
adenomyosis
Sent away to Warrington Hospital
COMMENT
Assess pre-dose. Peak levels may be useful
Smokers < 10%, lassitude 20%
Semicomatose 40%, coma 60%, death 80%
Increases in colorectal carcinoma
Desirable range
To calculate anion gap
Cobalt and Chromium to be tested together
Only indicated for certain metal on metal hip
replacements
Cobalt and Chromium to be tested together
Only indicated for certain metal on metal hip
replacements
St Helens and Knowsley Teaching Hospitals
Cortisol
Creatinine (Male)
Creatinine (Female)
CRP
Pathology Services
B5
B5
B5
B5
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
Cryoglobulins
B5 & K3
1 week
Digoxin
Direct Bilirubin
eGFR
B5
B5
B5
Electrophoresis
UE, Uric
UE, Uric
CRP
Dbili
UE
Ig’s,
Prot,Elec
9am:
< 24 hrs
< 24 hrs
< 24 hrs
120 - 620 nmol/L
<120 umol/L
<100 umol/L
< 10.0 mg/L
See report
0.8 – 2.0 ug/L
<10 umol/L
See report
B5
<4 days
See report
If required; immunofixation< 7 days
B5
B5
< 24 hrs
< 24 hrs
Male 22 – 322 microg/L
Female 10 – 291 microg/L
Low iron stores 22-25
Low iron stores 10-15
Ferritin (Male)
Ferritin (Female)
Fluids (please see note at end of table)
Folate
Free T3
TFT’s
B5
B5
< 24 hrs
< 24 hrs
>5.4 microg/L
3.5 – 6.5 pmol/L
Free T4
TFT’s
B5
< 24 hrs
10 – 20 pmol/L
Plasma Free Metanephrines
n/a
R8
2 weeks
See report
FSH
GGT
LH+FSH
LFT
B5
B5
< 24 hrs
< 24 hrs
See report IU/L
<55 IU/L
B5
2 weeks
See report
<12 hrs
< 24 hrs
< 24 hrs
< 24 hrs
2 weeks
See report
20 – 36 g/L
Fasting 3.0 – 5.9 mmol/L
See report
See report
Gastrin
Gentamicin
Globulin
Glucose
Glucose Tolerance Test
Growth Hormone
Prot
Gluc
GTT
B5
B5
Y5
Y5
B5
TEST
PROFILE
BLOOD BOTTLE
2 x 5ml EDTA
samples
B5
Y5
Gut hormones e.g. VIP etc
Haptoglobin
HbA1c
Fasting sample on ice received <10 min post
collection. Stop PPI for 2 weeks.
Fasting and 2 hour sample post glucose.
Usually measured as part of a DFT.
COMMENT
<4 weeks
See report
Send to the lab on ice <10 min of collection.
< 24 hrs
<24hrs
0.3-2.0 g/L
See report
B5
<24 hrs
<5 IU/L
HDL
IgA
IgE Specific
IgG
Lipids
Ig’s
B5
B5
B5
B5
< 24 hrs
< 24 hrs
3 days
< 24 hrs
1.0 –2.0 mmol/L
Adult 0.7 – 4.12 g/L
See report
Adult 6.1 – 15 g/L
Page 32 of 82
30% fall in pregnancy variable in sick
euthyroids
EDTA 5ml on ice sent to the lab immediately
REFERENCE RANGES
HCG
Version 14.01e
Sample >6 hrs after last dose
TURNAROUND
HCG
Ig’s
Contact laboratory for transport flask
Laboratory Handbook
Unsuitable in screening for Diabetes.
Investigation of ectopic pregnancy and
testicular tumours
Full clinical details required
St Helens and Knowsley Teaching Hospitals
Pathology Services
B5
< 24 hrs
Adult 0.5 – 3.3 g/L
B5
2 weeks
See report
Insulin/C-peptide
O5
2 weeks
See report
Iron
B5
< 24 hrs
Overdose assay (μmol/L)
Iron studies
Lactate
Lamotrigine
LDH
LDL
Lead
LH
B5
Y5
B5 or O5
B5
B5
R5
B5
< 4 days
< 24 hrs
2 weeks
<24 hrs
< 24 hrs
2 weeks
< 24 hrs
See report
0.5 – 2.5 mmol/L
4 – 60 umol/L
90 – 500 U/L
<3.0 mmol/L
See report μmol/L
See report IU/L
Age 65 years and over
0.4 – 0.8 mmol/L
Lithium
B5
< 24 hrs
Magnesium
Oestradiol
Osmolality
P3NP
Paracetamol
B5
B5
B5
B5
B5
< 24 hrs
< 24 hrs
< 24 hrs
2 weeks
< 24 hrs
0.7 – 1.0 mmol/L
See report
285 – 295 mOsmol/Kg
1.7 – 4.2 microg/L
Overdose assay mg/L
Parathyroid Hormone
B5 or K3
< 24 hrs
See report
Phenobarbitone
B5
2 weeks
10 – 30 mg/L
Phenytoin
Phosphate
Potassium
Progesterone
Prolactin
UE
B5
B5
B5
B5
B5
< 24 hrs
< 24 hr
< 24 hrs
< 24 hrs
< 24 hrs
10 – 20 mg/L
0.8 – 1.5 mmol/L
3.5 – 5.3 mmol/L
See report nmol/L
<400 mIU/L
TEST
PROFILE
BLOOD BOTTLE
TURNAROUND
REFERENCE RANGES
Protein
PSA
Prot, Elec
B5
B5
< 24 hrs
<24 hrs
B5
97% in 3 days
60 – 80 g/L
<4 μg/L
Reported as either Low
Risk or High Risk
st
1 Trimester <1/150 =
IgM
Insulin Like Growth Hormone Factor 1((IGF1)
Quad Test
Version 14.01e
Ig’s
LH+FSH
Page 33 of 82
Age 64 years and below
0.6 – 1.0 mmol/L
Laboratory Handbook
Only measured if hypoglycaemiac. Send to the
lab <10 min of collection.
For investigation for overdose only.
MUST contact Biochemistry Department
Only in borderline anaemia
Sample on ice to lab < 10 min
Target range
Sample 12 hrs after dose
Send a bone profile at the same time. Send to
the lab prompt after collection
Sample just before next dose (sent to Walton
Centre)
Sample just before next dose
COMMENT
Sent away to Ante Natal Screening, Clinical
Biochemistry, Royal Bolton Hospital.
St Helens and Knowsley Teaching Hospitals
Pathology Services
High Risk
nd
2 Trimester <1/200 =
High Risk
Renin SEE ALDOSTERONE
Salicylate
B5
< 24 hrs
Overdose assay mg/L
Sex Hormone Binding Globulin
B5
2 weeks
20 – 120 nmol/L
B5
B5
B5
B5
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
135 – 145 mmol/L
Male – see report
Female 0.5 – 2.6 nmol/L
> 3 months 10-20.0 mg/L
Thiopurine Methyl Transferase (TPMT)
K3 x 2 (min 0.5ml)
2 weeks
See report
Thyroid Peroxidase Antibody
Thyroid Receptor Antibody
Triglycerides
Troponin
TSH
Urea
Uric acid
Valproate
Vancomycin
B5
B5
B5
B5
B5
B5
B5
B5
B5
2 weeks
2 weeks
< 24 hrs
<24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
< 24 hrs
<12 hrs
Vitamin A & E
O5 or B5
20 days
Vitamin C
VIT D
Zinc
CSF
Glucose
Lactate
Oligoclonal Bands
Protein
Xanthochromia
Spec tube
B5
B5
1-2 days
<24 hours
1-2 days
<60 U/ml
<10 U/L
<2.0 mmol/L
See report
0.2 – 6.0 mIU/L
2.5 – 7.5 mmol/L
<0.45mmol/L
50 – 100 mg/L
See report
Vitamin A 1.05 – 2.97
umol/L
Vitamin E 13.9 – 47
umol/L
See report
See report
10 – 20 μmol/L
Y5
Y5
Universal container
Refer to section 5.12
Refer to section 5.12
<2 hrs
< 2hrs
2 weeks
< 2hrs
<6 hrs
2/3 of serum glucose
<2.4 mmol/L
See report
0.15-0.45 g/L
See report
Sodium
Testosterone (male)
Testosterone (female)
Theophylline
UE
Lipids
TFT’s
UE
Uric
Incomplete request forms will be rejected
Sent away to South Manchester Pathology
Services
Sample time dependant on preparation
Sent away to South Manchester Pathology
Services(except where requested alongside
6-TGN and 6-MMP then send to Birmingham
City Hospital)
Fasting sample required
Sample to be taken > 12 hrs post chest pain.
Variable in sick euthyroids
Does not correlate with efficacy.
Contact the laboratory. Fresh sample.
Send a serum sample B5
URINE
SAMPLE
PRESERVATIVE
TURNAROUND
REFERENCE RANGE
COMMENT
5HIAA
24 hrs
25 ml HCL
2 weeks
< 50 umol/24 hrs
Sent away to South Manchester Pathology
Services
Version 14.01e
Page 34 of 82
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
Amino Acids
Amylase
Bence-Jones protein
BHCG (Pregnancy test)
Random
Random
EMU
EMU
2 weeks
< 24 hrs
<1 week
< 24 hrs
Bile Pigments
EMU
1-2 days
Bilirubin
Calcium
Random
24 hrs
Cortisol
Creatinine
Creatinine Clearance
Creatinine:microalbumin (male)
Creatinine:microalbumin (female)
Drugs of Abuse
Microalbumin
Organic acid
Osmolality
Oxalate
Phosphate
Porphyrins
Potassium
Protein
Protein:creatinine ratio
< 24 hrs
< 24 hrs
See report
See report
Pos or Neg
<25 IU/L
Bilirubin/Urobilin: neg
Urobilinogen: upto 1 in 20
dilution
2.5 – 7.5 mmol/24 hr
24 hrs
2 weeks
30 – 290 nmol/24 hr
24 hrs
24 hrs
EMU
< 24 hrs
< 24 hrs
<24hrs
Random
Random
Random
Random
24 hrs
24 hrs
24
hrs/random
2 weeks
< 24 hrs
2 weeks
< 24 hrs
2 week
< 24 hrs
9 – 17 mmol/24 hr
70 – 140 ml/min
<2.5 mg/mmol
<3.5 mg/mmol
See report
<20 mg/L
See report
Variable
25 ml HCL
25 ml HCL
25 ml HCL
Random
24
hrs/random
Random
< 24 hrs/2 weeks
See report
< 24 hrs
Interpret with serum
potassium
< 24 hrs
0.01 – 0.05 g/L
<24 hrs
< 4 days (but can
be performed
urgently)
<45 mg/mmol
Sodium
Random
< 24 hrs
Urate
< 24 hrs
< 24 hrs
250 – 500 mmol/24 hr
Urobilinogen
24 hrs
24
hrs/random
Random
Interpret in light of serum
Na
1.0 – 3.0 mmol/24 hr
< 24 hrs
VMA/Catecholamines
24 hrs
>1/10 dil<1/20 dil
Nor Adren 120 – 590
Adrenaline <190
Dopamine 650 – 3270
Version 14.01e
Page 35 of 82
2 weeks
Interpret with serum osmolality
15-50 mmol/24 hr
Fresh urine
(same day)
25 mlHCL
Sent away to South Manchester Pathology
Services
<0.50 mmol/24hr
Reducing Substance
Urea
Fresh sample
Negative
Laboratory Handbook
Samples required vary with presentation.
Contact the laboratory.
