Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Title:
Haematology & Blood Transfusion
Laboratory Handbook
Code:
Haematology/Blood Transfusion/Clinical Chemistry 11133
Authors:
Chris Brammer and Marie Hughes
Version:
5.0
Document Category:
Haematology & Transfusion
Authorised By:
Sheila Kowalczyk
Authorised On:
30-Jun-2014
Review On:
30-Jun-2016
Location Of Copy:
Intranet
Section:
All Haematology, Chemistry & Transfusion Locations
Date Time Of Last Update:
30-Jun-2014 12:53
Date Time Printed:
30-Jun-2014 12:53
Document Status:
Authorised
Ou Name:
Department of Haematology, Blood Transfusion & Clinical Chemistry
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Department of Haematology and
Blood Transfusion
Laboratory Handbook
Section
1
2
3
4
5
6
7
8
8.1
9
9.1
9.2
9.3
9.4
10
11
12
13
14
15
16
Contents
Introduction, Location & Telephone Numbers
General Comments and Clinical Guidelines
Laboratory Opening Hours and Emergency Service
Request Forms
Specimen Tubes
Blood Transfusion
Obstetric Haematology
Thrombophilia investigation and testing
Anticoagulation and warfarin induction
Table of Haematology Tests, Turnaround Times and
Reference Ranges
Sample Type and Container Guide
Guide to notes in Table of Tests
Turnaround Times
Reference Ranges for Full Blood Count and White Cell
Differential
Reference Lab Addresses
Haematology Tests Special Precautions
Haematology Tests Time Limit for adding Additional
Request
Screening for Malaria and other blood borne parasites
Requesting and interpreting Haematinics tests (B12,
Folate, Iron studies)
Screening for Thalassaemia and Haemoglobinopathies
Investigation of Hereditary Spherocytosis
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 1 of 41
1. INTRODUCTION, LOCATION AND TELEPHONE NUMBERS
We provide a service to all hospitals and General Practitioners in the area and
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
receive about 2000 specimens each day.
The laboratory is located on the second floor as shown on the following floor
plan:
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 2 of 41
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
CONSULTANTS
Dr. C. Brammer
ext. 66771 (external 01324 566771)
Dr. R.F. Neilson
ext. 66772 (external 01324 566772)
Dr. M. Hughes
ext. 66770 (external 01324 566770)
Dr R. Boulton-Jones
ext. 66768 (external 01324 566768)
Secretary
ext. 67084 (external 01324 567084)
For urgent clinical queries Consultant Haematologist can be contacted on
01324 567675 Mon-Fri 9am – 5pm.
The on-call Haematologist can be contacted via hospital switchboard out with
these hours.
Non-urgent clinical or laboratory queries should be directed to the departmental
mailbox which will be reviewed daily Monday to Friday.
Email address: FV-UHB.haematology@nhs.net
SENIOR LABORATORY STAFF
Mrs Sheila Kowalczyk BMS 4
ext. 66767 (external 01324 566767)
Mrs Mandy Dawson BMS 3
ext. 66777 (external 01324 566777)
Mrs Gillian Lowe BMS 3
ext. 66775 (external 01324 566775)
Mr Mark Gilmour Quality Manager
ext. 66773 (external 01786 566773)
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 3 of 41
LABORATORY NUMBERS
Laboratory Emergency Pager out of hours
1777
(to page dial 68100 and follow instructions, from outside FVRH phone
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
switchboard and ask to page)
Specimen Reception Routine Enquiries
ext. 66695 (external 01324 566695)
Specimen Reception Emergency Requests ext. 66693 (external 01324 566693)
Haematology Laboratory
ext. 66755 (external 01324 566755)
Transfusion Laboratory
ext. 66779 (external 01324 566779)
Transfusion Practitioner
ext. 66762 (external 01324 566762)
FORTH VALLEY ROYAL SWITCHBOARD:
01786 566000
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 4 of 41
2. GENERAL COMMENTS AND CLINCIAL GUIDELINES
CHI Number
Please ensure that specimens and request forms are both adequately labelled so
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
that they can be matched up without error and the result sent to the appropriate
destination. If you do not use the CHI number, we may not be able to link earlier
results to the same patient and the result may not match to the patient when the
result processes into SCI Store. If you have access to laboratory results
electronically they may not be available to you.
Clinical Details
Relevant clinical details help us to be more helpful to you. It is rarely possible,
for example, to interpret blood film morphology without some knowledge of the
clinical situation. A comment such as “routine” is not any help. The Consultant
Haematologists are always willing to discuss problems and to give advice.
