Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
Q-Pulse Ref: BIO-I-P-010 Q -Pulse Revision No: 6 Authorised By: D Darby Page 1 of 68
Pathology at Wigan and Salford (PAWS)
Department of Clinical Biochemistry User Guide
February 2021
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Department of Clinical Biochemistry
Laboratory Handbook: Table of Contents
Location………………………………………………………………………………………………………………………………….. 3 Hours of Operation ………………………………………………………………………………………………………………… 3 Senior Staff Contact details ……………………………………………………………………………………………………. 3 Contacting the Laboratory………………………………………………………………………………………………………. 4 Urgent and Out of Hours specimens……………………………………………………………………………………….. 5 Sample collection and Delivery………………………………………………………………………………………………… 6 Completing the request form……………………………………………………………………………………… 6 Specimen identification criteria………………………………………………………………………………….. 6 The use of pre-printed pathology labels…………………………………………………………………….. 7 Consent………………………………………………………………………………………………………………………. 7 Sample delivery to the laboratory……………………………………………………………………………….. 7 Patient collected samples……………………………………………………………………………………………. 8 Sample Analysis……………………………………………………………………………………………………………………….. 8 Specimen types, patient preparation and sample stability……………………………………………………….. 8 Physiological factors affecting tests results………………………………………………………………………………. 8 Analytical Factors affecting the Performance of an examination………………………………………………. 9 Uncertainty of Measurement……………………………………………………………………………………………………. 11 Retesting Intervals…………………………………………………………………………………………………………………….. 11 Adding on Tests…………………………………………………………………………………………………………………………. 12 Telephone Limits……………………………………………………………………………………………………………………….. 13 Quality Assurance and Accreditation………………………………………………………………………………………… 14 Internal Quality Assurance and External Quality Assurance………………………………………….. 14 Accreditation……………………………………………………………………………………………………………….. 14 Data Protection and Audit……………………………………………………………………………………………. 15 Laboratory Compliments and Complaints Procedure………………………………………………………………… 15 A to Z Table of Tests (sample types, reference ranges, turnaround times)………………………………… 16 Protocol for collection and handling of CSF specimens for detection Of Bilirubin (Xanthochromia) in suspected Subarachnoid haemorrhage (SAH)………………………… 54 Troponin I interpretation……………………………………………………………………………………………………… 55 Blood Gas reference ranges………………………………………………………………………………………………………… 57 Procalcitonin………………………………………………………………………………………………………………………………….57 Tumour Markers……………………………………………………………………………………………………………………….. 58 Faecal Immunochemical Test (FIT)……………………………………………………………………………………………… 58 Clinical Toxicology Service…………………………………………………………………………………………………………… 60 Porphyria service/Urgent PBG…………………………………………………………………………………………………….. 61 List of Referral Laboratories……………………………………………………………………………………………………….. 63
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Department of Clinical Biochemistry
The department serves the acute trusts of Salford Royal NHS Foundation Trust, Wrightington, Wigan and Leigh NHS Foundation Trust, Greater Manchester West Mental Health trust, and the Clinical Commissioning Groups in Salford and Wigan. It is also working within the Northern Care Alliance; an alliance formed between Salford Royal NHS FT and Pennine Acute trust. The department is a specialist regional centre for endocrine assays, urine drugs of abuse screening, and porphyrin analysis. A full repertoire of assays performed within the department including tests referred to other laboratories can be found on pages 14-47.
At Salford Royal, the Central Services Laboratory is located within the department of Pathology on the second floor of the Turnberg building, and serves outpatient and primary care locations across both Salford and Wigan and inpatient services for Salford Royal. At Wigan, an Essential Services Laboratory is located on level 3 above the Cancer Care suite at the Royal Albert Edward Infirmary at Wigan, providing services for inpatient locations on that site. Site maps for both hospitals can be accessed as below:
http://intranet.srht.nhs.uk (Salford) http://www.wwl.nhs.uk (Wigan)
Hours of operation
Across both sites the core hours of service are 9.00am - 5.30pm Monday – Friday. The laboratory provides a reduced number of investigations outside of these core hours 24 hours a day, every day of the year, though as this service is provided by a limited number of staff, use of this service should be restricted to urgent investigations only. Laboratory contact details are listed below. For a list of tests available outside of normal working hours, please refer to page 5.
Senior Staff Contact Details
Name Position Telephone Email
Dr Denise Darby Consultant Chemical 0161 206 4955 [email protected] Pathologist and Clinical Lead
Dr Joanna Borzomato Consultant Clinical Scientist 0161 206 4205 [email protected]
Laura Owen Consultant Clinical Scientist 0161 206 4956 [email protected]
Barry Gallagher Biochemistry Services 0161 206 4179 [email protected] Manager Louise Bell Quality manager 0161 206 5016 [email protected]
Susan Simpson Point of care testing Co- 0161 206 1694 [email protected] ordinator
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Contacting the laboratory
Section Telephone Additional information
Results & general enquiries 0161 206 4958 Service operates 9am-5.30pm Monday-Friday. (Salford) Results will be transmitted to the Electronic patient 01942 82 2127 record (EPR) as soon as they are available. Please (Wigan) check the EPR before contacting the laboratory.
Add on tests Salford In-patients Add-on requests are performed on EPR
Wigan In-patients Add on requests should be written on request forms and sent via the pod system referring to the original specimen number.
GP Patients Salford - Please call 0161 206 4958 (9-5.30pm) Wigan – Please call 01942 82 2127 (9-5.30pm)
Clinical Advice 0161 206 8212 9am-5.30pm Monday-Friday (Duty Biochemist) For out-of-hours enquiries: Salford: Bleep on-call Biomedical Scientist 3012 Wigan: Telephone on-call Biomedical scientist 01942 82 2121
Main Laboratory, Wigan 01942 82 2121
Main Laboratory, Salford 0161 206 4964
Drugs Laboratory, 0161 206 4954 Please use this number for results and clinical advice Salford regarding urine drugs of abuse screening.
Specialist Laboratory, 0161 206 4966 For enquiries regarding the following specialist tests: Salford porphyrins, urine and plasma metadrenalines , 5HIAA, faecal calprotectin and Immunosuppressant’s.
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Urgent and out of hours specimens
The following tests are available on one or both sites at all times. Tests in brackets only offered on Salford site.
General Biochemistry (Serum/Plasma) General Biochemistry (Whole blood)
Renal profile (Na, K, urea, creatinine) Blood Gases Liver Profile (Bilirubin, ALT, ALP, albumin, total Co-oximetry (Carboxyhaemoglobin + protein) Methaemoglobin Bone Profile (Calcium, phosphate, albumin) Suspected toxicity or overdose (serum/plasma) Anion Gap (Na, K, Chloride, Bicarbonate) Digoxin CRP Lithium (SRFT)** Troponin I (high sensitivity) and nt-pro BNP Paracetamol Osmolality Salicylate Glucose/Lactate Gentamicin, Vancomycin, Tobramycin Cortisol Theophylline (SRFT)** Creatine Kinase Ethanol Magnesium Carbamazepine (SRFT)** -hCG Phenytoin (SRFT)** Ammonia Urine Bilirubin Urine electrolytes (Na, K, urea, creatinine) (SRFT) Iron Urine osmolality Amylase Urine porphobilinogen (PBG) (SRFT) Urate CSF Thyroid function tests CSF glucose and protein (SRFT)
** For those samples requested at WWL, transit time to SRFT should be factored into turnaround time for TDM drugs. Please contact the WWL laboratory on 01942 822 121 if you wish to discuss an urgent request.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Sample collection and delivery
Completing the request form
Users are encouraged to complete all requests via the electronic ordering system. Paper request forms may be used where electronic ordering is not available but should otherwise be reserved for events where electronic ordering systems are not working.