Positive samples confirmed by Thin Layer
Chromatography
Plasma Free Metanephrines have now
superseded this test. The patient should fast
overnight and the plasma sample needs to be
St Helens and Knowsley Teaching Hospitals
Pathology Services
FAECES
Elastase
Faecal Alpha 1 Antityrpsin
SAMPLE
Random
TURNAROUND
2 weeks
1g faeces
5 days
Faecal Calprotectin
1-5g
faeces
5 - 7 days
MISCELLANEOUS
Stone Analysis
Stone
Sweat Test
Sweat
<7 days
< 1 day from date
of analysis
REFERENCE RANGE
See report
See report
Sweat Chloride <40
mmol/L
collected at one of the hospital sites due to the
need for rapid handling to ensure correct quality
of the sample prior to sending to referral lab
(South Manchester Pathology Services)
COMMENT
Exocrine pancreatic insufficiency
Referral test - Cardiff Medical Biochemistry and
Immunology
Referral test - King's College Hospital, London
Contact lab to make appointment
NOTE: pH Measurements on Fluids including Pleural Fluids
Pleural fluid samples are to go through Cardio-Respiratory Blood Gas analyser only.
This test is rarely indicated and Pathology now has no means to measure this test. Should it be necessary to analyse, enquiries should be
made to the ECG Team on ext 1428 or out of hours bleep 7004. Tests must be pre-arranged to avoid delay before analysis and also to enable
the ECG Team to prepare for the Decontamination required before further use.
For pH testing of other fluids which is very rarely indicated please telephone before taking sample
2.11 REFERRAL LABORATORIES
NAME AND ADDRESS OF REFERRAL LABORATORY
Royal Liverpool Children's Hospital
Alder Hey, Eaton Road,
Liverpool
L12 2AP.
Tel: 0151 2525488
Department of Clinical Chemistry,
Version 14.01e
Page 36 of 82
TESTS PROVIDED
Blood/Urine/ CSF Amino Acids, Organic Acids, Blood Ammonia,
Reducing Substances, Catecholamine (Paediatric), free fatty acids, GAL1-PUT, Glycosaminoglycans, methotrexate.
ACTH, Caeruloplasmin, Copper, Growth Hormone, Insulin / C-Peptide,
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
4th Floor Duncan Building,
Royal Liverpool Hospital
Liverpool, L7 8XP
Tel: 0151 7064245
Tel: 0151 706 4230
Department Of Immunology,
3rd Floor Duncan Building,
Royal Liverpool Hospital
Liverpool,L7 8XP
Tel: 0151 7064350
Department Of Clinical Chemistry,
University Hospital Aintree,
Lower Lane, Liverpool, L9 7AL
Tel: 0151 5293242
Neurobiochemistry, The Walton Centre,
Buxton Labs, Lower Lane
Fazakerley, Liverpool, L9 7JL
Tel: 0151 5295577
Cheshire & Merseyside, Regional Molecular Genetics
Laboratory, Liverpool Womens NHS Foundation Trust,
Crown Street, Liverpool, L8 7SS
Tel: 0151 702 4011/ 4228
Department Of Clinical Biochemistry,
Warrington Hospital, Lovely Lane
Warrington, Cheshire, WA5 1QG
Tel: 01925 662352
Department of Biochemistry,
South Manchester Pathology Services, Wythenshawe
Hospital, M23 9LT
Tel: 0161 291 2136
SAS Specimen Reception, G Block, North Corridor,
Version 14.01e
Page 37 of 82
IGF-1, , Thyroid Receptor Antibody, Lead, Aluminium, , CA 15-3,
Calcitonin, CTX I, Cyclosporin (Adult), Urine Magnesium, Vitamin B1,
P1NP, P3NP, 17-OH Progesterone (Adults only)
ANCA, Auto Antibodies (ANA, AMA, SMA), Anti OvarianAntibody, Anti
skin Ab, Beta-2-Microglobulin, C1 Est. Inh. Ab, SFLC, Bence-Jones
Proteins, ENA, IgE Anti Gliadin, Intrinsic Factor Ab., MastCellTryptase,
Anti Adrenal Antibody, GBM Ab,
Serum, Acetone, Toxic Alcohols
Lamotrigine, Oligoclonal Bands, Phenobarbitone, Anti-Ach Rec. Ab. ,
Anti-Neuronal/ Paraneoplastic Antibody, , Anti purkinjeAb, BetaTransferrin, CSF ACE, CSF Lactate,
CF Gene Typing, Cytogenetics, DNA studies,
Thyroid Peroxidase Antibody, CA19-9
Aldosterone/ renin, 5-HIAA, Androstenedione / DHEAS, Plasma Free
Metanephrines/ metanephrines, Urine Cortisol, SHBG. Thiopurine Methyl
Transferase (TPMT) , Cotinine, Sirolimus, Thiopurine MethylTransferase, Urine Cysteine, Vitamin A & E
Gut Hormones
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
Charing cross Hospital, Du Cane Road, London, W6 8RF
Tel: 0208 3880649
Department Of Clinical Biochemistry, City Hospital,
Dudley road
Birmingham, B18 7QH
Tel: 0121 5075345
Somerset Pathology Service, Taunton and Somerset
Hospital
Musgrove Park, Taunton, TA1 5DA
Tel: 01823 342276
(The Porphyria Service), Department Of Medical
Biochemistry and Immunology,
University Hospital of Wales Healthcare NHS Trust,
Heath Park, Cardiff, CF14 4XW
Tel: 02920 743565
Biochemistry/ Immunology Department, Hope Hospital,
Stott Lane, Salford, M6 8HD
Tel: 0161 206 4958
Clinical Chemistry, Sheffield Children’s hospital, Western
Bank, Sheffield, S10 2TH, Tel: 0114 271 7305
Supra Regional Assay Laboratory, Chemical Pathology,
5th Floor North wing, St Thomas Hospital, Lambeth
Palace Road, London, SE1 7EH,
Tel: 020 7188 1240
Purine Research Laboratory, 4th Floor, North Wing, St
Thomas’ Hospital, Lambeth Palace Road London, SE1
7EH
Tel: 0207 188 1266/ 0207 188 1265
London Medical Toxicology Unit, 3rd Floor, Block 7, South
Wing, St Thomas Hospital, London, SE1 7EH
Tel: 020 7188 8689
Version 14.01e
Page 38 of 82
Beta-HydroxyButyrate, erythropoietin.Where 6-TGN and 6-MMP are
requested alongside TPMT, please send ALL of the tests including
TPMT to this location.
Faecal Elastase
Porphyrin, Oxalate,Citrate, Stone Metabolic Screen, faecal Alpha-1
Antitrypsin,
Porphyrin Screen, Specific Antibodies, IgG4,
Acyl carnitine profile, Cortisol (7-Hydro), Trimethylamine, VLCFA,
Pyruvate,
5-Alpha Dihydrotestosterone,
Thioguanine Nucleotides, Urine Xanthine,
Topiramate
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
Willink Biochemical Genetics Unit, St Marys Hospital,
Oxford Road, Manchester,
M13 9WL,
Tel: 0161 701 2143
Department of Biochemistry, Royal Manchester Childrens
Hospital, Oxford Road, Manchester, M13 9WL
Tel: 0161 701 2143
Supraregional Protein Reference Unit, Department of
Immunology, PO Box 894, Sheffield, S5 7YT
Tel: 0114 2715707
Leicester Pathology Service, Leicester royal Infirmary
NHS Trust, Infirmary Square, Leicester, LE1 5WW
Tel: 0116 258 6563
Neuroimmunology Laboratory, National Hospital for
Neurology, Queens Square, London, WC1N 3BG
Tel: 020 3448 3814
Lancashire & Lakeland Immunology Service, Royal
Preston Hospital, Sharoe Green Lane, Preston, Lancs,
PR2 9HT
Tel: 01772 716565 (ext. 3102)
Andrology Laboratory, 1st floor Old Building, St. Marys
Hospital, Hathersage road, Manchester, M13 0JH
Tel: 0161 276 6473
Clinical Biochemistry, Macewen Building, Glasgow Royal
Infirmary, Glasgow, G4 0SF
Tel: 0141 211 4638
Immunology Department, Churchill Hospital, Headington,
Oxford, OX3 7LJ
Tel: 01865 225995
SAS Genetic Enzyme Laboratory, Genetics Centre,
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Page 39 of 82
Alpha Galactosidase A, Steroid Sulphatase, White Cell Enzymes,
17-OH Progesterone (newborns only)
Alpha-1-Acid Glycoprotein, A1-AT phenotyping, Anti-GAD Ab,
Carbohydrate Deficient Transferrin, CH50- Total Haemolytic
Complement Screen, Chromogranin A, cartilage Ab., Islet Cell Ab.,
Mannose Binding Lectin, Neurone Specific Enolase,
Amiodarone,
Anti Basal Ganglia Antibody, Anti GQ1b, Transferrin Glycoform Analysis
Anti Endomysial Antibody, IgG ATTG,
Anti SpermAb,
Apolipoprotein Profile, Beta Carotene,
Aquaporin 4 Ab, Ca/ K Channel Ab, Transketolase, VGKC, MUSK Ab.,
Arylsulphatase A, Hexosaminidase A&B
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
5thFloor Guy’s Tower, Guy’s Hospital, London, SE1 9RT
Tel: 0207 955 4646 or 0171 955 2502
Enzyme Laboratory, Chemical Pathology, CameliaBotnar
Laboratories, Great Ormond Street Hospital Childrens
NHS Trust, London, WC1N 3JH
Tel: 0207 405 9200 ext. 2509
Clinical Chemistry, West Midlands Regional Laboratory
for Neonatal Screening & Inherited Metabolic Disorders,
Childrens Hospital, Steelhouse Lane, Birmingham, B4
6NH
Tel: 0121 333 9938/ 9925
Clinical Biochemistry, Cholinesterase Investigation Unit,
Pathology Sciences Building, Southmead Hospital,
Westbury-on-Trym, Bristol, BS10 5NB,
Tel: 0117 3236083
Centre for Clinical Science & Measurement, School of
Biological Sciences, University of Surrey, Guildford, GU2
5XH
Tel: 01483 259978
Clinical Biochemistry, Royal Free Hospital, Pond Street,
Hampstead, London,
NW3 2QG
Tel: 020 7794 0500 Ext. 38848
Therapeutic Drug Monitoring (NSE TDM), Chalfont
Centre for Epilepsy, Chesham Lane, Chalfont St Peter,
SL9 0RJ
Tel: 01494 601423
Cardiff Toxicology Laboratories, The Academic Centre,
Llandough Hospital, Penarth, CF64 2XX
Tel: 029 2071 6893
Clinical Chemistry, Pathology and Pharmacy Building,
Bart’s and the London NHS Trust, 80 Newark Street,
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Battens Disease Investigation,
Biotinidase, Tacrolimus
Cholinesterase Phenotype,
Chromium, Cobalt, Selenium, Silver,
CK Iso-Enzymes
Clobazam, Levetiracetam,
Clozapine, Urinary Drugs of Abuse
Cortisol (11-Deoxy)
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
Whitechapel, London
Tel: 020 324 60117
Clinical Biochemistry, Royal Hallamshire Hospital,
Glossop Road, Sheffield, S10 2JF
Tel: 0114 271 3416
Biochemistry Department, Freeman Laboratories,
Freeman Hospital, Newcastle upon Tyne, NE7 7DN
Tel: 0191 233 6161
Ante Natal Screening Clinical Chemistry, Royal Bolton
Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR
Tel: 01204 390424
UCLH Special Chemistry, 3rd Floor, 60 Whitfield Street,
London, W1T 4EU
Tel: 0845 155 5000 Ext. 2955
SAS Peptide Section, Clinical Laboratory, Royal Surrey
County Hospital, Egerton road, Guildford, Surrey, GU2
7XX
Tel: 01483 406715
Guildford SAS Hormone Centre, Guildford, Surrey, GU2
5XX
Tel: 01483464121
Selly Oak Hospital, Regional Endocrine Laboratory,
Raddlebarn Road, Selly Oak, Birmingham, B29 6JD
Tel: 0121 627 1627
Clinical Biochemistry, City Hospital, Dudley Road,
Birmingham, B18 7QH,
Tel: 0121 507 4135
Clinical Biochemistry, Rotheram General Hospital NHS
Trust, Moorgate Road, Rotheram, S60 2UD
Tel: 01709 304103
Clinical Biochemistry, Kings College Hospital, London,
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Cyanide, Flecainide, Beta HCG
Cyclosporin (Paediatric)
PAPPA First Trimester Screening, QUAD Test,
Steroid Profile,
Sulphonylureas,
Big-IGF-2, IGFBP-3,
Thyroglobulin
Thiazide Diuretic Screen, Laxative Screen,
Vitamin B6,
Faecal calprotectin
Laboratory Handbook
St Helens and Knowsley Teaching Hospitals
Pathology Services
SE5 9RS
Tel: 020 3299 3856
Molecular Genetics Laboratory, Royal Devon & Exeter
NHS Foundation Trust, Barrack Road, Exeter, EX2 5AD
Tel: 01392 406806
University Department of Clinical Chemistry, PO box 232,
Level 4, Addenbrookes Hospital, Cambridge, CB2 2QR
Tel: 01223 762634
Department of Clinical Biochemistry, Block 20, St James
University Hospital, Leeds, LS9 7TF
Tel: 0113 2066861
National Blood Transfusion Service, Longely Lane,
Sheffield, S5 7JN
Tel: 0114203 4800
Department of Clinical chemistry, Nottingham City
Hospital, Hucknall Road, Nottingham, Nottinghamshire,
NG5 1PB
Tel: 0115 962 7907
Department of Clinical Chemistry, Royal Infirmary, Acre
Street, Huddersfield, West Yorkshire, HD3 3EA
Tel: 01484 355885
SAS Unit for Trace Elements, Chemical Pathology, Mail
Point 804, Level D, Southampton General Hospital,
Tremona Road, Southampton, SO16 6YD,
Tel: 023 8079 6419 or 023 8079 6237
Trophoblastic Tumour Screening and Treatment Centre,
Department of Clinical Oncology, Weston park Hospital,
Whitham Road, Sheffield, S10 2SJ
Tel: 0114 226 5000
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GCK Gene Analysis, MEN 1 genetic testing,
Genetics of obesity study, Leptin,
Homocysteine,
IgA Deficiancy
LDH Iso-enzymes
Lipase,
Mercury,Alkaline Phosphatase Isoenzymes.65
Beta HCG (patients registered for hydatidiform mole and
choriocarcinoma only)
Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
3 SECTION THREE - HAEMATOLOGY
3.1
CONTACT NUMBERS
3.1.1 During Normal Working Hours
Laboratory Telephone
Haematology
Consultant Haematologists
Dr J.A. Tappin 1825 (0151-430-1825)
Dr M. Gharib
1315 (0151-430-1315)
Dr J.A.T. Nicholson 2366 (0151-430-2366)
Staff Grade Haematologist
Dr R.M.P. Kawonga
Secretary
3.1.2
1838 (0151-430-1838)
2473 (0151-430-2473)
1825/1432/1147/1662
(0151-430-1825/1432/1147/1662)
Out Of Normal Working Hours
For contacting the department to request urgent work please see details on page 2.