Clinical Guidelines
Relevant Clinical Guidelines are available on the Forth Valley Intranet at the
following link by selecting “Haematology” and “Transfusion Service”. The
handbooks for all laboratory departments are found by selecting “Laboratories”
through the Clinical Guidelines page or by using the “Departments A-Z” option
from the Intranet home page.
http://www.qifv.scot.nhs.uk/CE_ClinicalGuidelines.asp
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 5 of 41
3. LABORATORY OPENING HOURS AND EMERGENCY SERVICE
LABORATORY OPENING HOURS –HAEMATOLOGY AND BLOOD
TRANSFUSION
Monday to Friday 08:40 – 17:00 (Normal Service)
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Monday to Friday 17:00 -08:40 (Reduced 24 hour service)
Saturday and Sunday all day – (Reduced 24 hour service)
Public Holidays – Reduced service (details issued via staff comms)
SPECIMEN RECEPTION OPENING HOURS
Monday to Friday 08:45-20:00
Saturday and Sunday and 09:00-17:00
Out of hours: The department operates a shift system for Haematology and
Blood Transfusion, and the duty BMS should be contacted through the
switchboard or internal page number 1777.
EMERGENCY SERVICE
When sending urgent samples please notify the Laboratory in advance on the
numbers below:
Monday to Friday 08:45-20:00 and Saturday and Sunday and 09:00-17:00:
Phone specimen reception on 66693 (01324 566693) or the laboratory number
as in section 1.
At all other times contact the duty BMS by paging 1777 or phone the laboratory
number. From outside the hospital phone switchboard on 01324 566000 and ask
for page 1777.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 6 of 41
4. REQUEST FORMS
1. Haematology:
The front sheet (Red on White) of the multi-layer request form is for
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Haematology but not Blood Transfusion. If your request is for other
departments also you MUST write firmly with a ballpoint pen and if address
labels are used, attach them to all relevant pages. If you do take labels from
the patient’s notes check that they refer to the right patient.
Haematology request form requirements are:
•
Surname and forename, date of birth and / or CHI number must be
provided – use the CHI number whenever possible as this assists
matching results to previous result for the patient
•
Name and address of requestor is required in order that reports can be
directed appropriately or can be found on SCI store using the search
facility (consultants name should be clearly identified in full).
•
Date and time of specimen and person who bled the patient should be
recorded
•
Useful clinical details should be provided
•
Note that bar-coded addressograph labels should be used on request
forms whenever possible
2. Blood Transfusion: (Blue on White):
All requests for blood or blood products including “group and save”
procedures and Anti-D requests. Please refer to the NHS Forth Valley Blood
Transfusion Protocol for request form and sample labelling requirements (use
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
linkAuthorised
in section
6). Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
on: 30-Jun-2014.
Author(s): Chris Brammer, Marie Hughes
Page 7 of 41
3. Direct Order Comms:
The DartOCM system is being implemented across Forth Valley in 2014. The
system will not be used for Blood Transfusion. Training will be provided to
requestors before moving on to the system. Any requests that can’t be
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
generated through DartOCM must comply with 4.1 above.
5. SPECIMEN TUBES
Specimens are taken by the Becton Dickinson system. Under or overfilling may
lead to invalid results.
All anti-coagulated specimens should be mixed gently by repeated inversion, not
shaken. Becton Dickinson distributes charts with information on which bottles to
use for which test, order of draw and mixing requirements. Charts are available
through the practice development team.
DO NOT pre-label bottles as this can lead to misidentification errors. Sample
bottles should be labelled at the bedside by the person taking blood and initialled
by them.
A list of tests performed and the type of specimen tube required is in section 9.
Please ensure that separate bottles are sent for haematology and clinical
chemistry tests.
Addressograph labels are acceptable on Haematology sample bottles but under
no circumstances will they be accepted for blood transfusion work or ante-natal
grouping. This practice has been shown to increase the likelihood of
misidentification.
For blood transfusion or ante-natal blood group samples:
Bar-coded addressograph labels are not accepted on samples for transfusion
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
testingAuthorised
or ante
natal grouping. The minimum identification requirements are
on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
detailed in the Blood Transfusion
protocol which is found at the link in section 6.
Page 8 of 41
For Haematology samples the following information is required:
•
Minimum identification required on the sample is:
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
o Surname
o Forename
o Date of birth and / or CHI number
•
In addition there should be the name of requestor and requesting
location, the date and time the sample is taken and the signature of the
person who bled the patient.
•
The details on the sample and request form must match. Failure to
provide the correct details may result in the sample being rejected and
a repeat required.
•
A bar-coded addressograph label is preferred. Place the label on the
bottle so that the level of blood in the bottle can still be seen.
•
When emergency tests are required for unidentified patients a casualty
number should be used and as much other information e.g. unknown
male / unknown female.
•
The laboratory cannot process specimens that are not clearly identified.
•
Note that for requests generated via direct order comms DartOCM
barcoded sample labels are printed for each bottle required. Training
will be provided for requestors before moving on to the system during
2014. Any requests that can’t be generated through DartOCM must be
comply with the above.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 9 of 41
Precautions for High Risk Specimens:
•
All samples and request forms which are known to be or suspected may
be high risk e.g. hepatitis, HIV or other group 3 or 4 agent such as Dengue
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
fever must be labelled with a high risk sticker.
•
The laboratory must be informed in advance if a sample is suspected of
containing any high risk agent other than hepatitis or HIV e.g. Dengue
fever.
•
See section 11 for further information on special precautions required for
high risk samples.
