PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 1 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
A user guide for UHL Blood Sciences Pathology services
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Contents ...... 1 ...... 1 Foreword ...... 6 1. Introduction ...... 6 2. Location of Blood Sciences Laboratories ...... 6 3. Scope of Blood Sciences Laboratories ...... 7 Blood Transfusion ...... 7 Fast Track (General Biochemistry and Haematology) ...... 7 Immunology ...... 7 Special Chemistry ...... 7 Forensic Toxicology ...... 7 National Centre for Drug Adherence Testing (NCAT) ...... 7 Special Haemostasis ...... 8 Haemoglobinopathies ...... 8 Haematological Malignancy Diagnostic Links (HMDL) ...... 8 Molecular Diagnostics ...... 8 4. Opening Hours ...... 8 Clinical Advice and Results Interpretation ...... 9 Haematology (General and Specialist) and Blood Transfusion ...... 9 Biochemistry (General and Specialist) ...... 9 09:00-17:00 Mon to Fri (excluding bank holidays), please contact the Duty Biochemist (0116 258 6560). Out of hours there is an on-call Consultant Chemical Pathologist / Clinical Scientist available for advice who can be contacted via switchboard ...... 9 Immunology ...... 9 5. Laboratory and Staff Contact Details ...... 9 Laboratory Contact Details ...... 9 Key Staff ...... 10 Heads of Service ...... 10 Service Managers ...... 10 6. Request Forms ...... 10 Private Patients ...... 10 General Guidance ...... 11
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Filling out a handwritten request form ...... 11 Kleihauer Testing ...... 11 General Blood Transfusion Request Forms ...... 12 Incomplete Form Procedure for Blood Transfusion ...... 12 Requesting Blood Products ...... 12 7. Labelling of Specimens ...... 12 General Guidance ...... 12 Blood Transfusion Samples...... 13 MAJAX Samples ...... 13 Unrepeatable & Precious Samples ...... 14 8. Specimen Rejection Criteria ...... 14 9. Sample Collection Criteria ...... 14 Order of Draw ...... 14 Patient Collected Samples ...... 15 10. Sample Storage ...... 15 11. Additional Tests (Add-ons and Reflex Testing) ...... 15 Reflex Testing ...... 15 12. Specimen Contamination...... 15 Spurious Results ...... 15 13. Specimen Transport ...... 16 Primary Care ...... 16 Inpatient - Urgent ...... 17 Inpatient - Routine ...... 17 Major Haemorrhage Samples ...... 17 Outpatient ...... 18 Pathology Transport Service ...... 18 Transportation outside of UHL ...... 18 14. Results ...... 18 Telephone Limits ...... 18 15. Release of Samples to the Police ...... 19 16. Measurement Uncertainty ...... 19 17. Quality and Governance ...... 19 Confidentiality and Personal Information ...... 19 Duty of Candour ...... 20
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Audit...... 20 External Quality Assurance ...... 20 Research and Development ...... 20 18. Informed Consent ...... 20 Consent for Blood Transfusion ...... 20 19. User Comments, Suggestions, Compliments and Concerns ...... 21 20. Useful Resources ...... 21 Clinical Guidelines ...... 21 Patient Information Leaflets ...... 22 Online Resources ...... 22 Appendix 1: Map Locations ...... 23 Appendix 2a: Sample Containers ...... 25 Appendix 2a: Sample Storage and Handling Requirements ...... 26 Appendix 3: Blood Forms ...... 30 Blood Transfusion ...... 30 General Blood Transfusion Requests ...... 30 Kleihauer Request Form...... 31 Special Requirements Notification Form...... 32 NHSBT Request Forms ...... 33 Antenatal Testing Request Form ...... 33 Emergency “Flying Squad” Form 1 ...... 34 Emergency “Flying Squad” Form 2 ...... 35 Special Haematology ...... 36 Haemostasis ...... 36 Haemoglobinopathies - General ...... 36 Haemoglobinopathies – Antenatal Screening ...... 37 HMDL Form ...... 38 Immunology ...... 40 Routine Haematology & Chemistry ...... 41 Routine Chemistry ...... 42 Down’s screening ...... 42 Appendix 4: Pre-Transfusion Sample Requirements ...... 43 Appendix 5: Provision of Blood Products ...... 44 Urgent Red Cell Issue ...... 44
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Emergency O D negative red cells ...... 44 Patient Waiting ...... 45 Anti-D Issue ...... 45 Appendix 6: Blood Product Special Requirements ...... 46 Gamma Irradiated blood components ...... 46 CMV Seronegative blood components ...... 46 Appendix 7: Prescription, transport and administration of blood products ...... 47 Prescription of Blood Components ...... 47 Transport of Blood and Blood Components ...... 47 Storage of Blood Products ...... 47 Administration of Blood Components ...... 48 Transfer of Patients Receiving a Transfusion ...... 48 Disposal of Blood Bags ...... 49 Appendix 8: Transfusion reactions and adverse event reporting ...... 50 Transfusion Reactions ...... 50 Event/Incident Reporting ...... 50 Appendix 9: Blood Product Traceability ...... 51 Use of BloodTrack ...... 51 Orange Blood Fate Documentation Cards ...... 51 Appendix 10: Blood Transfusion Alternatives ...... 52 Appendix 11: Blood Transfusion Training ...... 53 Appendix 12: Test Directory...... 54
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Foreword Dear Colleague,
This handbook has been prepared by the Blood Sciences Department of University Hospitals of Leicester NHS trust. It combines information from previous handbooks of each component laboratory and is intended to provide essential information about the range of services available and how best to access these, including test repertoire, specimen requirements and laboratory contact details.
According to quality standards, each request accepted by our laboratories represents a formal agreement and as such must meet both local quality policies (available on InSite or on request) and national accreditation (UKAS/MHRA) requirements. Only examinations in which our staff have a suitable degree of skill and knowledge will be processed by our service. Other tests may be offered but samples may be sent to external referral laboratories for analysis.
Any views that users have about how our service can be improved would be welcome as this will ensure we are providing tests relevant to a changing healthcare environment. Feedback about how this guide could be improved would also be welcome for incorporation into future editions. Please send your comments to the Blood Sciences Quality Team via Yusuf Sidat (Quality Manager) by email: [email protected].
1. Introduction The Blood Sciences Department at University Hospitals of Leicester (UHL) is a part of the Clinical Support and Imaging directorate. The Department is an amalgamation of 5 component specialisms; General Haematology & Chemistry, Special Haematology, Special Chemistry, Blood Transfusion and Immunology.
The department provides a high quality, effective service to hospital patients, GP surgeries and community practitioners, as well as acting as a referral centre for certain analyses. To maintain the quality of our service we are dependent upon you, the user, to provide specimens appropriate for investigation. Please take note of the guidance provided in this handbook. If any doubt exists, please contact the relevant laboratory where staff will be happy to assist you.
2. Location of Blood Sciences Laboratories The Blood Sciences Laboratories are located across all three UHL Trust sites with the main laboratories at the Leicester Royal Infirmary (LRI). There are satellite laboratories in A&E at LRI, and at Leicester General Hospital (LGH) and Glenfield Hospital (GH) sites. Map locations of the three hospital sites can be found in Appendix 1.
Hospital Service Postal Address LRI General Chemistry and Level 4, Sandringham Building Haematology (Fast Track Leicester Royal Infirmary laboratory) Leicester Special Chemistry LE1 5WW Level 2, Sandringham Building Blood Transfusion Leicester Royal Infirmary Leicester Special Haematology LE1 5WW Level 1, Hearing Services Building Immunology Leicester Royal Infirmary Leicester LE1 5WW Department of Accident and Emergency General Chemistry and Leicester Royal Infirmary Haematology Leicester LE1 5WW
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Hospital Service Postal Address GH General Chemistry and Department of Pathology Haematology Glenfield Hospital Groby Road Blood Transfusion Leicester LE3 9QP LGH General Chemistry and Department of Pathology Haematology Leicester General Hospital Gwendolen Road Blood Transfusion Leicester Le5 4PW
3. Scope of Blood Sciences Laboratories Within the Department of Blood Sciences, there is a range of laboratory services covering both general and specialist tests, which are described below.
Blood Transfusion The Department of Transfusion Medicine provides a comprehensive range of blood transfusion services and has laboratories at all three UHL sites. Pre-transfusion testing and issue of blood products is available from all three laboratories. More specialist testing including Kleihauer testing for estimation of fetal maternal haemorrhage is offered from the main LRI laboratory. For specialist requests outside our available range of tests, samples are referred to an accredited reference laboratory for analysis.
Fast Track (General Biochemistry and Haematology) “Fast Track” is the largest laboratory within Blood Sciences and processes more than 12,000 samples a day. It provides a comprehensive service to hospital and community clinicians, covering both general haematology and chemistry investigations.
The Haematology service consists of both cellular haematology and coagulation screening, as well as blood film morphology and malaria parasite investigations/speciation. General Biochemistry provides an extensive repertoire of general investigations, including liver and kidney function testing, electrolyte monitoring and quantification of numerous analytes.
Immunology The Immunology laboratory offers a comprehensive service covering all aspects of allergy, autoimmunity, immunochemistry, immunodeficiency, and leukaemia and lymphoma immunophenotyping.
Special Chemistry The Special Chemistry laboratory offers a service to primary care, UHL and other healthcare providers. The laboratory test repertoire covers automated, semi-automated and manual assays, with a special interest in chromatography. Two of its specialist testing services are recognised internationally – Forensic Toxicology and National Centre for Drug Adherence Testing (NCAT).
Forensic Toxicology The Forensic Toxicology laboratory provides clinical and forensic toxicology services to HM Coroners, Home Office Pathologists, Consultant Histopathologists, police forces and other external laboratories. Please note Forensics has a separate handbook (available upon request) so information on forensic services is not included in this document.
National Centre for Drug Adherence Testing (NCAT) UHL has developed world leading expertise in the measurement of prescribed medications in the urine as a measure of adherence screening for the presence of over 60 drugs and their metabolites.
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Special Haemostasis The laboratory provides a full haemostatic/thrombotic diagnostic service including diagnosis of bleeding disorders, thrombophilia investigations, platelet function testing and anticoagulant monitoring.
Haemoglobinopathies The Haemoglobinopathy laboratory at UHL provides a full diagnostic service for patients with suspected abnormalities of haemoglobin production (known as haemoglobinopathies or haemoglobin disorders). The laboratory participates in the national neonatal and antenatal screening programmes. Additional tests for enzyme disorders (e.g. G6PD deficiency) and some specialised tests of red cell function are also available.
Haematological Malignancy Diagnostic Links (HMDL) HMDL co-ordinates the testing of bone marrow, CSF and other liquid samples (e.g. pleural fluid) when a haematological malignancy is suspected or to monitor response to treatment. The laboratory produced integrated reports for all samples which contain all information recorded on the sample. This includes morphology (which is reported by HMDL) along with additional diagnostic information produced by accredited laboratories (I.e. Immunology and Cytogenetics).
Molecular Diagnostics The Special Haematology Molecular Diagnostic Service provides additional support to both the Haemostasis and Thrombosis clinic and the HMDL service. The laboratory works with external, accredited laboratories to provide an extensive range of molecular investigations.
4. Opening Hours
Laboratory Service Routine Working Hours Out of Hours Fast Track Chemistry and 24 hours 7 days a week Haematology (LRI/LGH/GH) Blood Transfusion 24 hours 7 days a week (LRI/LGH/GH) Special Chemistry Monday – Friday 9.00am – 5.30pm On-call laboratory service specifically for Xanthochromia. Assay only available after discussion with the on call Consultant Chemical Pathologist/Clinical Scientist Special Haematology Monday-Friday 8.00am – 8.00 pm On-call service available after discussion with the Specialist Trainee for Haematology. (Contact via the UHL switchboard). Immunology Monday-Friday 8.00am – 6.00 pm Weekend (9am – 2pm) on-call laboratory service specifically for Haematological Malignancy samples (defined as urgent by Haematology Transplant Consultant on-call only)
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Clinical Advice and Results Interpretation In the event that advice regarding testing strategies or interpretation of results is required, dedicated senior laboratory and clinical staff are available 24 hours a day.
Haematology (General and Specialist) and Blood Transfusion A Haematology Specialist Trainee and Consultant Haematologist are available 24/7, and can be contacted via switch board.
Biochemistry (General and Specialist) 09:00-17:00 Mon to Fri (excluding bank holidays), please contact the Duty Biochemist (0116 258 6560). Out of hours there is an on-call Consultant Chemical Pathologist / Clinical Scientist available for advice who can be contacted via switchboard
Immunology 08:00-18:00 Mon to Fri, please contact either an Immunology Consultant or a Specialist Trainee via switchboard to discuss results interpretation, management or to arrange a ward consultation. Clinical Scientists and senior Biomedical Scientists can be contacted (0116 258 6710) to discuss result interpretation and requesting of laboratory requests.
5. Laboratory and Staff Contact Details
Laboratory Contact Details General Contacts Contact Number Duty Biochemist 0116 258 6560/6551 Results and Enquiries: Fast Track 0116 258 6531/7999 Results and Enquiries: Immunology 0116 258 6710 Add-on tests (GP) 0116 258 6531 Blood Transfusion – LRI 0115 258 6605/6606/6608 Bleep: 4703* Blood Transfusion – LGH 0116 258 4564 Bleep: 3383* Blood Transfusion - GH 0116 258 3577 Bleep: 2588* General Haematology and Biochemistry – LRI 0116 258 6565/6551 General Haematology and Biochemistry – LRI A&E 0116 258 0144/0147 General Haematology and Biochemistry – LGH 0116 258 4558 General Haematology and Biochemistry - GH 0116 258 3572 Special Chemistry – Functional Automation Lab 0116 258 6561 Special Chemistry – Chromatography Lab 0116 258 6555 Special Chemistry - Forensic Toxicology Lab 0116 258 6556 Special Haemostasis 0116 258 6619 Haemoglobinopathy 0116 258 7531 HMDL Service 0116 258 6518 Immunology - Autoimmunity, Allergy and Immunochemistry 0116 258 6709 Immunology - Immunodeficiency and Flow Cytometry 0116 258 6713 Pathology Duty Manager 07961 729901 The Blood Transfusion laboratory must be phoned or bleeped for all urgent requests. Activation of Major Haemorrhage Protocol via bleep AT ALL TIMES
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Key Staff
Heads of Service Name Role Direct Line Secretary Clinical Lead for Pathology 0116 258 6518 0116 258 6614 Head of Service for Dr Linda Barton Haematology Consultant Haematologist Head of Service for 0116 256 3577 0116 258 6558 Chemical Pathology Deputy Clinical lead for Dr Pankaj Gupta Blood Sciences Consultant Metabolic Physician and Chemical Pathologist Head of Service for Blood 0116 256 6612 Transfusion Service Air Pager: 07699 Dr Hafiz Qureshi Clinical lead for Blood 613428 Sciences Consultant Haematologist Clinical lead for adult 0116 258 6702 0116 258 6702 Clinical Immunology Dr Shanti Mahabir Head of Service for
Immunology Consultant Immunologist Clinical lead for 0116 258 6702 Dr Arthur Price Immunology
Service Managers Name Role Contact Number Cathy Lea Pathology General Manager 0116 258 6521 Hafiz Arif Blood Sciences General Manager: 0116 258 6574 Fay Sharman Deputy Service Lead Immunology 0116 258 6709 Deputy Service Manager: 0116 258 6574 Mark Asher General Biochemistry Deputy Service Manager: 0116 258 6574 Jo Melbourne General & Special Haematology & HMDL Deputy Service Manager: 0116 258 6574 Janine Rolland Special Chemistry Deputy Service Manager: 0116 258 6604 Amardeep Ghattaoraya Blood Transfusion Yusuf Sidat Quality Manager 0116 258 3211 Lead Transfusion Practitioner 0116 258 7876 Marie Browett
6. Request Forms
Private Patients Requests on private patients must be clearly labelled as such. A fee is payable for these tests - a list of charges is available on request.
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General Guidance It is the responsibility of the requesting clinician to ensure that request forms are completed to the agreed standard. Where possible, pathology requests should be made electronically via ICE, including ward and GP patients. This offers numerous advantages over completion of handwritten requests, including: • No rejected forms due to inaccurate information • No transcription errors when filling in forms • No missed tests • Ensures all mandatory fields are completed
Outpatient Clinic Pathology requests may still be made using hand written request forms until electronic requesting is available across the whole Trust.
Filling out a handwritten request form The correct forms must be used when making a request (see appendix 3). The form must be completed in FULL with ball point pen in BLOCK CAPITAL LETTERS. Addressograph labels may also be used. Please ensure that the destination and requesting consultant/GP are given. Failure to do so will result in a significant delay in patients receiving their results. The hospital S number should be used when known. If the patient falls into ‘High Risk’ category, this must be indicated on the form, as well as sample urgency. All forms should be signed and dated (and the collection time recorded for time critical tests) by the person collecting the sample. For ICE requests this is automatically recorded during the process. For hand written forms, the person collecting the sample must sign and date the form (and indicate collection time) even if there is no printed prompt to do so. Please add signature and date into the large ‘Clinical Details’ box. Compulsory Patient Information which must be completed on the request form by requestor: i. NHS/CHI or S number (if allocated) ii. Patient’s full name or unique coded identifier iii. Date of birth – indicate if unknown iv. Gender v. Location for the report to be sent (plus full details of additional copies) vi. Requesting clinician (full name) vii. Investigations required* viii. Priority status – if urgent ix. Clinical details (reason for the request and any underlying condition which may affect result interpretation or advice) x. Date and time of specimen collection xi. Patient’s address, including postcode xii. Practitioner’s contact number (bleep or extension) is desirable. *When hand written forms have to be used then non-tick test requests should be added in the ‘Other Tests’ area of the form. The ‘Clinical Details’ area must not be used to request tests. Non numerical/alphabetical characters should not be used in the S or NHS number (e.g. S-1234567). While this does not alter sample validity, it may slow sample processing and must be avoided.
Kleihauer Testing Gold ‘Kleihauer’ request forms (please see appendix 3) are required for feto-maternal bleed estimation and anti-D immunoglobulin issue. In addition to the above mentioned patient details, addition information must be provided on these forms. Additional mandatory fields include: • Serology history • Event/ reason for request, time of event and gestation period • Has anti-D immunoglobulin been given at this admission? • Confidentiality concerns for home issue. If there is a confidentiality problem then this must be indicated on the form. • Sample taken and positively identified by (including date and time of sample)
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• Baby details, forename, surname, DOB, hospital number • Baby sample taken and positively identified by (including date and time of sample)
General Blood Transfusion Request Forms General blood transfusion request forms are used for Group and Save (G&S) and Direct Antiglobulin Tests (DAT/DCT), as well as requesting blood components. Please indicate the Diagnosis/ Reason for Request on the form, avoiding unqualified terms such as anaemia.
In addition to the general requirements, it is essential that the ‘special requirements’ section is completed. This refers to the need for irradiated blood, CMV negative, HEV negative etc. Information about the indications for special requirements can be found in appendix 6, or one the back of the general blood transfusion request form.
If special requirements are needed, this must be specified, with a reason. A Special Requirements Notification (appendix 3) must also be submitted to the blood transfusion laboratory. If no additional provisions are required then the neither box must be ticked. Guidance on special requirement indications is provided on the back of the request form. Any suspicion of, or confirmed, pregnancy must also be documented on the form.
Incomplete Form Procedure for Blood Transfusion If the form is received with only the special requirements information missing it can be processed but a new form must be requested immediately.
In all other cases the sample will not be processed until a new form is received. Blood components will not be issued prior to receipt of a correctly completed form.
Requests which are not signed by the person taking the sample are not acceptable; this includes those from outlying hospitals
Requesting Blood Products When requesting FFP, cryoprecipitate, platelets, or red cells, this must be completed as an ‘add on’ request. If the laboratory holds a valid group and save sample for the patient, a request form only may be sent. For details of G&S sample timings, see appendix 4. For babies who require an ‘add on’ request, a new request form must be sent. If there is no valid group and save, a new sample must be sent.
If a transfusion is required the following information must be completed: • The number of units (or mls) required. • Date and time required. Please give a time and avoid use of vague comments such as ASAP.
7. Labelling of Specimens
General Guidance It is the responsibility of the requesting clinician to ensure that the patient has been positively identified and samples are correctly labelled to the agreed standard. Addressograph stickers should not be used to label samples and clinicians must NEVER pre-label sample bottles, with the exception of urine and stool sample bottles given to patients for collection at home. These should be labelled with patient details prior to being handed to the patient, along with the completed request form. Patients should be asked to complete the sample time and date following collection.
Details on the request form and sample MUST match. If request forms and/or specimens are received unlabelled, or inadequately labelled, the receiving laboratory reserves the right to discard the specimen for medico-legal reasons. This will be recorded in the laboratory IT system. Samples not meeting these requirements will only be processed in exceptional circumstances, e.g. unrepeatable or precious specimens.
Samples should be labelled, as a minimum with:
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i. NHS/S Number ii. Patient’s full name (surname and forename initial not acceptable), or unique coded identifier iii. Date of birth – indicate if unknown iv. Location of patient v. Date and time of specimen collection – essential for time sensitive tests (see relevant test directory, appendix 12, for sample timing requirements) vi. Nature of sample, if unique or unclear.
ICE generated sample labels containing the above information can be used, with the exception of blood transfusion specimens (see below).
High Risk samples must be sent in accordance with the Trust Policy, Infection Prevention Management Guidelines of Patients with Known or Suspected Blood Borne Viruses. Samples which are identified as ‘known High Risk’ must be labelled as such and sent in a biohazard bag. If a known High Risk sample is received that is not in a biohazard bag, a DATIX report will be completed.
Blood Transfusion Samples The Blood Transfusion laboratory operates strict policy with regard to sample labelling. Any samples with are incorrectly or insufficiently labelled cannot be amended, and must be rejected. The ONLY exceptions to this are: • Home delivery baby samples for Kleihauer testing can be accepted without a unique identification number to prevent delay in administration of anti-D • Stem Cell and BMT donor samples (Anthony Nolan, DE CAM etc.) which are received in the laboratory for confirmation of blood group may originate from locations outside the UK and so will not have S or NHS numbers • Casualty and flying squad numbers: o If patients arrive at A&E unconscious and cannot be identified, they will be called Unknown Male or Unknown Female. Such samples will be accepted if labelled with the S number and estimation of age. o If the flying squad team attends an accident and blood samples are taken, these may be labelled with a flying squad number. These are pre-prepared in case of major incident, and the patient is identified by means of a tabard with this number on it. The request form and all samples will have this number on, and an indication of age and sex. This form of labelling is acceptable for the provision of blood components.
All samples must be labelled by hand; addressograph labels are not acceptable unless they are ‘demand printed’ Blood Track sample labels (see below).
MAJAX Samples If a major accident (MAJAX) is declared, unknown patients will be labelled with an ‘S’ number and gender only. These details must be used until the patient’s true identity is known. This is in accordance with the UHL Major Incident Plan (available on INsite).
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Unrepeatable & Precious Samples Certain specimens processed within the Blood Sciences Department are collected through invasive procedures (e.g. bone marrow biopsies) or cannot be repeated (e.g. forensic samples). These are known as unrepeatable or ‘precious’ samples, identifying their unique nature. If a laboratory receives such a sample which is not labelled correctly, additional processes are used to safely identify the origin of the specimen and allow it to be processed. THIS IS ONLY FOR PRECIOUS OR UNREPEATABLE SAMPLES, AT THE DISGRESSION OF THE LABORATORY.
Precious or unrepeatable sample types include: • Bone marrow • Cerebrospinal fluid (CSF) • Forensic specimens • Tissue/stone samples
8. Specimen Rejection Criteria The department is committed to providing a safe service for our users and as such, will not process any samples where the patient information on sample and form do not match, or is incomplete as discussed above. Other rejection criteria include: Issues with sample • Sample too old to process • Clotted (with anti-coagulated samples) • Haemolysed samples • Leaking samples • Incorrect sample type • Over/under filled – N.B coagulation samples MUST be filled to the volume line indicated on the bottle
Issues with labelling • Unlabelled samples are unacceptable • Specimens without forms will not be processed • Request forms not containing the minimum number of identifiers. • Samples not containing the minimum number of identifiers
9. Sample Collection Criteria In addition to being correctly labelled, it is essential that any specific sample collection and transport criteria are also observed. These can include temperature requirements (transported on ice, at 37°C etc.), speed of receipt (i.e. must be received by the laboratory within a certain time following phlebotomy) or total sample volume. More information can be found in the specific test entry within this handbook.