Relevant clinical details are essential when submitting requests, in order to aid interpretation of results. The Duty Biochemist may add additional tests based on clinical information received. The requesting clinician MUST sign all handwritten request forms. Please ensure that paper request forms are legible and provide a contact telephone number so that critically abnormal results can be telephoned as soon as they are available. For electronic requests please ensure the correct patient episode has been selected prior to requesting the test as the results will be returned to the consultant responsible for the patient episode selected.
Specimen identification criteria
Each request accepted by the laboratory for an examination shall be considered an agreement.
For patients’ safety, it is essential that specimens are accompanied by the appropriate request form, with accurate and complete patient identification on both request form and patient samples. Medical staff are requested to provide ALL the information asked for on the request form Samples that do not meet the sample requirements below will be rejected.
Sample Request form Required Information Required Information
Patient’s full Name or Unique coded identifier The request form data MUST match the specimen information and include: Date of Birth • Patient’s full Name or Unique coded And identifier Hospital Number or NHS Number • Hospital Number or NHS number • Date of birth Date and time of collection • NHS number Request forms should also include: • the patient’s location/destination for the report (or a location code) • Tests required • Name of Consultant or GP • Name of the requester and contact number (bleep or extension) • Date and time of specimen collection
• All relevant clinical information Drug administered, dose, time of last dose, time • Patient address for GP requests of specimen in relation to dose for therapeutic
drug monitoring
Multiple specimens taken at different times on a 6
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patient MUST be labelled on the specimen container with the time (24 hr clock) when the specimen is taken. The request form should be labelled accordingly.
The specimen must have three identifiers that relate to the request form. It is essential that the date and time of collection be stated on the sample. If multiple tests are requested more than one blood tube may be required.
In situations where samples are considered precious or unrepeatable, the requesting clinician must accept responsibility for correcting any changes to the request form and/or specimen to allow processing to occur.
The Use of Printed Pathology Labels
Where self-adhesive labels are printed on the request form they should be used to label the specimen container. There will be a separate label for each container type required. It will state on the label which tube the label is intended for. Please ensure the correct label is stuck on the correct specimen container. The bar code must be vertical on the tube; the bottom of the label should be at least 13mm from the bottom of the tube. Add the date and time that the specimen was collected.
Consent
It is the responsibility of the requesting clinician to obtain consent from the patient for the collection of blood specimens. For certain tests (e.g. genetic testing) a consent form may be required in addition to the request form.
Sample delivery to laboratory
A pneumatic tube delivery (pod) system can be used to deliver specimens to the laboratory from a variety of inpatient locations across both sites, and should be used where available. Please note that the Estates department are responsible for any issues regarding pod system breakdowns.
All specimens irrespective of mode of delivery should be placed in the appropriate container which must be securely fastened. The container should be sealed into the plastic compartment attached to the request form. Specimens should be transported to the laboratory as rapidly as possible after collection to ensure that no significant deterioration occurs before processing.
Specimens for tests that are unstable (please refer to specimen A-Z), blood gas/CSF specimens, and for requests that are very urgent, should be taken directly to the laboratory to avoid delay and be handed to a member of specimen reception staff directly.
Samples that arrive via other hospitals via post or transport should be packaged according to UN3373 requirements for safe transport.
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Porter and phlebotomy services also serve several locations across both hospital sites. Please refer to trust intranet sites for contact details of these services.
Patient collected samples
Instructions for the collection of 24-hour urine samples by patients and their delivery to the laboratory can be found on the SRFT and WWL intranet and internet sites, and are available for patients from the laboratory specimen reception at Salford, Wigan, Leigh and the Thomas Linacre Centre.
Sample Analysis
Specimen types, patient preparation, and sample stability
Specimen requirements for each test are described in the test A-Z. If more than one test is required multiple tubes may be required. The sample volumes for each test are reviewed annually. Please contact the Duty Biochemist on 0161 206 8212 to discuss correct specimen types, stability or number of tubes required for any test not listed.
Physiological factors affecting test results
Many factors other than disease affect the value and the interpretation of a variety of tests. Common factors (i.e. age, gender) are often accounted for with the use of appropriate reference ranges.
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Analytical factors affecting the performance of an examination
Common analytical factors that are known to affect the performance of a test or the interpretation of results are described below.
Factors Precautions
Mixing Thorough but not violent mixing of blood with anti-coagulant must be carried out by gently inverting the tube at least three times, immediately on collection. Haemolysis Avoid mechanical trauma to red cells. Never inject blood through a syringe needle into a specimen collection tube. Avoid extremes of temperature. Contamination Do not take blood from the same limb being used for infusion of fluids or decant blood from one container to another. Collect tubes for haematology (EDTA tubes) AFTER samples for biochemistry (serum tubes) Venous Constriction It is essential that there should be no venous constriction (tourniquet) or active muscle movement during the collection of blood for the estimation of such constituents as calcium, protein, lactate and electrolytes, as this can lead to considerable alteration in levels. If avoidance of constriction is not practicable, its duration must be kept to an absolute minimum. Delay in Transport of specimens to laboratory Considerable changes in the concentration of some blood constituents (e.g. Potassium, Phosphate) may occur if the blood is allowed to stand for any length of time before analysis begins, or separation of serum or plasma occurs.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Factors Precautions
Biotin Biotin is a water-soluble B vitamin (B7), and exogenous supplementation is a known interference in several biochemistry immunoassays due to the interference in the biotin-streptavidin detection systems used in the many assay designs. Although biotin does not interfere with assays at normal dietary levels or those present in low dose multi-vitamin preparations (5- 10mg), large dose supplementation >100 mg (e.g. those taken in the treatment of metabolic diseases such as isolated carboxylase defects and defects of biotin metabolism and Multiple Sclerosis) are noted to have an effect on several assays. Biotin may have the potential to cause either falsely low or falsely high results and the direction and magnitude of interference are assay specific. The blood clearance time of biotin is dependent upon the dose and duration of supplementation but has been quoted as approximately 8 – 19 hours. Please contact the Duty Biochemist for more detailed explanation of potential interference. Interfering drugs Previous administration of a drug may cause interference in analysis. It is impossible to list all such potential interferences and advice should be sought from the Duty Biochemist when there is any doubt. Known interferences in tests using current instrumentation are:
Interference Assay affected N-Acetyl Cysteine May cause falsely negative paracetamol results Eltrombopag May cause falsely low/normal bilirubin results or falsely normal/elevated creatinine results Etamsylate May cause falsely low results in the following assays: Enzymatic Creatinine, Fructosamine, Lactate and Triglycerides. Sulfasalazine May cause falsely high results for Ammonia (up to +76%) and Salicylate (up to +25%), and falsely low results for ALT (up to -33%). Please collect blood sample prior to administration of this drug. Sulfapyridine May cause falsely low results for Ammonia (up to -18%) and Salicylate (up to -25%). Effect on ALT should be <10%. Please collect blood sample prior to administration of this drug.