6. BLOOD TRANSFUSION
The NHS Forth Valley “Blood Transfusion Protocol” details the procedures
adopted by this organisation to maximise transfusion safety and is based on
national guidelines. Please use the link below to the Forth Valley Intranet Clinical
Guidelines page and search for “Transfusion Service” guidelines.
http://www.qifv.scot.nhs.uk/CE_ClinicalGuidelines.asp
Alternatively from the intranet home page under main menu select “Departments
A-Z”, select “Laboratories” and click on the link to “Blood Transfusion”.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 10 of 41
7. OBSTETRIC HAEMATOLOGY
ANTI-D IMMUNOGLOBULIN
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Indications for Administration:
1. All Rhesus negative women as soon as possible after, or at least within 72
hours of, delivery of a Rhesus D positive infant, when the post delivery
maternal venous blood specimen contains no detectable anti-Rhesus D
antibody.
Advice should be sought if other antibodies are present.
2. All pregnant Rhesus negative women with no Rhesus D antibody on record,
to be given as soon as possible after, or at least within 72 hours of, the
following potential sensitising episodes:
•
Miscarriage; complete, incomplete or threatened at > 12/40;
•
Persistent PV bleeding at any stage of pregnancy
•
Termination of pregnancy
•
Amniocentesis, chorionic villus biopsy and cordocentesis
•
Anti-partum Haemorrhage
•
External cephalic Version
•
Abdominal trauma (sharp/blunt, open/closed) at >12/40
•
Ectopic pregnancy
•
Evacuation of molar pregnancy
•
Intrauterine death and stillbirth
•
In-utero therapeutic interventions (transfusion, surgery, insertion of
shunts, laser)
•
Delivery – normal, instrumental or Caesarean section
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 11 of 41
Dosage and Administration:
250 units (50 µg) intramuscularly up to 20 weeks gestation.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
500 units (100 µg) intramuscularly after 20 weeks gestation.
Timing of administration of anti-D
To be given preferably within 24 hours of the potential sensitising incident, and in
no case later than 72 hours. However, in the case of accidental omission, Anti-D
should still be given up to 7 days after the incident.
The preferred site of
injection is the deltoid muscle. Injections should be given every 6 weeks if there
is continued ante partum bleeding.
NB In the case of Intrauterine death, it should be noted that the diagnosis of IUD
is the sensitising event rather than delivery and hence anti-D Ig should be issued
for administration within 72 h of diagnosis.
Prophylactic anti-D programme
A programme for administration during pregnancy of prophylactic Anti-D to
suitable Rh(D) Negative women is now in place. Women are offered a dose of
1500 IU Prophylactic Anti-D at 30 weeks.
To request Prophylactic Anti-D on this programme send the request to the
transfusion laboratory with the 28 weeks grouping sample, stating on the
Transfusion Request Form when and where the Anti-D is required, the dose
required and that it is to be administered as part of the programme.
If a sensitising episode occurs at any stage of pregnancy to a patient who is on
the Anti-D Prophylactic Programme, they must be tested in the same way as
patients who are not on the programme as above. Anti-D will be issued if
appropriate and a Kleihauer test will be performed if the event is after 20 weeks
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 12 of 41
Kleihauer Tests
This measures the quantity of feto-maternal transplacental haemorrhage (FMH)
for calculation of any additional dose of Anti-D that may be necessary in non-
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
sensitised Rh(D) Negative patients.
A specimen of maternal blood in 4 ml EDTA (FBC Tube) for a Kleihauer test in
addition to the 6 ml EDTA grouping sample is required in the following
circumstances:
•
Instrumentation at any gestation
•
Within 2hrs after delivery
•
Any potentially sensitising event after 20 weeks gestation (as above)
•
Following a large transplacental bleed (as below)
For any FMH > 4 ml an appropriate supplementary dose of anti-D
immunoglobulin must be given immediately. A repeat estimation of the FMH
should be carried out 48 h following the initial anti D injection.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 13 of 41
Further Points to Remember
1.
THE COMMONEST CAUSE OF SENSITISATION TO THE RHESUS D
ANTIGEN IS FAILURE TO ADMINISTER ANTI-D IN APPROPRIATE
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
CASES.
2.
Particular vigilance is necessary in cases of abortion, whether therapeutic
or spontaneous; threatened, complete or incomplete, where stay in hospital
is brief.
Results must be telephoned as a matter of urgency and staff
trained to act properly on them. There must be close liaison between the
laboratory, the clinical units and the primary care teams.
3.
Where threatened or complete abortion occurs at home, the General
Practitioner must ascertain whether anti-D is necessary.
4.
Anti-D given to the mother antenatally is not harmful to the baby.
5.
Passively administered anti-D may be detected up to 6 weeks after
administration, and occasionally up to 6 months.
6.
If antibody is not detectable at delivery, further administration of
immunoglobulin is necessary whether or not the mother was given a
prophylactic dose antenatally.
7.
If there is any doubt about whether to give anti-D, advice may be obtained
from the Blood Transfusion Laboratory or from Consultant Haematologist.
8.
Seek advice when any other antibody is present.
9.