Order of Draw If multiple samples are being collected during one venepuncture event, it is important that specimens are taken in the correct ‘order of draw’, to maintain sample integrity. When using Sarstedt Monovette tubes, the correct order of draw is: 1. Blood Culture (if required) 2. Trisodium citrate 1:10 (green top) 3. Serum 4. Serum Gel 5. Heparin 6. EDTA 7. Fluoride
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Patient Collected Samples Some samples may need certain requirements on behalf of the patient (e.g. fasting prior to sample collection, early morning specimen etc.), whilst others will need to be collected by the patient themselves (e.g. 24hr Urine samples). For information about and additional collection requirements, please see the appropriate assay entry in the relevant test directory (appendix 12).
10. Sample Storage Sample storage is of particular importance, as incorrect storage and handling conditions can render a sample unfit for testing. For further information about key pre-laboratory storage and handling criteria (e.g. overnight storage conditions if unable to send sample on same day as collection), please see appendix 2b. Individual test requirements may also be found in the relevant assay entry in the test directory (appendix 12).
Once analysed, specimens are kept so that further tests can be undertaken or repeated, if required. The length of time that samples are kept varies, depending upon the stability of the analyte and nature of the sample. Retention times vary from 3 days (general haematology/biochemistry) to indefinite storage (DNA for molecular haematology).
Sample storage requirements, such as temperature, will also vary. Samples will be stored in conditions that best maintain sample integrity for the tests being conducted. For further details, please contact the relevant laboratory.
11. Additional Tests (Add-ons and Reflex Testing) Clinicians may request extra tests on a sample already in the department but these can only be completed if the analyte or cells are sufficiently stable. Such requests must be accompanied by a new form for the extra test(s) required.
GP requests to add on additional tests should be made by phoning the laboratory results and enquiries line. The final decision to perform an add-on test will rest with the laboratory, and will be influenced by the delay in receiving the request, and the stability of the analyte/cells concerned. Specific ‘add-on’ criteria can be found in the appropriate entry of the test directory (appendix 12).
Reflex Testing In certain instances, the laboratory may add on additional tests or request additional samples to aid in clinical interpretation of results. This will be done without the authorisation of the requester.
12. Specimen Contamination When taking blood samples for multiple investigations, remember that anticoagulants present in specimen bottles may cause problems if carried over from one type of container to another; always fill EDTA bottles last as EDTA interfered with many biochemistry assays, especially potassium and calcium measurement.
Spurious Results Inappropriate samples collection, storage and transport can interfere with a number of results. Some examples are given below:
Problem Common Causes Effect Inappropriate Sample taken from drip arm Increased drip analyte collection site e.g. potassium, glucose
Dilution effect - low results
Prolonged coagulation results e.g. contamination with heparin Haemolysis Expelling blood through a Increased potassium, phosphate, ALT, needle into the tube, vigorous LDH, magnesium, iron
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shaking, extremes of temperature Reduced haemoglobin measurement
Abnormal coagulation results e.g. increased D-dimers Storage Biochemistry samples in a Increased potassium fridge
Haematology samples Red cell swelling and white cell changes >24hours old Delay in Overnight storage, delay in Increased potassium, phosphate, LDH separation of transit serum/plasma Deranged clotting
Labile analytes Not immediately separated Decreased ACTH, insulin, C-peptide, and frozen gastrin and homocysteine
Incorrect No fluoride oxalate Decreased glucose container or anticoagulant EDTA contamination Decreased calcium, magnesium and alkaline phosphatase Increased potassium
Li sample collected into Li Increased lithium Heparin
Sodium in Na Citrate Increased sodium, decreased calcium
Clotted sample Poor sample mixing at Decreased haemoglobin and platelet counts (anti-coagulated collection specimens) Deranged clotting Sample activation during E.g. prolonged coagulation results if fully venipuncture clotted, shortened results if activated. Lipaemic Sample collected soon after Affects any assays which employ optical specimen ingestion of high-fat meal detection methods E.g. Raised Haemoglobin Icteric specimen
13. Specimen Transport
All specimens should be deposited in individual sealed, leak proof bags/containers and transported on/in an appropriate trolley, tray or receptacle that will contain leaks and spills. It is recommended that all trolleys used for sample transport have available spill kits, including an approved disinfectant and absorbent cleaning material.
Samples and forms contain confidential patient information and it is important that samples are transported in a way which maintains confidentiality. All specimens must be taken directly from source to the laboratory. This should be done in a timely manner, to ensure the integrity of the specimen. Specific transport requirements can be found associated with the assay entry in the test directory (appendix 12).
Primary Care Primary Care samples are collected by the community drivers at least once a day. To enable efficient processing within the department, a coloured bag system is used:
Bag Colour Department
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Red All urgent samples Green and Red Any Fast Track request that includes Urea & Electrolytes, Bone Profile Green Any Fast Track request that doesn’t meet the above conditions White Bag Special Chemistry Blue & White Antenatal Screening samples striped bag Striped Bag Immunology Other departments – Please see handbook for these departments for further details Yellow Histology Blue Microbiology & Virology
Inpatient - Urgent These are defined as samples which may yield results that will affect immediate patient management. Where present, the pneumatic air tube system should be used for the transport of urgent samples. However, the following specimens MUST NOT be transported via the air tube system: • High risk specimens* • HMDL Samples • Specialist H&T Tests • Cerebrospinal Fluid (CSF) samples • Samples on ice • Blood products • Glass containers
*High risk samples cannot be sent by air tube systems.
Where the air tube system is not present, or the specimen meets one of the above conditions, hand delivery via the porters or ward staff is required.
When using the air tube system, please be aware that: • Only authorised members should use the air tube system, and steps must be taken to ensure the health and safety of those using it. • It is the responsibility of the ‘sender’ to operate the system correctly, and to have back-up systems in place for when the system is unavailable or not performing correctly. • Specimens must be placed into sealed specimen bags. Any leaking samples must not be sent. • Samples must be transported using an air tube carrier (also known as ‘pod’). The lid must be secured before sending.
Inpatient - Routine Porters collect routine samples from all wards and outpatient departments on their planned route, and if specifically requested.
Please note: In all cases, the Blood Sciences Department is not responsible for the porter service at any of the three UHL sites. Advice on the collection and transport of samples is available on request from the laboratories.
Major Haemorrhage Samples Following activation of the Massive Haemorrhage Policy (MHP) at LRI only, Interserve will assign a porter for delivery of urgent samples to Blood Transfusion and for collection of products and components. The air tube system must not be used for urgent samples.
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At LGH and GH urgent samples can be hand delivered directly to the laboratory by a member of the ward staff or assigned ‘runner‘
The Blood Transfusion laboratory must always be contacted when urgent samples are being sent so they can be prioritised
Outpatient Samples collected from outpatient departments are analysed at the LRI. For samples collected from clinics held at the Royal Infirmary, these samples will be transported to the laboratory by porter or air tube system. For samples collected from LGH or GH outpatient departments, these will be transported to the LRI for testing, unless there are specific sample stability concerns in which case they will be analysed at site of collection.
Pathology Transport Service UHL provides a transportation network for the collection of samples collected by GP surgeries within the Leicestershire area. These samples are transported to the Leicester Royal Infirmary for analysis.
The Pathology Transport Service provides a third party transport route between the three hospital sites within UHL. This is used for the transport of specimens (if the required test is conducted at a different site to where the sample was collected), blood products and laboratory equipment.
Samples should be delivered to the local laboratory, who can then arrange further transport using the Pathology Transport System as required.
Transportation outside of UHL Occasionally, samples may need to be sent to referral centres for specialist testing not offered by UHL. In these circumstances, samples may be transported to external laboratories by a courier/taxi service, or using the Royal Mail postage service, dependent upon the nature of the specimen and the requirements of testing.
Some samples will need to be sent to referral laboratories directly from clinical areas, rather than by the local laboratory. Local protocols will be available to detail how and when samples should be packaged and sent. These MUST be followed to maintain sample integrity, and ensure safe transport of the specimen
It is important to note that all samples transported by road (whether provided by UHL transportation or external services) MUST abide by the European Agreement Concerning the International Carriage of Dangerous Goods by Road (ISBN 13 9789211391121)
14. Results Results are only released from the laboratory once they have been authorised. This may be a manual or automatic process, depending on the test. Authorised results can be accessed electronically via ICE or iLab. If users do not have access to iLab or ICE, the pathology results line will be happy to provide verbal results. They can be contacted on 0116 258 6531/7999 Mon-Fri between the hours of 09:00-17:00. Please note under no circumstances can results be released to or discussed with the patient or relatives on the telephone. Doctors are requested not to inform patients that they can ring the laboratory to obtain the results or any blood or other test.
If an erroneous result is issued, the clinical area will be notified of the error and the result will be recalled. The laboratory may then request an additional sample for repeat testing. If an amended report is issued, a comment will be added to identify this.
In exceptional circumstances, provisional results may be released where it is felt these are essential to the immediate management of the patient. These will be identified as provisional at the time of release.
Telephone Limits If the laboratory encounters a result which is identified as being critical in nature (i.e. suggests a significant risk to the patient), the result will be telephoned to the extension or bleep number provided on the request form. This is to highlight the abnormal result to the clinician so they may act on it (if required) in a timely fashion. If no number is
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15. Release of Samples to the Police The police may at any time request the release of specimens received by the laboratory for testing. The credentials of the police officer will be established by their warrant card.
Patient consent is required to release their samples to the Police (or any other body, or person). However, there are exceptions when samples may be released by the laboratory without patient consent including: a) Where serious public harm or a serious offence has occurred b) Where release of samples is provided for in statute law such as notifiable diseases, prevention of terrorism, or where the laboratory is required to produce samples by a court order.
If the patient is unwilling to give consent, the police officer is required to present an order from a judge, unless the patient is the subject of a police investigation related to a road traffic offence (e.g. drink / drug driving).
Post-mortem samples taken under the guidance of HM Coroner may be released to the police following approval from HM Coroner or a court of law.
16. Measurement Uncertainty In any laboratory process, there will be a degree of variability dependant on the test performed. This can be due to the handling and storage of the specimen, analytical processes or reporting and interpretation of results. For every procedure conducted within the department of Blood Sciences, non-pathological factors with the ability to influence results have been identified and minimised as much as feasibly possible.
All critical equipment and systems are calibrated to ensure accuracy of measurement and such calibration systems are traceable to a national or international standard. Information is also provided by the manufacturer regarding precision of equipment and any other factors which may influence the certainty of measurement. All staff undergo regular training and competency assessment in procedures and processes to ensure that they are competent to carry out the testing procedure.
Measurement uncertainty is particularly important to consider when results lie around clinically significant cut-offs, as patient management may be influenced by the result interpretation.
In order to provide an indication of the analytical uncertainty, the laboratory calculates a measurement uncertainty for each assay which produces numerical results. This value is the amount by which the actual result could differ from the result quoted (with a confidence interval of 95.5%). For example, a sodium result of 135 mmol/L has a measurement uncertainty of ± 3 mmol/L meaning that we can be 99.5% confident that this result is between 132 mmol/L and 138 mmol/L.
In addition, results may vary within an individual due to their biological variability. Information about this variability is available from the laboratory and can be used in conjunction with analytical uncertainty above to estimate how likely it is that two results on a patient are significantly different.
Details of measurement uncertainty for individual tests can be provided on request.
17. Quality and Governance
Confidentiality and Personal Information The laboratory is committed to maintaining patient confidentiality and practices Caldicott principles. No Trust employee shall misuse any personal information, or allow others to do so, and staff are protected from inappropriate use of their details. Laboratory staff follow the Trust Policy for Protection and Use of Personal
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Information (available in Insite) to ensure compliance with the Data Protection Act, NHS directives and other legislative requirements which govern how confidential information must be processed.
At times this will mean that electronic communications (phone, fax, email) to and from the laboratory may be constrained by these protocols to preserve patient confidentiality.
Under NO circumstances can results be released to or discussed with the patient or relatives on the telephone. Doctors are requested not to inform patients that they can ring the laboratory to obtain the results of any blood or other test.
Duty of Candour As an NHS service provider we are required by law to comply with the duty of candour. This means that we must be open and transparent with service users about their care and treatment, including when it goes wrong.
Audit The department adheres to a rigorous audit schedule, aimed at monitoring our practice against appropriate standards and identifying areas of improvement. The audits contained within this calendar are designed to cover key aspects of each individual laboratory and is reviewed on an annual basis.
External Quality Assurance The Blood Sciences service participates in a full range External Quality Assurance programmes surveys, covering all available areas of the department. Providers of these services include: • NEQAS • Qualaris • Binding Site
Research and Development The laboratory supports a number of local and national clinical trials. Before undertaking any investigations which are part of a clinical trial protocol, the relevant Head of Department must be approached and permission sought as the Directorate may charge for such work. For possible research collaborations, please contact the Head of Service or Laboratory Manager to discuss.
18. Informed Consent It is the responsibility of the clinical requester to ensure that the patient has been adequately supported to make an informed consent to testing. With the exception of Blood Transfusion samples (see below) or samples obtained from invasive procedures (e.g. bone marrow biopsies which require specific consent as per UHL protocols), provision of a request form and an associated sample to the pathology service is taken as consent to testing. The laboratory will conduct testing according to the information given on the request form.
Consent for Blood Transfusion Blood Transfusion carries potential risks, some of which may be serious or, very rarely, life threatening. The Department of Health’s Better Blood Transfusion 3 circular (HSC 2007/001) required NHS Trusts to implement a number of actions to improve appropriate use of blood and safety of transfusion. One of these actions was to ensure patients are well informed of the risks and benefits of blood transfusion, and that this discussion is clearly documented in the patient case notes. UHL Trust therefore implemented a formal consenting process to ensure patients are fully informed and aware of the risks, benefits and implications of receiving a blood transfusion.
All patients must give written consent to receive a blood component transfusion. Where the patient is unable to give written consent, the clinician must proceed in the best interests of the patient as with any other emergency situation.
The consenting process is outline in the Blood Transfusion Integrated Care Pathway, which also contains 2 ‘peel- off’ stickers. These are intended for use on the standard UHL consent form, of which the patient will be given a copy.
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19. User Comments, Suggestions, Compliments and Concerns The Department encourages feedback and comments regarding the quality of the service provided to our users and any suggestions as to how services can be improved. We would welcome any proposals for multidisciplinary clinical audit, suggestions for new tests to be added to the service’s repertoire or evidence of altered frequency of testing to facilitate evidence-based practice appropriate for the needs of our users. Compliments and concerns, written or verbal, should be directed to Yusuf Sidat (Quality Manager), Operational Head of Service, Deputy Service Managers or Clinical Leads of the relevant department. All concerns are logged, investigated and responded to with corrective actions implemented as appropriate to improve the quality of the Blood Sciences service. Compliments are communicated to appropriate staff.
All Complaints are dealt with by The Trust Patient Information and Liaison Service (PILS.) Any complaints received by the department are forwarded ASAP to the PILS service. To contact PILS Freephone: 0808 178 8337 Fax: 0116 258 8661 Email: [email protected] Online: www.leicestershospitals.nhs.uk/patients/patient-welfare/patient-information-and-liaison- service/contact-form
In accordance with the Blood Safety and Quality Regulations (BSQR), all complaints and other information concerning potentially defective products or components will be reviewed carefully according to written procedures in order to promptly and effectively recall any products or components known or suspected to be defective.
20. Useful Resources
Clinical Guidelines Clinical guidelines are available for all specialisms within Blood Sciences. These guidelines are produced by panels of national experts in each field and identify best practice with regards to diagnosis and treatment of the patient. The following are some societies which provide such guidance, although please note this is not an exhaustive list.
British Society for Haematology: https://b-s-h.org.uk/guidelines/
International Society on Thrombosis and Haemostasis: https://www.isth.org/?page=GuidanceDocuments
Haemoglobinopathy Screening Programme: https://www.gov.uk/guidance/sickle-cell-and-thalassaemia-screening-programme-overview
Association for Clinical Biochemistry: http://www.acb.org.uk/whatwedo/science/best_practice/acb-developed-guidelines
British Society for Allergy & Clinical Immunology: http://www.bsaci.org/Guidelines/bsaci-guidelines-and-SOCC
NHS Blood and Transplant: http://hospital.blood.co.uk/clinical-guidelines/nhsbt-clinical-guidelines/
Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee: https://www.transfusionguidelines.org/
National Institute for Health and Care Excellence: https://www.nice.org.uk/guidance
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National Institute for Health and Care Excellence (Cholesterol, HDL and LDL: https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/#!management https://www.lmsg.nhs.uk/useful-links/
Patient Information Leaflets The provision of high quality, evidence-based information for patients is essential not only for informed consent, but also to empower people to be involved in their own healthcare decisions. Patient information leaflets are available for certain procedures within Blood Sciences, usually those deemed invasive, or for patient collected specimens (e.g. urine). For more information about what patient information leaflets are available regarding sample collection, please contact the relevant laboratory.
Online Resources While this handbook aims to provide all relevant information for accessing and utilising the services provided by the Blood Sciences department at UHL, there is a wealth of information available online regarding testing strategies, analytical techniques and diagnostic markers. In addition to the guidelines suggested above, the following websites provide useful information which can aid in the identification of useful diagnostic tests:
Up-to-Date: https://www.uptodate.com/home
Practical Haemostasis: http://practical-haemostasis.com/
Labtestsonline: https://labtestsonline.org.uk/
NHSBT Services: http://hospital.blood.co.uk/diagnostic-services/
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Appendix 1: Map Locations Leicester Royal Infirmary The Blood Sciences Department is primarily found on levels 2 and 4 of the Sandringham building. The Immunology laboratory is located on level 1 in the Hearing Services Building. An additional satellite laboratory is located within A&E department
Leicester General Hospital The entrance to pathology laboratories is located at the end of the link corridor signposted for “Blood Test” and “Pathology”, leading off the main corridor.
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Glenfield General Hospital The entrance to Pathology Laboratories is located on ground floor in zone 2
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Appendix 2a: Sample Containers
Name Volume Details
Adult: 10ml White top monovette containing Serum Paediatric: 1.2ml no gel separator
Adult: 4.7ml Brown top monovette containing Serum Gel Paediatric: 1.2ml separating gel
Adult: 4.7ml Orange top monovette containing Lithium Heparin Paediatric: 1.2ml Heparin anticoagulant
Adult: 2.7ml Yellow top monovette containing Fluoride EDTA Paediatric: 1.2ml fluoride EDTA
Sterile Universal container or Random Urine: 10ml fluoride EDTA
24hour Urine: Supplied with collection Plain or acid N/A instructions preserved
Pink top bottle monovette Adult: 2.7ml K-EDTA containing Potassium EDTA Paediatric: 1.2ml anticoagulant
Adult: 4.3ml Green top monovette containing Citrate A&E: 1.8ml Sodium Citrate anticoagulant Paediatric: 1.4ml
2.7ml ONLY Purple top monovette containing EDTA Potassium EDTA anticoagulant
Adult: 7.5ml EDTA ‘’For Blood Pink Top monovette containing Paediatric: 1.49ml Transfusion’’ Potassium EDTA anticoagulant Neonatal: 1.2ml
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Appendix 2a: Sample Storage and Handling Requirements Storage of Samples for Chemical Pathology Tests.
Pathology specimens should be transported to the laboratory as soon as possible after collection. Delay could result in deterioration in the specimen and invalidate the results of the investigations carried out.
On occasions there may be an unavoidable delay in transporting samples to the laboratory. This document provides guidance on which samples may be stored overnight and how to store these samples to prevent deterioration.
Test/Profile Bottle Storage of Sample
U&E’s DO NOT STORE (sodium, potassium, urea and Sample to be sent to lab within 6 creatinine) hours.
LFT’s
(ALT, ALP, Bilirubin) Do not put in a fridge prior to Seum Gel sending sample to the laboratory Bone Profile (Albumin, Calcium, Phosphate, ALP)
Troponin DO NOT STORE Sample to be sent to lab immediately
Lithium Heparin
Glucose OK to store whole blood in fridge overnight
Fl/Ox tube
PTH DO NOT STORE Sample to be sent to lab within 6 hours.
EDTA tube
HbA1C OK to store whole blood in fridge overnight
EDTA tube
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GGT OK to store whole blood in fridge overnight
Seum Gel tube
Magnesium DO NOT STORE Sample to be sent to lab within 6 hours
Seum Gel tube
Cortisol OK to store whole blood in fridge overnight
Seum Gel tube
PSA OK to store whole blood in fridge overnight
Seum Gel tube
CK OK to store whole blood in fridge overnight
Seum Gel tube
Lipids OK to store whole blood in fridge (Cholesterol, triglycerides) overnight
Seum Gel tube
Lipid Profile (fasting) OK to store whole blood in fridge (Cholesterol, triglycerides, HDL overnight cholesterol, LDL cholesterol)
Seum Gel tube
Gender Hormones OK to store whole blood in fridge (LH, FSH, Oestradiol, prolactin, overnight progesterone, testosterone, SHBG)
Seum Gel tube
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Tumour Markers OK to store whole blood in fridge (CA125, CA19.9, CEA, AFP, HCG) overnight
Seum Gel tube
HCG (pregnancy) OK to store whole blood in fridge overnight
Seum Gel tube
Digoxin DO NOT STORE Sample to be sent to lab within 6 hours.
Seum Gel tube
TDMs (Paracetamol, Salicylate, OK to store whole blood in fridge Lithium, Theophylline, Anti- overnight convulsants)
Seum Gel tube
Cortisol OK to store whole blood in fridge overnight
Seum Gel tube
Lead OK to store whole blood in fridge overnight
EDTA tube
Osmolality DO NOT STORE Sample to be sent to lab within 6 hours (assay in conjunction with a random urine sample) Serum Gel tube
Others NOT listed Please phone the laboratory
Notes:-
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Some surgeries have access to a centrifuge. In these instances samples can be spun down according to the manufacturers guidance and stored in the fridge prior to sending to the laboratory for analysis the following day. Specimens for room temperature storage should not be exposed to extremes of temperature e.g. placed in direct sunlight, near a heat source (e.g. radiator) or allowed to chill or freeze. Ideally, they should be kept in an insulated container between 20°C – 25°C.
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Appendix 3: Blood Forms
Blood Transfusion
General Blood Transfusion Requests
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Kleihauer Request Form
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Special Requirements Notification Form
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NHSBT Request Forms http://hospital.blood.co.uk/diagnostic-services/hi/hi-test-request-forms/
Antenatal Testing Request Form
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Emergency “Flying Squad” Form 1
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Emergency “Flying Squad” Form 2
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Special Haematology
Haemostasis
Haemoglobinopathies - General
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Haemoglobinopathies – Antenatal Screening
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HMDL Form
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Immunology
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Routine Haematology & Chemistry
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Routine Chemistry
Down’s screening
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Appendix 4: Pre-Transfusion Sample Requirements There are strict guidelines in place regarding the frequency of transfusion samples due to the potential risk of transfusion complications, including development of significant antibodies. Although this risk can never be entirely removed, the laboratory has implemented the following requirements to mitigate this risk as much as possible:
• The ‘2 sample’ policy states that blood products will not be released from the laboratory until 2 separate samples from the patient have been received. The blood group of both samples are compared and, if identical, blood may be electronically crossmatched if appropriate. If not concordant, a third sample will be requested immediately. • Group and screen samples are ONLY valid for 72 hours UNLESS the plasma has been frozen OR they are multi-transfused Haematology patients whose samples are valid for 96 hours. • Freezing the plasma extends the sample validity up to 3 months • Sample validity MUST NOT be extended by freezing the sample if the patient has current OR historical antibodies – Because the status of the patient’s antibody(s) can change during this period of freezing a ‘fresh’ sample is required to ensure we check the antibody status again as close to the planned transfusion as possible. Using the frozen sample would not capture any potential changes in antibody status. • Sample validity MUST NOT be extended by freezing if the patient has been pregnant in the last 3 months – Because the patient may have developed an antibody during pregnancy • Sample validity MUST NOT be extended by freezing if the patient has had a transfusion in the last 3 months – Because the patient may have developed an antibody through the transfusion • The responsibility for ensuring the last 2 points are adhered to lies with the requesting Clinician to ensure that the patient has no previous history
Patients who WILL have plasma frozen: • Patients where the request for a blood transfusion is more than 72 hours in advance, who are NOT pregnant and who have NOT had a transfusion in the last 3 months • All ‘pre operative’ group and screen samples from patients who are NOT pregnant and who have NOT had a transfusion in the last 3 months
ALL samples EXCEPT the following 4 categories will have a frozen plasma sample: • Samples from Maternity wards, or patients that have been pregnant in the last 3 months • Samples from Haematology wards, Oncology wards and BMTU • Patients with antibodies • Patients who have been transfused in the last 3 months
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Appendix 5: Provision of Blood Products
The following blood products may be requested using the ‘Routine’ blood transfusion request form:
• Red blood cells • Platelets* • Fresh frozen plasma / Octaplas* • Cryoprecipitate* • Human albumin solution (4.5% and 20%) • Prothrombin Complex Concentrate (Only available following discussion with Haematology SpR/Consultant. Accompanying documentation and audit forms must be completed and returned to Blood Bank. The PCC Clinician pack is available on Insite). NB: Unused product must be returned to blood bank within 2 hours • Novoseven (Only available following discussion with Haematology SpR/Consultant. Can be issued on receipt of transfusion fluids form following telephone requests) NB: Unused product must be returned to blood bank within 2 hours
*Specialist product requests will only be processed following discussion with the Haematology SpR/Consultant, as part of the major haemorrhage protocol, following a TEG (thromboelastogram) result, or for peri- and immediate post-operative cardiothoracic patients.