If a sample is unsuitable for analysis due to one of these factors, the user will be notified on the report with a comment stating reason. If an unsuitable sample is analysed (in the rare case of unrepeatable samples e.g. blood gases, CSF analyses), a disclaimer may be issued to the user via the report. Please feel free to contact the Duty Biochemist on 01612068212 if you wish to discuss any patient in whom you suspect results may have been influenced by one of these factors.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Uncertainty of measurement
All biochemical results are subject to a degree of uncertainty of measurement. This may be due to a range of factors, including:
• Biological variation within individuals • Analytical measurement imprecision • Pre-analytical factors
If you require more information regarding the effects of these factors on the outcome of an individual test result please contact the Duty Biochemist on 0161 206 8212.
Retesting intervals
Users should consider the necessity of repeating tests within short timeframes and to check when tests were previously requested. Repeat intervals depend upon numerous factors: guidance and treatment/monitoring guidance, analytical considerations and biological half-life. The table below shows proposed minimum retesting intervals for some commonly requested tests. Exceptions to these intervals may apply in specific clinical circumstances.
Test Minimum retesting interval CRP 24 hours (except paeds) Iron/ferritin In a healthy patient: 1 year. Exceptions for patients on TPN, CKD, HHC Vitamin B12 and Folate Repeats are unnecessary for those patients who are deficient Troponin I (hs) 2 hours may need 6 hours and 12 hours Vitamin D Do not re-test unless clinically indicated. If patient on Chole/Ergo Calciferol for correction of confirmed low Vitamin D then 3-6 months Thyroid function test • Depends if patient on Treatment or not and for disorder: If not on treatment: Healthy person without symptoms: 3 years • If on Thyroxine: annually or 2-3 months after change of dose or initiation of therapy (children may have different time intervals according to age(NICE NG145 2019). • Sub-clinical hypothyroidism: 3-6 months. If confirmed and Antibody positive then annually Sub-clinical hyperthyroidism: 1-2months then if monitoring 6-12 months TPO antibodies Does not need to be repeated TMPT Does not need to be repeated
From National minimum re-testing intervals in Pathology Published by RCPath, ACB and IBMS, 2015
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Adding on tests
Freshly collected samples are preferred for analysis. However routine serum and urine samples are stored at 4ºC for approximately 2-4 days after receipt and certain tests may be added to these specimens. Commonly requested tests that may not be added to specimens after specific time intervals due to instability are described in the table below. Please contact the Duty Biochemist to discuss if required.
Test Time Limit ACTH Cannot be added Ammonia Cannot be added Calcitonin Cannot be added Gut hormones / Gastrin Cannot be added Bilirubin (CSF) Cannot be added Homocysteine Cannot be added Insulin/C-peptide Cannot be added LDH Cannot be added Metadrenalines (plasma) Cannot be added Porphyrins (plasma/urine) Cannot be added Renin/Aldosterone Cannot be added Reducing Substances (urine or faeces) Cannot be added Troponin I 24 hours 4OC Procalcitonin 24 hours 4OC PTH 8 hours at 4OC Lactate 6 hours at RT once spun B12 24 hours at 4OC Folate 24 hours at 4OC Enzymatic Creatinine 5 days at 4OC Bilirubin (serum) 5 days at 4OC ALT 5 days at 4OC Bicarbonate 5 days at 4OC Anion Gap 3 days at 4OC Prolactin 3 days at 4OC PSA 5 days at 4OC
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Telephone Limits
The following results will be telephoned to the requesting location or out-of-hours services at all times. Please note that the primary method for transmission of all results is to the electronic patient record.
Test Result Exceptions/Notes
AKI AKI stage 3 Unless last result was also AKI 3 AKI stage 2 GP patients only
ALT >1000 U/L (OP/GP only) Higher in last 7 days
Ammonia >100 U/L Higher in last 7 days If adult >200 bleep Metabolic Consultant on call via switch
Amylase >500 U/L Higher in last 7 days in inpatient
Bilirubin >250 (Neonates only) Higher in last 7 days in inpatient or haemolysed community samples Phone to antenatal midwife if community and have number; otherwise contact WWL Rainbow ward.
Calcium (adjusted) ≤1.8 or ≥3.0 mmol/L 1. If <1.8, lower in last 7 days 2. If ≥3.0, higher in last 7 days Carbamazepine >25 mg/L
Creatine Kinase (CK) >2000 U/L 1. Rheumatology/ Metabolic patients 2. Higher in last 7 days Carboxyhaemoglobin >15%
Creatinine >400 umol/L 1. Patient under renal physician 2. Higher in last 12 weeks
Digoxin >2.5 ug/L Higher in last 7 days
Gentamicin Trough >2 mg/L
Glucose <2.5 - >25 mmol/L (adults) 1. Only phone <2.5 in inpatients <2.5 - >15 mmol/L (children) 2. Not in dynamic function tests 3. Higher in last 2 days in inpatients Iron >90 umol/L
Lactate >4 mmol/L Higher in last 2 days
Lithium >1.5 mmol/L
Magnesium ≤0.4 mmol/L Lower in last 2 days (≤0.7 to Apollo/Athena wards)
Paracetamol If detected >50 mg/L Higher in last 24 hours
PBG (urgent) Any result
pH <7.20 >7.60
Phenytoin >25 mg/L Higher in last 7 days
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Test Result Exceptions/Notes
Phosphate ≤0.3 mmol/L Lower in last 7 days
Potassium ≤2.5 - ≥6.5 mmol/L (>7.0 if pre-dialysis)
Salicylate If detected >50 mg/L Higher in last 24 hours
Sodium ≤120 - ≥150 mmol/L (GP/OP) If <120 in last 7 days and current result ≥110 ≤120 - ≥160 mmol/L (Inpatients) (inpatients only) If >160 in last 7 days and current result ≤170 (inpatients only) Theophylline >25 mg/L
Tobramycin Trough >2.0 mg/L If location community based paediatrics Peak >8.0 mg/L phone Rainbow ward WWL
Troponin I All troponins >ULN ng/L to GP/OP WWL to inform ward of haemolysed samples 58 ng/L (m) 40 ng/L (f) Urea >30 mmol/L (Non-Renal) Higher in last 6 weeks >50 mmol/L (Renal)
Vancomycin >20 mg/L
Quality Assurance and Accreditation
IQC and EQA
The department participates in internal quality control (IQC) and external quality assurance (EQA) for all the tests undertaken within the laboratory where schemes exist. Performance is regularly monitored and subject to rigorous control, to ensure that analyses are accurate, precise and results are comparable with other laboratories. For information on the analytical performance of specific tests, contact the Duty Biochemist on 0161 206 8212.
Accreditation to ISO15189 standards
The Department of Clinical Biochemistry holds full accreditation to ISO15189 standards (UKAS) for most laboratory based analyses. Assays that are not currently ISO15189 accredited or are undergoing extension to scope activities will be marked as such on the report. The laboratory accreditation number is 8331 and a published schedule of accreditation can be found via the following link: http://www.ukas.org.
The laboratory also regularly monitors the ISO15189 UKAS accreditation status of the referral laboratories used for specialist testing.
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The Drugs of abuse screening laboratory is also ISO15189 UKAS accredited. The lab is also required to hold a Home Office Licence which is renewed annually. The Porphyrin Section is recognised internationally as a Specialised Porphyrin Laboratory by the European Porphyria Network (EPNET).