Additional doses of anti-D immunoglobulin, when recommended should be
administered in multiple muscular sites to avoid local reactions.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 14 of 41
8. THROMBOPHILIA INVESTIGATION AND TESTING
Information on thrombophilia testing is available as a Haematology Clinical
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Guideline on the Forth Valley intranet.
http://www.qifv.scot.nhs.uk/CE_Guidance.asp?topic=Haematology
The Clinical Guideline provides advice on testing in the following conditions:
•
Acute VTE (DVT+/- PE)
•
Venous thrombosis of Upper Limb/Eye/Venous
Sinus of Brain/Intra-abdominal Veins
•
Coronary, cerebral and peripheral arterial thrombosis
•
Woman being considered for HRT/COCP
•
Prevention of VTE in hospitalised patient
•
Relatives of patients with a history of VTE
•
Children
Tests Available and Sample Requirements:
The following tests comprise the thrombophilia screen:
•
Antithrombin Assay
•
Protein C assay
•
Protein S assay (Total & Free)
•
Lupus anticoagulant and anticardiolipin assays
•
Modified activated protein C sensitivity
•
Prothrombin G20210A mutation
•
APC:SR ratio as marker for Factor V Leiden
Genetic analysis for Factor V Leiden will only be undertaken if the APC:SR is
abnormal.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 15 of 41
Samples required for a thrombophilia screen are:
4 x citrate samples (blue topped tubes)
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Requests for thrombophilia testing MUST include full patient and family history
details and drug therapy, especially oral contraceptive use or HRT, where
appropriate. All requests will be vetted by a Haematology Consultant. Incomplete
or clinically inappropriate requests will be rejected and the requesting clinician
informed.
In all cases, if there is a doubt about who and when to test please contact a
consultant haematologist to discuss prior to sending the samples.
8.1 ANTICOAGULATION AND WARFARIN INDUCTION
For information on anticoagulation and warfarin induction refer to the Haematology
Clinical Guidelines on the FV intranet.
http://www.qifv.scot.nhs.uk/CE_Guidance.asp?topic=Haematology
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 16 of 41
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
9. TABLE OF HAEMATOLOGY TESTS, TURNAROUND TIMES AND REFERENCE RANGES
9.1 Table of tests analysed Test
Refer to sections 9.2 and 9.3 for guides to notes and bottle / container type
Notes
Anti-nuclear antibodies
Bone marrow
*
Bottle /
Container
type
Vol.
(ml)
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
SST
7
Less than 1/64
Tested locally
2 weeks
Tested locally
72 hours
Tested locally
12 hours
Tested locally
12 hours
Tested locally
12 hours
-
PT +APPT controls reported
Coagulation Screen
(PT, APTT and fibrinogen)
1
Citrate
4
with results
fibrinogen 1.5-4.0 g/l
D-Dimer for coagulopathy
(not for detecting
3
Citrate
4
EDTA
4
<0.5mg/l
thrombosis)
Direct anti-globulin test
(Coombs test)
Transfusion EDTA and
request form required (pink
positive in up to 5% of
normal controls
top bottle with hand written
details)
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 17 of 41
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Test
Erythrocyte sedimentation
rate (ESR)
Notes
Bottle /
Container
type
Vol.
(ml)
1
EDTA
4
EDTA
4
SST
7
Full Blood Count (FBC)
Reference range where
applicable
(adult unless otherwise stated)
Men 0-5mm in 1 hour
Women 0-7mm in 1hour
see later tables for
reference ranges
Reference
laboratory
Expected
turnaround time
for results
Tested locally
12 hours
Tested locally
8 hours
Haematinics:
Serum B12
2, 5
180-900ng/l
Tested locally
72 hours
Tested locally
72 hours
Tested locally
72 hours
Age 18-45
male 36-225 ug/l
Serum ferritin
5
SST
7
female 10-65 ug/l
Age 45+
male 42-262 ug/l
female 24-155 ug/l
Serum folate
5
SST
7
2.1-14.0 ug/l
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Test
Notes
Bottle /
Container
type
Vol.
(ml)
5
EDTA
4
5
EDTA
4
5
EDTA
4
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
Tested locally
1 week
1.8-3.2%
Tested locally
3 working days
0-0.9%
Tested locally
3 working days
Tested locally
48 hours
Tested locally
1 week
Tested locally
4 weeks
Tested locally
48 hours
Tested locally
2 weeks
Haemoglobin
electrophoresis
(See section 12)
Hb A2 (HPLC)
Hb F (HPLC)
Target range for good
HbA1c (HPLC)
5
EDTA
4
diabetic control is 48–59
mmol/mol (IFCC units)
Haemosiderin
6
Universal
20
SST
7
Infectious Mononucleosis
SST or
7 or
test
EDTA
4
SST
7
Haptoglobin
Intrinsic factor antibody
7
0.2-2.0 g/l
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Test
Notes
Bottle /
Container
type
Vol.
(ml)
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
Tested locally
12 hours
Tested locally
48 hours
Target INR range is
dependent on reason for
INR
1
Citrate
4
anticoagulation. Refer to
Haematology clinical
guidelines on intranet.