Urgent Red Cell Issue An urgent red cell crossmatch, given the maximum priority takes about 40 minutes from receipt of the sample in the laboratory, providing no red cell antibodies are detected. If antibodies are found, this will lead to delays in providing compatible blood. The extent of delay depends upon the nature of antibody(ies) and the availability of suitable blood (including accommodating any special requirements).
Group specific blood (ABO compatible – uncrossmatched) can be issued in emergencies within 20 minutes of receiving samples. This is only appropriate for patients who are experiencing life-threatening bleeding who cannot wait for crossmatched blood and as such is usually reserved for activation of major haemorrhage protocol.
Emergency O D negative red cells
Units of O D negative (rr), K negative adult red cells are available at all times in selected issue fridges for use in clinical emergencies. The units supplied to delivery suites are also CMV negative for neonates and women during pregnancy. Such units can be found in the following locations:
Location Number of Emergency Adult Units - O D Neg (rr) K negative
LRI Issue fridge 2 LRI ED 4 LRI Theatres 2 LRI Delivery Suite 2 units are also CMV neg for transfusion to neonates women during pregnancy LRI Haematology Day Ward 0 (not for overnight storage)
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LGH Issue Fridge 2 LGH Delivery Suite 2 units are also CMV neg for transfusion to neonates women during pregnancy LGH Main Theatre reception 0 (not for overnight storage) LGH Orthopaedic theatres 0 (not for overnight storage) GH Issue Fridge 2 GH CICU 6 GH Cardiac Theatres 1 & 2 0 (not for overnight storage)
The laboratory must be informed immediately if any O negative blood is removed for transfusion as stock must be immediately replaced for any other patient who may require emergency support. The forms included with the blood (appendix 3) must be fully completed and returned to the Blood Transfusion Laboratory without delay. The sticker on the form must also be fully completed and placed in the patient notes.
Patient Waiting When there is a patient waiting for a transfusion, requests will be prioritised for processing within 2 hours from receipt of sample providing no red cell antibodies are detected. The laboratory must be informed that the patient is waiting for a transfusion.
Anti-D Issue With the exception of 28 week gestation prophylaxis, all samples will have a kleihauer test performed to determine the appropriate anti-D dose. Anti-D can be requested from the Blood Bank using the ‘Kleihauer’ form (see appendix 3).
Retrospective issue of 28 week gestation anti-D must be requested using the K28 receipt form
The ward Anti-D Immunoglobulin Pathway must be completed for traceability (a legal requirement) and replacement of stock.
.
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Appendix 6: Blood Product Special Requirements Products can be requested to be irradiated and/or CMV negative, depending upon the clinical scenario and urgency of transfusion. Even if no requirements are required, this MUST be indicated on the routine request form.
When first identifying the need for a special requirement on a blood product request, a ‘Special Requirements Notification’ form (appendix 3) MUST also be provided. Gamma Irradiated blood components Gamma irradiated products are provided to reduce the risk of Graft versus Host Disease (GvHD). Irradiated products are indicated in the following scenarios: • Recipients of allogeneic bone marrow and PBSC transplant • Allogeneic bone marrow or PBSC donors • Recipients of autologous bone marrow and PBSC transplants • Hodgkin’s disease (any stage) • Recipients of Fludarabine, Clofarabine, Cladribine, Nelarabine, Deoxycoformycin (DCF, Pentostatin), Campath (Alemtuzumab) and anti- Thymocyte Globulin (ATG) • Intrauterine transfusions (IUT) of red cells or platelets • All exchange transfusions for neonates and infants • HLA Matched platelets and red cell, platelets or granulocyte donations from first or second degree relatives • Granulocytes on all occasions. Transfuse immediately after irradiation. • Congenital immunodeficiency states 1. Severe combined immunodeficiency (SCID) 2. Di George syndrome 3. Wiskott Aldrich syndrome 4. Reticular dysgenesis 5. Cellular immunodeficiency states, otherwise unclassified 6. Immunodeficiency with eosinophilia (Omenn’s syndrome) 7. Ataxia telangiectasia 8. Adenosine deaminase deficiency 9. Purine nucleoside phosphorylase deficiency 10. MHC class I or II deficiency 11. Leucocyte adhesion deficiency
CMV Seronegative blood components Cytomegalovirus (CMV) negative products are provided for patients at increased risk of serious consequences of CMV infection. However, they may not be provided if the clinical urgency is such that provision of CMV Seronegative blood is likely to cause unacceptable delay. Indications for CMV negative products include: • Neonates or infant up to 28 days old. For premature neonates, count 28 days cut off from their expected date of delivery • All Intrauterine transfusions • Planned transfusions during pregnancy, wherever clinically possible (Not necessary during or post delivery) • CMV negative recipients of allogeneic bone marrow and/or peripheral blood stem cell transplants. • Specific CMV-negative paediatric patients receiving chemotherapy, where the treatment protocol demands this. • Granulocyte components should continue to be provided as CMV seronegative for CMV seronegative patients
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Appendix 7: Prescription, transport and administration of blood products
Prescription of Blood Components Blood components can only be prescribed by qualified medical staff. If a transfusion is necessary, all blood components must be appropriately prescribed on the UHL Blood Component Prescription and Administration Chart (please see Trust policy: Blood Transfusion - Policy for Prescribing Collection Storage and Administration of Blood and Blood Products, available on Insite) A valid prescription must include the following information:
• Type of component • Number of units/volume to be transfused • Rate of transfusion • Special requirements e.g. irradiated, CMV negative. This must also be indicated on the request form. Failure to complete this detail will result in the request form being rejected due to the risk of random products being erroneously issued
Transport of Blood and Blood Components Before collection of any blood component from Blood Bank, to avoid unnecessary wastage and delays, check the following:
• Patients’ IV access is patent • Prescription • Availability of relevant paperwork e.g. crossmatch form • Informed verbal consent • Pre-transfusion observations have been completed
When collecting and transporting blood products from blood bank fridges to clinical areas, please note the following: • All blood components must be handled with care – red cells especially are easily damaged • Where available, carry blood components in the red transport bags provided • Blood components must be delivered to the ward immediately. If the patient’s situation changes and blood can no longer be given at that time, it must be returned to Blood Bank within 30 minutes of collection from the laboratory to be returned to stock. • Always alert Blood Bank staff when returning unused components to ensure that they can be returned to controlled storage in a timely manner • Hand the product to a qualified member of ward staff • Red cells must be collected one unit at a time unless exceptionally, the clinical urgency is such that more than one unit of blood is to be transfused simultaneously through separate IV lines • Platelets are stored at room temperature – under no circumstances must they be put into the fridge
Storage of Blood Products Red cells must only ever be stored in designated blood fridges at 4-6ºC. Transfusion must commence as soon after leaving the blood bank fridge as possible, and must be completed within 4 hours.
Platelets, Fresh Frozen Plasma (FFP) and Cryoprecipitate are issued on a named patient basis for immediate transfusion. They must not be collected from the blood bank until the patient is ready for infusion. Platelets and cryoprecipitate must not be placed in any blood fridge. They must be transfused immediately after collection from
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Blood Components that are kept out of the fridge for more than 30 minutes and not transfused must be returned to blood bank for wasting Human Albumin Solution (HAS) is stored at room temperature and can be kept on the ward for several hours as long as the temperature does not go outside 2-25º C.
Do NOT place any blood component in a domestic refrigerator or drug fridge
Administration of Blood Components Administration of blood components is fully covered in the Blood Transfusion - Policy for Prescribing Collection Storage and Administration of Blood and Blood Products which is available on Insite In the interest of patient safety, overnight transfusions must be avoided unless deemed absolutely necessary. If you have any concerns about the blood component, DO NOT TRANSFUSE. Use the contacts list at the front of this document for further advice. Do not add any drugs or fluid to a blood component. A fresh giving set must be used with each separate blood component, i.e. when switching from red cells to platelets or FFP. On completion of a transfusion, only 0.9% normal saline must be used as a flush, this includes blood warmers. No other fluid must be mixed with blood components, or blood components mixed with other blood components.
Transfer of Patients Receiving a Transfusion
If a patient undergoing a transfusion is to be transferred to another ward/department within UHL, a qualified member of staff trained in IV administration and competent in transfusion must accompany them. Any untransfused blood components must remain in a designated blood fridge for the receiving ward/department to collect as necessary. It is against UHL policy to send any blood components with a patient unless they are in progress at the time of transfer. Exceptionally, blood bank can arrange to package blood components in a transfer box for you. Liaise with blood bank staff if this service is absolutely necessary.
If a patient undergoing a transfusion needs to be transferred to a different trust, consider whether they will need to have crossmatched blood components sent with them. Please refer to the Blood Transfusion Policy for Prescribing Collection Storage and Administration of Blood and Blood Products which is available on Insite, to the Trent Transfer policy if the patient is being transferred within the Trent region, or contact Blood Bank for more information.
If a patient is transferred to UHL whilst undergoing a transfusion, ensure that 3 patient identifiers are used to check the blood i.e. the patient’s FULL name, date of birth and the referring hospital’s patient identification number. Ensure that the accompanying paper work is checked to verify if the products are in date and are safe to be administered. Blood bank MUST be notified of any blood or blood components that enter the UHL. This is part of the Legal requirement to ensure 100% compliance with traceability of blood and blood components.
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Disposal of Blood Bags
On completion of a successful transfusion episode, all used blood component packs must be placed back into the red transport bag which must be marked on the white panel with the patients name and the date of transfusion. These bags must then be kept in a designated area on each ward/theatre for at least 24 hours. This will make it possible to investigate any possible delayed transfusion reactions. After 24 hours, the bags must be disposed of as per the Waste Management Policy. Giving sets are disposed of into a sharps bin. In the event of a serious transfusion reaction, the implicated blood component pack must be sent to the blood transfusion laboratory, with the giving set still attached to the blood component pack, and the cannula end of the giving set sealed using an appropriate bung.
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Appendix 8: Transfusion reactions and adverse event reporting
Transfusion Reactions
Detailed guidance on transfusion reactions is fully covered in the Blood Transfusion - Policy for Prescribing Collection Storage and Administration of Blood and Blood Products which is available on Insite and included in the Blood Transfusion Integrated Care Pathway.
When reporting a suspected transfusion reaction: • Stop the transfusion immediately. • The cannula must be kept patent with a slow running drip of 0.9% saline until medical staff have reviewed the patient. • Staff must seek immediate advice from the patient’s own medical team. The patient’s own medical team may in turn seek advice from the Haematology SpR on call if necessary. • The patient’s clinical team must refer to the algorithm on the Blood Transfusion Integrated care pathway (i.e., blood transfusion prescription chart) for further guidance on the immediate management of a transfusion reaction. • Details of the transfusion reaction must be discussed with the blood transfusion laboratory.
If after review by the patient’s medical team, the reaction is considered to be significant, proceed with the following: • Ward / clinical staff must take blood cultures, a group and save, FBC, U+Es and a clotting screen from the patient irrespective of the symptoms of transfusion reaction • The implicated unit must be sent IMMEDIATELY to Blood Bank WITH THE GIVING SET STILL ATTACHED. • Clinical staff must complete a Datix incident form. Report the Datix reference number to Blood Transfusion staff on 0116 258 3211
Event/Incident Reporting It is a legal requirement that any incidents or events related to blood transfusion are reported. This must include suspected transfusion reactions and post transfusion infections. A DATIX incident form must always be completed - even if it was just a near miss, and notified to Blood Transfusion staff. The Blood Transfusion team or Lead Transfusion Practitioner will report to SHOT (Serious Hazards of Transfusion and SABRE (Serious Adverse Blood Reactions and Events) as appropriate.
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Appendix 9: Blood Product Traceability
Use of BloodTrack Maintaining vein to vein traceability of all blood products is a legal requirement. All units which are removed from the blood transfusion fridges must be ‘fated’, i.e. the final outcome of that unit is documented. This includes whether the unit was transfused, returned to stock, wasted etc. Within UHL, this is automatically recorded using BloodTrack. To maintain traceability, ensure the individual collecting the component has been adequately trained to carry out this duty and is fully competent in the use of the BloodTrack system. Staff bar codes for use with the BloodTrack system are unique to the individual and must not be shared. If you require training contact the Blood Bank to arrange a mutually convenient time. Always ensure a pickup slip is generated using electronic blood track for ALL transfusion fluids (including albumin solution).
Orange Blood Fate Documentation Cards Orange traceability cards have been withdrawn from use for blood and blood components within UHL. However they are still used for Albumin, Octaplex (Beriplex), Octaplas and NovoVII issue. Orange cards are also issued with blood components to external hospitals where the Blood Track devices are not implemented. On these occasions only, the procedure outlined below must still be followed.
Compatibility tags, attached to blood components are in two halves (one white; one ‘orange’), folded in the middle. The white section has a peel-off section detailing the donation number and must be peeled off and stuck onto the Integrated Care Pathway (ICP). The orange section must be completed immediately by the person starting the transfusion/ administering the product. Please detach along the perforations, fill in the required details, and return it to the Blood Transfusion department as soon as transfusion commences either via the air tube or the specimen porter’s service. Do not return the cards using the internal mail – this can be slow and cause delays. These products will then have their fate documented by the laboratory on return of the orange card to maintain the legal requirement for 100% traceability of blood products/ components. If the orange card is mislaid alternative evidence of transfusion must still be sent back to Blood Transfusion within 24hours of start of transfusion/administration. Please take a photocopy of the prescription chart (Integrated Care Pathway, ICP), detailing the unit number of the product, including 2 signatures. Failure to return evidence of transfusion will result in a Datix report being submitted against the clinical area
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Appendix 10: Blood Transfusion Alternatives
Transfusions may not always be the best treatment option for patients, as it poses a significant risk. Whilst every conceivable and practical step is taken to mitigate this risk, it must not be underestimated. With this in mind, always consider if an alternative to transfusion is available and more appropriate e.g. treating iron deficiency anaemia with iron supplements.
To determine transfusion need, always assess the patient’s clinical state AND laboratory values although if these do not correlate, treat as per clinical symptoms. If a patient remains asymptomatic and otherwise stable with no further blood loss anticipated (such as post-operatively), it is strongly advisable to avoid exposing them to the potential hazards of allogeneic (donated) blood. To avoid the need for blood transfusion, the following alternatives are available within UHL: Haematinic Replacement: Haemoglobin and red cell count may be optimised prior to surgery to reduce the need for intra- or post-operative transfusion Intra-Operative Cell Salvage: The patient’s own blood, lost during surgery, is collected, cleaned, processed and returned to the patient. Although encouraged in other types of surgery, intra-operative cell salvage is mainly used in:
• Cardiac surgery • Orthopaedic surgery • Liver surgery • Vascular surgery • Complex obstetric surgery
For further information about cell salvage, please contact a blood transfusion nurse practitioner
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Appendix 11: Blood Transfusion Training
It is a mandatory requirement for all staff involved in the Transfusion process, from collection through to administration, to receive annual training including training in GMP (Good Manufacturing Practice) to ensure compliance with National Guidelines and to address issues of patient safety and product liability. Within UHL each Clinical Management Group (CMG) has a mandatory training program and blood transfusion must be a fundamental part of this. In addition, the National Patient Safety Agency (NPSA) stipulates that every member of staff involved in any part of the transfusion process must have a Competency Assessment every 3 years. Within UHL, all relevant staff groups must successfully complete the blood transfusion e-learning modules before registering for a face-to- face Competency Assessment. The assessments will be carried out by a qualified LCAT (Leicester Clinical Assessment Tool) assessor competent in blood transfusion. To register for Competency Assessments or to complete E-learning modules follow the HELM Education and Learning Link on Insite
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Appendix 12: Test Directory
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Male: 1-10nmol/L Female: 1 x 4.9ml serum gel -Follicular phase: Age of patient >2days Special 17-Alpha Hydroxy Progesterone (1 x 1.1ml serum 4-6 weeks 1.0-10nmol/L Analysed at St Bartholomew’s Biochemistry gel for paediatrics) -Luteal phase: Hospital 1-20nmol/L 4wks: Up to 80nmol/L Not available to Primary Care 1 x 1.2mll serum Special 0-4 wks: Age of patient must be >2 days 17-alphahydroxyprogesterone (Paediatric) (no gel separator) 4-6 weeks Biochemistry up to 80 nmolL Analysed at St Bartholomew (Paediatric) Hospital London Adult females: Follicular phase 72 - 529 pmol/L Ovulatory phase A&E/Inpatients – 235 - 1309 pmol/L Routine 1 x 4.9ml serum gel 3 hours Luteal phase 205 17-Beta Oestradiol Biochemistry (1 x 1.1ml serum Outpatient/routine State day of menstrual cycle - 786 pmol/L (LRI ONLY) gel for paediatrics) GP – 24 hours Menopausal
< 118 pmol/L
Adult males: <146.1 pmol/L Not available to Primary Care 3-hydrocybutyrate with free Fatty Acids Special 1 x 1.2ml Fluoride Analysed at Nottingham University 4-6 weeks 0.02 – 0.29 mmol/L (Paediatric) Biochemistry EDTA (Paediatric) Hospitals Hypoglycaemic sample required
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 24 hour urine Special Adult: <2.3µmol/24 3-Methoxytyramine (adults) or random 15 working days Biochemistry hours urine (paediatric) A Special α2 Antiplasmin 1 x 4.3ml citrate 3 weeks N/A Analysed at UCL, London Haematology 1 x 4.9ml serum gel -10 Analysed at Oxford Radcliffe Acetylcholine receptor antibody Immunology (1 x 1.1ml serum 21 days 0-5 x10 M Hospital. gel for paediatrics) Not available to Primary Care 1 x 2.7ml EDTA Transport to laboratory on ice Special ACTH (1 x 1.2ml 10 working days < 46ng/L To be received by laboratory within Biochemistry Paediatrics) 30 mins of collection Send with cortisol A&E/Priority – 1 hour 1 x 4.3ml Citrate Inpatients – 3 Newborn-1mnth: Routine 1 x 1.8ml (A&E Activated Partial Thromboplastin Time hours 30.0-48.0s Can be added onto samples up to Haematology ONLY) (APTT) Urgent Primary Adult: 8 hours old (LRI/LGH/GH) (1 x 1.4ml care – 8 hours 24.0-33.0 Paediatrics) Outpatient/routine GP – 24 hours A&E/Priority – 1 Adult: 0.8 – 1.2 hour 1 x 4.3ml Citrate For monitoring heparin therapy Inpatients – 3 Telephone Limits: Routine 1 x 1.8ml (A&E Refer to UHL guidelines Activated Partial Thromboplastin Time Ratio hours During core hours: Haematology ONLY) (APTTR) Urgent Primary >6.0 (LRI/LGH/GH) (1 x 1.4ml Can be added onto samples up to 8 care – 8 hours Paediatrics) hours old Outpatient/routine Outside core hours: GP – 24 hours N/A Special Analysed at Hammersmith hospital, ADA/Diamond-Blackfan anaemia 4 x 2.7ml EDTA 2 months N/A Haematology London
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Special Analysed at the Doctor’s ADAMTS13 1 x 4.3ml citrate 24 hours N/A Haematology Laboratory, London 1 x 4.9ml serum gel Analysed at Nottingham University Adrenal antibody Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Trust gel for paediatrics) Up to 4 wks: A&E/Priority – 1 5 - 100 iu/L hour Up to 1yr: Routine 1 x 4.9ml serum gel Inpatients – 3 5 - 60 iu/L Alanine Transaminase Biochemistry (1 x 1.1ml serum hours Adult: Part of liver function tests (ALT) (LRI/LGH/GH) gel for paediatrics) Outpatient/routine 2 - 53 iu/L GP – 24 hours Telephone Limits: >500iu/L
A&E/Priority – 1 hour Routine 1 x 4.9ml serum gel < 28 days: 30-45 g/L Inpatients – 3 Albumin Biochemistry (1 x 1.1ml serum 28-15 yrs: 30-50 g/L hours (LRI/LGH/GH) gel for paediatrics) >15 years: 35-50 g/L Outpatient/routine GP – 24 hours
Not available to Primary Care 1 x 2.7ml EDTA Send to laboratory within 3 hours of Special Aldosterone (1 x 1.2ml 2-4 weeks collection Biochemistry Paediatrics) Send with renin Interpretation provided
Blood Alkaline Denaturation (APT) test Transfusion Various 3 days N/A (LRI/LGH/GH)
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Female: 0-9 yrs: 163-427 iu/L 10-12 yrs: 132-432 iu/L 13-14 yrs: 70-370 iu/L 15-16 yrs: 52-182 iu/L A&E/Priority – 1 17-18 yrs: 43-132 hour iu/L Routine 1 x 4.9ml serum gel Inpatients – 3 >18 yrs: 30-130 iu/L Part of liver function tests Alkaline Phosphatase Biochemistry (1 x 1.1ml serum hours Contact laboratory for bone & liver (ALP) (LRI/LGH/GH) gel for paediatrics) Outpatient/routine Male: isoenzymes GP – 24 hours 0-9 yrs: 163-427 iu/L 10-12 yrs: 132-432 iu/L 13-14 yrs: 176-515 iu/L 15-16 yrs: 86-390 iu/L 17-18 yrs: 53-191 iu/L >18 yrs: 30-130 iu/L 2 x 2.7ml EDTA (blood) OR Special ALL MRD 1 x 2.7ml EDTA 2 weeks N/A Analysed at UCL Medical School. Haematology BONE MARROW (1 x 1.2ml Paediatrics)
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 5 days for common Allergen-specific IgE/ Component Resolved 1 x 4.9ml serum gel allergens Diagnostics Immunology (1 x 1.1ml serum <0.35 kU/L (Please allow up (CRD) gel for paediatrics) to 5 weeks for rare allergens) 1 x 4.9ml serum gel (1 x 1.1ml serum gel for paediatrics) Special Alpha-1 Acid Glycoprotein OR 5 working days 0.3-1.1 g/L Biochemistry 1 x 4.9ml Heparin (1 x 1.2ml Paediatric) Interpretation provided Special Various – contact Alpha-1 antitrypsin (genotyping) 2 weeks N/A Analysed at Nottingham University Biochemistry laboratory Hospitals A&E/Urgent Inpatients – 3 1 x 4.9ml serum gel Special hours Alpha-1 Antitrypsin (total) (1 x 1.1ml serum 0.78-2.00 g/L Avoid venous stasis Biochemistry Wards/Outpatient/ gel for paediatrics) routine GP – 24 hours A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Male/non-pregnant: Alpha-fetoprotein Biochemistry (1 x 1.1ml serum Outpatient/routine >10Ku/L LRI ONLY gel for paediatrics) GP – 24 hours
1 x 4.9ml serum gel Alternative pathway complement activity Immunology (1 x 1.1ml serum 21 days 90-130% Sample must arrive in laboratory (AP100) gel for paediatrics) within 4 hours of collection
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 1.2ml Heparin Available to Community (Paediatric) Paediatricians Special OR Amino Acids (Paediatric) 10 working days N/A Analysed at Nottingham University Biochemistry Random Urine in Hospitals Sterile universal or Interpretation provided fluoride bottle Therapeutic: 0.5-2.0 mg/L PLEASE NOTE THAT THE Potentially toxic : AMIODARONE RANGES ARE 1 x 4.9ml serum gel >2.5 mg/L Special FOR ADULTS ONLY - NO Amiodarone (monitoring) (1 x 1.1ml serum 10 working days Telephone limit: >2.5 Biochemistry PAEDIATRIC gel for paediatrics) mg/L REFERENCE RANGES (Baselt, Deposition of ESTABLISHED. toxic drugs and chemicals in man) 2 x 2.7ml EDTA AML molecular markers: Special Analysed at City Hospital, (Blood or bone 10 working days N/A FLT3/NPM1/t(15;17)/t(8;21)/inv(16) Haematology Nottingham marrow) 4 x 2.7ml EDTA (blood) Special Analysed at Manchester Royal AML MRD (not APML) OR 2-3 weeks N/A Haematology Infirmary 2 x 2.7ml EDTA BONE MARROW
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range "Sick or premature infant: <150 umol/L Neonate ( up to 28 days ): <100 umol/L Infant to 16 yrs : <50 Routine umol/L To be transported on ice and 1 x 4.9ml Heparin Ammonia Biochemistry 1 hour Adult : <50 umol/L received by laboratory within 30 (1.2ml Paediatric) (LRI ONLY) minutes of collection Telephone Limits: ≤28 days: ≥ 100umol/L >28 days: ≥ 50umol/L" Sick/premature Not available to Primary Care Routine infant: 1 x 1.2ml Heparin Transport on ice to laboratory Ammonia (Paediatric) Biochemistry 1 hour 0-107 mmol/L (Paediatric) Must be received by laboratory (LRI ONLY) 0-28 days: within 30 minutes of collection 0-75 mmol/L
1 x 4.9ml serum gel A&E/Priority – 1 30 - 110 iu/L Routine (1 x 1.1ml serum hour 120 - 1120 iu/24hr Amylase Biochemistry gel for paediatrics) Inpatients – 3 (LRI/LGH/GH) OR hours Telephone Limits: 24 hour urine Outpatient/routine >500iu/L GP – 24 hours 0-6IU/mL
1 x 4.9ml serum gel Ordered within laboratory following Telephone Limits: ANCA – MPO (Myeloperoxidase) antibodies Immunology (1 x 1.1ml serum 3 days positive ANCA result or can be New positive results gel for paediatrics) requested separately will be telephoned to requestor
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-5IU/mL
1 x 4.9ml serum gel Ordered within laboratory following Telephone Limits: ANCA - PR3 (Proteinase 3) antibodies Immunology (1 x 1.1ml serum 3 days positive ANCA result or can be New positive results gel for paediatrics) requested separately will be telephoned to requestor 1 x 4.9ml serum gel Male: 2.1 - 10.8 Special Androstenedione (1 x 1.1ml serum 10 working days nmol/L Female: 1.0- Biochemistry gel for paediatrics) 11.5 nmol/L 1 x 4.9ml serum gel Angiotensin Converting Enzyme Special (1 x 1.1ml serum 5 working days 8-52 iu/L (ACE) Biochemistry gel for paediatrics) Blood Antenatal testing Transfusion 1 x 7.5ml EDTA 7 working days N/A (LRI/LGH/GGH) Samples must be hand delivered to Assay for Heparins/direct Xa inhibitors laboratory within 2 hours of Rivaroxaban See UHL Guidelines phlebotomy, and before 16:30 Special Same day Apixaban 2 x 4.3ml citrate for Heparin and Oral NO AIRTUBE SYSTEM. Haematology (2hrs on request) Edoxaban Anticoagulant dosing Special Haematology to be notified Fondaparinux of wards sending samples for these assays Blood Antibody investigations Transfusion 2 x 7.5ml EDTA 7 days N/A (LRI/LGH/GGH) 1 x 4.9ml serum gel Analysed at the Institute of Anti-ganglioside (GD1a) antibodies Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences, Southern gel for paediatrics) General Hospital Glasgow. 1 x 4.9ml serum gel Analysed at the Institute of Anti-ganglioside (GD1b) antibodies Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern gel for paediatrics) General Hospital Glasgow.