Accreditation for training
The Clinical Biochemistry department is committed to providing a quality training and education. It holds accreditation for training for Biomedical Scientists through the Institute of Biomedical Science (IBMS) and for Clinical Scientists through the National School of Health Care Science (NSHCS).
Data Protection and Audit
In order to protect patient confidentiality, clinicians or other healthcare professionals wanting to request data for research or audit practices are advised to contact the Duty Biochemist on 0161 206 8212 in the first instance. A departmental pro-forma must be completed prior to the release of this information.
Only healthcare professionals directly involved in the analysis of the patient’s sample or interpretation of the patient’s results will have access to the laboratory computer systems required to process the patient sample.
Laboratory Compliments/Complaints Procedure
Users are encouraged to contact senior laboratory staff to discuss any concerns, in addition to using the Trusts’ Datix systems available across both sites to register non-conformances. If you wish to feed back on the performance of any aspect of the laboratory, please contact the Pathology Quality Manager Mrs Louise Bell on 0161 206 5016 or the department’s Clinical Governance Lead Dr Joanna Borzomato.
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Table of Tests (listed alphabetically) All reference ranges are for adults unless specified. All turnaround times for in-house assays reflect time taken from receipt of sample into lab to report authorisation. The minimum turnaround time for GP samples in 24-hours. Turnaround times for referred analyses refer to time taken from receipt at referral laboratory to authorisation of report from referral lab. Total turnaround time will therefore be greater to incorporate transport times and result transmission via various means.
Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
ACE, serum Serum 20 - 70 U/L 7 working In-house, (angiotensin (brown), <18 y 29-112 days Batched converting enzyme) 1 mL test
ACE, CSF Plain < 1.2 µmol/min/L 10 days Referred to (angiotensin container, external lab converting enzyme) 0.5 mL
Acyl carnitines EDTA (red), See report 2 weeks Referred to 1 mL or external lab Bloodspot
AFP Serum 0 - 6.7 KU/L Urgent: In-house, (alpha fetoprotein) (brown), 1 hour routine 5 mL Routine: 3 hours ACR Random Both sexes: 24 hours In-house, (Albumin:Creatinine urine, 1 mL <3.0 g/mol Routine ratio)
ACTH EDTA (red), 0 - 46 ng/L Deliver to lab 7 working In-house, (Adrenocorticotropic 1 mL within 1hr of days Batched hormone) collection. test Adalimumab – see Infliximab
Alpha Glucosidase EDTA (red), See report Ideally take 2 weeks Referred to (Acid Maltase) 5 mL or sample Mon- Blood spots external lab Pompe Bloodspot Thurs. up to 4 Needs to reach weeks referral lab within 48 hrs. Albumin Serum < 1y: 30 - 45 Urgent: In-house, (brown), 1y -16y: 30 - 50 1 hour, Routine 5 mL >16y : 35 - 50 Routine: 3 hours Units: g/L
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Aldosterone EDTA (red), <630 pmol/L Investigation of 10 days Referred to 1 mL primary hyper- external lab Aldosterone: renin aldosteronism ratio (ARR): <1000: requires 1º hyper- concurrent renin aldosteronism measurement to unlikely calculate ARR. Ideally stop 1000-2000: Blockers 2 weeks Equivocal prior to measurement. >2000: Consistent Patients should be with 1º hyper- normokalemic. aldosteronism
ALP Serum 0 - 4w: 70 - 380 Urgent: In-house, (alkaline phosphatase) (brown), 4w - 16y: 60 - 425 1 hour, Routine 1.0 mL >16y: 30 - 130 Routine: 3 hours Units: U/L
ALP isoenzymes Serum See report Request to be 3 weeks Referred to (brown) discussed with external lab 1 mL Duty Biochemist beforehand. Alpha-1 Antitrypsin, Serum >16y: 0.8 - 2.0 g/L Phenotyping 24 hours In-house, serum (brown), added to patient Routine 0.5 mL samples with alpha-1- antitrypsin <0.8g/L and children <18 years
Alpha-1 Antitrypsin, Formed stool See report 5 working Referred to faeces in plain days external lab container,1 g
Alpha-1 Antitrypsin Serum See report 10 days Referred to Phenotyping (brown), external lab 2 ml
Alpha-1 Antitrypsin EDTA (red), See report 28 days Referred to Genotyping 2 mL external lab
Alpha-Subunit Serum See report 3 weeks Referred to (brown), external lab 0.5 mL 17
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
ALT Serum 7 - 40 U/L Urgent: In-house, (alanine (brown), 1 hour, Routine aminotransferase) 0.5 mL Routine: 3 hours Aluminium Lithium < 0.5 µmol/L Brown serum <5 days Referred to heparin tubes contain external lab (orange), aluminium in the 1 mL gel, hence should not be used.
Amino acids, CSF CSF, See report Includes CSF 3 weeks Referred to 1 mL & paired glycine external lab Lithium heparin (orange), 3 mL
Amino acids, plasma Lithium See report Urine amino acids 3 weeks Referred to heparin are recommended external lab (orange), as the initial 3 mL screening test for Sample needs investigation of to be at the amino acid lab within 30 metabolic mins. of disorders. collection
Amino acids, urine Random See report If organic acids 3 weeks Referred to urine, also requested, external lab 5 mL requires 10 mL urine Ammonia EDTA (red), <4w: < 100 Deliver to lab Urgent: In-house, 5 mL 4w - 16y: < 50 ASAP -must be 1 hour Routine >16 y: 12-32 separated within 15 mins. of Units: µmol/L collection
Amylase, serum Serum 30 - 118 U/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours Amylase, urine Random < 650 U/L 24 hours In-house, urine, Routine 5 mL
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Amylase (fluid) Fluid in plain Fluid assays are Routine In-house, container not CE marked or 3 hours Routine 1 mL within scope of ISO15189 accreditation Amylase isoenzymes Serum See report Request to be 5 weeks Referred to & macroamylase (brown), discussed with external lab 1 mL Duty Biochemist beforehand.
Amyloid A Serum 0 – 10 mg/L 7 days Referred to (brown), external lab 2 mL
Androgen profile Serum Refer to individual Performed on 10 working In-house, Includes: (brown), analytes female patients. days Batched Testosterone 5 mL test Androstenedione SHBG Free androgen index
Androstenedione Serum 0 - 6 nmol/L (f) 10 working In-house, (brown), 0.9-7.2 nmol/L (m) days Batched 5 mL test (Pre-pubertal: <2)
Anion Gap Serum 12 - 20 mmol/L Calculated: Urgent: In-house, (brown), (Na + K) – (Cl + 1 hour, Routine 5 mL HCO3) Routine: 3 hours
Anti-Mullerian Serum See report Deliver to lab 1 day Referred to Hormone (brown), immediately external lab (AMH) 1 mL following sample collection (within 4 h). Restricted to requests on obs/gynae patients.