3.2 ROUTINE TESTS (click to view ‘SPECIMEN COLLECTION AND HANDLING’)
3.2.1
Full Blood Count
Specimen:
Pink EDTA bottle (K3) adult: 2.7 ml. Mix by inversion.
Parameters available include Hb, RBC, WBC, Diff, Plat, Hct, MCV, MCH, MCHC and
RDW
3.2.2
Other tests available using the same specimen
Blood film
This is carried out when results from analyser or clinical
(+ differential WCC)
information show it to be necessary or on request
Malarial parasites
Glandular Fever Test
Reticulocyte count
Sickle test
Results will be confirmed by Hb electrophoresis, family history
may be helpful if available.
Hb electrophoresis Family history or ethnic origin may be helpful if available.
ESR
Minimum of 2 ml sample needed, paediatric volume will be insufficient.
3.3 COAGULATION TESTS
Green citrate - adult
3 ml volume (G3)
Paediatric size available
1.4 ml volume
(Sample bottles MUST be filled to the volume indicator line)
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Laboratory Handbook
St Helens and Knowsley Hospitals
N.B.
Pathology Services
Blood obtained by clean venepuncture without clotting or tissue-juice contamination.
Accurate volume is critical otherwise sample will not be processed.
Do not underfill or overfill
Tests available
Prothrombin time (INR)
Activated Partial Thromboplastin time (APTT)
Fibrinogen
D-dimer
Please specify test required rather than ‘coagulation screen’ and indicate if patient is on
anticoagulant therapy.
Clotting Factor Assays
Please contact the laboratory before sending. One 10 ml green citrate tube required
Thrombotic Screen
(Protein S, C, AT III, Lupus, ACA, Factor V Leiden and Prothrombin Gene Mutation)
One 10.0 ml green citrate tube required.
Thrombotic screen during the acute phase is unreliable. If patient is on Warfarin
Proteins, C, S and lupus anticoagulant will not be done as results will be inaccurate.
Platelet Function Screening Tests – please contact laboratory staff before requesting.
3.4 CONTROL OF ANTICOAGULANT THERAPY
Anticoagulant Clinics
If patients require to see a Nurse/Clinician they should attend the following times
Whiston:
Tuesday 1.30 pm - 4 p.m.
St. Helens:
Monday
9.00 am – 11 am
Out-Patients Dept.
Diagnostic Treatment Centre
Patients for Warfarin monitoring who do not need to see a Clinician may attend with
their yellow books to
St. Helens Phlebotomy Room
Mon to Fri 8.30 – 3.30 pm.
Or to Whiston Phlebotomy Room
Mon to Thurs 9 am – 3 pm.
Fri 9 am – 1 pm.
New patients should be referred using the correct request form or a letter containing full
details of the reason for and duration of therapy, the drug used and dosage, and any
other relevant history and medication.
3.5 SPECIAL TESTS
Glucose 6 phosphate
Dehydrogenase
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2.7 ml EDTA
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Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
PNH Screening Test
2.7 ml EDTA (Pink K3)
Bone marrow aspirate biopsy – contact Haematology Medical Staff.
RF IgM
Anti CCP
5ml brown tube
5ml brown tube
Rhematology Request
only
Hereditary Spherocytosis Screen
2.7 ml EDTA (Pink K3)
3.6 HIGH RISK SPECIMENS
Please bag every specimen separately i.e. one bag/one specimen with high risk label.
Where patients are new it would be helpful to telephone Haematology and indicate
reason for ‘risk’ status. Patients with Multiresistant organisms are not considered high
risk for Haematology.
3.7 HAEMATOLOGY REFERENCE RANGES
Red Cell Count
Men
Women
Infants (full-term, cord blood)
Children, 3 months
Children, 1 year
Children, 3 – 6 years
Children, 10 – 12 years
5.25 ± 0.75 x 1012/L
4.8 ± 1.0 x 1012/L
5.0 ± 1.0 x 1012/L
4.0 ± 0.8 x 1012/L
4.4 ± 0.8 x 1012/L
4.8 ± 0.8 x 1012/L
4.7 ± 0.7 x 1012/L
Haemoglobin
Men
Women
Infants (full-term, cord blood)
Children, 3 months
Children, 1 year
Children, 3 – 6 years
Children, 10 – 12 years
150 ± 25 g/L
140 ± 25 g/L
165 ± 35g/L
115 ± 20 g/L
120 ± 20g/L
120 ± 20 g/L
130 ± 20g/L
Packed cell volume (PCV, haematocrit value)
Men
0.46 ± 0.06
Women
0.42 ± 0.05
Infants (full-term, cord blood)
0.54 ± 0.10
Children, 3 months
0.38 ± 0.06
Children, 3 – 6 years
0.40 ± 0.04
Children, 10 – 12 years
0.41 ± 0.04
Mean cell volume (MCV)
Adults
Infants (full-term, cord blood)
Children, 3 months
Children, 1 year
Children, 3 – 6 years
Children, 10 – 12 years
Version 14.01e
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90 ± 12 fl
114 ± 16 fl
96 ± 19 fl
82.5 ± 9.5 fl
81 ± 7.0 fl
84 ± 8.0 fl
Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
Mean cell haemoglobin (MCH)
Adults
Children, 3 months
Children, 1 year
Children, 3 – 6 years
30.2 ± 4.6 pg
30 ± 4.0 pg
28 ± 4.0 pg
28.5 ± 3.5 pg
Mean cell haemoglobin concentration (MCHC)
Adults and Children
335 ± 25 g/L
Red cell Distribution Width (RDW)
Reticulocytes
Adults and Children
Infants, (full-term, cord blood)
Leucocyte count
Men
Women
Infants (full-term) 1 day
Infants, 1 year
Children, 4 – 7 years
Children, 8 – 12 years
0.2 – 2.0%
(10 – 100 x 109/L)
3.0 – 7% (150 – 350 x 109/L)
3.7 - 9.5 x 109/L
3.9 - 11.1 x 109/L
9 - 18.4 x 109/L
5 - 17.0 x 109/L
6.3 - 16.2 x 109/L
4.9 - 13.7 x 109/L
Differential leucocytes count
Adults
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Infants (1st day)
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Infants (3 days)
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Children (6 years)
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
1.8 – 7.5 x 109/L
1.0 – 4.0 x 109/L
0.0 – 1.0 x 109/L
0.0 – 0.4 x 109/L
0.0 – 0.2 x 109/L
4.8 – 17.1 x 109/L
2.0 – 7.3 x 109/L
0.1 – 1.9 x 109/L
0.0 – 0.8 x 109/L
0.0 – 0.2 x 109/L
2.0 – 9.4 x 109/L
2.0 – 7.3 x 109/L
0.1 – 1.9 x 109/L
0.0 – 0.8 x 109/L
0.0 – 0.2 x 109/L
1.6 – 9.0 x 109/L
2.2 – 9.8 x 109/L
0.1 – 1.0 x 109/L
0.0 – 0.8 x 109/L
0.0 – 0.2 x 109/L
150 – 450 x 109/L
<500 ng/ml
Platelet count
D-dimers
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Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
3.8 SPECIMEN INFORMATION
BLOOD TEST
BLOOD
BOTTLE
TURNAROUND
REFERENCE
RANGES
Full Blood Count
Pink 2.7 ml EDTA (K3)
< 4 hrs
See Page 41
ESR
Pink EDTA 2.7 ml (K3)
< 8 hrs
Male 0 – 10 mms
Female 0 – 15 mms
Blood Film
Pink EDTA 2.7 ml (K3)
< 2 days
3 days at weekend
Malaria Parasites
Pink EDTA 2.7 ml (K3)
Screen < 6 hrs
Morphology < 24 hrs
Travel history is helpful if available
Reticulocyte count
Pink EDTA 2.7 ml (K3)
< 4 hrs
Infectious Mononucleosis screen
(Glandular Fever)
Pink EDTA 2.7 ml (K3)
or brown top serum
sample
< 4 hrs
COMMENT
Includes
Hb, RBC, WCC, Diff, HCT, MCV, MCH,
MCHC, RDW
Not done on paed tubes –
Minimum 2 ml required
0.2 - 2.00%
9
(10-100 x 10 /L)
Family history + ethnic origin are helpful
if available.
Positive results confirmed by
electrophoresis.
Family history + ethnic origin are helpful
if available.
Positive results confirmed by
electrophoresis.