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 4.9ml serum gel Analysed at the Institute of Anti-ganglioside (GQ1b) antibodies Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern gel for paediatrics) General Hospital Glasgow. 1 x 4.9ml serum gel Analysed at the Institute of Anti-ganglioside (GT1b) antibodies Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern gel for paediatrics) General Hospital Glasgow. 1 x 4.9ml serum gel Analysed at the Institute of Anti-gangliosidemonosialicacid (GM1 and Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern GM2) antibodies gel for paediatrics) General Hospital Glasgow. 1 x 4.9ml serum gel Analysed at the Institute of Anti-gangliosidemonosialicacid (GM3) Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern antibodies gel for paediatrics) General Hospital Glasgow. Analysed at NHSBT and UHL Blood Discuss with Transplant Laboratory Anti-HLA antibody investigations Transfusion 7 days N/A laboratory NHSBT form required – see link in (LRI/LGH/GGH) Appendix 3 Screen against specified anti- Random Urine in Special hypertension drugs Anti-hypertension drug screen Sterile universal or 2 weeks N/A Biochemistry Specific forms required – obtained fluoride bottle through laboratory Analysed at NHSBT, Barnsley Anti-IgA Antibody Immunology 2 x 6ml EDTA 21 days N/A If detected a National Blood Service care is issued 1 x 4.9ml serum gel Analysed at the Institute of Anti-myelin-associated glycoprotein (MAG) Immunology (1 x 1.1ml serum 14 days N/A Neurological Sciences Southern antibodies gel for paediatrics) General Hospital Glasgow. 1 x 4.9ml serum gel Anti-neutrophil cytoplasmic antibodies Immunology (1 x 1.1ml serum 3 days N/A (ANCA) gel for paediatrics) 1 x 4.9ml serum gel Anti-nuclear antibodies Immunology (1 x 1.1ml serum 3 days N/A (ANA) gel for paediatrics)
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Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to laboratory within 2 hours of Special Antithrombin 2 x 4.3ml citrate 2 weeks 90 - 120% phlebotomy, and before 16:30 Haematology NO AIRTUBE SYSTEM Part of Thrombophilia Screen Special Analysed at QMC Hospital, Antithrombin gene mutation 2 x 2.7ml EDTA 6 weeks N/A Haematology Nottingham 8 x 2.7ml EDTA (blood) Special Analysed at Guy’s Hospital, London APML MRD OR 2 weeks N/A Haematology Do not send samples on Friday 2 x 2.7ml EDTA BONE MARROW 1 x 4.9ml serum gel Female: (1 x 1.1ml serum 121 yrs: 0.96-2.04 Special gel for paediatrics) g/L Apolipoprotein A1 5 working days Not available to Primary Care Biochemistry OR Male: 1 x 4.9ml Heparin 121 yrs: 0.79-1.91 (1.2ml Paediatric) g/L 1 x 4.9ml serum gel Special Apolipoprotein B (1 x 1.1ml serum 5 working days 0.47-1.61 g/L Not available to Primary Care Biochemistry gel for paediatrics) Samples must be hand delivered to Special Same day (2hrs laboratory within 2 hours of Argatroban 2 x 4.3ml citrate No reference range Haematology on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM. A&E/Priority – 1 hour Routine 1 x 4.9ml serum gel Aspartate Transaminase Inpatients – 3 Biochemistry (1 x 1.1ml serum 2-53iu/L (AST) hours (LRI/LGH/GH) gel for paediatrics) Outpatient/routine GP – 24 hours
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 64 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 4.9ml serum gel Aspergillus fumigatus IgG precipitins Immunology (1 x 1.1ml serum 4 days 0-40mg/L gel for paediatrics) 1 x 4.9ml serum gel Autoantibody screen - smooth muscle Immunology (1 x 1.1ml serum 3 days N/A antibodies gel for paediatrics) 1 x 4.9ml serum gel Autoantibody screen – liver kidney Immunology (1 x 1.1ml serum 3 days N/A microsomal (LKM) antibodies gel for paediatrics) 1 x 4.9ml serum gel Autoantibody screen – mitochondrial Immunology (1 x 1.1ml serum 3 days N/A antibodies gel for paediatrics) 14 working days Contact Filton NHSBT to discuss Blood 21 working days if crossmatch requirements 2 x 4.9ml Serum Autoimmune Neutropaenia Screen Transfusion further N/A Sample sent to Barnsley NHSBT Gel (LRI/LGH/GGH) investigations NHSBT form required – see link in required Appendix 3 Contact laboratory before collecting 3 x 2.7ml EDTA Blood samples Autoimmune Thrombocytopaenia AND Transfusion 7 days N/A Sample sent to Barnsley NHSBT (AITP) 2 x 4.9ml Serum (LRI/LGH/GGH) NHSBT form required – see link in Gel Appendix 3 1 x 4.9ml serum gel Pigeon <38mg/mL Avian IgG precipitins Immunology (1 x 1.1ml serum 4 days Budgie <8mg/mL gel for paediatrics) Parrot 0-13.6mg/mL B 1 x 4.9ml serum gel β2 glycoprotein (β 2GPI) IgG and IgM Immunology (1 x 1.1ml serum 14 days 0-19.9CU antibodies gel for paediatrics) 2 x 4.9ml serum gel Analysed at the Institute of paroxy Immunology (1 x 1.1ml serum 14 days N/A Neurology and Neurosurgery, gel for paediatrics) Queen’s Square, London.
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 65 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour Inpatients – 3 Routine 1 x 2.7ml EDTA hours Adult: Basophils Haematology (1 x 1.2ml 9 Part of Full Blood Count Urgent Primary 0.02 – 0.10 x 10 /L (LRI/LGH/GH) Paediatrics) care – 8 hours Outpatient/routine GP – 24 hours BCR ABL samples must be delivered to the Special 2 x 2.7ml EDTA Haematology Laboratory urgently Special BCR-ABL (Diagnostic) (Blood or bone 10 working days N/A and by no later than 4pm. Haematology marrow) Samples NOT to be sent on Fridays Analysed at HODS, Addenbrookes Hospital, Cambridge 'BCR ABL samples must be delivered to the Special 6 x 2.7ml EDTA Haematology Laboratory urgently (blood) Special and by no later than 4pm. BCR-ABL (Quantitative) OR 10 working days N/A Haematology A Samples NOT to be sent on 2 x 2.7ml EDTA Fridays BONE MARROW Analysed at HODS, Addenbrookes Hospital, Cambridge Special Sample analysed at King’s College BCR-ABL Kinase Domain Mutation Analysis 7 x 2.7ml EDTA 21 days N/A Haematology Hospital, London 1 x 4.9ml serum gel Special Beta-2 Microglobulin (1 x 1.1ml serum 10 working days 1.0-2.4mg/L Biochemistry gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 66 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 Up to 16yrs: hour 19-28mmol/L Routine 1 x 4.9ml serum gel Inpatients – 3 Adult: Bicarbonate Biochemistry (1 x 1.1ml serum hours 22-29mmol/L Not available to Primary Care (LRI/LGH/GH) gel for paediatrics) Outpatient/routine GP – 24 hours Telephone Limit: < 10mmol/L 0-10umol/L
1 x 4.9ml serum gel Special Telephone limits: Bile Acids (1 x 1.1ml serum 3 working days Biochemistry Results above gel for paediatrics) reference range in pregnant patients 1 x 4.9ml serum gel A&E/Priority – 1 0-5umol/L (1 x 1.1ml serum hour
Routine gel for paediatrics) Inpatients – 3 Telephone Limits: Bilirubin (conjugated) Biochemistry OR hours ≤28 days old: (LRI/LGH/GH) Random Urine in Outpatient/routine >25umol/L Sterile universal or GP – 24 hours
fluoride bottle A&E/Priority – 1 hour 0-21umol/L Routine 1 x 4.9ml serum gel Inpatients – 3
Bilirubin (total) Biochemistry (1 x 1.1ml serum hours Telephone Limit: (LRI/LGH/GH) gel for paediatrics) Outpatient/routine >300umol/L GP – 24 hours
Not available to Primary Care Special 1 x 1.2ml Heparin Biotinidase (Paediatric) 4-6 weeks 1.9 – 7.1 iu/L Analysed at Nottingham University Biochemistry (Paediatric) Hospitals Routine 1 x 2.7ml EDTA Blood Film Haematology (1 x 1.2ml 3 working days N/A May require clinical comment (LRI/LGH/GH) Paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 67 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Urgent Acute Leukaemia 4 1 x 2.7ml EDTA hours Bone marrow aspirate immunophenotyping Immunology N/A BONE MARROW Myeloma 24 hours All others 3 days Special BMA slides x 8 Samples should arrive in laboratory Haematology Trephine >16mm, before 4pm Bone Marrow Morphology (trephine 10 working days N/A 10% formalin (as Current FBC results must be processed by required) provided on request form histology)
Preferred sample type: 1 x 4.9ml <400 ng/L - Heart serum gel (1 x failure unlikely A&E/Inpatients – 1.1ml serum gel for 400-2000 ng/L - Routine 3 hours paediatrics) Heart failure not NT Pro BNP Biochemistry Outpatient/routine excluded (LRI ONLY) GP – 24 hours Also acceptable: 1 >2000 ng/L - Heart
x 2.7ml grey-top failure likely EDTA (1 x 1.2ml Paediatrics) C A&E/Priority – 1 hour 0-10mg/L Routine 1 x 4.9ml serum gel C Reactive Protein Inpatients – 3 Biochemistry (1 x 1.1ml serum Do not repeat within 48hrs (CRP) hours Telephone Limit: (LRI/LGH/GH) gel for paediatrics) Outpatient/routine >250mg/L GP – 24 hours 1 x 4.9ml serum gel Sample should reach laboratory C1 esterase inhibitor Immunology (1 x 1.1ml serum 7 days 0.21-0.38g/L within 6 hours gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 68 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Sample should reach laboratory 1 x 4.9ml serum gel within 24 hours C1q antibodies Immunology (1 x 1.1ml serum 25 days 0-15 U/mL Analysed at Sheffield Teaching gel for paediatrics) Hospitals NHS Foundation Trust. Sample should reach laboratory 1 x 4.9ml serum gel within 24 hours C1q level Immunology (1 x 1.1ml serum 14 days 50-250 mg/L Analysed at Sheffield Teaching gel for paediatrics) Hospitals NHS Foundation Trust Sample should reach laboratory 1 x 4.9ml serum gel within 6 hours C3 nephritic factor Immunology (1 x 1.1ml serum 5 days N/A Analysed at Sheffield Teaching gel for paediatrics) Hospitals NHS Foundation Trust. 1 x 4.9ml serum gel Special Caeruloplasmin (1 x 1.1ml serum 5 working days Adult: 0.18 – 0.45g/L Biochemistry gel for paediatrics) Non-toxic: 1 x 4.9ml serum gel Special 10-20mg/L Not routinely available – contact Caffeine (monitoring) (1 x 1.1ml serum 15 working days Biochemistry Potentially toxic: laboratory (x6555) to discuss gel for paediatrics) >20mg/L Special Calcitonin Various 4-6 weeks Fasting <0.08µg/L Analysed at Charing Cross Hospital Biochemistry A&E/Priority – 1 2.12 – 2.51mmol/L hour Routine 1 x 4.9ml serum gel Inpatients – 3 Calcium (adjusted) Biochemistry (1 x 1.1ml serum Telephone Limits: Avoid venous stasis hours (LRI/LGH/GH) gel for paediatrics) <1.8mmol/L Outpatient/routine >3.2mmol/L GP – 24 hours A&E/Priority – 1 hour Routine Random Urine in Calcium to Inpatients – 3 Children only: Urine acidifed on Calcium (random) Biochemistry Sterile universal or createnine ratio: hours receipt in laboratory (LRI/LGH/GH) fluoride bottle <0.59 Outpatient/routine GP – 24 hours
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 69 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 2.12 – 2.51mmol/L hour Routine 1 x 4.9ml serum gel Inpatients – 3 Calcium (Total) Biochemistry (1 x 1.1ml serum Telephone Limits: Avoid venous stasis hours (LRI/LGH/GH) gel for paediatrics) <1.8mmol/L Outpatient/routine >3.2mmol/L GP – 24 hours A&E/Priority – 1 hour Routine 24 hour urine Inpatients – 3 Calcium (urine) Biochemistry 2.5-7.5mmol/24hours acidifed (2M HCl) hours (LRI/LGH/GH) Outpatient/routine GP – 24 hours Stone or stone fragments in 20ml Special Universal, 60ml pot Calculus 4 weeks N/A Interpretation provided Biochemistry or any suitable plastic container. No preservative. Special Analysed at Addenbrooke’s CAL-Reticulin (Exon 9) 2 x 2.7ml EDTA 15 working says N/A Haematology Hospital, Cambridge A&E/Priority – 1 Non-toxic: 4-12mg/L hour Potentially toxic: Routine 1 x 4.9ml serum gel Inpatients – 3 >15mg/L Carbamazepine (monitoring) Biochemistry (1 x 1.1ml serum hours
(LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limit: GP – 24 hours >25mg/L
A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Carbohydrate antigen CA12.5 Biochemistry (1 x 1.1ml serum Outpatient/routine 0-35Ku/L (LRI ONLY) gel for paediatrics) GP – 24 hours
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 70 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Carbohydrate antigen CA15.3 Biochemistry (1 x 1.1ml serum Outpatient/routine 0-35Ku/L
(LRI ONLY) gel for paediatrics) GP – 24 hours
A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Carbohydrate antigen CA19.9 Biochemistry (1 x 1.1ml serum Outpatient/routine 0-37Ku/L (LRI ONLY) gel for paediatrics) GP – 24 hours
A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Carcinoembryonic antigen Biochemistry (1 x 1.1ml serum Outpatient/routine 0-5ug/L (CEA) (LRI ONLY) gel for paediatrics) GP – 24 hours
Available to Community Special 1 x 1.2ml Heparin Free Carnitine: Paediatricians Caritine Acyl and Free (Paediatric) 4-6 weeks Biochemistry (Paediatric) 15-53 mmol/L Analysed at Sheffield Children’s Hospital. 24 hour urine Paediatric urine must reach acidified (H SO ) or laboratory within 1 hour of Special 2 4 Adult:<3µmol/24 Catecholamines - Dopamine random urine 15 working days collection. Biochemistry hours acidified for Children’s values reported as children creatinine ratio 24 hour urine acidified (H SO ) or Paediatric urine must reach Catecholamines - Homovanillic acid Special 2 4 Adult:<40µmol/24 random urine 15 working days laboratory within 1 hour of (HVA) Biochemistry hours acidified for collection. children 24 hour urine Paediatric urine must reach acidified (H SO ) or laboratory within 1 hour of Special 2 4 Adult:<200nmol/24 Catecholamines - Adrenaline random urine 15 working days collection. Biochemistry hours acidified for Children’s values reported as children creatinine ratio
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 71 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 24 hour urine Paediatric urine must reach acidified (H SO ) or laboratory within 1 hour of Special 2 4 Adult:<700nmol/24 Catecholamines - Noradrenaline random urine 15 working days collection. Biochemistry hours acidified for Children’s values reported as children creatinine ratio 24 hour urine Paediatric urine must reach acidified (H SO ) or laboratory within 1 hour of Special 2 4 Adult:<40µmol/24 Catecholamines - VMA random urine 15 working days collection. Biochemistry hours acidified for Children’s values reported as children creatinine ratio As provided by Stem Cell Laboratory 1 hour for blood according to samples CD34+ stem cell enumeration Immunology procedure (buffy N/A 2 hour for buffy coat, bone marrow, coat samples peripheral blood, or positive selection sample) Sample should reach laboratory 1 x 2.7ml EDTA 9 0.49-1.67x10 /L within 48 hours CD4 count monitoring in HIV infection Immunology (1 x 1.2ml 2 days (adults) Please ensure sample reaches Paediatrics) laboratory before 16:30 on Fridays 1 x 4.9ml serum gel Centromere antibodies Immunology (1 x 1.1ml serum 3 days N/A (IFA) gel for paediatrics) Cerebrospinal Fluid (CSF)/ other fluid >0.5ml in transfix Immunology 24 hours N/A immunophenotyping bottle
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 72 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 1 x 4.9ml serum gel hour (1 x 1.1ml serum Routine Inpatients – 3 gel for paediatrics) 95-108mm/L Chloride Biochemistry hours Not available to Primary Care OR 150-250mmol/24hr (LRI/LGH/GH) Outpatient/routine 24 hour urine (No GP – 24 hours preservative)
<6 months old: 0-30 mmol/L CF unlikely 30-60 mmol/L equivocal Chloride Assay – See Sweat Test Special >60 mmol/L CF likely Sweat collection 7 days Not available to Primary Care (Paediatric) Biochemistry >6 months old: 0-40 mmol/L CF unlikely 40-60 mmol/L equivocal >60 mmol/L CF likely A&E/Priority – 1 hour 1 x 4.9ml serum gel Inpatients – 3 For adults, see latest Routine Required for primary CVD Cholesterol (HDL) (1 x 1.1ml serum hours guidelines, range Biochemistry calculation gel for paediatrics) Outpatient/routine depends on CVD risk GP – 24 hours
A&E/Priority – 1 hour Routine 1 x 4.9ml serum gel Inpatients – 3 For adults, see latest Required for primary CVD Cholesterol (total) Biochemistry (1 x 1.1ml serum hours guidelines, range calculation (LRI/LGH/GH) gel for paediatrics) Outpatient/routine depends on CVD risk GP – 24 hours
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 73 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour 1 x 4.9ml serum gel Inpatients – 3 For adults, see latest Routine Required for primary CVD Cholesterol (Total/HDL Ratio) (1 x 1.1ml serum hours guidelines, range Biochemistry calculation gel for paediatrics) Outpatient/routine depends on CVD risk GP – 24 hours
Analysed at Bristol Southmead 1 x 4.9ml serum gel Special Hospital Cholinesterase (1 x 1.1ml serum 4-6 weeks >5300iu/L Biochemistry Report will give phenotype gel for paediatrics) Call x6553 for advice Samples must be hand delivered to Special laboratory within 2 hours of Chromogenic VIII assay 1 x 4.3ml citrate 2 weeks 60.2 - 182.7 IU/dL Haematology phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Trough level preferable. 1 x 4.9ml serum gel Analysed at TDM Unit, Epilepsy Special Clobazam (1 x 1.1ml serum 10 working days 30-300ug/L Centre, Chalfont St Peter. Biochemistry gel for paediatrics) Clobazam metabolite (norclobazam) also analysed.
1 x 4.9ml serum gel Trough level preferable. Special Clonazepam (1 x 1.1ml serum 10 working days 20-70ug/L Analysed at TDM Unit, Epilepsy Biochemistry gel for paediatrics) Centre, Chalfont St Peter.
2 x 2.7ml EDTA (blood) Special OR Analysed at Salisbury District C-KIT D816V 2 months N/A Haematology 1 x 2.7ml EDTA Hospital BONE MARROW(1 x 1.2ml Paediatrics) 1 x 4.9ml serum gel Classical pathway complement activity Immunology (1 x 1.1ml serum 21 days 392-1019 UI/mL (CH100) gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 74 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 3 x 2.7ml EDTA (blood) o Special CLL MRD OR 10 working days N/A Analysed at HMDS, Leeds Haematology 2 x 2.7ml EDTA BONE MARROW Blood Samples must be transported to Cold agglutinins Transfusion 2 x 7.5ml EDTA 7 days N/A laboratory at 37°C (LRI/LGH/GGH) Samples must be hand delivered to laboratory within 2 hours of Special Collagen Binding Assay 2 x 4.3ml citrate 4 weeks 50 - 200% phlebotomy, and before 16:30 Haematology NO AIRTUBE SYSTEM Part of von Willebrand Screen 1 x 4.9ml serum gel C3: 0.75-1.65 g/L Samples must arrive in laboratory Complement C3 and C4 Immunology (1 x 1.1ml serum 2 days C4: 0.14-0.54 g/L within 4 hours of collection gel for paediatrics) 1 x 4.9ml serum gel (1 x 1.1ml serum 5 working days Special gel for paediatrics) (serum) 13-24umol/L Analysed at Nottingham University Copper Biochemistry OR 10 working days 0.2-0.8umol/24hrs Hospitals 24 hour urine (No (urine) preservative) A&E/Priority – 1 hour 9.00am: 1 x 10ml serum (no Routine Inpatients – 3 145 - 619 nmol/L Always state time of sample; should gel separator) Cortisol Biochemistry hours be 9.00 am. State current (1 x 1.2ml (LRI ONLY) Outpatient/routine Telephone Limits: medications Paediatric) GP – 24 hours <100nmol/L
24 hour urine (5ml Special Analysed at South Manchester Cortisol (urine free) 1% boric acid or 20 working days 28-221nmol/24hrs Biochemistry Hospital plain bottle)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 75 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Not available to Primary Care Sample to be received by laboratory within 120 mins of 1 x 4.9ml Heparin Special collection C-peptide (1 x 1.2ml 10 working days 298-2350 pmol/L Biochemistry Prevailing blood glucose Paediatric) <2.5mmol/L required Interpret results as appropriate to prevailing glucose level < 28 days: 75-700 A&E/Priority – 1 iu/L hour 28 days - 1 year: Routine 1 x 4.9ml serum gel Inpatients – 3 Creatine Kinase 100-350 iu/L Biochemistry (1 x 1.1ml serum hours (CK) > 1 year: 25-200 iu/L (LRI/LGH/GH) gel for paediatrics) Outpatient/routine
GP – 24 hours Telephone Limit:
>5000iu/L Adults (≥ 16 years): 60-120 µmol/L Gender specific A&E/Priority – 1 1 x 4.9ml serum gel paediatric ranges The Jaffe method is used for the hour (1 x 1.1ml serum available on request majority of patients. Enzymatic Routine Inpatients – 3 gel for paediatrics) analysis is used in patients ≤ 16 Creatinine Biochemistry hours OR Telephone limits: years of age and where the (LRI/LGH/GH) Outpatient/routine 24 hour urine (No >16 yrs: >354 umol/L laboratory identifies potential GP – 24 hours preservative) 12-16 yrs: interference from bilirunhsbtbin.