Anti-Streptolysin Serum <200 IU/mL 1 week In-house, Antibody-O (ASO) (brown), Batched 5 mL test
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Apo A and B EDTA (red), Apo A: 1.0 – 2.2 g/L 1 week Referred to 2 mL Apo B: 0.6 – 1.3 g/L external lab
Apo-E genotyping EDTA (red), See report 4 weeks Referred to 3 mL external lab
Aryl Sulphatases EDTA (red), See report Needs to reach 4 weeks Referred to 5 mL (two referral lab within external lab samples 72hrs required)
AST Serum 13 - 40 U/L Urgent: In-house, (aspartate (brown), 1 hour, Routine aminotransferase) 5 mL Routine: 3 hours Beta-2 Microglobulin Serum 1.0 - 2.4 mg/L 7 working In-house, (B2M) (brown), days Batched 5 mL test
Beta Carotene Serum 0.19-1.58 μmol/L Protect from light 21 days Referred to (brown), external lab 3.5 mL
Beta C-terminal EDTA (red), 0.1 – 0.5 μg/L Fasting sample <72 hours Referred to Telopeptide (βCTX) 1 mL preferred external lab
Beta Galactosidase EDTA (red), See report Needs to reach 3 weeks Referred to 5 mL referral lab within external lab 72hrs
Beta Glucosidase EDTA (red), See report Ideally take 3 weeks Referred to (Gaucher) 5 mL sample Mon- external lab Thurs. Needs to reach referral lab within 72hrs.
Beta-2-transferrin Fluid (plain Not detected / Investigation of Same day if In-house (Tau protein) container), Detected CSF leak. received 5 mL. Send before concurrent 12pm. serum sample Otherwise 1 mL (brown next tube) with working fluid. day.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Beta-hydroxybutyrate Lithium See report If Free Fatty Acids 2 weeks Referred to (BHB) heparin also required, external lab (Plasma ketones) (orange), deliver sample to 1 mL lab ASAP following sample collection. Bicarbonate Serum <16y: 19 - 28 Urgent: In-house, (Total CO2) (brown), >16y: 22 - 29 1 hour, Routine 5 mL Routine: Units: mmol/L 3 hours
Bile acids Serum 0 - 14 µmol/L 1 day Referred to (brown), external lab 1 mL
Bilirubin – Conjugated Serum <5 µmol/L Protect sample Urgent: In-house, (brown), from light. 1 hour, Routine 5 mL Routine: 3 hours
Bilirubin – Total Serum <21 µmol/L Protect sample Urgent: In-house, (brown), from light. 1 hour, Routine 5 mL Routine: 3 hours
Bilirubin – Neonatal Serum See above Protect sample Urgent: In-house, (includes total and (brown), from light. 1 hour, Routine conjugated bilirubin) paediatric Routine: tube 3 hours 0.3 mL
Biotinidase Lithium 4 -12 nmol/min/mL Sample must be 2 weeks Referred to heparin received into lab external lab (orange) within 30 mins of 2 mL collection.
Blood Brain Barrier CSF 1mL See report 10 working In-house, studies Serum days Batched (brown) 5mL test
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Blood Gases Arterial Arterial: Remove needle 30 minutes In-house, /venous/ pH: 7.35-7.45 from syringe /cap Routine capillary PCO2: 4.5-6.4 kPa with a luer lock blood in plug. Ensure no O2: 11-14.4 kPa heparin-ised P air bubbles in Bicarbonate: 21-28 syringe, sample. Deliver to mmol/L 3 mL lab within 30 mins BE: -3 to +2 of collection mmol/L Recommend do O2 Saturation: not send in 94-98 % pneumatic air
tube. K+: 3.5-5.1 mmol/L
Na+: 136-145 Currently not mmol/L within ISO15189 Ca++: 1.15-1.33 scope of mmol/L accreditation Cl-: 98-107 mmol/L Glu: 3.6-5.3 mmol/L Lactate: 0.4-0.8 mmol/L
*Please see additional ranges for venous and capillary blood gases at the end of this table.
BNP Serum < 400 ng/L Currently not Urgent: In-house, (NT-pro-BNP Brain (brown), within ISO15189 1 hour, Routine natriuretic peptide) 5 mL scope of Routine: accreditation 3 hours
Bone Profile Serum See individual Urgent: In-house, (includes: (brown), analytes 1 hour, Routine total calcium, 5 mL Routine: adjusted calcium, 3 hours Phosphate ,albumin and ALP
CA 12-5 Serum < 30 KU/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
CA 15-3 Serum < 32 KU/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours
CA 19-9 Serum < 37 KU/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours
Cadasil EDTA (red), See report 8 weeks Referred to 3 mL external lab
Cadmium EDTA (red), See report 5 days Referred to 2 mL external lab Or Random urine 10 mL
Caeruloplasmin Serum 0.15 – 0.26 (m) 24 hours In-house, (brown), 0.17-0.34 (f) Routine 5 mL Units: g/L
Calcitonin Serum Male: <8.4 ng/L Deliver to lab 1 week Referred to (brown), Female: <5.0 ng/L immediately external lab 2 mL following sample collection. Patient must be fasted overnight.
Calcium, serum Serum Reference ranges Total calcium and Urgent: In-house, (brown), for adjusted albumin values 1 hour, Routine 5 mL calcium: are used to Routine: >4w: 2.2 - 2.6 calculate the 3 hours adjusted calcium Units: mmol/L value.
Calcium, urine 24-hour 2.5 - 7.5 24 hours In-house, urine/random mmol/24hour Routine (no preservative)
Ionised Calcium Arterial blood 1.15 – 1.33 mmol/L 30 mins In-house, in heparin- Routine ised syringe, 3 mL
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Calcium excretion Serum 0.013 - 0.037 Requires paired 24 hours In-house, index (brown), mmol/L serum +early Routine 5 mL and morning urine random urine, samples. Patient 10mL must be Vitamin D replete
Calprotectin Faeces < 50 µg/g faeces 7 working In-house, in plain days Batched container, test 1-5 g
Carbamazepine Serum 4 - 12 mg/L Trough (pre-dose) Urgent: In-house, (brown), sample. SRFT 1h Routine 5 mL WWL 3h Routine: SRFT 3 h WWL 5h
Carbohydrate Serum 0.0-2.6% 5 days Referred to Deficient Transferrin (brown), external lab (CDT) 2 mL
Catecholamines in Urine, random See report Sample must be 1 week Referred to Children (VMA & HVA) 10 mL received in the lab external lab within 3hrs of collection
CEA serum/fluid Serum <3 µg/L Analysis of fluids Urgent: In-house, (Carcinoembryonic (brown), not CE marked or 1 hour, Routine antigen) 5 mL within scope of Routine: Fluid, 5 mL ISO15189 3 hours accreditation
Chitotriosidase EDTA (red), 4-120 nmol/mL/hr Take sample Mon- 3 weeks Referred to 2 mL Thurs.Needs to external lab reach referral lab within 72hrs.
Chloride Serum 95 - 108 mmol/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Cholestanol EDTA (red), <16 μmol/L 4 weeks Referred to 2 mL external lab
Cholesterol - Total Serum <5.0 (primary Urgent: In-house, (brown), prevention) 1 hour, Routine 5 mL <4.0 (secondary Routine: prevention) 3 hours
Units: mmol/L
Cholesterol - HDL Serum Male: >1.0 Urgent: In-house, (brown), Female: >1.2 1 hour, Routine 5 mL Routine: Units: mmol/L 3 hours
Cholesterol - LDL Serum < 3.0 (primary Fasting sample. Urgent: In-house, (brown), prevention) Calculation 1 hour, Routine 5 mL < 2.0 (secondary derived from total Routine: prevention) cholesterol, HDL 3 hours and triglycerides. Units: mmol/L Calculation not performed when triglycerides >4.5 mmol/L.