Sickle Test
Pink EDTA 2.7 ml (K3)
< 4 hrs
Haemoglobinopathy Screening
Pink EDTA 2.7 ml (K3)
3 working days
RF IgM
Brown top serum
14 days
<15 u/ml
only performed at Rheumatology
request
Anti CCP
Brown top serum
14 days
<5 u/ml
only performed at Rheumatology
request
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Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
BLOOD TEST
BLOOD
BOTTLE
COAGULATION
3 ml green citrate
Paediatric 1.4 ml
Prothrombin Time
3 ml green citrate
< 4 hours
INR
3 ml green citrate
APTT (PTT)
TURNAROUND
REFERENCE
RANGES
COMMENT
Paediatric tubes to be used on
paediatric patients or in adults in
exceptional circumstances only.
Please state if on anticoagulants.
9-12 sec
Sample must be correct level i.e. neither
over or under filled.
< 4 hrs
2.0 – 4.0 (Oral
anticoagulant)
Sample must be correct level i.e. neither
over or under filled.
3 ml green citrate
< 4 hrs
20 – 30 seconds
Sample must be correct level i.e. neither
over or under filled.
Fibrinogen
3 ml green citrate
< 4 hours
1.5- 4.5g/l
Not routinely tested.
Thrombin Time
3 ml green citrate
< 4 hrs
1.0-1.2 ratio
Not routinely tested.
D-Dimer
3 ml green citrate
< 4 hrs
<500ng/ml
Only available through AED for DVT
prediction.
Thrombotic Screen
10.0 ml green citrate
< 3 weeks
Refer to report
Protein C
Testing during the acute phase of a
thrombosis is unreliable.
Protein S
Antithrombin
If patient is on Warfarin then PC, PS
and Lupus will not be tested.
Factor V Leiden
Thrombin Time
Sample must be correct level, i.e.
neither over or under filled.
Prothrombin Gene Mutation
Lupus Anticoagulant
Anticardiolipin Antibodies
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Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
BLOOD TEST
BLOOD
BOTTLE
TURNAROUND
REFERENCE
RANGES
COMMENT
CLOTTING FACTOR
ASSAYS
One 9.0 ml green citrate tube
< 4 hrs if urgent or
< 2 weeks if not urgent
50-150%
By arrangement only – Contact Laboratory
Factors: II, V, VII, VIII, IX, X, XI,
XII
Intrinsic Assays: FVIII, IX, X, XI,
XII
Extrinsic Assays: FII, V, VII, X
50-150%
50-150%
50-150%
< 4 hrs if urgent or
< 2 weeks if not urgent
vWF Assay
Platelet Function Tests
By arrangement only – Contact Laboratory
By arrangement only – Contact Laboratory
3 ml green citrate tube
SPECIAL TESTS
Glucose-6-Phosphate
Dehydrogenase
2.7 ml EDTA
2 days
PNH Screening Test
Pink EDTA 2.7 ml/
Pink EDTA 1.2 ml Paed only
< 2 weeks
Bone Marrow Aspirate/Biopsy
Bedside Procedure
Hereditary spherocytosis
screening test
2.7 ml EDTA
Version 14.01e
Contact Haematology Medical Staff – by
arrangement
3 days
Page 49 of 82
Sample sent to Alder Hey
Laboratory Handbook
St Helens and Knowsley Hospitals
3.9
Pathology Services
REFERRAL LABORATORIES
Name and Address of Referral Laboratory
Haematology Dept., Film Room, Floor 2,
Duncan Building, Royal Liverpool Hospital.
Telephone no: 0151706 4334
Alder Hey Hospital, Eaton Road, West Derby,
Liverpool, L12 2AP
Telephone no: 0151 228 4811.
Tests Provided
Red Cell Membrane Markers: Prognostic
Markers for CLL: G6PD: PNH screening: Red
Cell Mass: Red Cell Fluoresence: Factor V
Leiden: Prothrombin Gene :
T & B subsets: Red Cell Membrane Markers
for Children: 5EMA screen for spherocytosis:
Liverpool Womens Hospital, Crown St,
Liverpool L8 7SS
Telephone no: 702 4229
Cytogenetics : HFE gene: JAK2 gene
Manchester Royal Infirmary, Oxford Road,
Manchester, M13 9WL
Tel: 0161 276 1234
Lysomzymes
Manchester NBS Centre, Plymouth Grove,
Manchester, M13 9LL
0161 251 4234
Platelet antibodies: White Cell antibodies
Salford Royal NHS FoundationTrust, Hope
Hospital, Stott Lane, Salford, M6 8HD
Telephone: 0161-206 4100
Neutrophil Antibodies:
Cytoplasmic Antibodies :
Neutrophil Function
Liverpool School of Tropical Medicine,
Pembroke Place, Liverpool, L3 5QA
0151 708 9393
Malaria
HMDS, Algernon SirthBuilding,Leeds
General Infirmary Leeds. LS1 3EX
Tel 0113 2026285
CD55/59 (Test for PNH)
Pathology Reception,University Hospital of
Wales,Heath Park, Cardiff, CF14 4XW
Telephone: 029 2074 7747
Erythropoietin Studies
Haematology,Pathology,G Block
Hammersmith Hospital
Du Cane Road
London W12 0HS
Pyruvate Kinase(PK)
Haematology Department, Red Cell Section
University Hospital,Queens Medical Centre
Derby Road
Nottingham
NG7 2UH
01159709181 / 2
Haemoglobin Variants
rd
Department Of Immunology, 3 floor Duncan
Building, Royal Liverpool Hospital, Liverpool,
L78XP
01517064350
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Laboratory Handbook
St Helens and Knowsley Hospitals
4
Pathology Services
SECTION FOUR - BLOOD TRANSFUSION
4.1.1
CONTACT NUMBERS
4.1.2
During Normal Working Hours
Laboratory Telephone
Transfusion Co-ordinator
Bleep
Consultant Haematologists
Secretaries
1584 (0151-430-1584)
4214 (0151-290-4214)
1584
Dr. J.A. Tappin
Dr. M. Gharib
Dr. J.A.T. Nicholson
1825 (0151-430-1825)
1315 (0151-430-1315)
2366 (0151-430-2366)
1825/1432/1147/1662
(0151-430-1825/1432/1147/1662)
Please do not hesitate to call or visit the Transfusion Department for help or
information.
4.2 TRANSFUSION POLICY
There is a Trust Policy – ‘Policy on the Administration of Blood and Components’. It
is available on the intranet. All staff who are involved in any aspect of transfusion
must receive transfusion training and adhere to this policy. The information given
below is a brief outline of the contents of the policy. It is not intended to replace it.
4.3 IMPORTANT FACTS FOR TRANSFUSIONS
Two facts cannot be stressed too strongly

An incompatible transfusion may be fatal, check full patient identity at all
stages of the process.

Blood for transfusion is a limited resource and wastage must be avoided if the
service is to remain viable.
4.4 TRANSFUSION REQUESTS
4.4.1
Request forms
Request forms must be completed with a minimum of 3 patient identifiers,
 Full name
 Date of Birth
 Address/Hospital number or A&E emergency number
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Pathology Services
In addition, location, consultant, clinical details, sex of patient, date and time of
request, blood products required, date and time required, and any other relevant
information must be completed.
The signature of the authorised requestor and the person positively identifying the
patient and taking the sample must also be given.
Remember that addressograph labels are only acceptable on transfusion request
forms, please ensure they are on both copies of the request form not on samples.
4.4.2
Samples (CLICK TO VIEW ‘Specimen collection and handling’)
The sample for grouping/crossmatching must be taken and labelled by either the
responsible Medical Officer, or an authorised phlebotomist/nurse/midwife.
Samples must be labelled with at least the same 3 identifiers present on the request
form and the patient’s location. The sample must also be dated and timed, and signed
by the collector. Sample labels must be HANDWRITTEN.
TO AVOID DELAY, PLEASE CHECK THAT THE DETAILS ON THE SAMPLE AND
THE REQUEST FORM ARE COMPLETE AND CORRECT BEFORE BRINGING
THEM TO THE LABORATORY.
4.5 ROUTINE CROSSMATCHING
4.5.1
Routine requests
A group and save less than 7 days old can be converted to a routine cross match
providing the patient has not received any red blood cells in the preceding 28 days.
Routine crossmatch are generally processed in batches and are usually available the
same working day. However a routine crossmatch can be provided in 45-60 minutes
if clinical need indicates. However, a day's notice should normally be given.Additional
units can be added to a crossmatch within 72 hours of the start of a continuous
transfusion. Any additional units after this time period will require a fresh sample.
4.5.2
Surgical requests (Fast Issue)
Blood can be provided at short notice for patients provided that TWO separate
samples for blood group are recorded in the Laboratory, there is a retained sample
less than 7 days old at the time the blood is required and the patient has no irregular
antibodies on record. Cross matched samples will be kept for 5 days post crossmatch. To confirm patient suitability for fast issue contact Blood Transfusion on Ext.
1584. Patients with antibodies will not be suitable for ‘Fast Issue’ and units may take
up to 48 hours to prepare.
4.6 EMERGENCY CROSSMATCHING
In an emergency, please contact the Transfusion department on 1584. The sample
should be brought DIRECTLY TO THE BLOODTRANSFUSION LABORATORY. It
should NOT be left at Reception. SAMPLES MUST BE HANDED TO A MEMBER
OF STAFF.
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4.6.1
Pathology Services
Responsibility
PLEASE NOTE THAT FOR THE PROCEDURES LISTED BELOW THE FULL
TESTING NORMALLY PERFORMED DURING A ROUTINE CROSSMATCH HAS
BEEN SHORTENED.
THE REQUESTING MEDICAL OFFICER ASSUMES
RESPONSIBILITY FOR THE TRANSFUSION OF EMERGENCY-SUPPLIED
BLOOD.
4.6.2
Blood supplied by the Laboratory
Following a request via the responsible Medical Officer, the following prepared blood
can normally be supplied.
Times are from receipt of a valid sample.
4.6.3
30 minutes -
Emergency crossmatched blood
Labelled with patient details
15 minutes -
UNCROSSMATCHED, same ABO/Rh D group as patient
Labelled with patient details
Immediately -
UNCROSSMATCHED, Confirmed ORh D NEGATIVE or ORh D
POSITIVE BLOOD
Labelled with GROUP only
Emergency O Negative Blood
There are two units of uncrossmatched, confirmed and labelled ORh D NEGATIVE
available for EMERGENCY USE ONLY in the blood refrigerators in:



A & E Dept.
Labour Suite
St. Helens Hospital – Elyn Lodge
Burns Unit
IT IS IMPERATIVE TO CHECK THE LABELS ON THESE UNITS CAREFULLY
BEFORE TRANSFUSION SINCE THE REFRIGERATORS ALSO HOLD
CROSSMATCHED BLOOD OF DIFFERENT GROUPS.
The Transfusion Laboratory MUST be informed as soon as these units have been
removed from the refrigerator so that they can be replaced.
4.7 CONSERVATION OF BLOOD
4.7.1
Group and Save
Ordering blood as a precautionary measure results in wastage and reduces available
stocks. A procedure which minimises wastage and delay if blood is required is the
request 'GROUP AND SAVE'. The patient's blood group is determined and the
sample screened for irregular antibodies. The serum is retained so that blood can be
crossmatched immediately if the need for blood arises.
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4.7.2
Pathology Services
Unused blood
Blood not used within 24 hours of the time and date required will normally be returned
to stock unless the Laboratory is notified.
4.8 COLLECTION OF CROSSMATCHED BLOOD
4.8.1
Location of cross-matched blood
Cross-matched blood may be collected at any time from the designated Blood Bank
refrigerator in the Blood Issue Room or satellite refrigerators (A&E, Delivery Suite,
Burns Unit, Main Theatre, St Helens Elyn Lodge, Ward 2A and the Lilac Centre).
4.8.2
Collection
A blood collection card should be brought from the ward to confirm the patient
identification details against those on the blood bag label. When details are confirmed
the collector must complete the issue book, and sign, date and time the collection.
Any products collected from the laboratory must be taken back to ward/destination in
a transport box.