>200umol/L <12 yrs: 3 x upper limit of normal
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 76 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 1 x 4.9ml serum gel hour Adult males: Routine (1 x 1.1ml serum Inpatients – 3 90-130mL/min Send simultaneous urine and Creatinine Clearance Biochemistry gel for paediatrics) hours Adult females: serum samples (LRI/LGH/GH) AND Outpatient/routine 80-120mL/min 24 hour urine GP – 24 hours
24 hours (patients without red cell antibodies) 5 hours (urgent samples – MUST Blood be agreed with See appendix 4 for valid group and Cross Match (without valid group & screen) Transfusion 1 x 7.5ml EDTA N/A laboratory and screen sample criteria (LRI/LGH/GGH) identified on request form) Presence of antibodies will prolong process. Maximum 3 hours See appendix 4 for valid group and (Urgent screen sample criteria perioperative Blood Cross match technique will be samples turned Cross Matching (with valid group & screen) Transfusion 1 x 7.5ml EDTA N/A dependent on clinical scenario, around within 10 (LRI/LGH/GGH) patient transfusion history etc. If minutes when further information required, contact arranged directly laboratory with laboratory) 2 x 2.7ml EDTA (2 x 1.2ml Contact laboratory before taking Paediatrics) blood to arrange collection and Cryofibrinogen Immunology AND 9 days N/A transport. Samples to be 2 x 4.9ml serum gel transported at 37°C. (2 x 1.1ml serum gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 77 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 2 x 2.7ml EDTA (2 x 1.2ml Contact laboratory before taking Paediatrics) blood to arrange collection and Cryoglobulins Immunology AND 9 days N/A transport. Samples to be 2 x 4.9ml serum gel transported at 37°C. (2 x 1.1ml serum gel for paediatrics) Not available to Primary Care Fasting sample received by laboratory within 3 hours of 1 x 2.7ml EDTA <0.5 mg/L males and Special collection (within 8 hours CTX beta crosslaps (1 x 1.2ml 4-6 weeks pre-menopausal Biochemistry acceptable from GPs but must be Paediatrics) females placed in red transport bags) Analysed at Nottingham University Hospitals 2 x 2.7ml Fluoride Usual/non-toxic: Not available to Primary Care Special EDTA <10µg/100mL Transport to laboratory immediately Cyanide 4-6 weeks Biochemistry (5 x 1.2ml Toxic: Analysed at University Hospitals of Paediatric) Over 100µg/100mL Wales 1 x 4.9ml serum gel 0-6 U/ml negative Cyclic citrullinated peptide (CCP) antibody Immunology (1 x 1.1ml serum 3 days 7-10 U/mlLequivocal gel for paediatrics) >10 U/mL positive Not available to Primary Care Special Contact pharmacy for interpretation Cyclosporin (monitoring) 1 x 4.9 mL EDTA 24 hours N/A Biochemistry Analysed at Nottingham University Hospitals D
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 78 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 Adult: hour 1 x 4.3ml Citrate 0.00-0.50 ug/mL Inpatients – 3 Routine 1 x 1.8ml (A&E FEU hours Can be added on to samples up to D-Dimers Haematology ONLY) Urgent Primary 24 hours old (LRI/LGH/GH) (1 x 1.4ml Telephone Limits: care – 8 hours Paediatrics) Raised d-dimers only Outpatient/routine if new sepsis or DIC GP – 24 hours Samples must be hand delivered to Special Same day (2hrs laboratory within 2 hours of Dabigatran 2 x 4.3ml citrate No reference range Haematology on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM. No therapeutic range established for desethylamiodarone although most 1 x 4.9ml serum gel Special individuals will have Desethylamiodarone (monitoring) (1 x 1.1ml serum 10 working days Biochemistry roughly equivalent gel for paediatrics) concentrations of desethylamiodarone to amiodarone at a steady state. Male: 1 x 4.9ml serum gel Special 2.2-15.7µmol/L DHEA-S (1 x 1.1ml serum 10 working days Biochemistry Female: gel for paediatrics) 0.9-12.0µmol/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 79 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Take sample at least 6 hours post Non-toxic: 0.5- dose A&E/Priority – 1 1.0µg/L *Increased risk of toxicity (even if hour Potentially toxic: result within therapeutic range) if 2 Routine 1 x 4.9ml serum gel Inpatients – 3 >2.0 µg/L or more of following: Digoxin (monitoring) Biochemistry (1 x 1.1ml serum hours Age >40yrs (LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limit: Potassium <3.5mmol/L GP – 24 hours >2.5ug/L (confirm Potassium <3.5mmol/L sample taken 6 Adj.Ca >2.8mmol/L hours post dose) Creat >150umol/L 24hrs (urgent Blood Direct Antiglobulin Test 1 x EDTA (any requests to be Transfusion N/A (DAT) size) processed (LRI/LGH/GGH) quicker) 1 x 4.9ml serum gel 0-27 IU/mL (normal) Double stranded DNA antibodies Immunology (1 x 1.1ml serum 3 days 27-35IU/ml
gel for paediatrics) (indeterminate) 1 x 4.9ml serum gel Double stranded DNA antibodies (Crithidia) Immunology (1 x 1.1ml serum 14 days N/A
gel for paediatrics) Always state gestation on request Routine 1 x 4.9ml serum gel form Down’s Screen Biochemistry (1 x 1.1ml serum 2-3 weeks N/A Risk factor issued with report (LRI ONLY) gel for paediatrics) Analysed at Kettering General Hospital Special Analysed at St Thomas’ Hospital, DPD Screening (for 5FU toxicity) 2 x 2.7ml EDTA 3 working days N/A Biochemistry London Contact laboratory before collecting 2 x 4.9ml Serum Blood samples Gel Drug Induced Thrombocytopaenia Transfusion 20 working days N/A Sample sent to Barnsley NHSBT AND (LRI/LGH/GGH) NHSBT form required – see link in Sample of drug(s) Appendix 3
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 80 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Contact blood transfusion 14 working days 2 x 4.9ml Serum laboratory before collecting Blood 21 working days if Gel samples Drug Related Neutropaenia Transfusion further N/A AND Sample sent to Barnsley NHSBT (LRI/LGH/GGH) investigations Sample of drug(s) NHSBT form required – see link in required Appendix 3 Random Urine in Special Cut-offs available on Drugs of Abuse Screen Sterile universal or 5 working days Biochemistry request fluoride bottle Analysed at Blizard Institute, Special University of London Dyskeratosis Congenita (DKA) mutation 5 x 2.7ml EDTA 6 months N/A Haematology Additional request form needed, contact : [email protected] E >10 yrs: 2 x 4ml lithium heparin Samples must be analysed within 2-9yrs: 1 x 4ml Negative: < 5 spots 6 hours of collection and be ELISPOT T-test Immunology lithium heparin 48 hours Equivocal: 5-8 spots received by the laboratory before <2 years: 1 x 2ml Positive: > 8 spots 2pm. lithium heparin All requests must be discussed with (paediatric) the laboratory Analysed at Birmingham Children’s 1 x 2.7ml EDTA 1-24 days Special Hospital EMA Binding (red cell membrane defects) (1 x 1.2ml dependent on N/A Haematology Contact laboratory prior to Paediatrics) complexity collection of samples
Special Requests only accepted from Emicizumab 1 x 4.3ml Citrate 2 weeks N/A Haematology Haematology Clinicians
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 81 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
1 x 4.9ml serum gel Ordered within laboratory following Endomysial antibodies Immunology (1 x 1.1ml serum 7 days N/A positive IgA tTG antibodies gel for paediatrics)
A&E/Priority – 1 hour Inpatients – 3 0-2years: Routine 1 x 2.7ml EDTA 9 hours 0.00-0.50 x 10 /L Eosinophil count Haematology (1 x 1.2ml Part of Full Blood Count Urgent Primary >2 years: (LRI/LGH/GH) Paediatrics) 9 care – 8 hours 0.04-0.40 x 10 /L Outpatient/routine GP – 24 hours Legal driving Limit: 80mg/100mL A&E/Priority – 1 Confusion: hour 200-300mg/100mL Routine 1 x 4.9ml serum gel Inpatients – 3 Stupor: Can be added onto samples up to Ethanol Biochemistry (1 x 1.1ml serum hours 300-400mg/100mL 4 hours old (LRI ONLY) gel for paediatrics)) Outpatient/routine Possible coma: GP – 24 hours 400>mg/100mL
Telephone Limit: >400mg/dl Non-toxic: 40- 1 x 4.9ml serum gel Special 120mg/L Ethosuximide (monitoring) (1 x 1.1ml serum 15 working days Analysed at TDM Epilepsy Centre Biochemistry Potentially toxic: gel for paediatrics) >100 mg/L Severe toxicity: >50 1 x 2.7ml Fluoride mg/100mL Special EDTA Ethylene Glycol 5 working days Analysed at Heartlands Hospital Biochemistry (1 x 1.2ml Telephone Limits: Not available to Primary Care Paediatric) Phone ALL results
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 82 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – Centromere B (CENP) antigen gel for paediatrics) 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – Jo-1 antigen gel for paediatrics) 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – La (SS-B) antigen gel for paediatrics) Extractable nuclear antigen (ENA) 1 x 4.9ml serum gel antibodies – RNP (U1 RNP and RNP70) Immunology (1 x 1.1ml serum 3 days N/A antigens gel for paediatrics) 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – Ro (SS-A) antigen gel for paediatrics) 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – Scl-70 antigen gel for paediatrics) 1 x 4.9ml serum gel Extractable nuclear antigen (ENA) Immunology (1 x 1.1ml serum 3 days N/A antibodies – Smith (Sm) antigen gel for paediatrics) 1 x 4.9ml serum gel Erythropoietin assay Special OR Analysed at Nottingham City 10 working days N/A (EPO) Haematology 1 x 4.9ml Lithium Hospital Heparin F Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor II 1 x 4.3ml citrate 78.7 – 115.5% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 83 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor IX 1 x 4.3ml citrate 72 - 154% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Samples must be hand delivered to laboratory within 2 hours of Special Same day Batch specific- refer Factor Sensitive APTT 1 x 4.3ml citrate phlebotomy, and before 16:30 Haematology (1hr on request) to report NO AIRTUBE SYSTEM Part of Special Clotting Screen Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor V 1 x 4.3ml citrate 53.8 – 127.7% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM 2 x 2.7ml EDTA Special Factor V Leiden OR 14 working days N/A Analysed at QMC, Nottingham Haematology 1 x 4.3ml Citrate Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor VII 1 x 4.3ml citrate 47.4 – 143.4% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Factor VII genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor VIII 1 x 4.3ml citrate 59.6 – 177.6% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 84 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Analysed at Royal Hallamshire Special Hospital, Sheffield Factor VIII binding 2 x 4.3ml Citrate 6 weeks N/A Haematology Include FVIII, vWFAg and vWF results if possible Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor X 1 x 4.3ml citrate 73.1- 132.7% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Factor X genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor XI 1 x 4.3ml citrate 74- 152% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Factor XI genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form Samples must be hand delivered to Special Same day laboratory within 2 hours of Factor XII 1 x 4.3ml citrate 35 - 147% Haematology (1hr on request) phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Special Please Discuss with Laboratory Factor XIII screen 1 x 4.3ml citrate 2 weeks N/A Haematology Assay sent to referral lab
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 85 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
Sample must arrive in laboratory 1 x 4.9ml serum gel within 4 hours of collection Factor H Immunology (1 x 1.1ml serum 21 days 0.35-0.59g/L Analysed at Royal Victoria gel for paediatrics) Infirmary, Newcastle upon Tyne
Sample must arrive in laboratory 1 x 4.9ml serum gel within 4 hours of collection Factor I Immunology (1 x 1.1ml serum 21 days 21-40mg/L Analysed at Royal Victoria gel for paediatrics) Infirmary, Newcastle upon Tyne
<80 ųg /g stool: GI inflammation unlikely. 80-160 ug/g stool: Inflammation cannot Special be excluded. Full interpretive comment provided Faecal Calprotectin 1 x Faecal sample 5 working days Biochemistry >160 ug/g stool: May with resultsbcx signal active inflammatory disease. Specialist investigations suggested
1 x 2.7ml EDTA Special 200 to >500 mg/g Faecal elastase (1 x 1.2ml 4-6 weeks Biochemistry stool Paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 86 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Protect sample from light Fresh faeces Only for known patients or Special Faeces (fresh Faecal porphyrins quantitation 5 weeks N/A abnormal screens Biochemistry random sample) Interpretation provided Analysed at University Hospitals of Wales Analysed at Guy’s Hospital London. Special 1 x 4.9ml Lithium Fanconi’s anaemia screen 10 working days N/A Requires genetics specimen form, Haematology Heparin MUST contain NHS number Farmers Lung (EEA) 1 x 4.9ml serum gel MICROPOLYSPORUM/THERMOACTINO Immunology (1 x 1.1ml serum 4 days <60mg/L MYCES gel for paediatrics) A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Male: 23-540µm/L Levels rise with inflammation, Ferritin Biochemistry (1 x 1.1ml serum Outpatient/routine Female: regardless of iron status (LRI/LGH/GH) gel for paediatrics) GP – 24 hours 10-420µg/L
Maternal: 1 x 7.5ml if any foetal cells are EDTA Blood seen in 25 low power Foetal maternal haemorrhage estimation Newborn: 1 x 7.5ml 72 hours from Maternal samples to be taken at Transfusion fields then a full (FMH) EDTA (cord) or 1 x time of event least 30 to 45 minutes post event (LRI/LGH/GGH) count will be 1.2ml EDTA (heel performed’ prick sample) Maternal: 3 x 2.7ml EDTA + 2 x 4.9ml Sample sent to Barnsley NHSBT Foetal/Neonatal Alloummune Blood Serum Gel NHSBT form required – see link in Thrombocytopaenia Transfusion Paternal: 3 x 2.7ml 7 days N/A Appendix 3 (NAIT) (LRI/LGH/GGH) EDTA Contact Filton lab to discuss Neonate: 1 x 1.2ml crossmatch requirements EDTA
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 87 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour 1 x 4.3ml Citrate Inpatients – 3 Newborn-1mnth: Routine 1 x 1.8ml (A&E hours 1.1-3.1g/L Can be added onto samples up to Fibrinogen Haematology ONLY) Urgent Primary Adult: 8 hours old (LRI/LGH/GH) (1 x 1.4ml care – 8 hours 2.0-4.0g/L Paediatrics) Outpatient/routine GP – 24 hours Samples must be hand delivered to laboratory within 2 hours of Special Same day Fibrinogen 1 x 4.3ml citrate 2.0 - 4.0g/L phlebotomy, and before 16:30 Haematology (1hr on request) NO AIRTUBE SYSTEM Part of Special Clotting Screen Analysed at QMC, Nottingham. Special Fibrinogen genetics Contact laboratory 6 weeks N/A Must be discussed with Haematology Haemostasis Consultant 5 x 2.7ml EDTA Analysed at Salisbury District Special OR FIPIL1-PDGFRa 2 months N/A Hospital Haematology 3 x 4.7ml Lithium Do NOT send samples on Friday Heparin Non-toxic: 1 x 4.9ml serum gel 200-800µg/L Special Flecainide (monitoring) (1 x 1.1ml serum 10 working days Biochemistry gel for paediatrics) Telephone Limit: >1000ug/L Fluid (pleural, ascitic etc.) fluid >1ml in sterile Immunology 24 hours N/A immunophenotyping universal container Special 0.5ml in sterile Samples should arrive in the Fluid morphology: CSF 5 days N/A Haematology universal container laboratory before 3:30pm Special ~5ml in sterile Fluid morphology: Pleural/ascitic fluid 5 days N/A Haematology universal container
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 88 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Folate Biochemistry (1 x 1.1ml serum Outpatient/routine 2.6-17.3µg/L (LRI ONLY) gel for paediatrics) GP – 24 hours
Male: 1-10iu/L Female: -Follicular phase: A&E/Inpatients – Routine 1.0-10iu/L 1 x 4.9ml serum gel 3 hours Follicle Stimulating Hormone Biochemistry -Mid cycle peak: (1 x 1.1ml serum Outpatient/routine State day of menstrual cycle (FSH) (LRI ONalkaline 2.0-20iu/L gel for paediatrics) GP – 24 hours LY) -Luteal phase:
1.0-8.0iu/L - Post Menopausal: 30-135iu/L 4 x 2.7ml EDTA (blood) Special Analysed at Nottingham City Follicular lymphoma t(14;18) confirmation OR 10 working days N/A Haematology Hospital 2 x 2.7ml EDTA BONE MARROW Random Urine in Sterile universal or A&E/Inpatients – Routine fluoride bottle 3 hours Fractional Excretion of Phosphate Biochemistry AND Outpatient/routine 0-20% Require urine AND serum samples (FREP) (LRI/LGH/GH) 1 x 4.9ml serum gel GP – 24 hours (1 x 1.1ml serum gel for paediatrics) Not available to Primary Care Special 1 x 1.2ml Fluoride Analysed at Sheffield Children’s Free Fatty Acids (Paediatric) 4-6 weeks 0.3-0.8 mmol/L Biochemistry EDTA (Paediatric) Hospital Hypoglycaemic sample required
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 89 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Inpatients – 3.5-6.5pmol/L Routine 1 x 4.9ml serum gel 3 hours
Free T3 Biochemistry (1 x 1.1ml serum Outpatient/routine Telephone Limit: (LRI ONLY) gel for paediatrics) GP – 24 hours >8pmol/L
A&E/Inpatients – 9-25pmol/L Routine 1 x 4.9ml serum gel 3 hours Free T4 Biochemistry (1 x 1.1ml serum Outpatient/routine (LRI ONLY) gel for paediatrics) GP – 24 hours Telephone Limit: >50pmol/L 1 x 4.9ml serum gel Special Fructosamine (1 x 1.1ml serum 15 working days 240-379 µmol/L Biochemistry gel for paediatrics) Consists of: White cell count Red cell count A&E/Priority – 1 Haemoglobin hour Haematocrit Inpatients – 3 1 x 2.7ml EDTA See reference Mean cell volume Routine hours Full Blood Count (FBC) (1 x 1.2ml ranges for individual Mean cell haemoglobin Haematology Urgent Primary Paediatrics) parameters Platelet count care – 8 hours Neutrophil count Outpatient/routine Lymphocyte count GP – 24 hours Monocyte count Eosinophil count Basophil count 1 x 4.9ml serum gel Sample should reach laboratory Functional C1 inhibitor Immunology (1 x 1.1ml serum 20 days 70-130% within 4 hours gel for paediatrics) Special Analysed at Royal Hallamshire FXIII assay 1 x 4.3ml citrate 3 weeks N/A Haematology Hospital, Sheffield G
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 90 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Therapeutic range: 1 x 4.9ml serum gel 2 – 20 mg/L. For therapeutic monitoring Special Minimum sample Gabapentin 10 working days (Baselt, Deposition of purposes, a trough (before dose) Biochemistry volume required: toxic drugs and sample should be taken. 100 µL chemicals in man) Not available to Primary Care Random Urine in Special Analysed at Bristol Southmead Galactitol (Paediatric) Sterile universal or 4-6 weeks N/A Biochemistry Hospital fluoride bottle Interpretation provided Special 1 x 1.2ml Heparin Not available to Primary Care Galactosaemia Screen (Paediatric) 5 working days N/A Biochemistry (Paediatric) Interpretation required A&E/Priority – 1 hour Routine 1 x 4.9ml serum gel Inpatients – 3 Adult male: 0-50iu/L Gamma GT Biochemistry (1 x 1.1ml serum hours Adult female: (LRI/LGH/GH) gel for paediatrics) Outpatient/routine 0-35iu/L GP – 24 hours
Part of gut hormone profile Sample to be received by 1 x 2.7ml EDTA laboratory within 15 minutes of Special Gastrin (1 x 1.2ml 4-6 weeks Up to 40pmol/L collection. Biochemistry Paediatrics) Stop H2 antagonists for 72 hours, Omeprazole for 2 weeks Analysed at Charing Cross Hospital Genetic testing for primary immune Various - contact deficiency: after discussion with Consultant Immunology Variable N/A laboratory Immunologist Various samples Any requests must be discussed Genetic Tests for Periodic Syndromes Immunology Variable N/A may be required with a consultant Immunologist
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 91 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour 1 x 4.9ml serum gel Inpatients – 3 Telephone Limit: Assay performed on behalf of Routine Gentamycin (monitoring) (1 x 1.1ml serum hours Pre-dose: >2mg/L Microbiology Biochemistry gel for paediatrics) Outpatient/routine Trough: >12mg/L Contact Microbiology for advice GP – 24 hours
Routine 1 x 2.7ml EDTA Glandular Fever Screen Haematology (1 x 1.2ml 48 hours N/A (GF) (LRI ONLY) Paediatrics) 1 x 4.9ml serum gel Glomerular basement membrane (GBM) Immunology (1 x 1.1ml serum 1 day 0-19.9CU antibodies gel for paediatrics) Special Various - contact Part of gut hormone profile Glucagon 4-6 weeks Up to 50pmol/L Biochemistry laboratory Analysed at Charing Cross Hospital A&E/Priority – 1 hour 1 x 2.7ml Fluoride Routine Inpatients – 3 EDTA 2/3 plasma glucose Glucose (CSF) Biochemistry hours Not available to Primary Care (1 x 1.2ml result (LRI ONLY) Outpatient/routine Paediatrics) GP – 24 hours
A&E/Priority – 1 Fasting: 3.3- hour 6.0mmol/L 1 x 2.7ml Fluoride Routine Inpatients – 3 EDTA Glucose (plasma) Biochemistry hours Telephone Limits: (1 x 1.2ml (LRI/LGH/GH) Outpatient/routine <2.5mmol/L Paediatrics) GP – 24 hours >25mmol/L >30 yrs: >10mmol/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 92 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Analysed at King’s College Hospital, London 1 x 2.7ml EDTA Special Send FBC and Reticulocyte results Glucose-6-Phosphate (G6PD) assay (1 x 1.2ml 15 working days N/A Haematology with sample Paediatrics) Inform laboratory when sending sample Request to be authorised by 1 x 2.7ml EDTA Special SpR/Clinical Scientist Glucose-6-Phosphate (G6PD) Screen (1 x 1.2ml 1 working day N/A Haematology Can be requested on sample up to Paediatrics) 5 days old if stored at 4°C 1 x 4.9ml serum gel Glutamic acid decarboxylase (GAD) Immunology (1 x 1.1ml serum 21 days 0 - 10 IU/mL antibodies gel for paediatrics) 5ml urine required Available to Community Random Urine in Special Paediatricians Glycosaminoglycans (Paediatric) Sterile universal or 4-6 weeks Biochemistry Analysed at Nottingham University fluoride bottle Hospitals Interpretation provided Blood Group (Neonatal <4 months) Transfusion 1 x 1.2ml EDTA 24hours N/A (LRI/LGH/GGH) 24hours (may be Blood 1 x 7.5ml EDTA extended if See appendix 4 for valid group and Group and screen (Adult) Transfusion “FOR BLOOD patient has N/A screen sample criteria (LRI/LGH/GGH) TRANSFUSION’’ anomalous red cell antibodies) 4hours (may be Blood 1 x 1.2ml EDTA extended if See appendix 4for valid group and Group and screen (Paediatric <10kg) Transfusion OR patient has N/A screen sample criteria (LRI/LGH/GGH) 1 x 4.9ml EDTA anomalous red cell antibodies)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 93 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range HGH release is pulsatile and very low random levels are not an indicator Routine 1 x 4.9ml serum gel of deficiency. Not available to Primary Care Growth Hormone Biochemistry (1 x 1.1ml serum 10 working days Interpretation provided (LRI ONLY) gel for paediatrics) Performed primarily as part of DFT’s which have respective specific reference ranges. Gastrin: 0-40pmol/L Glucagon: 0-50 pmol/L CART: 0-85 pmol/L Pancreatic Not available to Primary Care Gut Hormone Profile: polypeptide 1 x 2.7ml EDTA Sample to be received by Gastrin, glucagon, CART, pancreatic Special 0-300 pmol/L (1 x 1.2ml 4-6 weeks laboratory within 15 minutes of polypeptide, somatostatin, VIP, Biochemistry Somatostatin: Paediatrics) collection chromagranin A, chromogranin B 0-150 pmol/L Analysed at Charing Cross Hospital VIP: 0-30 pmol/L Chromogranin A: 0-60 pmol/L Chromogranin B: 0-150 pmol/L H
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 94 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour Inpatients – 3 Adult (Male): Routine 1 x 2.7ml EDTA Haematocrit hours 0.400 – 0.54 L/L Haematology (1 x 1.2ml Part of Full Blood Count (Hct) Urgent Primary Adult (Female): (LRI/LGH/GH) Paediatrics) care – 8 hours 0.370 – 0.47 L/L Outpatient/routine GP – 24 hours Special 5ml Bone marrow, Send to HMDL laboratory, NOT Haematology heparinised culture cytogenetics Haematological Malignancy Cytogenetics (processed by 28 days N/A medium (provided Cytogenetics form required – cytogenetics by cytogenetics) contact laboratory for advice laboratory) Special Haematology Haematological Malignancy FISH 1 x 4.9ml Lithium Send to HMDL laboratory, NOT (Processed by 28 days N/A (CLL P53 status, AML, CML etc.) Heparin cytogenetics cytogenetics laboratory) Adult (or age-specific for children) 2 x 2.7ml EDTA reference ranges are Sample should reach laboratory Haematoncology tests Immunology (2 x 1.2ml 3 days provided as within 48 hours Paediatrics) appropriate for the Please ensure sample reaches examination laboratory before 16:30 on Fridays performed.