Cholinesterase Serum 620 - 1370 U/L 3 weeks Referred to (brown), external lab 1 mL
Chromogranin A Serum 0-91 ng/mL Must be received 1 week Referred to (brown), within 2h external lab 0.5 mL collection
Ciclosporin A EDTA (red), 60 - 220 µg/L Trough (pre-dose) 1 day (same In-house, 3 mL (post-renal or 2 hours post- day if Batched transplant) dose. received test before 9 am) Citrate, Urine 24-hour urine 1680 - 6450 Sample acidified 2 weeks Referred to (no µmol/24hour to pH ≤2.0 on external lab preservative) receipt.
Clozapine EDTA (red), Contact Duty 2 working Referred to 2 mL Biochemist before days external lab sending.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Cobalt/Chromium EDTA (red), See report 5 days Referred to 2 mL external lab
Co-oximetry Arterial blood Arterial: Remove needle 30 minutes In-house, in heparin- OxyHb: 90 - 95% from syringe and Routine ised syringe, COHb: 0.5- 1.5% cap with a luer 3 mL non-smokers lock plug. Deliver MetHb: < 1.5% to lab HcT: 37-50 % immediately after tHB: 117-174 g/L collection. Do not send in pod.
Co-Peptin Serum See report Need to include 4 weeks Referred to (brown), EDTA osmolality results external lab (red), Lithium with referral. Heparin (orange)
1 mL
Copper, serum Serum 13 - 24 µmol/L 5 working In-house, (brown), days Batched 5 mL test
Copper, urine 24-hour urine < 1.0 µmol/24hour <5 days Referred to (no external lab preservative)
Cortisol, serum Serum 0900h: 200 -500 Sample should Urgent: In-house, (brown), 2400h: 50 - 250 ideally be 1 hour, Routine 5 mL collected at 9am Routine: Units: nmol/L for accurate 3 hours interpretation of result.
Cortisol, urine 24-hour urine < 180 7 working In-house, in plain nmol/24hour days Batched container test
Cortisol (salivary) 0.125 mL 8-9am: 5-46 nmol/L Salivettes 10 days Referred to saliva Late night: <26 (obtained from external lab nmol/L lab). Contact Duty Biochemist.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Creatinine, serum Serum Male >16y: 62 -115 Urgent: In-house, (brown), Female >16y: 1 hour, Routine 5 mL 44-97 Routine: 3 hours Units: µmol/L
Creatinine, urine 24-hour urine Male: 7 - 18 24 hours In-house, (no Female: 5 – 16 Routine preservative) Units: mmol/24hour
Creatinine clearance 24-hour urine Male: 97 – 137 Paired serum for 24 hours In-house, (no Female: 88 – 128 U&E required. Routine preservative) Pregnant: 88 -137
Units: mL/min
C-Peptide:Creatinine Random urine See report Sample should be 1 week Referred to ratio (Borate taken 2h post external lab container) 10 meal mL
Creatinine and Lithium See report Sample to be 6 weeks Referred to Guanoacetic acid Heparin received in the lab external lab (GAA) (orange) within 2hrs of 0.1 mL and collection Urine (random) 0.1 mL
CRP Serum < 10 mg/L Urgent: In-house, (C-reactive protein) (brown), 1 hour, Routine 5 mL Routine: 3 hours
Creatine kinase (CK) Serum Male: 40 – 320 Urgent: In-house, (brown), Female: 25 – 200 1 hour, Routine 5 mL Routine: Units: IU/L 3 hours
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Cryoglobulin Serum Flasks for sample 7 days Referred to (brown), transport external lab 5mL and available from EDTA (red) Central Reception. 3.5mL Collect blood into a pre-warmed (40°C) tube and deliver to lab in flask ASAP.
Cystatin C Serum See report < 24 hours Referred to (brown) external lab 1 mL
Cystine, urine 24-hour urine < 100 mg/24hour 10 days Referred to (no external lab preservative)
CSF Biomarkers:Total 2 mL CSF See report Sample MUST be 1 week Referred to Tau Protein, Phospho (NOT collected in external lab Tau and Amyloid haemolysed) polypropylene Beta) tube. Contact lab for further information
CSF Plain See report Sample collection 30 days Referred to Neurotransmitters container needs to be external lab 2 mL arranged in Collection advance with tubes to be Duty Biochemist collected from so that collection referral lab tubes can be ordered
D-lactate Serum See report Need to arrive in 1 day Referred to (brown), lab within 1 hr external lab 1 mL
11-deoxycortisol Serum Sample should be 1 week Referred to (brown), taken >48 hours external lab 0.1 mL post-birth in neonates
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
DHEAS Serum <9y: <2.0 7 working In-house, (Dihydroepiandrosten (brown), Male >9y: 2.2 - 15.2 days Batched edione sulphate) 5 mL Female >9y: test 1.0 - 12.0
Units: µmol/L
1, 25- Serum 43-144 pmol/L 4 weeks Referred to dihydroxyvitamin D (brown), external lab 2 mL
Digoxin Serum 0.8 - 2.0 µg/L Collect sample Urgent: In-house, (brown), minimum 6 hrs 1 hour, Routine 5 mL post-dose. Routine: Hypokalaemia can 3 hours exacerbate digoxin toxicity.
Drugs of abuse screen Random See interpretive Screen includes: 5 working In-house, (standard) urine, report Opiates, days Batched 15 mL Methadone test Cocaine met, Amphetamine, Buprenorphine, Benzodiazepines
Please indicate on request form if ethanol/ cannabis is required.
Drugs of abuse screen Random See interpretive If known, please 5 working In-house, (extended) urine, report state drugs of days Batched 15 mL interest. test Also: Stimulants, Benzodiazepines, Amphetamines eGFR Serum CKD 1: ≥90 Serum creatinine Urgent: In-house, (Estimated (brown), CKD 2: 60-89 concentration is 1 hour, Routine Glomerular Filtration 5 mL CKD 3a: 45-59 used to calculate Routine: Rate) CKD 3b: 30-44 eGFR. 3 hours CKD 4: 15-29 CKD 5: <15
Units: mL/min/1.73m2
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Elastase, faeces Faeces > 200 µg/g faeces Deliver sample to 3 weeks Referred to in plain lab within 2 hours external lab container, after collection for 2 g freezing.
Electrophoresis Serum See report Early morning 5 working In-house, (brown), urine sample days Routine 5 mL (random) (serum) preferred 10 working Urine 10 mL days (urine)
Erythropoietin Serum 5 - 25 IU/L Send to lab 7 days Referred to (EPO) (brown), immediately external lab 5 mL following sample collection.
Ethanol, plasma Fluoride < 100 mg/L In the UK, the Urgent: In-house, oxalate legal blood 1hour Routine (yellow), alcohol limit for 1 mL drivers is 800 mg/L
Ethanol, urine Random (<100 mg/L) 5 working In-house, urine, days Batched 10 mL test
Ethosuxamide Lithium 40-100 mg/L Trough level 3 working Referred to heparin preferred days external lab (orange) 5 mL
Ethylene Glycol Fluoride See report Send fluoride <24 hours Referred to oxalate oxalate (yellow) external lab (yellow), or tube if alcohol Lithium measurement also heparin non- required. Contact gel (orange) Duty Biochemist 1 mL before sending. Out-of-hours, contact on-call Consultant Clinical Scientist in Birmingham City Hospital: switch (0121 554 3801).