Multiple units of blood signed out must be stored in the designated satellite blood
refrigerators and unused units returned to the Laboratory Blood Bank refrigerator as
soon as possible.
The transfusion MUST be started within 30 minutes of removing the blood from the
refrigerator.
4.9 RETURN OF UNUSED BLOOD
The fate of each unit of blood must be recorded. All blood that is no longer required
MUST be returned to the Laboratory Blood Bank Refrigerator.
4.9.1
Within 30 minutes of removal
If blood is not required and it has been out of the refrigerator for less than 30
minutes it may be re-issued. Details must be entered into the Blood Bank register.
4.9.2
More than 30 minutes after removal
Blood returned to the Laboratory after 30 minutes is NOT SAFE for re-issue and must
be labelled and placed in the Laboratory quarantine tray for discard by Transfusion
staff. STAFF MUST BE NOTIFIED IMMEDIATELY.
4.10 ADMINISTRATION OF BLOOD TO A PATIENT INCLUDING SPECIAL
REQUIREMENTS FOR A PATIENT
Please refer to the ‘Policy on the Administration of Blood and Components’ for full
details of identification, administration, and observations required for safe
transfusion to the patient and for the ‘Use of CMV and/or irradiated blood and
platelets for haematology patients’.
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4.11 TRANSFUSION REACTIONS
For the procedure for what to do in the event of a transfusion reaction please refer to
the ‘Policy on the Administration of Blood and Components’ that includes the
management and reporting of transfusion reactions - Outline below.
4.11.1 Procedure
If a member of staff suspects a significant transfusion reaction, either immediate or
delayed, then a medical officer must be called and the transfusion will be stopped if
indicated.
The blood bag and attached giving set should be returned to the Transfusion
Department, together with required samples indicated on the investigation form. The
Transfusion Reaction Investigation form will be issued by the laboratory and MUST be
completed in full.
4.11.2 Notification
All transfusion incidents, including near misses, (e.g. patient not fully identified,
wrongly labelled sample) should be notified as a Trust Incident Report, (via Datix)
In addition they should be reported to Serious Hazards of Transfusion (SHOT) via
the Transfusion Co-ordinator or other Transfusion staff. This is a national scheme
designed to share and learn from errors to prevent them recurring.
For more information about SHOT, please contact the Transfusion Co-ordinator.
4.11.3 Plasma products
The following plasma products are held in stock and available on receipt of a fully
completed request form
4.5% Human Albumin Solution (H.A.S.)
4.5% Human Albumin Solution (H.A.S.)
500 ml
100 ml
Small stocks of H.A.S. are held by G1 & AED.
20% 'Salt-poor' Albumin
Anti Rh immunoglobulin
Anti Rh immunoglobulin
100 ml
500 I.U.
250 I.U.
Record of administration
Since these products are human-derived, it is essential that a record be kept by the
departments of



Patient's name/DOB and hospital number/address
Product batch number
Date transfused
THIS IS A REQUIREMENT OF PRODUCT LIABILITY UNDER THE CONSUMER
PROTECTION ACT (1987)
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A form (WH BP1) is provided on G1 & AED which MUST be meticulously recorded
on EVERY OCCASION.
4.11.4 Frozen Plasma
Fresh Frozen Plasma (FFP)
Cryoprecipitate (CRYO)
Must be ABO compatible
These products take about 30 minutes to thaw in the laboratory prior to issue, and
must be transfused within 4 hours of thawing. A fully completed handwritten request
form is required. Record must be made as for HAS.
4.11.5 Platelet Concentrates
Platelets are not held in stock. They are ordered by the Laboratory on a named
patient basis from the NBS on receipt of a fully completed handwritten request form,
including the reason for the request. They must be ABO and Rh D compatible,
therefore the patient’s blood group will need to be determined if there is no previous
record in the department.
The platelets will be delivered to the Transfusion Laboratory and the ward will be
notified upon arrival. Platelets should be collected immediately prior to use, as they
need to be continually mixed on agitator in the Laboratory before transfusion.
4.12 SAMPLE REQUIREMENTS
BLOOD GROUP
ANTIBODY SCREEN
ANTIBODY IDENTIFICATION
CROSSMATCH
TRANSFUSION REACTION
HLA/DR TYPING
7.5 ml EDTA (Red) blood sample
in a Blood Transfusion tube
DIRECT COOMBS TEST
3 ml EDTA bottle (PINK)
KLEIHAUER
3 ml EDTA bottle (PINK)
COLD AGGLUTININS
(normal range < 64 at 4oC)
7.5 ml EDTA (Red) Blood Transfusion tube
- maintained at 37oC in a beaker of warm
water and delivered immediately to
Transfusion Department
4.13 TRANSFUSION RECORDS
In order to comply with the EU Blood Directive, there must be a complete audit trail
from blood donor to recipient which must be retained for 30 years. A blood
transfusion record sheet must be completed by clinical staff for EVERY unit
transfused. One sheet can be used for a maximum of 4 units, or each transfusion
episode if less than 4 units. The top copy MUST be returned to the Transfusion
Laboratory without delay, and the bottom copy is to be filed in the patient’s notes.
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The Trust is subject to inspection for compliance. (See page 40)
4.14 TRAINING IN TRANSFUSION
To comply with Clinical Governance and improve patient safety, all staff involved in
the process must receive training in safe transfusion practice according to their
grade and role. Awareness sessions are provided at Trust induction of clinical staff
and training provided at IV Drug Administration Sessions, in addition to yearly
Clinical Mandatory Training, Ad hoc sessions are provided as required. Porters
receive training in collection of blood and blood components as part of their local
induction programme.
Training is carried out by the Transfusion Co-ordinator or deputy. Please contact the
Transfusion Co-ordinator for more information about training available.
Competency Assessment for any grade of staff taking part in the Transfusion
process is 3 yearly and is accessed through ward based assessors. There are
three competencies attached to the transfusion process, venepuncture, collection of
blood from fridge and administration of blood.
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Fig 1 Blood Component Collection Card
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Fig 2 Blood Transfusion Record Sheet
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5
Pathology Services
SECTION FIVE - MICROBIOLOGY
5.1 CONTACT NUMBERS
5.1.1
During Normal Working Hours
Microbiology Department
0151 430 1837
Dr M S Vardhan
Consultant Microbiologist
0151 430 1836
Dr K D Allen
Consultant Microbiologist
0151 430 1834
Dr K Mortimer
Consultant Microbiologist
0151 430 1622
Mr K McLachlan
Microbiology Manager
0151 290 4140
Specialist Trainees
0151 426 1600 Ext. 2367/2459/7505
Microbiology Secretary
0151 290 4123
Andrology appointments
0151 290 4123
Out of Normal Working Hours
For urgent requests for laboratory tests please see details on page 2
For urgent medical advice contact the Microbiologist on call via Whiston Hospital
Switchboard 0151 426 1600
5.2 ABOUT MICROBIOLOGY
We provide a comprehensive range of diagnostic services including:
General Microbiology
Parasitology
Mycology
Virology / Serology
Andrology
Molecular testing, Chlamydia/GC, MRSA, C.difficile
Antibiotic Assays (Gentamicin/Vancomycin performed by Biochemistry)
We participate in national quality control schemes for all of the above services with
consistently high performance. We provide training for junior medical staff,
biomedical scientists and medical students. We are also actively involved with
research and development. Both laboratory and clinically based audit projects are
regularly undertaken.
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5.3 ANTIBIOTIC PRESCRIBING
See the Trust Antibiotic Policy. If further information is required please contact the
medical microbiologist for advice ext.1837 or 0151 430 1837
5.4 INFECTION PREVENTION AND CONTROL ADVICE
See the Infection Control Manual located on the intranet.
If further information is required contact:
Dr K D Allen,
Consultant Microbiologist and Director of Infection Prevention & Control
Whiston Hospital Ext. 1834 (0151-430-1834)
Dr K Mortimer
Consultant Microbiologist
Whiston Hospital Ext, 1622 (0151-430-1622)
Dr M S Vardhan
Consultant Microbiologist
Whiston Hospital Ext. 1836 (0151-430-1836)
Mrs G White, Service Manager, Infection Prevention and Control
Whiston Hospital Ext. 1193 (0151-430-1193)
Mrs M Kendrick, Clinical Nurse Specialist, Infection Prevention and Control,
Whiston Hospital Ext. 1384 (0151-430-1384)
Mrs J Grimes, Clinical Nurse Specialist, Infection Prevention and Control,
Whiston Hospital Ext. 2452 (0151-430-2452)
5.5 DIAGNOSTIC MICROBIOLOGY
Contact the medical microbiologist for advice (Ext. 0151-430-1837).
Out-of-hours, contact the medical microbiologist on call via Whiston Hospital
Switchboard.
5.6 MICROBIOLOGY SPECIMENS (click to view ‘SPECIMEN COLLECTION AND
HANDLING’)
Always obtain appropriate specimens e.g. blood, faeces, urine, swabs, pus before
starting the patient on antibiotics. Send specimens promptly to ensure that all
routine specimens are received in the laboratory before 4.00 pm
5.7 ANTIBIOTIC ASSAYS
Gentamicin and vancomycin assays are analysed by the Biochemistry Department.
Other aminoglycosides e.g. amikacin, streptomycin, tobramycin, netilmicin,
teicoplaninare reserved antibiotics and should onlybe used after consulting the
Microbiologist. These assays need to be sent away to other laboratories (e.g.
Bristol Antibiotic Reference Laboratory).
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Wherever possible antibiotic assays should be performed during normal laboratory
hours. On call assays should only be requested in exceptional circumstances
5.7.1 GENTAMICIN LEVELS – refer to the Trust Antibiotic Policy on the intranet
5.8 BLOOD CULTURES
Please note that avoiding blood culture contamination reduces laboratory work and
hospitalisation costs.
Adequate clinical information must be written on the request form e.g. suspected
clinical conditions like meningitis, osteomyelitis, arthritis, pneumonia and always give
travel history if any.
There isno value in collecting more than 3 sets of blood cultures. One or two setsare
sufficient for most infections apart from infective endocarditis.
If infective endocarditis or endovascular infection is suspected, take three sets of
blood cultures at separate times to demonstrate persistent bacteraemia as a result
of an endovascular focus of infection: 1 hour intervals are a minimum; ideally take
samples
at
6
hours
apartunless
the
patient
is
acutely
unwellorhaemodynamically unstable in which case, in order to avoid delaying
antibiotics, take the blood cultures at 15 minute intervals then start antibiotics.
Significant positive blood culture bottles will be communicated by telephone to the
clinical team by a medical microbiologist.
Negative blood culture results: an interim report is sent out after 48 hours incubation,
final report at 5 days.
Take blood cultures using aseptic non-touch technique (ANTT).
Please refer to: http://nww.sthk.nhs.uk/pages/AboutUs.aspx?iPageId=13856, for a
clinical skills demonstration video on the procedure for collection of blood for culture,
on the intranet for details.
Please use blood culture packs provided by the laboratory.
Clean skin with ChloraprepFrepp 1.5ml applicator, allow to dry. Collect sample using
ANTT technique and sterile neutral blood collection tubes. Remove culture bottle
caps and clean with Sanicloth wipe making sure the rubber stopper is cleaned
thoroughly
Inject blood through stopper of culture bottle using a new needle for each culture
bottle DO NOT inoculate more than the maximum amount of blood into each vial as
excess blood will clot and render detection of micro-organisms less likely
Complete audit label and attach to paperwork for Laboratory.
Aerobic bottle: Add 3-10 ml blood (optimum 8-10 ml)
Anaerobic bottle: Add 3-10 ml blood (optimum 8-10 ml)
Paediatric bottle: Add 1-3 ml blood
Send blood cultures in a plastic bag, with one request form for each set, to the
laboratory as soon as possible. All blood culture samples should be delivered to
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Pathology Reception.When taking other blood specimens e.g. FBC, U &Es etc.
always inoculate theblood cultures first so that they are not contaminated.