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 95 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-2 yrs: 95 – 140 g/L 2-6 yrs: 110 – 140 g/L 6-12 yrs: A&E/Priority – 1 115 – 145 g/L hour Adult (Male): Inpatients – 3 130 – 180 g/L Routine 1 x 2.7ml EDTA Haemoglobin hours Adult (Female): Haematology (1 x 1.2ml Part of Full Blood Count (Hb) Urgent Primary 115 – 165 g/L (LRI/LGH/GH) Paediatrics) care – 8 hours Outpatient/routine Telephone Limits: GP – 24 hours During core hours: <80g/L >220g/L Outside core hours: <60g/L >220g/L Analysed at John Radcliffe 1 x 2.7ml EDTA 3-40 days, Hospital, Oxford Special *Purple Top* Haemoglobinopathy Investigations dependent on N/A Needs specific request form, Haematology (1 x 1.2ml complexity contact: Paediatrics) [email protected] MUST also request FBC (with 1 x 2.7ml EDTA 3 working days additional 4.9ml EDTA sample) Special *Purple Top* (7 working days if Hb A 1.9 - 3.4% Family Origin Questionnaire MUST Haemoglobinopathy screen 2 Haematology (1 x 1.2ml abnornormality Hb F 0.0 – 0.7% be provided for antenatal samples Paediatrics) detected) Can be requested on sample up to 5 days old if stored at 4°C Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Haemophilia A genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 96 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 2.7ml EDTA Special Haemophilia A/B carrier genetics (1 x 1.2ml 6 weeks N/A Analysed at QMC, Nottingham Haematology Paediatrics) Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Haemophilia B genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form Optimal protective 1 x 4.9ml serum gel level >1.00 mg/L Haemophilusinfluenzae type b (Hib) specific Immunology (1 x 1.1ml serum 16 days (Suboptimal IgG level gel for paediatrics) protective level >0.15 mg/L) 1 x 4.9ml serum gel Special Haptoglobin (1 x 1.1ml serum 5 working days 0.6-1.8g/L Biochemistry gel for paediatrics) Normal: 20-41mmol/mol 1 x 2.7ml EDTA Routine (4.0 – 5.9%) *Purple Top* HbA1c Biochemistry 2 working days (1 x 1.2ml (LRI ONLY) Diabetic: Paediatrics) ≥48 mmol/mol Hb (≥6.5%) MUST also request FBC (with 1 x 2.7ml EDTA Special 3 working days additional 4.9ml EDTA sample) HbS Quantification (1 x 1.2ml N/A Haematology (1hr on request) Can be requested on sample up to Paediatrics) 5 days old if stored at 4°C A&E/Priority – 1 hour Adult: <5iu/L Routine 1 x 4.9ml serum gel Inpatients – 3 For ectopic In Pregnancy: hCG (total) Biochemistry (1 x 1.1ml serum hours pregnancy/emergencies, contact Variable with (LRI ONLY) gel for paediatrics) Outpatient/routine x6553 gestation GP – 24 hours
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 97 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to Heparin (with instructions to send to Routine See UHL Guidelines Same day laboratory within 2 hours of Fastrack) Haematology 2 x 4.3ml citrate for Heparin and Oral (2hrs on request) phlebotomy, and before 16:30 (LRI/LGH/GH) Anticoagulant dosing NO AIRTUBE SYSTEM. Urgent samples must be discussed with laboratory before sending Blood 5 working days Heparin Induced Thrombocytopaenia 2 x 4.9ml Serum sample Transfusion (1 working day if N/A (HIT) Gel Send within 4 hours and it doesn't (LRI/LGH/GGH) urgent) matter if sent in air tub
Samaples must be hand delivered to laboratory within 2 hours of Heparin Induced Thrombocytopenia Screen Special 1 x 4.3ml gel phlebotomy, and before 16:30 Same day (HIT) Haematology sample NO AIRTUBE SYSTEM See UHL Guidelines for Heparin Induced Thrombocytopenia (HIT) 1 x 4.9ml serum gel Analysed at Queen’s Medical Histone antibodies Immunology (1 x 1.1ml serum 14 days N/A Centre, Nottingham. gel for paediatrics) Sample should reach laboratory within 48 hours 1 x 2.7ml EDTA Please ensure sample reaches HLA B27 Immunology (1 x 1.2ml 2 days N/A laboratory before 16:30 on Fridays Paediatrics) Equivocal results confirmed at Transplant Immunology, Leicester General Hospital. Blood Sample sent to Barnsley NHSBT 2 x 4.9ml Serum HLA Specific Antibody Screen Transfusion 7 working days N/A NHSBT form required – see link in Gel (LRI/LGH/GGH) Appendix 3 Blood Sample sent to Barnsley NHSBT HLA Typing Transfusion 3 x 2.7ml EDTA 5 working days N/A NHSBT form required – see link in (LRI/LGH/GGH) Appendix 3
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 98 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Analysed at NHSBT and UHL Transplant Laboratory Blood NHSBT form required – see link in HLA typing (full) Transfusion 3 x 2.7ml EDTA 7 working days N/A Appendix 3 (LRI/LGH/GGH) Contact laboratory if WBC below 2 x 109/L Not available to Primary Care 1 x 4.9ml serum gel Fasting sample sent to the Special Homocysteine (1 x 1.1ml serum 15 working days laboratory within 30 minutes of Biochemistry gel for paediatrics) collection Interpretation provided 1 x 4.9ml serum gel Special Non-toxic: Hydroxycarbazepine (monitoring) (1 x 1.1ml serum 15 working days Biochemistry 12-30 mg/L gel for paediatrics) I 1 x 4.9ml serum gel IA2 antibodies Immunology (1 x 1.1ml serum 21 days 0 - <10 IU/mL gel for paediatrics) Serum free kappa: 0.57-2.08 g/L 1 x 4.9ml serum gel Serum free lambda: IgA Hevylight chain quantitation Immunology (1 x 1.1ml serum 7 days 0.44-2.04 g/L gel for paediatrics) Kappa / lambda ratio: 0.78-1.94 0-4 IU/mL- Negative Patients with low response will be 1 x 4.9ml serum gel 4-10 IU/mL- tested for tTG IgG antibody, IgA tissue transglutaminase (tTG) antibody Immunology (1 x 1.1ml serum 4 days Equivocal immunoglobulins and serum gel for paediatrics) >10 IU/mL- Positive electrophoresis 1 x 4.9ml serum gel IgD Immunology (1 x 1.1ml serum 3 weeks 2-100 KU/L Analysed at Sheffield Teaching gel for paediatrics) Hospitals NHS Foundation Trust
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 99 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 1.2ml serum (no Not available to Primary Care Special IGF-1 (Paediatric) gel separator) 10 working days Contact laboratory (x16559) to Biochemistry (Paediatric) discuss 1 x 4.9ml serum gel Analysed at Sheffield Teaching IgG and IgA Gliadin antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Foundation Trust gel for paediatrics) Blood Sample sent to Barnsley NHSBT 2 x 7.5ml EDTA for IgG and IgM anti-A and B levels Transfusion 7 days N/A NHSBT form required – see link in Blood Transfusion (LRI/LGH/GGH) Appendix 3 1 x 4.9ml serum gel IgG and IgM Cardiolipin antibodies Immunology (1 x 1.1ml serum 7 days 0-19.9CU
gel for paediatrics) 1 x 4.9ml serum gel IgG Subclasses Immunology (1 x 1.1ml serum 7 days Variable gel for paediatrics) 0-7 IU/mL- Negative 1 x 4.9ml serum gel 7-10 IU/mL- IgG tissue transglutaminase (tTG) antibody Immunology (1 x 1.1ml serum 7 days Equivocal gel for paediatrics) >10 IU/mL- Positive Cord Blood: 3.6 – 8. g/L 0-6mo 1.5 – 3.0 g/L 6mo-2yrs 2.3 – 5.8 1 x 4.9ml serum gel g/L IgG1 Immunology (1 x 1.1ml serum 7 days 2-5yrs 2.3 – 6.4 g/L gel for paediatrics) 5-10yrs 3.6 – 7.3 g/L 10-15yrs 3.8 – 7.7 g/L Adult 3.2 – 10.2 g/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 100 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Cord Blood 1.2 – 4.0 g/L 0-6mo 0.3 – 0.5 g/L 6mo-2yrs 0.3 – 3.9 1 x 4.9ml serum gel g/L IgG2 Immunology (1 x 1.1ml serum 7 days 2-5yrs 0.7 – 4.5 g/L gel for paediatrics) 5-10yrs 1.4 – 4.5 g/L 10-15yrs 1.3 – 4.6 g/L Adult 1.2 – 6.6 g/L Cord Blood 0.3 – 1.5 g/L 0-6mo 0.1 – 0.6 g/L 6mo-2yrs 0.1 – 0.8 1 x 4.9ml serum gel g/L IgG3 Immunology (1 x 1.1ml serum 7 days 2-5yrs 0.1 – 1.1 g/L gel for paediatrics) 5-10yrs 0.3 – 1.1 g/L 10-15yrs 0.2 – 1.2 g/L Adult 0.2 – 1.9 g/L Cord Blood <0.5 g/L 0-6mo <0.5 g/L 1 x 4.9ml serum gel 6mo-2yrs <0.5 g/L IgG4 Immunology (1 x 1.1ml serum 7 days 2-5yrs <0.5 g/L gel for paediatrics) 5-10yrs <0.5 g/L 10-15yrs <0.5 g/L Adult <0.5g/L 1 x 4.9ml serum gel Immunosorbent Allergen Chip Analysed at Sheffield Teaching Immunology (1 x 1.1ml serum 3 weeks <0.35 kU/L (ISAC) Hospitals NHS Foundation Trust. gel for paediatrics) Random Urine in Special Indicans Sterile universal or 10 working days Biochemistry fluoride bottle
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 101 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Special Inhibitor Assay 2 x 4.3ml citrate 2 weeks Please Discuss with Laboratory Haematology Special 2 weeks Inhibitor Screen 1 x 4.3ml citrate N/A Please Discuss with Laboratory Haematology (4hrs on request) 1 x 4.9ml serum gel Analysed at Cambridge Life Inner ear antibodies Immunology (1 x 1.1ml serum 21 days N/A Sciences reference laboratory. gel for paediatrics)
Not available to Primary Care 1 x 4.9ml Heparin Prevailing blood glucose Special Insulin (1 x 1.2ml 10 working days 4.4-26 mu/L <2.5mmol/L required Biochemistry Paediatric) Interpret results as appropriate to prevailing glucose level
Age 95% Range 19–21 117–323 22–24 99–289 25–29 84–259 30–34 71–234 35–39 63–223 40–44 58–219 Insulin-Like Growth Factor (IGF1) (Adult) Special 45–49 53–215 For paediatrics, contact laboratory 1 x 4.9ml serum gel 10 working days Biochemistry 50–54 48–209 Interpretation provided
55–59 45–210 60–64 43–220 65–69 40–225 70–79 35–216 80–90 31–208
Unit ng/mL
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 102 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Male Age 95% Range 0–3 <15–129 4–6 22–208 7–9 40–255 10–11 69–316 12–13 143–506 14–15 177–507 16–18 173–414 Insulin-Like Growth Factor (IGF1)
(Paediatric) (18 y/o & less) Special 1 x 1.2ml serum Not available to Primary Care 10 working days Female Biochemistry (Paediatric) Contact laboratory Age 95% Range
0–3 18–172 4–6 35–232 7–9 57–277 10–11 118–448 12–13 170–527 14–15 191–496 16–18 190–429
Unit ng/mL A&E/Priority – 1 Adult: 0.9-1.2 hour 1 x 4.3ml Citrate Inpatients – 3 For monitoring warfarin dose ONLY Routine 1 x 1.8ml (A&E Telephone Limits: International Normalised Ratio hours Haematology ONLY) During core hours: (INR) Urgent Primary Can be added onto samples up to 8 (LRI/LGH/GH) (1 x 1.4ml >8.0 care – 8 hours hours old Paediatrics) Outside core hours: Outpatient/routine >8.0 GP – 24 hours 1 x 4.9ml serum gel Intrinsic factor antibodies Immunology (1 x 1.1ml serum 7 days N/A gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 103 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Usual/non-toxic: A&E/Priority – 1 14-28µmol/L hour Toxic - children: Routine 1 x 4.9ml serum gel Inpatients – 3 >90µmol/L consider Sample to be taken 4 hours after Iron Biochemistry (1 x 1.1ml serum hours desferrioxamine ingestion (LRI/LGH/GH) gel for paediatrics) Outpatient/routine >180µmol/L severe GP – 24 hours toxicity likely Toxic - adults: >143µmol/L 1 x 4.9ml serum gel Islet cell antibodies Immunology (1 x 1.1ml serum 14 days N/A gel for paediatrics) 1 x 2.7ml EDTA Confirmatory test for abnormal Special Iso-Electric Focussing (1 x 1.2ml 7 working days N/A haemoglobins identified in initial Haematology Paediatrics) screen Prophylaxis: Pre 0.5-4.0mg/L
1 x 4.9ml serum gel Therapy: Special For further interpretation, contact Itraconazole (monitoring) (1 x 1.1ml serum 5 working days Pre 1.0-4.0mg/L Biochemistry microbiology gel for paediatrics) All pre-dose levels to be kept below 4.0mg/L J Special Analysed at Addenbrooke’s JAK2 Exon 12 2 x 2.7ml EDTA 14 working days N/A Haematology Hospital, Cambridge K
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 104 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Maternal: 1 x 7.5ml if any foetal cells are EDTA Maternal samples to be taken at Blood seen in 25 low power Newborn: 1 x 7.5ml 72 hours from least 30 to 45 minutes post event Kleihauer (delivery) Transfusion fields then a full EDTA (cord) or 1 x time of event All positive results will be sent for (LRI/LGH/GGH) count will be 1.2ml EDTA (heel confirmation by Flow Cytometry performed’ prick sample) if any foetal cells are Blood seen in 25 low power 72 hours from All positive results will be sent for Kleihauer (non-delivery) Transfusion 1 x 7.5ml EDTA fields then a full time of event confirmation by Flow Cytometry (LRI/LGH/GGH) count will be performed’ L 1 x 4.9ml serum gel Trough level preferable Special 10-20 mg/L24 hour Lacosamide (monitoring) (1 x 1.1ml serum 10 working days Analysed at TDM Unit, Epilepsy Biochemistry quantitation gel for paediatrics) Centre, Chalfont St Peter. Adult: 0.6-2.5mmol/L Not available to Primary Care Routine 1 x 2.7ml Fluoride Transported to laboratory on ice Lactate Biochemistry EDTA 1 hour Telephone Limit: To be received by laboratory within (LRI ONLY) (1.2ml Paediatrics) >4.0mmol/L 30 minutes of collection Plasma: Not available to Primary Care Special Variable – contact Lactate (Paediatric) 1 hour 0.6-2.4 mmol/L Transport immediately to laboratory Biochemistry laboratory CSF: 1.2-2.1 mmol/L on ice A&E/Priority – 1 hour 10d-2yrs: 180- Routine 1 x 4.9ml serum gel Inpatients – 3 430iu/L Lactate Dehydrogenase Biochemistry (1 x 1.1ml serum hours 2yrs-12yrs: 110- (LDH) (LRI/LGH/GH) gel for paediatrics) Outpatient/routine 295iu/L GP – 24 hours >12yrs: 125-255iu/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 105 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Non-toxic: 1.0-4.0mg/L 1 x 4.9ml serum gel Potentially toxic: 3 to Special Lamotrigine (monitoring) (1 x 1.1ml serum 10 working days 15mg/L Biochemistry gel for paediatrics) Telephone Limit: >15mg/L
Usual/non-toxic: <0.5µmol/L Toxic - Industrial exposure: 0.5-1.4µmol/L, rpt in Analysed at Nottingham University 1 x 2.7ml EDTA 12 months. Special Hospitals Lead (1 x 1.2ml 15 working days 1.4-1.9µmol/L, rpt in Biochemistry Lower values apply to women of Paediatrics) 6 months. reproductive age & children. 1.9-2.9µmol/L, rpt in 3 months. Over 2.9µmol/L: employee unfit for work.
1 x 4.9ml serum gel Special Non-toxic: Levetiracetam (monitoring) (1 x 1.1ml serum 10 working days Biochemistry 10-40 mg/L gel for paediatrics) Non-toxic: A&E/Priority – 1 0.4-1.0mmol/L hour (> 0.8 mmol/L for Routine 1 x 4.9ml serum gel Inpatients – 3 acute Rx) Lithium (monitoring) Biochemistry (1 x 1.1ml serum hours Potentially toxic: Sample 12 hours post dose (LRI ONLY) gel for paediatrics) Outpatient/routine >1.5mmol/L GP – 24 hours Telephone Limit: >1.5mmol/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 106 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to laboratory within 2 hours of Special Batch specific- refer Lupus Screen 2 x 4.3ml citrate 2 weeks phlebotomy, and before 16:30 Haematology to report NO AIRTUBE SYSTEM Part of Thrombophilia Screen Samples must be hand delivered to laboratory within 2 hours of Special Same day Batch specific- refer Lupus sensitive APTT 1 x 4.3ml citrate phlebotomy, and before 16:30 Haematology (1hr on request) to report NO AIRTUBE SYSTEM Part of Special Clotting Screen Male:1.0-9.0iu/L Female: -follicular phase: 1.0-10iu/L A&E/Inpatients – -mid cycle peak: Routine 1 x 4.9ml serum gel 3 hours Lutenising Hormone 14-70iu/L Biochemistry (1 x 1.1ml serum Outpatient/routine State day of menstrual cycle (LH) -luteal phase: (LRI ONLY) gel for paediatrics) GP – 24 hours 1.0-13iu/L
-post menopausal: 15-64 iu/L -pre pubertal: <0.1iu/L Sample should reach laboratory 2x 2.7ml EDTA within 48 hours Lymphocyte subsets Available upon Immunology (2 x 1.2ml 3 days Please ensure sample reaches (Suspected primary immunodeficiency) request Paediatrics) laboratory before 16:30 on Fridays
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 107 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
0-3 yrs: 4.0 – 13.5 x 109/L A&E/Priority – 1 3-6 yrs: hour 9 2.0 – 9.5 x 10 /L Inpatients – 3 Routine 1 x 2.7ml EDTA 6-12 yrs: hours 9 Lymphocytes Haematology (1 x 1.2ml 1.5 – 6.5 x 10 /L Part of Full Blood Count Urgent Primary (LRI/LGH/GH) Paediatrics) 12-15 yrs: care – 8 hours 9 1.5 – 6.0 x 10 /L Outpatient/routine Adult: GP – 24 hours 9 1.0 – 4.0 x 10 /L
M < 28 days: 0.6-1.0 A&E/Priority – 1 mmol/L 1 x 4.9ml serum gel hour 28 days - 15 yrs: 0.7- Routine (1 x 1.1ml serum Inpatients – 3 1.0 mmol/L Magnesium Biochemistry gel for paediatrics) hours ≥ 16 yrs: 0.7-1.0 (LRI/LGH/GH) OR Outpatient/routine mmol/L 24 hour urine GP – 24 hours Telephone Limit: ≤ 0.4 mmol/L Consists of rapid diagnostic test (LRI ONLY) and blood film Routine 1 x 2.7ml EDTA Parasitaemia provided on Malaria and/or other Parasite Investigations Haematology (1 x 1.2ml 24 hours N/A falciparum and knowlesi species (LR/LGH/GH) Paediatrics) May require clinical comment Can be added onto samples up to 2 hours old 1 x 4.9ml serum gel Mannose-binding lectin Immunology (1 x 1.1ml serum 2 days N/A Analysed at Sheffield Teaching (MBL) gel for paediatrics) Hospitals NHS Foundation Trust
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 108 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 4.9ml serum gel 2-14 µg/L Mast cell tryptase Immunology (1 x 1.1ml serum 7 days 2-44.3 µg/L post gel for paediatrics) mortem A&E/Priority – 1 hour Inpatients – 3 Routine 1 x 2.7ml EDTA 0-12 yrs: Mean Cell Haemoglobin hours Haematology (1 x 1.2ml 25.0 – 32.0 pg Part of Full Blood Count (MCH) Urgent Primary (LRI/LGH/GH) Paediatrics) Adult: 27.0 – 32.0 pg care – 8 hours Outpatient/routine GP – 24 hours A&E/Priority – 1 hour Inpatients – 3 0-2 yrs: 74–95 fL Routine 1 x 2.7ml EDTA Mean Cell Volume hours 2-6 yrs: 70–95 fL Haematology (1 x 1.2ml Part of Full Blood Count (MCV) Urgent Primary 6-12 yrs: 77–95 fL (LRI/LGH/GH) Paediatrics) care – 8 hours Adult: 80–99 fL Outpatient/routine GP – 24 hours Meningococcal polysaccharide serogroup 1 x 4.9ml serum gel Protective serum A, W135 & Y-specific IgG levels and serum Immunology (1 x 1.1ml serum 3 months bactericidal activity Analysed at HPA Meningococcal bactericidal titres gel for paediatrics) titre ≥ 8 Reference Laboratory, Manchester Analysed at HPA Meningococcal Meningococcal polysaccharide serogroup 1 x 4.9ml serum gel Protective serum Reference Laboratory, Manchester C-specific IgG levels and serum bactericidal Immunology (1 x 1.1ml serum 3 months bactericidal activity Patient must not take antibiotics titres gel for paediatrics) titre ≥ 1:8 prior to sample collection Available to Community Paediatricians Metabolic Screen (Paediatric): Random Urine in Can all be performed on 1 sample, Special Glycosaminoglycans, amino acids, Sterile universal or 4-6 weeks N/A but at least 10-15ml urine required Biochemistry oligosaccharides, organic acids fluoride bottle Analysed at Nottingham University Hospitals Interpretation provided
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 109 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 24 hour urine Special Adult: <1.0µmol/24 Metadrenaline (adults) or random 15 working days Biochemistry hours urine (paediatric) Severe toxicity: >50mg/100mL Special 1 x 2.7ml Fluoride Methanol 5 working days Not available to Primary Care Biochemistry EDTA Telephone Limit: Phone ALL results A&E/Inpatients – Routine 1 x 4.9ml serum gel 3 hours Methotrexate (monitoring) Biochemistry (1 x 1.1ml serum Outpatient/routine N/A Contact pharmacy for interpretation (LRI ONLY) gel for paediatrics) GP – 24 hours
Female: Routine Random Urine in 0-3.5mg/mmol creat Microalbumin Biochemistry Sterile universal or 5 working days Male: (LRI ONLY) fluoride bottle 0-2.5mg/mmol creat
1 x 4.9ml serum gel Analysed at Nottingham University Mitochondrial M2 antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Trust. gel for paediatrics)
A&E/Priority – 1 hour Inpatients – 3 Routine 1 x 2.7ml EDTA hours Adult Monocyte count Haematology (1 x 1.2ml 9 Part of Full Blood Count Urgent Primary 0.2 – 0.8 x 10 /L (LRI/LGH/GH) Paediatrics) care – 8 hours Outpatient/routine GP – 24 hours
Special Analysed at Addenbrooke’s MPL mutation analysis 4 x 2.7ml EDTA 15 working days N/A Haematology Hospital, Cambridge
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 110 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
Available to Community Random Urine in Paediatricians Special Mucopolysacharide Screen (Paediatric) Sterile universal or 4-6 weeks Analysed at Nottingham University Biochemistry fluoride bottle Hospitals Interpretation provided
1 x 4.9ml serum gel Analysed at the Neuroimmunology MuSK antibody Immunology (1 x 1.1ml serum 28 days N/A laboratory, Oxford. gel for paediatrics)
1 x 4.9ml serum gel Analysed at Nottingham University Myocardial antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Trust. gel for paediatrics)
N Maternal: 1 x 7.5ml EDTA ‘for blood transfusion & 2 x 14 working days Blood 4.9ml Serum Gel 21 working days if Sample sent to Barnsley NHSBT Neonatal Alloummune Neutropaenia Transfusion Paternal: 1 x 7.5ml further N/A NHSBT form required – see link in (NAIN) (LRI/LGH/GGH) EDTA ‘for blood investigations Appendix 3 transfusion required Neonate: 1 x 1.2ml EDTA (Paediatrics) 1 x 4.9ml serum gel Neuronal antibodies Analysed at Nottingham University Immunology (1 x 1.1ml serum 14 days N/A (IFA) Hospitals NHS Trust. gel for paediatrics) 1 x 4.9ml serum gel Analysed at Nottingham University Neuronal antibodies (Immunoblot) Immunology (1 x 1.1ml serum 14 days N/A Hospital NHS Trust gel for paediatrics) Special 1 x 4.9 mL Serum Not available to Primary Care Neurone Specific Enolase (Paediatric) 4-6 weeks 5-25 mg/L Biochemistry Gel Analysed at Kings College Hospital
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 111 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range >90% response (>2 1 x 2.7ml EDTA log change in median Neutrophil oxidative burst test Immunology (1 x 1.2ml 3 days fluorescence (DHR) Paediatrics) intensity with sharp peak)
0-2 yrs: 1.0 – 8.5 x 109/L 2-6 yrs: 1.5 - 8.5 x 109/L 6-12 yrs: 1.5 – 8.0 x 109/L A&E/Priority – 1 12-15 yrs: hour 9 1.8 – 8.0 x 10 /L Part of Full Blood Count Inpatients – 3 Routine 1 x 2.7ml EDTA Adult: hours 9 Neutrophils Haematology (1 x 1.2ml 1.5 – 7.5 x 10 /L * If neutropaenia consistent with Urgent Primary (LRI/LGH/GH) Paediatrics) chemotherapy, will only be phoned care – 8 hours 9 Telephone Limits: if neutrophils <0.510 /L Outpatient/routine During core hours: GP – 24 hours 9 <1 x 10 /L* >30.0 109/L
Outside core hours: <0.5 x 109/L >50 x 109/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 112 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
Complete request form from Oxford 1 x 4.9ml serum gel Analysed at the department of NMO/Aquaporin 4 Antibodies Immunology (1 x 1.1ml serum 21 days N/A Clinical Neurology, Oxford gel for paediatrics) University Hospitals NHS Trust.