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Everolimus EDTA (red), See report 1 day Referred to 1 mL external lab
Fabry screen 3.5 mL EDTA See report 2 weeks Referred to (α-galactosidase) Whole Blood (enzyme), 4 external lab (genetics) weeks 7.5 mL (DNA) Lithium Heparin (enzyme)
Ferritin Serum Male: 22 - 322 Urgent: In-house, (brown), Female: 10 – 291 1 hour, Routine 5 mL Routine: Units: µg/L 3 hours
Fibroblast (Skin) Fatty Skin See report 3-4 months Referred to Acid Oxidation (FAO) fibroblasts external lab Studies
Fibroblast (Skin) Skin See report 4 weeks Referred to Vitamin B Studies fibroblasts external lab
Faecal Faecal sample Negative <10 7 days Referred to Immunochemical test in specific FIT Positive >10 external lab (FIT) collection device: EXTEL Units: g Hb/g HEMO-AUTO faeces MC collection picker
Flecainide Serum 200 – 800 g/L Trough level 5 working Referred to (brown), preferred days external lab 0.5 mL
Folate Serum >4 µg/L Urgent: In-house, (brown), 1 hour, Routine 5mL Routine: 3 hours
Free Androgen Index Serum < 4.6 (females) Calculated 10 working In-house, (FAI) (brown), parameter in days Batched 5 mL androgen profile. test
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Free Fatty Acids Lithium See report Sample needs to 2 weeks Referred to heparin be spun within 30 external lab (orange) mins of collection. 1mL Duration of fast helpful.
Free Light Chains Serum Kappa: 3.3-19.4 Kappa:Lambda 7 working In-house, (brown), Lambda: 5.7-26.3 ratio also days Batched 5 mL reported test Units: mg/L
Free PSA Ratio Serum See report 2 days Referred to (brown), external lab 2 mL
Free T3 (Tri- Serum 0-2y: 5.1 - 8.0 24 hours In-house, iodothyronine) (brown), 2-12y: 5.1 - 7.4 Routine 5mL >12y: 3.5 - 6.5
Units: pmol/L
Free T4 (Thyroxine) Serum 0-2y: 12.1 - 18.6 TSH is first-line Urgent: In-house, (brown), test for GP 1 hour, Routine 5 mL 2-12y: 11.1 - 18.1 samples. Free T4 Routine: added when 3 hours >12y: 10.0 – 20.0 indicated. TSH and free T4 Units: pmol/L performed on all inpatient and outpatient samples.
Fructosamine Serum 153 - 300 µmol/L 7 working In-house, (brown), days Batched 1 mL test
FSH Serum Males: 24 hours In-house, (Follicle stimulating (brown), 13-70y: 1-18 Routine hormone) 5 mL Females: 9-54 y: 3-10 (follicular) >54 y: 23-116 (post-menopausal)
Units: U/L
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Galactokinase Lithium See report Needs to reach 1 week Referred to heparin referral lab within external lab (orange), 24 hrs. 1 mL Ideally take sample Mon- Thurs.
Galactose-1- Lithium 5 - 10 μg/L packed Needs to reach 3 weeks Referred to Phosphate (Gal-1-P) heparin red cells referral lab within external lab Level (orange), 24 hrs. 5 mL
Galactosaemia screen Lithium See report Sample must be 3 days Referred to (Beutler test/GAL-1- heparin delivered to lab external lab PUT) (orange) immediately 0.5 mL following collection. If previously transfused, 5 ml Lithium heparin required for Gal- 1-P.
Gamma-Glutamyl Serum Male: < 73 Urgent: In-house, Transpeptidase (GGT) (brown), Female: < 38 1 hour, Routine 5 mL Routine: Units: IU/L 3 hours
Gastrin EDTA (red), 0-40 pmol/L Patients must be 21 days Referred to 3 mL fasted, PPI external lab medication must be stopped 2 weeks before and H2 blocker medication for 72h prior to sampling if possible Sample must arrive in lab within 15 mins of collection.
Genetics requests Confirm with See report Up to 8 Referred to Lab- depends weeks external lab on test
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Gentamicin Serum Trough (pre-dose For clinical advice Urgent: In-house, (brown), targets): contact 1 hour, Routine 1 mL Neonate: < 2 microbiology Routine: Adult: <1 3 hours Peak level target: 3 – 5
Units: mg/L
Gilbert’s Genotype EDTA (red), See report 3 working Referred to 4 mL days external lab
Globotriaosylsphingos Lithium See report 6-8 weeks Referred to -ine (GB-3) Heparin external lab (Fabry’s) (orange), 0.5mL
Urine, 5 mL 4-6 weeks
Glucose, plasma Fluoride 3.0 - 6.0 mmol/L *Note glucose in Urgent: In-house, oxalate plasma will give 1 hour, Routine (yellow), different values Routine: 1 mL than in whole 3 hours blood
Glucose, CSF Fluoride CSF glucose Urgent: In-house, oxalate should be 70% of 1 hour, Routine (yellow), concurrent Routine: 1 mL plasma glucose – 3 hours collect paired sample
Glucose tolerance test Fluoride See WHO Collect samples at Routine: In-house, (GTT) oxalate guidelines for T=0 min and 3 hours Routine (yellow), diagnosis of T=120 min. 1 mL each diabetes. Collection times must be stated.
Glycogen Storage Lithium See report Includes: glycogen 6-8 weeks Referred to Disease (GSD) Screen heparin debrancher, external lab (orange), glycogen 8-10 mL phosphorylase, phosphorylase b kinase.
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Growth Hormone Serum Units: µg/L May be requested 7 working In-house, (GH) (brown), as part of a days Batched 5 mL dynamic function test test.
Gut Hormones EDTA (red), See report Overnight fasting 3 weeks Referred to 2 x 2.7 mL sample required. external lab Panel includes: Patient must not Chromogranin A+B be taking PPIs or Gastrin, Glucagon H2 blockers. Pancreatic polypeptide, Deliver to lab Somatostatin,VIP within 15 mins of collection.
β-HCG Serum Male: < 10 Urgent: In-house, (Human chorionic (brown), Female (non- 1 hour, Routine gonadotrophin) 5 mL pregnant): < 6 Routine: Female (post- 3 hours menopausal): < 10
Units: U/L
5-HIAA 24-hour urine < 50 µmol/24hour 7 working In-house, (5-hydroxyindole in acidified days Batched acetic acid) container test
Homocysteine EDTA (red), 0-16 μmol/L For CV risk 10 working Referred to 1 mL assessment: days external lab sample referred to University Hospital of Wales (Cardiff).
Lithium <15 μmol/L For metabolic 4 weeks heparin investigation: (orange), sample referred 3 mL to Willink, Manchester. All samples need to be received in the lab within 30 min
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
17-Hydroxy Serum < 6 nmol/L Only request on 2 weeks Referred to progesterone (brown), babies >48h old external lab (17OHP) 0.5 mL
IGF-1 Serum See report (age and 7 working In-house, (Insulin-like growth (brown), sex related ranges) days Batched factor 1) 2 mL test
Immunofixation Serum See report 6 working In-house, (brown), days Batched 5 mL test
Immunoglobulins Serum IgG : 6.0-16.0 5 working In-house, (IgG, IgA, IgM) (brown) 5mL IgA : 0.8-4.0 days Routine IgM : 0.5-2.0
(other age related reference ranges exist)
Units g/L
Infliximab (or Serum See report Please complete 2 weeks Referred to Adalimumab) (brown), Viapath anti-TNFα external lab 0.3 mL drugs request form.