Kleihauer
EDTA
4
See section 7
Malarial screen
antigen test
(and other blood borne
12 hours
parasites
EDTA
4
See section 10
Tested locally
(thick and thin film and
films
plasmodium antigen test)
24 hours
Reticulocytes
Rheumatoid factor
Sickle test
9
EDTA
4
SST
EDTA
10-150 x109/l
Tested locally
4 hours
7
Tested locally
72 hours
4
Tested locally
24 hours
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REFERRED TESTS - see section 10 for list of reference laboratories
Test
Acetyl choline receptor
antibodies
Adrenal Antibodies
Notes
Bottle /
Container
type
Vol.
(ml)
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
**
SST
7
<0.1nmol/l
xiv
4 weeks
**
SST
7
vii
4 weeks
**
SST
7
vii
6 weeks
**
SST
7
xv
4 weeks
**
SST
7
vii
4 weeks
**
SST
7
vii
4 weeks
**
SST
7
xiv
4 weeks
**
SST
7
xv
4 weeks
Allergy testing (RAST)
allergens must be
specified
Alpha-NMDA receptor
antibodies
Anti-Mitochondrial
antibodies
Anti-Neutrophil
cytoplasmic antibodies
Anti-neural antibodies (e.g.
anti-Hu, Yo)
Aquaporin-4-antibodies
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Test
Notes
Bottle /
Container
type
Vol.
(ml)
Anti-neutrophil antibodies
**
EDTA,
20,
SST
10
10, **
SST
**
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
i
4 weeks
7
vii
4 weeks
SST
1
xv
4 weeks
**
EDTA
4
ii
2 weeks
**
EDTA
4
iii
2 weeks
**
Citrate
4
iv
1 week
Auto-antibodies (DNA
binding, ENA, AMA, SMA,
Ro, La, TTG, Gastric
parietal cell, skin, smooth
muscle, glomerular
basement membrane,
cardiac, MPO, Scl70/Jo1,)
Anti-musk
Bcr-abl pcr
Cell marker analysis
Coagulation factor assay
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Test
Notes
Bottle /
Container
type
Vol.
(ml)
Complement
**
SST
7
Reference range where
applicable
(adult unless otherwise stated)
C3
0.877-1.82 iu
C4
0.185-0.452 iu
Factor B
C1esterase
Reference
laboratory
Expected
turnaround time
for results
vii
4 weeks
ix
4 weeks
v
4 weeks
0.137-0.348 iu
inhibitor
0.178-0.351 iu
CH50
Cytogenetics
**
Erythropoietin
**
Glutamic acid
decarboxylase antibodies
Ganglioside antibodies
G-6-PD
Genetics
Genetic
SST,
EDTA
5
7,4
5-25 mU/ml
**
SST
5
xiii
4 weeks
**
SST
2
xiv
4 weeks
**
EDTA
4
xvii
2 weeks
**
EDTA
4
ix
4 weeks
4.3-10.5 iu/gHb at 37oC
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Test
Haemoglobin DNA
screening
Hereditary Spherocytosis
H.I.T. screen (anti-PF4)
HLA-DR, HLA B27
Insulin antibodies
Islet cell antibodies
JAK 2 PCR
Lupus anticoagulant
Lymphocyte
phenotyping/subsets
Notes
Bottle /
Container
type
Vol.
(ml)
**
EDTA
**
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
4
xii
4 weeks
EDTA
4
iii
4 weeks
**
SST
2
vi
4 weeks
**
EDTA
10
viii
4 weeks
**
SST
7
xviii
4 weeks
**
SST
1
xiii
4 weeks
**
EDTA
4
ii
4 weeks
8, **
Citrate
16
iv
2 weeks
**
EDTA
4
vii
4 weeks
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Test
Mast cell tryptase
Notes
Bottle /
Container
type
Vol.
(ml)
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
**
EDTA
5
2-14 ug/l
vii
4 weeks
vii
4 weeks
iv
2 weeks
xvi
4 weeks
xvi
4 weeks
EDTA
from
Neutrophil function
**
patient
and a
4
healthy
control
See section 11
Thrombophilia screen
**
4 x Citrate
16
Requests screened by
Haematology Consultant
Thyroid Peroxidase
antibodies
Thyrotropin receptor
antibody
**
SST
7
**
SST
3
-
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Test
Tissue transglutaminase
Tissue typing
Plasma Viscosity
Voltage gated Ca+ channel
antibodies
Warfarin assay
Notes
Bottle /
Container
type
Vol.
(ml)
**
SST
7
**
EDTA
20
**
EDTA
4
**
SST
1
4, **
SST
2
Reference range where
applicable
(adult unless otherwise stated)
Reference
laboratory
Expected
turnaround time
for results
vii
4 weeks
viii
4 weeks
xix
48 hours
-
xx
6 weeks
-
x
2 weeks
-
1.50 – 1.72
The list above is not exhaustive so if the test required is not listed phone the laboratory for advice.