24 hour urine Special Adult: <3.0 µmol/24 Normetadrenaline (adults) or random 15 working days Biochemistry hours urine (paediatric) O Plain Universal for CSF AND 3-4 weeks (faster Not available to Primary Care Oligoclonal Banding Immunology N/A 1 x 4.9ml serum gel if urgent) Interpretation provided (1 x 1.1ml serum gel for paediatrics) 1 x 4.9ml serum gel A&E/Priority – 1 (1 x 1.1ml serum hour Routine gel for paediatrics) Inpatients – 3 275-295 mOsm/kg Osmolality Biochemistry OR hours Dependent on hydration status (serum) (LRI ONLY) Random Urine in Outpatient/routine Sterile universal or GP – 24 hours fluoride bottle 1 x 4.9ml serum gel Analysed at Sheffield Teaching Ovarian antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Foundation Trust. gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 113 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
1-16yr: 0.09-0.40mmol/24hr Male: 0.1-0.41mmol/24hr Female: 0.04-0.31mmol/24hr 24 hour urine acidified (2M HCl) 0-1yr: OR 15-260µmol/mmol Special Analysed at University College Oxalate Random Urine in 4-6 weeks creatinine Biochemistry London Hospitals Sterile universal or 1-5yr: fluoride bottle 11-120µmol/mmol (Paediatrics) creatinine 5-12yr: 6-150µmol/mmol creatinine >12yr: 2-83µmol/mmol creatinine
1 x 4.9ml serum gel Special See Hydroxycarbazepine Oxcarbazepine (monitoring) (1 x 1.1ml serum 10 working days N/A Biochemistry monitoring (active metabolite) gel for paediatrics) P 4 x 2.7ml EDTA (blood) Special Analysed at Royal Hallamshire Paediatric ALL MRD OR 14 days N/A Haematology Hospital, Sheffield 2 x 2.7ml EDTA BONE MARROW Special 2 x 2.7ml EDTA Analysed at Sheffield Children’s Paediatric APML MRD 14 days N/A Haematology BONE MARROW Hospital
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 114 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Analysed at Great Ormond Street Hospital, London Special Discuss with Samples must be hand delivered to Paediatric thrombophilia screen 1 month N/A Haematology laboratory laboratory within 2 hours of phlebotomy, and before 16:30 NO AIRTUBE SYSTEM Trephine core in Special Paediatric trephines 10% Saline 15 working days N/A Haematology Formalin A&E/Priority – 1 hour Usual/non-toxic: Anticonvulsants and alcohol abuse Routine 1 x 4.9ml serum gel Inpatients – 3 <10mg/L increase susceptibility to poisoning Paracetamol Biochemistry (1 x 1.1ml serum hours Risk of hepatoxicity depends on (LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limit: time from ingestion. GP – 24 hours All detectable levels See current edition of BNF.
N/A Serum gel tube or
20ml early morning Telephone Limits: urine sample (plain Paraprotein Characterisation Immunology 5 days New IgG >15g [white-capped] New IgA/M >10g sterile universal New IgD without boric acid) New IgE 1 x 4.9ml serum gel Analysed at Sheffield Teaching Parathyroid antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Foundation Trust. gel for paediatrics) A&E/Inpatients – Sample must be received by Routine 1 x 2.7ml EDTA 3 hours Parathyroid Hormone laboratory within 6-8 hours of Biochemistry (1 x 1.2ml Outpatient/routine 1.95-8.49 pmol/L (PTH) collection (LRI ONLY) Paediatrics) GP – 24 hours Calcium required with PTH sample
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 115 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be received by the Immunology laboratory within 48 1 x 2.7ml EDTA Paroxysmal Nocturnal Haemoglobinuria hours of collection. Urgent results Immunology (1 x 1.2ml 3 days N/A (PNH) (New PNH clones) will be Paediatrics) telephoned out to the requesting clinician 1 x 4.9ml serum gel Analysed at Nottingham University Pemphigoid (skin) antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Trust. gel for paediatrics) 1 x 4.9ml serum gel Analysed at Nottingham University Pemphigus (skin) antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Trust. gel for paediatrics) Medical comment provided Blood film following referral from routine Peripheral blood morphology (suspected Special OR 5 days haematology laboratory haematological malignancy or medical N/A Haematology 1 x 2.7ml EDTA (1 (6hrs if urgent) In suspected malignancy cases, comment) x 1.2ml Paediatrics) current FBC results must be provided on HMDL request form Non-toxic: A&E/Inpatients – 10-40mg/L Routine 1 x 4.9ml serum gel 3 hours Potentially toxic: Tolerance develops with chronic Phenobarbitone (monitoring) Biochemistry (1 x 1.1ml serum Outpatient/routine >50mg/L dosage (LRI ONLY) gel for paediatrics) GP – 24 hours Telephone Limit: >70mg/L A&E/Priority – 1 Non-toxic: hour 5-20mg/L Routine 1 x 4.9ml serum gel Inpatients – 3 Potentially toxic: Phenytoin (monitoring) Biochemistry (1 x 1.1ml serum hours >20mg/L (LRI ONLY) gel for paediatrics) Outpatient/routine GP – 24 hours Telephone Limit: >25mg/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 116 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range < 28 days: 1.3-2.6 mmol/L A&E/Priority – 1 28 days - 12 months: hour 1.3-2.4 mmol/L Routine 1 x 4.9ml serum gel Inpatients – 3 1 - 15 yrs: 0.9-1.8 Phosphate Biochemistry (1 x 1.1ml serum hours mmol/L Avoid venous stasis (LRI/LGH/GH) gel for paediatrics) Outpatient/routine ≥ 16 yrs: 0.8-1.5 GP – 24 hours mmol/L
Telephone Limits: ≤0.3mmol/L A&E/Priority – 1 hour Routine Random Urine in Inpatients – 3 Phosphate (random) Biochemistry Sterile universal or hours N/A (LRI/LGH/GH) fluoride bottle Outpatient/routine GP – 24 hours
A&E/Priority – 1 hour Routine Inpatients – 3 24 hour urine Phosphate (urine) Biochemistry hours 15-50mmol/24hr acidified (2M HCl) (LRI/LGH/GH) Outpatient/routine GP – 24 hours
Not available to Primary Care Part of very long chain fatty acid Special 1 x 1.2ml Heparin Phytanic Acid (Paediatric) 4-6 weeks 0.2-19.3 umol/L profile Biochemistry (Paediatric) Analysed at Sheffield Children’s Hospital
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 117 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 1 x 2.7ml EDTA Routine *Purple Top* Plasma Viscosity Haematology (1 x 1.2ml 24 hours Adult: 1.50 – 1.72 cp (PV) (LRI ONLY) Paediatrics)
Special Plasminogen 1 x 4.3ml citrate 3 weeks N/A Analysed at UCL, London Haematology Adult: 140 – 400 x 109/L A&E/Priority – 1
hour Telephone Limits: Inpatients – 3 Routine 1 x 2.7ml EDTA During core hours: hours 9 Platelet Count Haematology (1 x 1.2ml <20 x 10 /L Part of Full Blood Count Urgent Primary 9 (LRI/LGH/GH) Paediatrics) >1000 x 10 /L care – 8 hours
Outpatient/routine Outside core hours: GP – 24 hours 9 <20 x 10 /L >1000 x 109/L Sample bottles only Special Platelet Function Studies available from Same day N/A Please Discuss with Laboratory Haematology Haemostasis Clinic Contact laboratory before collecting Blood samples Platelet Glycoprotein Estimation Transfusion Variable 7 days N/A Sample sent to Barnsley NHSBT (LRI/LGH/GGH) NHSBT form required – see link in Appendix 3 Analysed at Birmingham Children’s 1 x 2.7ml EDTA Special Hospital Platelet glycoproteins (1 x 1.2ml 24 hours N/A Haematology MUST contact the laboratory before Paediatrics) samples are taken 3 x 2.7ml EDTA Blood Up to 21 days, Sample sent to NHSBT AND Platelet Refractoriness Transfusion depending upon N/A NHSBT form required – see link in 2 x 4.9ml Serum (LRI/LGH/GGH) donor availability Appendix 3 Gel
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 118 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Blood Up to 21 days, 2 x 4.9ml Serum Platelet Refractoriness Transfusion depending upon N/A Gel (LRI/LGH/GGH) donor availability 1 x 4.9ml serum gel Pneumococcal polysaccharide serotype- Immunology (1 x 1.1ml serum 5 weeks >=0.35 mg/L Analysed at Addenbrookes specific IgG levels gel for paediatrics) Hospital, Cambridge 1 x 2.7ml EDTA (1 x 1.2ml Paediatrics) Special PBG:Creat ratio: Porphobilinogen quantitation OR 1 x 4.9ml 5 weeks Protect samples from light Biochemistry 0 to 1.5 umol/mmol Heparin (1.2ml Analysed at Paediatric) University Hospitals of Wales Random Urine in Special Protect samples from light Porphobilinogen screen Sterile universal or 5 working days N/A Biochemistry Fresh urine fluoride bottle Urine, preferably Protect samples from light early morning Please provide details of presenting AND symptoms and relevant family/past 3 x 2.7ml EDTA Special medical history. Porphyria screen (acute) AND 5 working days N/A Biochemistry When supplying family details, faecal sample please indicate type of porphyria, (ONLY if dates of birth and relationship to past/family history patient of porphyria) Protect samples from light Please provide details of presenting Urine, preferably symptoms and relevant family/past early morning Porphyria screen Special medical history. AND 5 working days N/A (cutaneous/bullous) Biochemistry When supplying family details, 3 x 2.7ml EDTA please indicate type of porphyria,
dates of birth and relationship to patient
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 119 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Protect samples from light Please provide details of presenting symptoms and relevant family/past Porphyria screen Special 3 x 2.7ml EDTA medical history. 5 working days N/A (erythropoietic/photosensitive) Biochemistry When supplying family details, please indicate type of porphyria, dates of birth and relationship to patient Protect samples from light Please provide details of presenting symptoms and relevant family/past Porphyria screen 3 x 2.7ml EDTA Special medical history. (pseudoporphyria with cutaneous AND 5 working days N/A Biochemistry When supplying family details, symptoms) faecal sample please indicate type of porphyria, dates of birth and relationship to patient Protect samples from light Please provide details of presenting Porphyria monitoring symptoms and relevant family/past (acute intermittent porphyria/variegate or Special Urine, preferably medical history. 5 working days N/A hereditary coproporphyria/porphyria Biochemistry early morning When supplying family details, cutanea tarda ) please indicate type of porphyria, dates of birth and relationship to patient Protect samples from light Please provide details of presenting symptoms and relevant family/past Porphyria monitoring Special 3 x 2.7ml EDTA medical history. 5 working days N/A (erythropoetic protoporphyria) Biochemistry When supplying family details, please indicate type of porphyria, dates of birth and relationship to patient
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 120 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Protect samples from light Fresh sample required Please provide details of presenting symptoms and relevant family/past Special Porphyrins screen (faecal) Faecal sample 5 working days N/A medical history. Biochemistry When supplying family details, please indicate type of porphyria, dates of birth and relationship to patient Protect samples from light Fresh sample required 1 x 2.7ml EDTA Please provide details of presenting (1 x 1.2ml symptoms and relevant family/past Special Porphyrins screen (total & plasma) Paediatrics) OR 1 x 5 working days N/A medical history. Biochemistry 4.9ml Heparin When supplying family details, (1.2ml Paediatric) please indicate type of porphyria, dates of birth and relationship to patient Protect samples from light Fresh sample required Please provide details of presenting Random urine in symptoms and relevant family/past Special Porphyrins screen (urine) sterile universal of 5 working days N/A medical history. Biochemistry fluoride bottle When supplying family details, please indicate type of porphyria, dates of birth and relationship to patient
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 121 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Prophylaxis: Pre 0.7-3.75 mg/L
1 x 4.9ml serum gel Therapy: Special For further interpretation, contact Posaconazole (monitoring) (1 x 1.1ml serum 5 working days Pre 1.0-3.75 mg/ Biochemistry microbiology gel for paediatrics) All pre-dose levels to be kept below 3.75mg/L 3 x 2.7ml EDTA Blood Sample sent to Barnsley NHSBT Post Transfusion Purpura AND Transfusion 7 days N/A NHSBT form required – see link in (PTP) 2 x 4.9ml Serum (LRI/LGH/GGH) Appendix 3 Gel "< 28 days: 3.4-6.0 mmol/L 28 days - 12 months: 3.5-5.7 mmol/L 1 - 15 yrs: 3.5-5.0 mmol/L ≥ 16 yrs: 3.5-5.3 A&E/Priority – 1 mmol/L 1 x 4.9ml serum gel hour
Routine (1 x 1.1ml serum Inpatients – 3 Telephone Limits: Potassium Biochemistry gel for paediatrics) hours Neonates (<28 (LRI/LGH/GH) OR Outpatient/routine days): ≥ 6.9mmol or 24 hour urine GP – 24 hours ≤ 2.5mmol/L
> 28 days old: ≥ 6.0mmol/L or ≤ 2.5mmol/L ≥ 6.5mmol/L (GP and outpatients out of hours) "
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 122 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Therapeutic range: 1 x 4.9ml serum gel 2 – 5 mg/L For therapeutic monitoring Special Minimum sample Pregabalin 10 working days (Baselt, Deposition of purposes, a trough (before dose) Biochemistry volume required: toxic drugs and sample should be taken. 100 µL chemicals in man) Routine 1 x 4.9ml serum gel See Phenobarbitone monitoring Primidone (monitoring) Biochemistry (1 x 1.1ml serum N/A (active metabolite) (LRI ONLY) gel for paediatrics) Not available to Primary Care Part of very long chain fatty acid Special 1 x 1.2ml Heparin Pristanic Acid (Paediatric) 4-6 weeks 0-1.88 mmol/L profile Biochemistry (Paediatric) Analysed at Sheffield Children’s Hospital
Routine 1 x 4.9ml serum gel Inpatients – 3 Pro-calcitonin (PCT) Biochemistry (1 x 1.1ml serum <0.05 ng/ml hours (LRI ONLY) gel for paediatrics)
Males : 22-87 mg/L Female (pre- 1 x 4.9ml serum gel menopausal) Special Analysed at Nottingham University Pro-collagen peptide I (1 x 1.1ml serum 4-6 weeks 19-83 mg/L Biochemistry Hospitals. gel for paediatrics) Female (post- menopausal) 16-96 mg/L Routine 1 x 4.9ml serum gel Pro-collagen peptide III Biochemistry (1 x 1.1ml serum 10 days 2.4-8.7ug/L (LRI ONLY) gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 123 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Female: Day 21 A&E/Priority – 1 progesterone: hour > 30 nmol/L Routine 1 x 4.9ml serum gel Inpatients – 3 probably Ovulatory State day of menstrual cycle Progesterone Biochemistry (1 x 1.1ml serum hours < 20 nmol/L Day 21 sample required for (LRI ONLY) gel for paediatrics) Outpatient/routine probably Non assessing ovulation GP – 24 hours Ovulatory 20-30 nmol/L Equivocal Male: 0.2-1.9 nmol/L A&E/Priority – 1 hour Male: 50-400iu/L Routine 1 x 4.9ml serum gel Inpatients – 3 Female: 50-400iu/L Prolactin Biochemistry (1 x 1.1ml serum hours (LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limits: GP – 24 hours >5000iu/L
Analysed at Northern General 5mL urine no 0 - 825ng/mmol Hospital Sheffield. Prostaglandin D2 Immunology 28 days preservative. creatinine. 24hour collection advised if investigating MCAS 5mL urine no Analysed at Northern General preservative 0 - 2300 ng/mmol Hospital Sheffield Prostaglandin DM Immunology 24hour collection 28 days creatinine. 24hour collection advised if advised if investigating MCAS investigating MCAS Analysed at Northern General 5mL urine no 0 - 105ng/mmol Hospital Sheffield Prostaglandin F2 ALPHA Immunology 28 days preservative. creatinine. 24hour collection advised if investigating MCAS
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 124 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Male: Up to 50yr: 0- A&E/Inpatients – 2.5µg/L Routine 1 x 4.9ml serum gel 3 hours Prostate Specific Antigen Up to 60yr: 0-3.0µg/L Biochemistry (1 x 1.1ml serum Outpatient/routine (PSA) Up to 70yr: 0-4µg/L (LRI ONLY) gel for paediatrics) GP – 24 hours Up to 80yr: 0-5µg/L
Over 80yr: 0-20µg/L A&E/Priority – 1 Adult: 0.10-0.45g/L hour 1 x 2.7ml Fluoride 1 day: 0.40-1.20g/L Routine Inpatients – 3 EDTA Up to 4 wks: 0.20- Protein (CSF) Biochemistry hours Not available to Primary Care (1 x 1.2ml 0.80g/L (LRI ONLY) Outpatient/routine Paediatric) Up to 1yr: 0.20- GP – 24 hours 0.70g/L
1 x 4.9ml serum gel (1 x 1.1ml serum Adult: 60-80g/L gel for paediatrics) Adult: up to OR Routine 0.15g/24hr 24 hour urine (no Protein (total) Biochemistry 5 working days Protein/creatinine preservative) (LRI/LGH/GH) ratio up to OR 0.03g/mmol Random Urine in creatinine Sterile universal or fluoride bottle Samples must be hand delivered to laboratory within 2 hours of Special Protein C 2 x 4.3ml citrate 2 weeks 69 - 128% phlebotomy, and before 16:30 Haematology NO AIRTUBE SYSTEM Part of Thrombophilia Screen
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 125 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to laboratory within 2 hours of Special Female: 53 -128% phlebotomy, and before 16:30 Protein S 2 x 4.3ml citrate 2 weeks Haematology Male: 71 - 165% NO AIRTUBE SYSTEM Part of Thrombophilia Screen Not tested during pregnancy 2 x 2.7ml EDTA Special Prothrombin gene mutation OR 14 working days N/A Analysed at QMC, Nottingham Haematology 1 x 4.3ml Citrate A&E/Priority – 1 hour 1 x 4.3ml Citrate Inpatients – 3 Newborn-1mnth: Reported with INR Routine 1 x 1.8ml (A&E Prothrombin Time hours 14.0-16.0s Haematology ONLY) (PT) Urgent Primary Adult: Can be added onto samples up to 8 (LRI/LGH/GH) (1 x 1.4ml care – 8 hours 11.0-14.0s hours old Paediatrics) Outpatient/routine GP – 24 hours Samples must be hand delivered to laboratory within 2 hours of Prothrombin Time Special Same day 1 x 4.3ml citrate 12 – 15 secs phlebotomy, and before 16:30 (PT) Haematology (1hr on request) NO AIRTUBE SYSTEM Part of Special Clotting Screen Special Analysed at St Thomas Hospital, Purine/Pyramidine metabolism defects 5 x 2.7ml EDTA 3 weeks N/A Haematology London Not available to Primary Care Random Urine in Special Fresh sample required Purines (Paediatric) Sterile universal or 4-6 weeks Biochemistry Analysed at St Thomas’ London. fluoride bottle Interpretation provided Special Analysed at St Thomas Hospital, Pyrimidine-5-Nucleotidase 2 x 2.7ml EDTA 3 weeks N/A Haematology London
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 126 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Fasting: Not available to Primary Care Special 41-91 mmol/L Pyruvate (Paediatric) Various 5 working days Contact laboratory (x6559) to Biochemistry Postpradial: discuss 41-114 mmol/L Analysed at King’s College Hospital, London 1 x 2.7ml EDTA Special Send FBC and Reticulocyte results Pyruvate Kinase Screen (1 x 1.2ml 10 working days N/A Haematology with sample Paediatrics) Inform laboratory when sending sample R 0-2 yrs: A&E/Priority – 1 3.90–5.50 x 1012/L hour 2-6 yrs: Inpatients – 3 3.70–5.50 x 1012/L Routine 1 x 2.7ml EDTA Red Blood Cell Count hours 6-12 yrs: Haematology (1 x 1.2ml 12 Part of Full Blood Count (RBC) Urgent Primary 3.90–5.50 x 10 /L (LRI/LGH/GH) Paediatrics) care – 8 hours Adult (Male): Outpatient/routine 4.50–6.50 x 1012/L GP – 24 hours Adult (Female): 3.90–5.60 x 1012/L Blood Sample sent to Barnsley NHSBT Red cell allo-antibody identification - 2 x 7.5ml EDTA ‘for Transfusion 7 days N/A NHSBT form required – see link in complex blood transfusion’ (LRI/LGH/GGH) Appendix 3 Available to Community Paediatricians Random Urine in 5 working days Urine or faecal sample must reach Sterile universal or Special (urine) laboratory on da of collection Reducing Substances (Paediatric) fluoride bottle N/A Biochemistry 10 working days Minimum 1.0g in occult pot. OR (faeces) Analysed at Nottingham University Faeces Hospitals Interpretation provided
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 127 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Sample must be received by 1 x 2.7ml EDTA laboratory within 3 hours of Special Renin (1 x 1.2ml 2-4 weeks N/A collection Biochemistry Paediatrics) Send with aldosterone Interpretation provided A&E/Priority – 1 hour 1 x 4.3ml Citrate Inpatients – 3 Routine 1 x 1.8ml (A&E Requested by laboratory in hours Reptilase Time Haematology ONLY) Adult: 16.0-18.0s suspected cases of heparin Urgent Primary (LRI/LGH/GH) (1 x 1.4ml contamination care – 8 hours Paediatrics) Outpatient/routine GP – 24 hours A&E/Priority – 1 hour Inpatients – 3 Routine 1 x 2.7ml EDTA Can be added to samples <24 hours 9 Reticulocyte Count Haematology (1 x 1.2ml Adult: 20 – 80 10 /L hours old Urgent Primary (LRI/LGH/GH) Paediatrics) Reported with CHr care – 8 hours Outpatient/routine GP – 24 hours A&E/Priority – 1 hour Inpatients – 3 Can be added to samples <24 Routine 1 x 2.7ml EDTA hours hours old Reticulocyte Haemoglobin Content Haematology (1 x 1.2ml Urgent Primary Adult: 29 – 34 pg Reported with reticulocyte count (CHr) (LRI/LGH/GH) Paediatrics) care – 8 hours Not suitable for patients with Outpatient/routine thalassaemia GP – 24 hours N/A 1 x 4.9ml serum gel Rheumatoid factor Immunology (1 x 1.1ml serum 2 days <16 IU/mL gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 128 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Samples must be hand delivered to laboratory within 2 hours of Special 4 weeks Ristocetin Co-factor 2 x 4.3ml citrate 44.6- 138.6% phlebotomy, and before 16:30 Haematology (2hrs on request) NO AIRTUBE SYSTEM Part of von Willebrand Screen Special Ristocetin Induced Platelet Aggregation 2 x 4.3ml Citrate 4 weeks 1.0 - 1.25mg/mL Sample requirement Haematology S 1 x 4.9ml serum gel 82% people <5mg/L SAA Immunology (1 x 1.1ml serum 1 month Analysed at National Amyloidosis 96 %< 10mg/L gel for paediatrics) Centre, London A&E/Priority – 1 hour Therapeutic/non- Routine 1 x 4.9ml serum gel Inpatients – 3 toxic: <100 mg/L Levels may continue to rise after Salicylate Biochemistry (1 x 1.1ml serum hours Toxic: >300mg/L gastric lavage. (LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limit: GP – 24 hours >300mg/L
<6 months: 0.35- 0.46µmol/L 6 months – 2 years: 1 x 4.9ml serum gel Special 0.32-0.63 µmol/L Analysed at Nottingham University Selenium (1 x 1.1ml serum 5 working days Biochemistry 2 years – 16 years: Hospitals gel for paediatrics) 0.57-0.90 µmol/L >16 years: 0.89-1.65 µmol/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 129 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range
Therapeutic range: For therapeutic monitoring 1 x 4.9ml serum gel 0.05 - 0.25 mg/L purposes, a trough (before dose) Special Minimum sample Sertraline 10 working days (Baselt, Deposition of sample should be taken. If toxicity Biochemistry volume required: toxic drugs and suspected, take sample at the 100 µL chemicals in man) earliest opportunity.