Blood cultures should be sent via the Ait Tube system ensuring that the appropriate
transport inserts are used.
5.9 ASCITIC FLUID
Send in sterile universal containers.
5.10 A.S.O.T
5 ml clotted blood (plain tube).
1ml paediatric samples will be processed
Normal range <200 IU/ml.
5.11 CHLAMYDIA/ NEISSERIA NUCLEIC ACID AMPLIFICATION TEST (NAAT)
This is a very sensitive molecular test, please avoid any contamination when taking these
samples
Use Aptima transport medium for sending first void urine,
Use Aptima transport for urethral swab, cervical swab or eye swab
Do not use bacterial culture swabs.
5.12 CSF
Please use CSF collection packs provided by the laboratory.
Please always notify microbiology on 1837 for all CSF samples during normal working
hours or via switch board during on call hours.
Protocol for CSF sampling in the investigation of Subarachnoid Haemorrhage (SAH) and
Meningitis.
1. Please label samples carefully with order number (1-4), patients’ name, DOB,
ward, date and time.
2. Unlabelled specimens will not be accepted.
3. Fully complete each request form with suspected diagnosis, test request,
patientdemographics and doctor bleep/contact number. NB: The Laboratory must
take suitable safety precautions when handling a CSF specimen from a known or
likely source of a spongiform encephalopathy infection e.g. CJD. Specimens
from such patients should always have included relevant clinical details.
4. CSF specimen number 4 must be sent in the envelope for light protection.
5. Do not use this pack for any cytology investigations.
Diagnosis
?
Meningitis
or
SAH
CSF
Specimen 1
Volume
1 ml or >
Container
Sterile
Universal
Container
Form
Microbiology
CSF Test
Red Cell Count
only measured if
?SAH
Accompanying
Specimens
None
Protein & Glucose
Meningitis
Specimen 2
or
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Yellow Top
Biochemistry
Tube
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glucose in Yellow
top tube
SAH
Meningitis
or
SAH
Specimen 3
1 ml or >
Sterile
Universal
Container
Microbiology
Cell Count &
Culture
SAH
Specimen 4
> 0.5ml
Sterile
Universal
Container
Biochemistry
Xanthochromia
None
Blood (4ml) for
bilirubin and protein
in Brown top tube
PLEASE NOTE – When investigating possible SAH/Xanthochromia:
1. Only do an LP in CT Negative or CT equivocal patients.
2. Collect CSF samples at least 12 hours post event and up to 3 weeks after an
event.
3. Take the blood samples either immediately before or after the LP and send with
the CSF samples.
4. Transport the CSF samples for Biochemistry by hand within 30 minutes of
collection. DO NOT USE THE PNEUMATIC TUBE as this may invalidate the test.
5. If LP fails, do not attempt repeat LP next day or thereafter, as false xanthochromia
may be obtained.
5.13 FAECES
Bacteriology
Virology
Ova, cysts and parasites,
C. difficile – NB: Formed stool specimens are note tested for C. difficile. Stool should
only be sent for C. difficile investigations if patient does not have any other
explanation for diarrhoea.
H. pylori antigen testing
Blue or Brown topped plastic container.
Use scoop attached to lid to obtain a sample of the specimen.
Do not fill container more than half full. Notify of any Foreign Travel etc.
5.14 GENITAL TRACT SWABS
For detection of Neisseria gonorrhoeae by culture:
Male patient
urethral swab (pharyngeal and anal swabs if indicated)
Female patient:
cervical swab (pharyngeal and anal swabs if indicated)
For detection of chlamydia/Neisseria gonorrhoeae by nucleic acid amplification test
(NAAT):
Use Aptima collection kits for either genital swabs or first void urine.
For detection of
Candida:
Bacterial vaginosis:
Trichomonas:
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HVS (ordinary swab)
HVS (ordinary swab)
HVS in TV medium
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5.16 FUNGAL/MYCOLOGY SPECIMENS
SKIN– Usually epidermal scrapings are received in the lab. These should be
received in a dry state, either in paper or in a sterile universal container or between 2
slides. Please use Derm a Pack fungal transport system.
NAIL – Nail clippings are the most common samples received. These again
should be received in a dry state.Please use Derm a Pack fungal transport system.
HAIR – As for skin and nail.
SPUTUM AND BODY FLUIDS – Fresh sputum should be collected into sterile
containers. Usually three consecutive samples should be processed. All body
fluids for mycology should be collected into sterile containers.
If there is insufficient material for both microscopicexamination and culture always
do microscopy and report insufficient for culture.
5.17 PLEURAL FLUID
Send in sterile universal containers.
5.18 PUS
Transport to microbiology ASAP
Never send swabs of pus when the pus is of sufficient quantity to be aspirated using
a plastic syringe. Transfer pus into sterile universal container and send to lab.
5.19 SPUTUM
Routine culture:
White screw-capped plastic 30ml/60 ml container.
TB culture:
Three consecutive early morning sputum specimens.
Saliva specimens will be discarded. They are of no use.
5.20 SWABS
Routine bacteriology:
Use swabs provided (with transport medium in container).
Virology (e.g. vesicle fluid):
Use viral transport
Microbiology).
medium
(available
from
5.21 ROUTINE SEROLOGY BROWN GEL TUBE, RED TOPPED EDTA SAMPLE FOR
PCR
Hepatitis A, IgG&IgM
Hepatitis B surface Antigen,(Current Infection)
Hepatitis B core Antibody (Past Infection)
Anti Hepatitis B surface Antibody (Immunity status following vaccination)
Hepatitis C Antibody (Current / Past infection)
Syphilis screen (Current / Past infection)
HIV (Current / Past infection)
Rubella IgGAntibody (Past infection / Vaccination) Measles IgG
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Mumps IgG
Varicella Zoster (chickenpox) IgG
CMVIgM and IgG
EBVIgM and IgG
Toxoplasma antibody
ABNORMAL RESULTS ARE REFERRED TO REGIONAL VIROLOGY LAB
5.22 SEMEN ANALYSIS
5.22.1 Post-vasectomy specimens
Send semen in sterile 30ml/60ml container with form giving patient’s name, address,
unit number and specimen number (i.e. whether specimen is first or second
sample). Specimens can be left in the laboratory at Whiston Hospital Tuesdays and
Thursdays between 9 – 11 am No appointment necessary (click to view Patient
Information Leaflet)
5.22.2 Infertility specimens
Full details are on the Patient Information Sheet (click to view). The patient MUST
telephone the laboratory (0151 290 4123 or 0151 430 1837) to make an
appointment (i.e. to ensure that a trained member of staff is available to examine the
fresh specimen so that it isn’t wasted). Appointments are only available on certain
weekdays. The specimen must be examined within 1 hour of ejaculation for
accurate results. The patient must not have had sex or masturbated in the past 48
hours. They should not have abstained from sex for more than 7 days. A sheath or
condom must not be used. Normal ranges for results are printed on the laboratory
report form.
5.23 THREADWORM
Sellotape slide.
1
2.
3
4
5
6
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Early morning specimen best.
Stick end of sellotape to glass slide.
Separate the patient’s buttocks and apply sellotape over anus.
Stick sellotape down onto glass slide.
Send in plastic bag to lab with request form
Wash hands (Threadworm ova are very infectious)
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5.24 TISSUE
Transport directly to microbiology, notify microbiology on 1837 or urgent samples
or via switchboard during on call hours
Never add formalin to specimens for microbiology. Even traces of formalin in the
container can prevent us from isolating pathogens.
Use a sterile container and label it clearly ‘Microbiology’ to prevent any mix-up with
specimens intended for histopathology.
5.25 URINE
Allows follow the Urinary Tract Dipstick Algorithm. Bacteriology use Green VMonovette container. For viral PCR use a sterile universal bottle. Do not use
sputum containers as these do not hold liquids. Always state the nature of the
specimen e.g. MSSU, CSU, clean catch, nephrostomy urine etc.
5.25.1 CSU
Do not send urine from the collection bag, use the sampling port. Only send CSUs
from patients who have clinical features of urinary tract infection: the only exception
to this should be CSUs sent as a part of MRSA screening.
Do not send “removal of catheter” specimen of urine. An MSSU taken 1-2 days
later is a much more useful specimen.
5.25.2 MSSU
Clean vulva/meatus prior to collection of specimen.
Collect the midstream specimen of urine.
Transport urine specimens to the laboratory in a boric acid container within 2 hours
or ensure they are refrigerated.
5.25.3 TB Culture
3 consecutive early morning urines should be sent in separate sterile universal
containers.
5.25.4 Legionella/pneumococcal antigen
Urine should be sent in sterile universal container.
5.26 VIROLOGY/SEROLOGY
For viral serology requests not processed at Whiston, please use microbiology
request forms, OCS or ICE to request serology investigations. Complete clinical
information and date of onset, otherwise the specimen will not be processed.
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5.26.1 Detection of virus by polymerase chain reaction (PCR)
For respiratory viral PCR (including influenza virus) please send nose and throat
swab in one vial of viral transport medium. Please give relevant clinical details
especially pregnancy.
Swabs must be sent to the laboratory in viral transport medium (available from
Microbiology).
Laboratory staff (Ext. 1837) must be notified before 9.20 am if a nasopharyngeal
swabs/aspirate/lower respiratory tract specimens have been taken for respiratory
virus detection. The specimen MUST arrive in the laboratory by 9.30 am for
transportation to Manchester Royal Infirmary (MRI).
At weekends and on Bank Holidays, wards should contact MRI directly on 0161
276 8788/8854 and send the sample themselves by taxi.
5.26.2 Detection of antibody e.g. in blood.
a.
b.
Take acute phase specimen of blood (5-10 ml clotted blood) in tube.
Take convalescent blood specimen at least 14 days later.
Both specimens are required to demonstrate rise in antibody titre.
Always make sure that the appropriate specimens are taken.
5.27 TURN-AROUND TIMES FOR MICROBIOLOGY SPECIMENS
5.27.1 MICROBIOLOGY PROCESSED AT WHISTON
INVESTIGATION
FAECES
GENITAL TRACT
SWABS (HVS,
IUCD, Penile)
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Salmonella, Shigella,
Campylobacter
Cryptosporidia, OC&P
Cholera, Yersinia
Clostridium difficile
E.coli 0157
Adenovirus and
rotavirus antigen
detection
Helicobacter pylori
antigen detection
C.albicans
Group B streptococci
N.gonorrhoeae
Trichomonasvaginalis
Actinomyces
Minimum
48 hours
Reporting times
Maximum
72 hours
24 hours
72 hours
<24 hours
48 hours
24 hours
72 hours
3 weeks
24 hours
72 hours
48 hours
24 hours
48 hours
24 hours
10 days
72 hours
72 hours
5 days
72 hours
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72 hours
Laboratory Handbook
St Helens and Knowsley Hospitals
PUS/WOUND /
SWABS
MRSA SCREENS
Chlamydia/GC
PCR
SPUTUM
URINE
SWABS
FUNGAL
CULTURE
Skin scrapings
Nail clippings
ASOT
SEROLOGY
ANDROLOGY
Semen Analysis
Pathology Services
Routine culture and
Gram stain
(Actinomyces culture)
MRSA
Chlamydia
N.gonorrhoeae
Gram stain and routine
culture
Mycobacterial culture
Routine culture
Microscopy
48 hours
72 hours
10 days
24 hours
24 hours
72 hours
72 hours
24 hours
48 hours
3 weeks
24 hours
< 24 hours
10 weeks
48 hours
Mycobacterial culture
Nose
Throat
Ear
Eye
Pertussis culture
Microscopy
3 weeks
24 hours
24 hours
24 hours
24 hours
5 days
24 hours
10 weeks
48 hours
48 hours
48 hours
48 hours
Culture
1 week
4 weeks
<24 hours
72 hours
Mumps, Measles, VZV,
EBV, CMV, Toxoplasma
24 hours
72 hours
Infertility analysis
7 days
10 days
Post vasectomy analysis
24 hours
24 hours
72 hours
To help attain these target turnaround times please clearly label samples and request
cards with adequate patient details: DOB, Hospital/NHS No. and sender
information:consultant and ward plus relevant clinical details including details of
recent/current antimicrobial treatment and date and time of sample collection.