Requests for New Tests:
If a new test not previously provided is required a “New Test Request Form” must be completed, signed off by a
General Manager and submitted to the Laboratory Service Manager for approval. The form is available from laboratory
senior staff (contact details in section 1). Approval must be obtained in advance of sending a sample for a new test or
testing will not be carried out.
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9.1 Sample type and container guide
Note that the bottle cap colour of paediatric bottles may not match that of the
adult bottle
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Bottle /
Container
Description
Colour of bottle cap
Code
SST
serum separation tube
Citrate
citrate for coagulation
yellow (gold)
red (paediatric)
light blue (adult)
green (paediatric)
purple (Haematology)
EDTA
Potassium EDTA
pink (Transfusion)
pink/lilac (Paediatric)
Heparin
Universal
Genetic
Heparin
green
urine – use plain universal container
white
Marrow transport media kept at 2-8oC
contact department
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9.2 Guide to Notes from test table above
Notes
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*
**
1
2
Description
By arrangement with lab
Referred elsewhere. Must be in laboratory before Thursday 12 midday
Specimen tube must not be under or overfilled
Do not test following B12 injection
D-dimers may be raised in presence of thrombosis, disseminated
intravascular coagulation, inflammation, infection, underlying malignancy or
3
recent surgery. The sensitivity of the laboratory test currently only allows for
assessment of coagulopathy. Testing for underlying thrombosis requires a
lithium heparin sample and is not performed by the laboratory but is
available as a point of care test in other hospital departments.
4
5
6
7
8
9
10
Sample should be taken pre-dose
Must be requested PRE-TRANSFUSION
Early morning sterile urine sample
Must be sent before starting cobalamin treatment as test disrupted by high
levels of serum B12
Samples should arrive in laboratory no later than 2pm
A positive test must be followed by haemoglobin electrophoresis to
distinguish between heterozygote and homozygote
Please specify which are of clinical interest
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9.3 Turnaround Times:
•
For urgent tests contact the laboratory as in section 3
•
Urgent Full Blood Count and Coagulation: results within 2 hours from
receipt of sample
•
If other tests are required urgently contact laboratory staff
•
See table of tests for routine turnaround times
•
Results are available in SCI Store between 15 – 45 minutes after
completion in the laboratory.
9.4 Reference ranges
NORMAL RANGES FULL BLOOD COUNT
ADULTS
MEN
WOMEN
White Cell Count (x109/l)
3.9 - 10.6
3.5 - 11.0
Red Cell Count(x1012/l)
4.4 - 5.9
3.8 - 5.2
Haemoglobin (g/l)
133 - 177
117 - 157
Packed Cell Volume
.40 - .52
.35 - .47
Mean Cell Volume (fl)
81 - 100
81 - 100
Mean Cell Haemoglobin (pg)
26.6 - 33.8
26.4 - 34.0
MCH Concentration (g/dl)
31.5 - 36.3
31.4 - 35.8
Platelet Count (x109/l)
150 - 440
150 - 440
CHILDREN
BIRTH
1 YEAR
6
10
WBC (x109.l) 9.30
6.0 - 17.5
5.0 -14.5
4.5 - 13.5
Hb (g/l)
9.0 - 14.6
10.6 - 15.5
10.7 - 15.5
14.6 - 23.4
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DIFFERENTIAL WHITE CELL COUNT (as absolute counts, x 109/l)
1 year
6
10
Adult
1.5 - 8.5
1.5 - 8.0
1.5 - 8.0
1.8 - 7.7
Lymphocytes 4.0 - 10.5
1.5 - 7.0
1.5 - 6.5
1.0 - 4.8
Monocytes
0.05- 1.1
0 - 0.65
0 - 0.8
0 - 0.8
Eosinophils
0 – 0.65
0 - 0.65
0 - 0.60
0 - 0.45
Basophils
0 - 0.20
0 - 0.20
0 - 0.20
0 - 0.20
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Neutrophils
(Data extracted from “Haematology”, W J Williams et al., 3rd edition, 1983, McGraw Hill)
•
Reference ranges for other tests are shown in the table of tests.
•
Reference ranges are provided on reports from referral laboratories.
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10. REFERENCE LABORATORY ADDRESSES
i.
NHSBT Filton (Bristol)
500 North Bristol Park
Northway
Filton
Bristol
BS34 7QH
0117 9217372
ii.
Department of Molecular Haematology
Southern General Hospital
Govan Road
Glasgow
0141 354 9408/9409
iii.
Department of Haematology
Gartnavel General Hospital
2nd Floor Laboratory Building
21 Shelly Road
Glasgow G12 0XL
Tel 0141 3017707
iv.
Department of Haematology
Glasgow Royal Infirmary
82 Castle Street
Glasgow
G4 OSF
0141 211 4000
v.
SAS Erythropoietin Laboratory
Department of Clinical Biochemistry
King’s College hospital
Denmark Hill
London
SE5 9RS
020 3299 3856
vi.
Scottish National Blood Transfusion Service
Shelley Road
Gartnavel General Hospital
Great Western Road
Glasgow
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0141 357 7700
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vii.