Serum free kappa: 3.3-19.4 mg/L Serum free lambda: 5.7-26.3 mg/L Kappa / lambda ratio: 1 x 4.9ml serum gel 0.26-1.65 Serum free light chain quantitation Immunology (1 x 1.1ml serum 7 days
gel for paediatrics) Telephone Limits: Kappa/lambda >500mg Ratio <0.01 or >100
1 x 4.9ml serum gel N/A Serum protein electrophoresis Immunology (1 x 1.1ml serum 5 days gel for paediatrics) Female: 12-166 Routine 1 x 4.9ml serum gel nmol/L Sex Hormone Binding Globulin Biochemistry (1 x 1.1ml serum 10 working days Male: 17-66 nmol/L (LRI ONLY) gel for paediatrics)
1 x 2.7ml EDTA Special 3 working days MUST also request FBC (with Sickle Solubility Test (1 x 1.2ml N/A Haematology (1hr on request) additional 4.9ml EDTA sample) Paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 130 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Adult: A&E/Priority – 1 133-146mmol/L 1 x 4.9ml serum gel hour Adult: Routine (1 x 1.1ml serum Inpatients – 3 110-275mmol/24hr Sodium Biochemistry gel for paediatrics) hours
(LRI/LGH/GH) OR Outpatient/routine Telephone Limit: 24 hour urine GP – 24 hours <120mmol/L
>150mmol/L Samples must be hand delivered to Special Clotting Screen: Special Same day laboratory within 2 hours of PT, factor/lupus sensitive APTT, fibrinogen, 1 x 4.3ml citrate N/A Haematology (1hr on request) phlebotomy, and before 16:30 thrombin time NO AIRTUBE SYSTEM Gives analysis of adrenal gonadal Special Steroid Profile (Urine) 24 hour urine 4-6 weeks N/A steroids with interpretation Biochemistry Analysed at Kings College Hospital Available to Community Paediatricians Urine or faecal Random Urine in sample must reach laboratory on Sterile universal or Special da of collection Sugar Chromotography (Paediatric) fluoride bottle 15 working days N/A Biochemistry Minimum 1.0g in occult pot. OR Analysed at Nottingham University Faeces Hospitals Interpretation provided 1 x 4.9ml serum gel Analysed at the Institute of Sulphatide antibodies Immunology (1 x 1.1ml serum 28 days N/A Neurological Sciences Southern gel for paediatrics) General Hospital Glasgow. Not available to Primary Care For routine appointments, send request form to Special Special Sweat Test N/A 3 working days N/A Biochemistry. The laboratory will Biochemistry organise an appointment through a weekly clinic. For urgent tests, contact laboratory (x6559)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 131 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range T A&E/Inpatients – Female: 0.5-2.6 Routine 1 x 4.9ml serum gel 3 hours nmol/L Testosterone Biochemistry (1 x 1.1ml serum Outpatient/routine Male: 9.0-34.7 (LRI ONLY) gel for paediatrics) GP – 24 hours nmol/L
0.01-7.00 IU/mL 1 x 4.9ml serum gel Optimal protective Tetanus toxoid-specific IgG level Immunology (1 x 1.1ml serum 16 days level ≥0.15 IU/mL gel for paediatrics) Minimum protective level ≥0.01 IU/mL A&E/Priority – 1 Non-toxic: hour 10-20mg/L Routine 1 x 4.9ml serum gel Inpatients – 3 Potentially toxic: To exclude toxicity both trough and Theophylline (monitoring) Biochemistry (1 x 1.1ml serum hours >20mg/L peak sampling may be required (LRI ONLY) gel for paediatrics) Outpatient/routine GP – 24 hours Telephone Limit: >25mg/L Samples must be hand delivered to laboratory within 2 hours of Special Same day Thrombin Time 1 x 4.3ml citrate 15 – 18secs phlebotomy, and before 16:30 Haematology (1hr on request) NO AIRTUBE SYSTEM Part of Special Clotting Screen A&E/Priority – 1 hour 1 x 4.3ml Citrate Inpatients – 3 Newborn-1mnth: Routine 1 x 1.8ml (A&E hours Thrombin Time 14.0-21.0s Can be added onto samples up to 8 Haematology ONLY) Urgent Primary (TT) Adult: hours old (LRI/LGH/GH) (1 x 1.4ml care – 8 hours 15.0-18.0s Paediatrics) Outpatient/routine GP – 24 hours N/A
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 132 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Thrombophilia Screen: Special Requests to be authorised by Lupus anticoagulant , antithrombin, protein 4 x 4.3ml citrate 2 weeks N/A Haematology clinical staff C and protein S 1 x 10ml serum (no Routine gel separator) Thyroglobulin Biochemistry 4-6 weeks N/A Interpretation provided (1 x 1.2ml (LRI ONLY) Paediatric) 0-25 IU/mL 1 x 4.9ml serum gel <25- Negative Thyroid peroxidase antibody Immunology (1 x 1.1ml serum 4 days 25-35 Equivocal gel for paediatrics) >35 Positive A&E/Priority – 1 hour 0.3-5.0miu/L Routine 1 x 4.9ml serum gel Inpatients – 3 Thyroid Stimulating Hormone Biochemistry (1 x 1.1ml serum hours Telephone Limit: (TSH) (LRI ONLY) gel for paediatrics) Outpatient/routine >50miu/L GP – 24 hours
A&E/Priority – 1 hour Assay performed on behalf of Routine 1 x 4.9ml serum gel Inpatients – 3 Telephone Limits: Microbiology Tobramycin (monitoring) Biochemistry (1 x 1.1ml serum hours >2mg/L Contact Microbiology for (LRI ONLY) gel for paediatrics) Outpatient/routine interpretation GP – 24 hours
1 x 4.9ml serum gel Special Non-toxic: Topiramate (monitoring) (1 x 1.1ml serum 10 working days Biochemistry 5-20 mg/L gel for paediatrics) 1 x 4.9ml serum gel Total IgE Immunology (1 x 1.1ml serum 5 days <81 kU/L (adults) gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 133 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-2 weeks .01- 0.08g/L 2-6 weeks 0.02- 0.15g/L 6-12 weeks 0.05- 0.4g/L 3-6 months 0.1- 0.5g/L 6-9 months 0.15- 0.7g/L Patients with newly identified 1 x 4.9ml serum gel 9-12 months 0.2- panhypogammaglobulinaemia will Total immunoglobulin levels IgA Immunology (1 x 1.1ml serum 2 days 0.7g/L automatically be tested for serum gel for paediatrics) 1-2 yrs 0.3-1.2g/L immunofixation 2-3 yrs 0.3-1.3g/L 3-6 yrs 0.4-2.0g/L 6-9 yrs 0.5-2.0g/L 9-12 yrs 0.7-2.5g/L 12-15yrs 0.8-2.8g/L 15-45 yrs 0.8-2.8g/L >45yrs 0.8-4.0g/L Telephone Limit: >10g/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 134 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-2 weeks 5.0-17.0 g/L 2-6 weeks 3.9-13.0 g/L 6-12 weeks 2.1- 7.7g/L 3-6 months 2.4- 8.8g/L 6-9 months 3.0-9.0 g/L 9-12 months 3.0- Patients with newly identified 1 x 4.9ml serum gel 10.9g/L panhypogammaglobulinaemia will Total immunoglobulin levels IgG Immunology (1 x 1.1ml serum 2 days 1-2 yrs 3.1-13.8g/L automatically be tested for serum gel for paediatrics) 2-3 yrs 3.7-15.8g/L immunofixation 3-6 yrs 4.9-16.1g/L 6-9 yrs 5.4-16.g/L 9-12 yrs 5.4-16.1g/L 12-15yrs 5.4-16.1 g/L >15yrs: 6.0-16.0g/L
Telephone Limit: <6.0g and >15g/L(adults)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 135 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-2 weeks 0.05- 0.2g/L 2-6 weeks 0.08-0.4 g/L 6-12 weeks 0.15-0.7 g/L 3-6 months 0.2-1.0 g/L 6-9 months 0.4-1.6 g/L 1 x 4.9ml serum gel 9-12 months 0.6-2.1 Total immunoglobulin levels IgM Immunology (1 x 1.1ml serum 2 days g/L gel for paediatrics) 1-2 yrs 0.5-2.2 g/L 2-3 yrs 0.5-2.2 g/L 3-6 yrs 0.5-2.0 g/L 6-9 yrs 0.5-1.8 g/L 9-12 yrs 0.5-1.8 g/L 12-15yrs 0.5-1.9 g/L 15-45yrs 0.5-1.9 g/L >45yrs 0.5-2.0 g/L Telephone limits IgM >10g/L 24 hour urine Special Adult: <3.7µmol/24 Total Metanephrine (adults) or random 15 working days Biochemistry hours urine (paediatric) Not available to Primary Care Special Interpretation TPMT (thiopurine methyl transferase) 4.9 mL EDTA 4-6 weeks Analysed at City Hospital Biochemistry provided Birmingham
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 136 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range A&E/Priority – 1 hour Routine 1 x 4.9ml serum gel Inpatients – 3 Only available for Haematology Transferrin Biochemistry (1 x 1.1ml serum hours 2-4g/L patients, or on guidance from (LRI/LGH/GH) gel for paediatrics) Outpatient/routine Haematology GP – 24 hours
Inpatients – 3 1 x 4.9ml serum gel Routine hours Transferrin Saturation (1 x 1.1ml serum 20-55% Biochemistry Outpatient/routine gel for paediatrics) GP – 24 hours
6 x 2.7ml EDTA If concern of Transfusion- post transfusion Associated Graft Versus Host AND Blood Disease (TA-GVHD), discuss with 3 x 2.7ml EDTA Transfusion Reaction Investigations Transfusion 14 days N/A H&I Consultant pre-transfusion (LRI/LGH/GGH) Sample sent to Barnsley NHSBT AND NHSBT form required – see link in lines/remnants from Appendix 3 Units Pre-transfusion Donation numbers of all blood serum sample products transfused < 24hrs before AND Transfusion Related Acute Lung Injury event required 2 x 4.9ml Serum 14 days N/A (TRALI) Sample sent to Barnsley NHSBT Gel NHSBT form required – see link in AND Appendix 3 3 x 2.7ml EDTA A&E/Priority – 1 < 1 yr: 0.3-1.20 hour mmol/L Routine 1 x 4.9ml serum gel Inpatients – 3 ≥ 1 yr: 0-2.0mmol/L Must fast for 12-16 hours before Triglyceride Biochemistry (1 x 1.1ml serum hours sample collection (LRI/LGH/GH) gel for paediatrics) Outpatient/routine Telephone Limit: ≥ GP – 24 hours 20mmol/L
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 137 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range For interpretation of result see UHL Policy and Guidelines Document Number B41/2016:Non- Specific Chest Pain Routine 1 x 4.9ml Heparin Not available to Primary Care. in Adults Troponin I Biochemistry (1 x 1.2ml 1 hour If GP suspects coronary event, Investigation (LRI/LGH/GH) Paediatric) send patient to A&E immediately Pathway
Telephone limit: ≥100ng/L Increase/decrease of ≥3ng/L
1 x 4.9ml serum gel Analysed at Sheffield Teaching TSH receptor antibodies Immunology (1 x 1.1ml serum 14 days N/A Hospitals NHS Foundation Trust. gel for paediatrics) U A&E/Priority – 1 1 x 4.9ml serum gel hour Male: (1 x 1.1ml serum Routine Inpatients – 3 200-430 µmol/L gel for paediatrics) Urate Biochemistry hours Female: OR (LRI/LGH/GH) Outpatient/routine 140-360 µmol/L 24 hour urine (no GP – 24 hours 1.5-4.5mmol/24hr preservative)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 138 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range < 28 days: 0.8-5.5 mmol/L 28 days - 12 months: 1.0-5.5 mmol/L A&E/Priority – 1 1 - 15 yrs: 2.5- 6.5 1 x 4.9ml serum gel hour mmol/L Routine (1 x 1.1ml serum Inpatients – 3 ≥ 16 yrs: 2.5-7.8 Urea Biochemistry gel for paediatrics) hours mmol/L (LRI/LGH/GH) OR Outpatient/routine
24 hour urine GP – 24 hours Telephone limits:
≥30mmol/L (>16yrs) ≤10mmol/L (<16yrs)
400-750mmol/24hr Test not routinely available. Please 20ml urine sample discuss with laboratory and send Urinary free light chain characterisation Immunology (plain sterile 3 days N/A serum sample for suspected universal) myeloma cases Urinary free light chain quantitation (24 hour Analysed at Immunology Sheffield Immunology Immunology 7 days excretion) 5mL urine no <25µg/ mmol Analysed at Northern General Urinary Methyl Histamine Immunology 21 days preservative creatinine Hospital Sheffield. Protect sample from light Fresh urine Random Urine in Only for known patients or Special Urine porphyrins quantitation Sterile universal or 5 weeks N/A abnormal screens Biochemistry fluoride bottle Interpretation provided Analysed at University Hospitals of Wales
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 139 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Not available to Primary Care Random Urine in Patient >2days old Special Urine Steroid Profile (Paediatric) Sterile universal or 4-6 weeks N/A Collect sample prior to drug therapy Biochemistry fluoride bottle Analysed at Kings College Hospital Interpretation provided V A&E/Priority – 1 hour Potentially toxic: Routine 1 x 4.9ml serum gel Inpatients – 3 >150mg/L Valproate (monitoring) Biochemistry (1 x 1.1ml serum hours (LRI ONLY) gel for paediatrics) Outpatient/routine Telephone Limit: GP – 24 hours >150mg/L
A&E/Priority – 1 hour Assay performed on behalf of Routine 1 x 4.9ml serum gel Inpatients – 3 Telephone Limit: Microbiology Vancomycin (monitoring) Biochemistry (1 x 1.1ml serum hours >20mg/L Contact Microbiology for (LRI ONLY) gel for paediatrics) Outpatient/routine interpretation GP – 24 hours
1 x 4.9ml serum gel Analysed by Neuoimmunology VEGF Immunology (1 x 1.1ml serum 4 weeks 0.01-9.00pg/ml London gel for paediatrics)
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 140 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range C22: 15-115 mmol/L C24: 14-80 mmol/L C26: 0.33-1.5 Not available to Primary Care Very Long Chain Fatty Acids Peroxisomal Special 1 x 1.2ml Heparin mmol/L Includes phytanate and pristanate 4-6 weeks Disorders (Paediatric) Biochemistry (Paediatric) C24/C22: 0.44- Analysed at Sheffield Children’s 0.97mmol/L Hospital. C26/C22: 0.005- 0.030 mmol/L 0-6 yr: 0.7-1.5 µmol/L 7-12 yr: 1 x 4.9ml serum gel Samples should be separated and Special 0.9-1.7 µmol/L Vitamin A (1 x 1.1ml serum 20 working days frozen at -80° C within 24 hours of Biochemistry 13-19 yr: gel for paediatrics) collection 0.9-2.5 µmol/L Over 19 yr: 1.1-2.8 µmol/L Protect from light. To be Ideally 2 x 2.7 mL Special transported on ice and received by Vitamin B1 EDTA (1 x 1.2ml 20 working days 66.5-200 nmol/L Biochemistry laboratory within 60 minutes of Paediatrics) collection A&E/Inpatients – 1 x 4.9ml serum gel 3 hours Special Contact haematology for Vitamin B12 (1 x 1.1ml serum Outpatient/routine 220-700ng/L Biochemistry interpretation gel for paediatrics) GP – 24 hours
Protect from light. To be Ideally 2 x 2.7 mL Special transported on ice and received by Vitamin B6 EDTA (1 x 1.2ml 20 working days 35.2-110.1 nmol/L Biochemistry laboratory within 60 minutes of Paediatrics) collection
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 141 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Severe deficiency: <15 nmol/L A&E/Inpatients – Deficiency: 15 to 25 Routine 1 x 4.9ml serum gel 3 hours nmol/L Vitamin D Biochemistry (1 x 1.1ml serum Outpatient/routine 25-OH vitamin D analysis Insufficiency: 25 to (LRI ONLY) gel for paediatrics) GP – 24 hours 50 nmol/L
Adequate: >50 nmol/L
0-12 yr: 7-21 µmol/L 1 x 4.9ml serum gel 13-19 yr: Samples should be separated and Special Vitamin E (1 x 1.1ml serum 20 working days 14-23 µmol/L frozen at -80° C within 24 hours of Biochemistry gel for paediatrics) Over 19 yr: collection 12-42 µmol/L 3 x 2.7ml EDTA Protect sample from light Special Vitamin K assay OR 10 days N/A Analysed at St Thomas Hospital, Haematology 1 x 4.9ml serum London 1 x 4.9ml serum gel Voltage-gated calcium channel (VGCC) Analysed at the Neuroimmunology Immunology (1 x 1.1ml serum 28 days < 45 pM antibodies laboratory, Oxford. gel for paediatrics) 1 x 4.9ml serum gel Voltage-gated potassium channel (VGKC) Analysed at the Neuroimmunology Immunology (1 x 1.1ml serum 21 days <100 pM antibodies laboratory, Oxford. gel for paediatrics) Samples must be hand delivered to laboratory within 2 hours of Special von Willebrand Antigen 2 x 4.3ml citrate 4 weeks 51.9 – 154.3% phlebotomy, and before 16:30 Haematology NO AIRTUBE SYSTEM Part of von Willebrand Screen Analysed at QMC, Nottingham 1 x 2.7ml EDTA Inform laboratory when sending Special Von Willebrand genetics (1 x 1.2ml 6 weeks N/A sample Haematology Paediatrics) Include family tree if available Needs genetics request form
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 142 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Special Analysed at Royal Free Hospital, Von Willebrand Multimers 2 x 4.3ml citrate 1 month N/A Haematology London von Willebrand Screen: Factor VIII, Ristocetin Co-factor, von Special 4 x 4.3ml citrate 4 weeks N/A N/A Willebrand Antigen and Collagen Binding Haematology Assay if specifically requested) Prophylaxis and therapy: 1 x 4.9ml serum gel Pre 1.0-5.5mg/L Special For further interpretation, contact Voriconazole (monitoring) (1 x 1.1ml serum 5 working days OR Biochemistry microbiology gel for paediatrics) 2.0-5.5mg/L for bulky/disseminated infections W Analysed at St Thomas Hospital, London Special Warfarin assay 3 x 2.7ml EDTA 10 days N/A Notify laboratory before collecting Haematology sample Avoid collecting on Friday Blood Sample sent to Barnsley NHSBT 1 x 7.5ml EDTA ‘for Weak D versus Partial D Transfusion 7 days N/A NHSBT form required – see link in blood transfusion (LRI/LGH/GGH) Appendix 3
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 143 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range 0-2 yrs: 6.0–17.5 x 109/L 2-6 yrs: 6.0–17.0 x 109/L 6-12 yrs: A&E/Priority – 1 9 5.0-15.5 x 10 /L hour 12-15 yrs: Inpatients – 3 9 Routine 1 x 2.7ml EDTA 4.5–13.0 x 10 /L White Cell Count hours Haematology (1 x 1.2ml Adult: Part of Full Blood Count (WBC) Urgent Primary 9 (LRI/LGH/GH) Paediatrics) 4.0–11.0 x 10 /L care – 8 hours
Outpatient/routine Telephone Limits: GP – 24 hours During core hours: >30 x 109/L
Outside core hours: >50 x 109/L
Not available to Primary Care Sample to reach laboratory before Special 1 x 1.2ml EDTA White Cell Enzymes (Paediatric) 4-6 weeks N/A 1pm Monday to Thursday Biochemistry (Paediatric) Analysed at Willink, Manchester Interpretation provided
X
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017
PATHOLOGY Title: Blood Sciences User Handbook Reference: IN5501 Version: 8 Active date: August 2021 Pages: Page 144 of 144 Owner: Yusuf Sidat Author: Richard Wolfe
Sample Turn Around Reference Test Laboratory Additional Notes Requirements Time Range Not available to Primary Care MINIMUM volume 70µl required Recommended that sample is not taken until at least 12 h after and not more than 14 days relative to timing of suspected haemorrhage.
SAMPLE MUST BE PROTECTED 1 x 2.7ml Fluoride FROM LIGHT to prevent bilirubin EDTA Special All positive results degradation. (Place sample bag in Xanthochromia (CSF) (1 x 1.2ml 24 hours Biochemistry phoned out urgently thick brown envelope.) Paediatric)
Samples should be delivered to Pathology as soon as possible to allow centrifugation within 1 hour of collection. Do not use pneumatic air tube.
See Section 4 for out-of-hours procedure. Z 1 x 10ml serum (no gel separator) 5 working days Special (1 x 1.2ml (blood) 8.4-23µmol/L Analysed at Nottingham University Zinc Biochemistry Paediatric) 10 working days 4.9-5.8µmol/24hrs Hospitals OR (urine) 24 hour urine 1 x 4.9ml serum gel Trough level preferable. Special Zonisamide (monitoring) (1 x 1.1ml serum 10 working days 10-40 mg/L Analysed at TDM Unit, Epilepsy Biochemistry gel for paediatrics) Centre, Chalfont St Peter.
Please note that reference range provenance is available upon request.
Template Title: Template Headed Blank (Portrait Orientation) Reference: TF20 Version: 6 Active Date: November 2017