All significant positive results from blood, CSF, faeces, TB cultures are telephoned
to sender by Medical Microbiologist.
5.27.2 VIROLOGY AND SEROLOGY
TURNAROUND TIMES
Turnaround time = time from receipt of specimen into the laboratory to 90% of reports
leaving the laboratory.
SPECIMEN TYPE
90% TURNAROUND
Non Viral Serology
Syphilis
3 days
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Brucella
Legionella urine antigen
7 days
2 days
Acid alcohol fast bacilli
Microscopy
3 day
Culture
Up to 6 weeks – positive culture 12 weeks
Processed at Whiston
Please notify microbiology medical staff of any urgent serology requests
Rubella Screen
Up to 2 days
Hepatitis B surface antigen screen*
Up to 3 days
Hepatitis B Immunity
Up to 3 days
Hepatitis B Markers
Up to 3days
Hepatitis A and C
Up to 3 days
HIV Serology Screen*
Up to 3 days
Varicella-zoster Immunity Screen (IgG)*
Up to 3 days
CMV IgM and IgG
Up to 3 days
EBV IgM and IgG
Up to 3 days
Measles IgG*
Up to 3 days
Mumps IgG
Up to 3 days
Toxoplasma
Up to 3 days
Note: The stated times are based on normal working hours, Monday to Friday, excluding
statutory bank and public holidays.
Results for specimens requiring testing by Reference Laboratories will take longer.
* Urgent results may be obtained on the same day after consultation with a
Consultant Microbiologist
5.27.3 REFERRAL LABORATORIES
INVESTIGATION
Antibiotic Assays


Amikacin
Tobramycin



Chloramphenicol
S-Flucytosine
Streptomycin

Teicoplanin
Amoebic IFAT
Hydatid CFT
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REFERENCE CENTRE
Royal Liverpool Childrens Hospital
Alder Hey
Eaton Road
Liverpool L12 2AP
Telephone: 0151 252 5488
Antimicrobial Reference
Laboratory Dept of Medical
Microbiology
North Bristol NHS Trust
Southmead Hospital
Bristol BS10 5NB
Telephone: 0117 959 5633
TURNAROUND TIME
1 day
2-3 days
2-3 days
Liverpool School of Tropical
Medicine
Diagnostic Parasitology
Laboratory
Pembroke Place
Liverpool L3 5QA
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Max 7 days
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St Helens and Knowsley Hospitals
Fungal Serology
CFT
INVESTIGATION
Meningococcal PCR
Meningococcal typing &
Virology
Pneumocystis pneumonia
HIV Confirmation
Complement Fixation
Pathology Services
Telephone: 0151 705 3220
Mycology Ref. Lab. Bristol/Leeds
Mycology Reference Laboratory
PHA – Southwest Laboratory
Myrtle Road
BRISTOL BS2 8EL
Telephone: 0117 928 5031
Liverpool School of Tropical
Medicine
Diagnostic Parasitology
Laboratory
Pembroke Place
Liverpool L3 5QA
Telephone: 0151 705 3220
REFERENCE CENTRE
Meningococcal Reference Unit
PO Box 209
Clinical Sciences Building
Manchester Royal Infirmary
Oxford Road
Manchester M13 9WZ
Telephone: 0161 276 6757/6758
Virology Department
Manchester Royal Infirmary
Oxford Road
Manchester M13 9WZ
Telephone: 0161 276 8788/8854
Microbiology Department
MRI Clinical Sciences Buildings
Oxford Road
Manchester M13 9WL
1-15 days
Max 7 days
TURNAROUND TIME
1 week 1 day
2 days
1 day
3 days
3 days
Torch screen
3 days
Other virus serology
5 days
Viral resistance and
genotyping
5 days
Tissue Culture
up to 14 days
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6
Pathology Services
SECTION SIX - HISTOPATHOLOGY AND CYTOLOGY
6.1 CONTACT NUMBERS
6.1.1
During Normal Working Hours
CONSULTANT
HISTOPATHOLOGISTS
Dr N. Hasan
1190 (0151-430-1190)
Dr L. Forsyth
1835 (0151-430-1835)
Dr S.A. Kelly
1839 (0151-430-1839)
Dr. M. Pinto
1731 (0151-430-1731)
Dr. N. Sharma
2759 (0151-430-2759)
Dr. D Barker
1620 (0151-430-1620)
SPECIALIST REGISTRARS
4124 (0151-430-4124)
DEPARTMENTAL MANAGER
ASSISTANT MANAGER
CONSULTANT BMS CERVICAL
CYTOLOGY (Clinical advice)
Mr. D. Walsh
Mr. I. Young
Ms. S. Montgomery
4319 (0151-290-4319)
1916 (0151-430-1916)
1816 (0151-430-1816)
HISTOPATHOLOGY
Secretaries (Report enquiries)
Technical enquiries and Frozen section requests
1824 (0151-430-1824)
1828 (0151-430-1828)
CYTOLOGY
Secretaries (Report enquiries) Non-gynae
Gynae enquiries/Technical enquiries/Supplies
1824 (0151-430-1824)
1765 (0151-430-1765)
MORTUARY
Office
Bereavement Office
Coroners Officers
6.1.2
1954 (fax 1290)
1336 (0151-430-1336)
1238 (0151-430-1238)
Out of Normal Working Hours
Mortuary
Out of hours service is available through the Duty Bed Manager
There is no routine Histopathology/Cytology service available at weekends or Bank
Holidays. Urgent out of hours requests for Histopathology may only be made
through the Consultant Histopathologists who can be contacted via switchboard.
6.2 DEPARTMENTAL NORMAL WORKING HOURS
Histopathology
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Cytology
Mortuary
Pathology Services
8.00 am – 5.00 pm
8.30 am – 5.00 pm
6.3 HISTOPATHOLOGY SAMPLES (click to view ‘SPECIMEN COLLECTION AND
HANDLING’)
6.3.1
Requests
All specimens must be appropriately identified with:







name
date of birth/patient identification number
specimen type
location of patient
site of specimen
date taken
time taken
and accompanied by a legible completed white request form giving:









patient identification (name, date of birth, hospital or NHS number, address
and postcode)
location of patient
specimen type
site of specimen
date taken
time taken
clinical details are mandatory
previous histology/cytology number (where available or relevant)
signature of requester
Details of hazard status, where relevant, must be indicated on both the request
form and specimen container.
Inadequately labelled specimens/incomplete request forms will not be accepted by
laboratory staff and will be returned to the sender. This will result in delay in
reporting the specimen.
Requests for urgent specimen processing and reporting must be clearly indicated on
the request form and the department contacted (Ext. 1828).
Specimens in 60 ml and 120 ml pots should be placed into a small orange hazard
bag.
The department will endeavour to provide 80% of diagnostic biopsies reported,
confirmed and authorised within 7 calendar days. Additionally, 80% of all
histopathology and diagnostic cytology final reports available within 10 calendar
days of procedure. These targets will be audited annually as part of the
departmental audit schedule.
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6.3.2
Pathology Services
Specimen Fixation
All tissues for routine histological examination should be placed immediately in 10%
buffered formalin. The container should be of adequate size and the volume of
formalin used should be at least ten times the volume of the specimen. Pre-filled 60
ml specimen containers should be used for biopsies only and 120 ml for small
specimens e.g. skin.
Remember that tissue samples for Microbiology MUST NOT have formalin added.
6.3.3
Supplies
Hospital
GP/Outpatients
6.3.4
Stocks of pre-filled 60 ml and 120 ml containers, empty
specimen containers, and 5 litre containers of formalin and
small orange hazard bags are supplied by the laboratory.
For supplies of pre-filled specimen pots contact the
laboratory (Telephone 0151 430 1828)
Frozen Sections
Frozen sections are available by arrangement giving at least 24 hours notice
(telephone 1828). Specimens for frozen section must be brought fresh and unfixed
immediately and directly to the laboratory. IF A BOOKED FROZEN SECTION IS
NO LONGER REQUIRED THE DEPARTMENT MUST BE INFORMED.Unbooked
frozen sections may not be performed.
* Please note – Danger of Infection specimens will not be accepted.
6.3.5
Immunofluorescence Studies
Skin specimens for Immunofluorescence (IMF) should be sent in Michel’s
transport medium; supplies are available from the Histology department.
6.3.6
Pregnancy Loss Specimens and Non-Viable Fetuses (Up to end of 15 Weeks
Gestation)
If pathological examination is not required the hospital procedure for the Sensitive
Disposal of the Non-viable Fetus (available on the intranet) should be consulted.
The Pregnancy loss specimen or fetus should be placed in an appropriately sized
specimen container and covered with formalin, a Histology request form completed
and Consent form 10 must be completed by patient and staff. The specimen or
fetus and documentation should be sent to Histopathology.
If pathological examination is required, the formalin fixed specimen or fetus and
placenta should be sent to Histopathology accompanied by a completed request
form and consent form 10 as per current guidelines. The whole placenta must be
submitted, a small fragment is not sufficient. Remember that once in formalin,
cytogenetic and microbiological investigations are no longer possible.
Copies of the guidelines are available throughout the Obs. &Gynae. Department.
Please label request form and specimen container with all correct information.
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Note: 1. ‘Fetuses from 16 weeks to 23 weeks & 6 days gestation requiring
Histological examination are sent (via Mortuary) to Alder Hey Children’s
NHS Foundation Trust, Alder Hey Hospital, Eaton Road, West Derby,
Liverpool, L12 2AP. See ‘Procedure for the Sensitive Disposal of the Non
ViableFetus’ (available on the Intranet) for required documentation.
2. From 24 weeks gestation please refer to Post Mortem section.
6.3.7
Review of Archival Material
It is usually possible to access the past 10 years provided that the laboratory
number, including the year, is supplied.
6.4 NON-GYNAE CYTOLOGY
6.4.1
Requests (click to view ‘SPECIMEN COLLECTION AND HANDLING)
6.4.2
All specimens must be appropriately identified and accompanied by a
completed request form (see above).
Details of hazard status where relevant must be indicated on both the request form
and specimen container
Inadequately labelled specimens/incomplete request forms will not be accepted by
laboratory staff.
Specimens should be transported to the laboratory on the same day as collection.
Specimens should be refrigerated if transport is delayed (e.g. weekends).
6.4.3
Fine Needle Aspiration Cytology
Spread aspirated material onto glass slides labelled in pencil with the patient’s
name and date of birth. The smears should be fixed immediately with Cytology
Fixative and the needle contents rinsed into Cytology Preservative (red fluid).
Dispose of the needle safely. Do not leave it in the bottle.
Aspiration cytology kits are available from the Cytology Department.
6.4.4
Body Fluid Cytology
Collect specimens into sterile universal containers. The department will not accept
bags, they will be returned not sampled. UNIVERSALS ONLY.
6.4.5
Urine Cytology
Urine cytology kits including full instructions for use are supplied by the Cytology
Department. Do not discard the fixative (clear fluid) provided in bottle supplied.
Urine should be obtained at the beginning or end of voiding not early morning or
mid stream specimens. The minimum volume for examination is 20 ml.