Immunology laboratory
1st floor
Laboratory medicine and facilities management building
Southern General Hospital
Govan Road
Glasgow
G51 4TF
Tel 0141 301 7752
viii.
Histocompatibility and immunogenetics
Tissue typing service
Gartnavel hospital
Glasgow
0141 301 7755
ix.
West of Scotland genetic services
Level 2b, Laboratory medicine and facilities
Management Building.
Southern General Hospital
Glasgow G51 4TF
Tel 0141 301 7752
x.
Department of Clinical Chemistry
Queens Medical Centre
Nottingham
NG7 2UH
0115 9249924 Ex. 63411
xi.
Deleted
xii
National Haemoglobinopathy reference laboratory
Molecular Haematology
Level 4
John Radcliffe Hospital
Oxford OX3 9DU
Telephone-01865572769
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xiii
Protein reference unit
Department of Immunology
Northern General Hospital
Herries Road
PO BOX 894
Sheffield
S5 7YT
Tel 0114 271 5552
xiv
Department of Neuro-Immunology
Southern General Hospital
1345 Govan Road
Glasgow
G51 4TF
141 2491
xv
Immunology laboratory
John Radcliffe Hospital
Headley Way, Headington
Oxford, Oxfordshire
OX3 9DU
1865 66
xvi
Department of Biochemistry
Glasgow Royal Infirmary
Alexandra Parade
Glasgow
0141 211 4000
xvii
Department of Haematology
Edinburgh Royal infirmary
51 Little France Crescent
Edinburgh, EH16 4SA
0131 536 1000
xviii
SAS peptide hormone section
Clinical laboratory
Royal Surrey County Hospital
Egerton Road
Guildford
Surrey GU2 7XX
Tel 01483 571122 ext 4696
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xix
xx
Haematology Department
South Laboratory
Victoria Hospital
Kirkcaldy
Fife
KY2 5AH
Tel 01592 643355 ext 29471
Immunology Department
Churchill Hospital
Headington
Oxford OX3 7LJ
Tel 01865 225992
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11. SPECIAL PRECAUTIONS:
The Haematology and Blood Transfusion laboratories are containment level 2
facilities. This means that there is a limited capacity to test samples containing
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biological agents categorised as group 3 by the “Advisory Committee on
Dangerous Pathogens”.
The Advisory Committee prepare the “Approved List of Biological Agents” for the
Health & Safety Executive. A Biological Agent is categorised by:
•
The likelihood it will cause disease or toxicity in humans
•
How likely it is that the infection would spread to the community
•
The availability of any prophylaxis or treatment (includes vaccines)
Hepatitis and HIV, although group 3 agents, are officially approved to be tested in
a level 2 facility provided the necessary containment and safety precautions are
taken. It is therefore extremely important to identify high risk samples or
potentially high risk samples to all staff involved by applying high risk stickers to
sample and request form.
Group 3 Biological Agents
a. All known high risk samples must be clearly labelled as such on the
sample and form.
b. All samples suspected of containing group 3 biological agents other than
hepatitis and HIV must be notified to the laboratory in advance. Only
limited testing on other group 3 pathogens may be available e.g. malaria
antigen test. Further advice can be sought from the Consultant
Microbiologist.
Group 4 Biological Agents
a) Do not send samples suspected of containing group 4 biological agents to
the laboratory other than after a risk assessment has been carried out by
the clinician in charge of the patient and after consultation with the
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Consultant
Microbiologist.
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Other Special Precautions
a) There are no other special precautions required other than the requirements
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noted in the table of tests.
12 TIME LIMIT FOR REQUESTING ADDITIONAL REQUESTS:
Coagulation: 2 hours from venesection
Full Blood Count: 4 hours from venesection
Clotted samples, e.g. haematinics: 24 hours
Transfusion: Contact the transfusion laboratory for advice
Referred tests: Contact the referral laboratory for advice
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13. SCREENING FOR MALARIA AND OTHER BLOOD BORNE PARASITES
If a diagnosis of malaria is suspected, the gold standard diagnostic test is a thick blood
film for detection of parasites, accompanied by a thin film for species identification and
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estimation of parasitaemia. Thick and/or thin films may also detect other blood borne
parasites, such as microfilaria or trypanosomes. For specific diagnostic and clinical
advice, please contact a consultant haematologist and/or infectious disease specialist.
If malaria is suspected:
a) Send 4ml blood in EDTA (FBC sample) urgently to the haematology laboratory –
samples should ideally arrive in the laboratory within 2 hours of venepuncture
(lengthy exposure to anticoagulant may significantly diminish the likelihood of
detecting parasites).
b) The request form must clearly state that malaria is suspected, and include travel
history – which should be as specific as possible. This is likely to significantly aid
species identification.
c) A thick film and a thin film will be prepared and examined.
d) In addition, a rapid malarial antigen detection test (for Plasmodium spp.) will be
performed to complement microscopy. Outside of normal working hours, this may be
reported before a blood film has been examined. Please note that a negative antigen
test must be confirmed by microscopy, and, if clinical suspicion is high, a negative
antigen test alone must not be relied upon to fully exclude malaria.