6.4.6
Sputum Cytology
Cytology of sputum samples will only be performed on patients with a clinical
suspicion of lung cancer who are unfit for bronchoscopy. If the clinical details given
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do not indicate this, the specimen will be not be processed. The specimen should be
obtained from early morning deep cough sputum, before the patient eats, drinks or
cleans their teeth, and collected into a sterile sputum pot
6.4.7
Joint Fluids
Collect specimen into a sterile universal container and transport immediately to the
laboratory. The clinical details should indicate any history of intra-articular steroids.
6.4.8
Endoscopic Brushings
Bottles containing preservative are available from the Cytology Department. Push
the brush beyond the end of the tube, cut through the tube at an appropriate length,
and place the tube and brush into cytology preservative.
6.4.9
Endoscopic Washings
Collect specimens into sterile universal containers.
6.4.10 FNA Adequacy Assessment Service
The department also offers an FNA adequacy assessment service at the St.
Helens DTC. This service is available during clinic days. It involves the attendance
of a Biomedical Scientist in the laboratory to give a decision on whether the sample
contains adequate number of cells for analysis.
6.4.11 Turn Around Times for Non Gynae Cytology
Turn around times for Non Gynae cytology is within 5 working days from receipt
unless clinically indicated/urgent.
6.5 GYNAECOLOGICAL CYTOLOGY
6.5.1
Service overview
Call and recall for the Cervical Screening Programme are provided by
CentralOperations Merseyside (COM), Bevan House, 65 Stephenson Way,
Wavertree,Liverpool, L13 1HN (telephone: 0151 296 7000) and LaSCA (NHS) 3
Caxton Road, Fulwood, Preston PR2 9ZZ (telephone 017720221444). Any
queries about priornotification lists or patient recall should be directed to COM or
LaSCA.
Failsafe letters are issued by the laboratory where there is no recorded follow-up
for previous positive results. Any queries regarding failsafe should be made to the
Hospital Based Cervical Screening Programme Manager (Tel: 0151 430 1770).
Reports are not given by telephone in case of transcription error. However a
smear report may be faxed to external recipients (GP's and clinics). Copy results
within the Trust must be collected from the laboratory by the requesting
department. Request the copy by telephoning 0151 430 1770 or 0151 430 1765
with patient details and when the sample was taken. A form will be sent to check
the fax number, and transfer responsibility for the result being faxed to the
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requestor. This form must be completed and faxed back to 0151 430 2364 before
the result can be faxed.
All requesting and results are available in various electronic formats.
Liquid Based Cytology (LBC)
Surepath vials should be sent to the laboratory at Whiston Hospital, from where
they will be forwarded to the Royal Liverpool Hospital for processing. The prepared
sample will be returned to Whiston, and reported in the usual way. Any query
regarding a specimen should be directed to Whiston Hospital (0151-430-1765).
In addition to routine screening of call and re-call Gynaecological Cytology LBC
samples, the laboratory carries out testing for High-Risk Human Papilloma Virus
(HR-HPV). This was implemented on 26th March 2012.
HPV testing is carried out as triage for women with low grade (mild or borderline)
cervical screening test results and as a test of cure (TOC) for treated women.
HPV Triage
Women with borderline changes or mild dyskaryosis are tested to establish those
that are HR-HPV positive and may thus have significant disease. They are
referred immediately to colposcopy. Women who do not have HR-HPV are
unlikely to have significant disease so can be returned to routine recall.
HPV TOC
This element of HPV testing is used to determine which women can proceed to
routine recall, following treatment.
Women who have been treated for CGIN (Cervical Glandular Intraepithelial
Neoplasia) and invasive disease are excluded from TOC.
Year One of HR-HPV Implementation (from 26th March 2012).
o HPV testing for triage is conducted on the first occurrence of a borderline
or mild sample in eligible women routinely invited for screening.
o TOC is restricted to newly treated women with normal, borderline or mild
cytology six months after treatment.
Year Two (commencing 1st April 2013)
o testing for triage will be extended to all borderline and mild samples.
o test of cure will be extended to all women treated for CIN (Cervical
Intraepithelial Neoplasia) who have normal, borderline or mild cytology six
months after treatment.
6.5.2
Samples and Request Forms
All Surepathvials must be labelled with




patients full name
date of birth
location
NHS Number
The vial should be placed in the bag attached to the form. The request form should
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give the following information: patient’s full name (avoiding abbreviations)
 previous surname
 NHS number
 address
 date of birth
 clinical data including hormone therapy such as tamoxifen, oral
contraceptives, HRT etc
 all relevant codes ringed including cervix visualised and 360° sweep
 sender including GMC/NMC smear taker code
 GP
Please use legible handwriting if completing handwritten request forms. Complete
all prompted/mandatory fields on electronic requests. Inadequately labelled
specimens and forms will be discarded.
6.5.3
LBC Cervical Sampling/Smear Taking and Transport
All vials should be placed in specimen bags with their request forms attached and
sent to the lab via designated transport runs from each surgery practice following
Whiston Hospital transport policy and procedures, in transport boxes with spillage
kits and safety data sheets.
Check use by/expiry dates on LBC vials before use. Rotate stock of vials in
surgery.
To ensure adequate sampling:




women should be invited mid-cycle (at least day 7)
the cervix fully visualised
360° sweep 5 times
Cervex head placed into the vial as quickly as possible
The cervex broom head must be placed in the container or an inadequate report will
be issued.
Primary screening should not be undertaken with an endocervical brush sample
only, but if an endocervical brush is used it must be in conjunction with a cervex
sampler. The brush must be supplied by Medical Solutions and have a removable
head. Place the brush head and the cervex head in the same vial, and note on the
form that two samplers are in the pot.
If the patient has a wide ectropian, two Cervex brooms may be used, so that the
transformation zone is sampled. Place both Cervex heads into one vial and note on
the form that two samplers have been used. Only send two vials if the patient has
two cervices, labelling the pots with the cervix position.
The Cervex broom must be rotated 5 times, even if the patient bleeds, to ensure
adequate endocervical cell sampling.
Please refer to the Surepath video received with the training pack for more details.
Smear takers are welcome to visit the cytology department by appointment, contact
Julie Campbell (Tel 0151 430 1765 or Julie.Campbell@sthk.nhs.uk).
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6.5.4
Pathology Services
Turn Around Times for Cervical LBC Samples
The turn around time for Cervical LBC samples is to meet monthly targets of 98%
within 14 days from date of sample collection.
6.5.5
6.5.6
Supplies
Supplies should be requested from the laboratory using the appropriate form.
Please stamp the form with the practice stamp so we can charge the correct CCG.
Please manage stock sensibly, as the kits are expensive and the CCG will be
charged when the kit is requested. Please note endocervical brushes will not be
supplied from the laboratory.
Clinical Advice for Cervical Cytology
Clinical Advice for Cervical Cytology is available from Sandra Montgomery, BMS
Consultant 0151-430-1816 and Dr Maria Pinto, Consultant Histopathologist/Lead
in Cytology 0151-430-1731
6.6 POST MORTEMS
6.6.1
Contact numbers
Mortuary
Bereavement Office
Coroner’s Officers
Consultant Pathologists
6.6.2
1954 (fax 1290)
1336
1238
1824
Hospital Post Mortems
Hospital post mortems may be requested on any case not requiring a Coroner’s
post mortem (see below). Written consent must to be obtained from the next of kin
and Consent Form 5 completed (available from the Bereavement Office). A Death
Certificate must be issued before the post mortem is performed. Hospital doctors
involved with the patient’s management should attend the post mortem and they
will be contacted by the mortuary staff.
6.6.3
Coroner’s Post Mortems
In some circumstances the case must be referred to HM Coroner e.g.
death due to




accident
suicide
industrial disease
drugs
or death



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under anaesthesia
when the cause of death is not known, i.e. where a Death Certificate cannot
be issued
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In these circumstances the Coroner’s Officers must be contacted. They will advise if
a post mortem is required and if so, will be responsible for issuing the Death
Certificate. In suspected industrial disease deaths, the deceased’s occupation or
previous occupation must be noted for the Coroner’s information. Written consent
from family is not required for Coroner’s post mortems which are a medico-legal
requirement.
In any event the Consultant Pathologists will be able to give advice. Stillbirths and
Perinatal Deaths
This applies to babies delivered from 24 weeks gestation. Refer to the hospital
procedure for the Sensitive Disposal of Stillbirth infants (available on the intranet).
For further information please contact the Head of Midwifery.
Fetal(16 weeks and over) and perinatal autopsy and placental histopathology is
undertaken by Alder Hey Children’s NHS Foundation Trust (Alder Hey) via a service
agreement.
If only the placenta from stillbirths and fetuses of 16 weeks gestation are to
be sent to Alder Hey; the placenta should be in an appropriately sized
specimen container and covered with formalin , a Whiston Histology request
form completed and a Alder Hey ‘ Request for the examination of the
placenta’ form completed. The placenta and request forms are taken to the
Histology dept at Whiston. See 6.7 Referred samples.
6.7 REFERRAL LABORATORIES
INVESTIGATION
Post Mortem
Examination of
Fetuses from 16 weeks
gestation.
Post Mortem
Examination of
Stillbirths.
REFERENCE CENTRE
TURNAROUND TIME
Histology Department
Alder Hey Children’s NHS
Foundation Trust
Eaton Road
Liverpool L12 2AP
Telephone: 0151 292 3656
Up to 12 weeks
Histology Department
Immunohistochemistry
Department
Royal Liverpool University
Hospital
th
5 Floor, Duncan Building
Prescot Street
Liverpool L7 8XP
Telephone 0151 706 4483
Fax 0151 706 5859
Ophthalmologic Pathology
Department
Royal Liverpool University
Hospital
th
5 Floor, Duncan Building
Prescot Street
Liverpool L7 8XP
Within 10 working days
Referral
centre
CPA status
Full CPA
Histological
examination of
Placentas
FISH Testing
Eye Pathology
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Full CPA
Full CPA
Up to 20 working days
Laboratory Handbook
St Helens and Knowsley Hospitals
KRAS Genetic Service
Sudden Cardiac Death
specimens
Lung Tissue for
Asbestos fibres
Tissue block for
Oncotype DX
Brain / Spinal cord
EGFR
BRAF
HER2
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Pathology Services
Telephone 0151 706 4483
Fax 0151 706 5859
Liverpool Women's NHS
Foundation Trust
Crown Street
Liverpool
L8 7SS
Tel: 0151 708 9988
Fax: 0151 702 4028
Royal Brompton &Harefield
Pathology Department
Sydney Street
London
SW3 6NP
TEL: 020 7351 8425
Histology Department
Royal Liverpool University
Hospital
th
5 Floor, Duncan Building
Prescot Street
Liverpool L7 8XP
Telephone 0151 706 4483
Fax 0151 706 5859
Genomic Healthcare Inc.,
301 Penobscot Drive,
Redwood City,
CA 94063, USA
Buxton Laboratories
The Walton Centre for
Neurology and Neurosurgery
NHS Trust
Lower Lane
Fazakerley
Liverpool
Merseyside
L97LJ
Dept of Cellular Pathology
th
5 Floor Duncan Building
RLUH
Liverpool, L69 3GA
Central Manchester Univ.
Hospitals
Regional Genetics Lab.
Services
th
Genetic Medicine (6 Floor)
St Mary’s Hospital
Manchester, M13 9WL
Source Bioscience.
Pathlore,
Medical Solutions PLC,
1 Orchard Place,
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Full CPA
5 working days
14 days
Conditional
CPA
98% within 2 weeks of
receipt
Full CPA
7-10 days from receipt
of sample
Regulated
under the
Clinical
Laboratory
Amendments
of 1988
(CLIA)
90% within 5 working
days
Full CPA
10 working days
Full CPA
5 working days
Full CPA
Up to 7 days
Full CPA
Laboratory Handbook
St Helens and Knowsley Hospitals
Pathology Services
Nottingham Business Park,
NOTTINGHAM,
NG8 6PX
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