e) If the initial thick film proves negative, yet clinical suspicion remains high, send two
further consecutive daily samples for malaria screening. Three negative thick films
make a diagnosis of malaria unlikely.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 37 of 41
14. REQUESTING AND INTERPRETING HAEMATINIC TESTS (B12, FOLATE, IRON
STUDIES)
Serum B12 and Folate assay
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
a) Tests for serum vitamin B12, serum folate levels and serum ferritin are frequently
requested for the initial investigation of anaemia, or microcytosis / macrocytosis in
the absence of anaemia. In addition, a serum B12 assay is included in the list of
screening tests in a number of neurological and psychiatric conditions, and ferritin is
used as a marker of whole body iron levels in patients with (suspected and
confirmed) haemochromatosis. Interpretation of results can be problematic.
b) For information on B12 and folate requesting and interpretation refer to the
Haematology clinical guideline “B12 and Folate: Practical Guide” which can be
found on the Forth Valley Intranet at the following link:
http://www.qifv.scot.nhs.uk/CE_Guidance.asp?topic=Haematology
Iron studies
a) Serum Ferritin is the usual test for iron deficiency.
b) The normal range is different for women of childbearing age compared to men and
postmenopausal women, but it is debatable whether this is a real physiological
difference or simply reflects a high incidence of iron deficiency in the population of
women from whom the normal range is derived.
c) In general, a serum ferritin <12µg/L is diagnostic of iron deficiency, and if <30µg/L is
highly suggestive. Interpretation should be in the context of the FBC (MCH, MCV
and blood film features).
d) Ferritin is an acute phase reactant, so may be normal even in the presence of iron
deficiency if there is intercurrent infection, inflammation or neoplasia. A rough guide
might be to interpret a ferritin of <100µg/L with caution in the presence of intercurrent
illness, as iron deficiency cannot be excluded. Again, haematological parameters are
likely to help.
e) A high serum Ferritin (>300µ/l) may indicate iron overload, but such a finding is
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
common
in hospitalised patients and others with intercurrent illness.
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Author(s): Chris Brammer, Marie Hughes
Page 38 of 41
f) A better guide to iron overload is the Transferrin Saturation (calculated from serum
iron x100 divided by TIBC – see Chemistry handbook), which, if over 55% (men) or
50% (women) warrants further investigation.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
g) Serum iron and TIBC are generally unreliable tests for diagnosing iron deficiency.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 39 of 41
15. SCREENING FOR THALASSAEMIA AND HAEMOGLOBINOPATHIES
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Indications for screening for thalassaemia and/or haemoglobinopathies include:
•
Investigation of a hypochromic blood picture in the absence of iron deficiency
•
Investigation of anaemia in a patient of non-Northern European ancestry
•
Screening in an individual with a family history of thalassaemia or
haemoglobinopathy
•
Antenatal screening Identification of Sickle haemoglobin prior to surgery in
patients from ethnic
•
Groups with a high incidence of Sickle Cell Disease.
When requesting thalassaemia and/or haemoglobinopathy screening please
include the following clinical information:
a. Ethnic origin of the patient (as precisely as possible).
b. Whether or not there is a family history of thalassaemia/haemoglobinopathy, with
details of diagnosis if available.
c. Please state clearly if the test is for antenatal screening purposes (pregnant woman
or partner).
d. Reason for request.
This information will help direct laboratory tests, which in general will include:
a. FBC and blood film examination
b. Serum ferritin if MCH is subnormal.
c. High Pressure Liquid Chromatography (HPLC) for HbA2, HbF and variant
haemoglobins.
d. Further analysis by gel electropheresis or DNA testing dependent on HPLC. Further
samples may be requested from the patient.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 40 of 41
16. INVESTIGATION OF HEREDITARY SPHEROCYTOSIS
Based on BCSH Guidelines 2011
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
http://www.bcshguidelines.com/documents/HS_BCSH_Sept_2011_final.pdf
a) Although the diagnosis of HS is often made in childhood and young adult life,
it may be diagnosed at any time of life including old age.
Diagnostic testing
a) Newly diagnosed patients with a family history of HS, typical clinical features
and laboratory investigations (spherocytes on blood film, raised MCHC,
increase in reticulocytes, negative DCT) do not require any additional tests.
b) If there is no family history AIHA should be excluded.
c) If the diagnosis is equivocal the EMA (Eosin-5-maleimide) binding test has a
high predictive value for HS.
d) This is a flow cytometry test performed at Gartnavel Hospital using an EDTA
sample. Testing should be discussed with a haematology consultant and the
correct request form obtained.
e) Gel electrophoresis analysis of erythrocyte membranes is the method of choice for
diagnosis of atypical cases.
Haematology & Blood Transfusion Laboratory Handbook - Version: 5.0. Index: Haematology/Blood Transfusion/Clinical Chemistry 11133. Printed: 30-Jun-2014 12:53
Authorised on: 30-Jun-2014. Authorised by: Sheila Kowalczyk. SOP Unique Reference: 112-40460436. Due for review on: 30-Jun-2016
Author(s): Chris Brammer, Marie Hughes
Page 41 of 41