Inhibin A and B Serum 2 weeks Referred to (brown) or external lab Lithium Heparin (orange), 2 mL
Insulin / C-peptide Adults and See report Deliver to the lab 1 week Referred to (and Proinsulin) neonates: within 30-60 mins external lab Serum of collection. (brown), Lithium Glucose sample Heparin also required. (orange) Patient should be 2 mL hypoglycaemic Proinsulin (glucose ≤2.5 available upon mmol/L) at time request of sample collection.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Test and volume and Units time
Iron Serum Males: 11-31 Urgent: In-house, (brown), Females: 9-30 1 hour, Routine 5 mL Routine: Units: µmol/L 3 hours
Keratan Sulphate Urine (early See report Up to 6 Referred to morning) weeks external lab 5-10ml
Lactate (plasma) Fluoride 0.5 - 2.2 mmol/L Deliver to lab 1 hour In-house, oxalate within 3hrs of Routine (yellow), collection. 1 mL *Note lactate in plasma will give different values than in whole blood
Lactate (CSF) Fluoride 1.1 - 2.4 mmol/L Deliver to lab 1 hour In-house, oxalate within 3hrs Routine (yellow), collection. 1 mL
Lactate Serum 120 - 246 U/L Avoid delay. 3 hours In-house, Dehydrogenase (LDH) (brown), Haemolysed Routine 5mL samples are unsuitable.
Lamotrigine Serum 3.0-15.0 mg/L Routine 7 days Referred to (brown) or monitoring is not external lab Lithium recommended. Heparin (orange), 1 mL
Laxatives Random Not Detected Ideally collect 3 2 weeks In-house, urine, (qualitative result) samples on Batched 20 mL consecutive days test Currently not during symptoms. within ISO15189 Screen: Bisacodyl scope of (Dulcolax), accreditation Danthron, Rhein (Senokot) and Phenolphthalein.
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Clinical Biochemistry Information for Users of the PAWS Biochemistry Service
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Lead (whole blood) EDTA (red), < 0.24 µmol/L 5 days Referred to 2 mL external lab
Lead (urine) 20 mL See report 5 days Referred to Random urine external lab or 24-hour urine (acid washed container).
Levetiracetam Serum Target range: 12-46 5 working Referred to (brown), mg/L days external lab 1 mL
LFT Serum Refer to individual Globulin Urgent: In-house, (Liver function tests) (brown), tests calculated: total 1 hour, Routine Panel includes: 5mL protein – albumin Routine: Total bilirubin, ALT, 3 hours ALP, Total protein, Albumin, Globulins
Lipase Serum 12-53 U/L 4 h Referred to (brown), external lab 0.5 mL
Lipid Profile Serum Refer to individual Urgent: In-house, Panel includes: (brown), tests 1 hour, Routine Cholesterol, 5 mL Routine: Triglycerides, HDL, 3 hours LDL, HDL ratio, Non- HDL-C
Lipoprotein a EDTA (red), <30 mg/dL 1 week Referred to 2 mL external lab
Luteinising hormone Serum Males: 24 hours In-house, (LH) (brown), 20-70y: 2 - 9 Routine 5 mL >70y: 3 - 35 Females: 9 - 54y: 2 - 13 (follicular) >54 y: 16 - 54 (post-menopause)
Units: U/L
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Lithium Serum 0.40-1.0 mmol/L Sampling time Urgent: In-house, (brown), should be pre- SRFT 1h Routine 5mL dose or at least 12 WWL 3h hours post-dose. Routine: SRFT 3 h WWL 5h
Macroprolactin Serum Pos/Neg 14 days Referred to (brown), external lab 0.5 mL
Magnesium, serum Serum < 4w: 0.6 - 1.0 Urgent: In-house, (brown), >4w: 0.70 - 1.0 1 hour, Routine 5mL Routine: Units: mmol/L 3 hours
Magnesium, urine 24-hour urine 2.4 - 6.5 24 hours In-house, (no mmol/24 hours Routine preservative)
Manganese EDTA (red), 70-280 nmol/L <5 days Referred to 1 mL external lab
Mercury 24-hour urine <15 nmol/24 hr Chronic exposure 5 days Referred to (no = urine external lab preservative) Acute exposure = Blood
EDTA (red) <25.0 nmol/L 2 mL
Metadrenalines, urine 24-hour urine Normetadrenaline: Samples with 10 working In-house, in acidified Females: urine pH ≥ 6.5 are days Batched container ≤4.3µmol/24hours unsuitable for test Males: metadrenaline ≤5.3µmol/24hours estimation.
Metadrenaline: ≤ 2 µmol/24hours
Metadrenalines, EDTA (red), Normetadrenaline: Fasting sample 10 working In-house, plasma 2 mL <1.07nmol/L preferred. Avoid days Batched caffeine. Patient test Metadrenaline: should ideally be <0.33nmol/L supine. Send to lab within 1 hour.
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Methaemoglobin Arterial blood ≤ 1.5 % Remove needle 30 minutes In-house, (part of Co-oximetry in heparin and cap syringe Routine panel) syringe with a luer-lock 3 mL. plug. Send to lab immediately.
Methanol Fluoride Absent Should have <24 hours Referred to oxalate (refer to report) confirmed external lab (yellow) osmolar gap. Contact Duty Biochemist before sending. For out- of-hours, contact on-call Consultant Biochemist in Birmingham City Hospital via switch (0121 554 3801).
Methotrexate Serum Units: ng/mL Sample will be Within 2 Referred to (brown), processed on the working external lab 1 mL same day if it days arrives at Christie lab by 8pm.
Methylmalonic acid EDTA (red), See report 3 weeks Referred to (MMA) 1 mL external lab
For adult Metabolic unit request: 2 mL EDTA (Willink)
Molar hCG Serum See report 2 weeks Referred to (brown), external lab 5 mL
Mucopolysaccharides Random Qualitative test Screen includes 3 weeks Referred to screen urine, oligosaccharides, external lab (Glycosaminoglycans) 10mL sialic acid and muco- polysaccharides.
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Mycophenalate EDTA (red), 2.5-4.5 mg/L for Trough sample 8 days Referred to 2 mL heart/lung preferred external lab transplant patients
Myoglobin, serum Serum See report Sample must 24h Referred to Not routinely offered (brown), arrive in the lab external lab 2 mL within 4 hours of collection.
Myoglobin, urine Random See report Sample must 24h Referred to Not routinely offered urine, arrive in the lab external lab 20 mL within 4 hours of collection.
Neurone Specific Serum <12.5 μg/L 3 days Referred to Enolase (NSE) (brown), external lab 2 mL
NSAID screen EDTA (red), See report Screen identifies: 7 days Referred to 2 mL diclofenac, external lab naproxen, mefamanic acid, ibuprofen.
NSAID Screen Random See report Screen identifies 8 weeks Referred to urine, ibuprofen. external lab 2 mL
Oestradiol Serum Male: 24 hours In-house, (brown), 0 - 146 Routine 5 mL Female: 9 - 54y: Follicular 72 - 529
>54y: 0 - 118 (post- menopausal)
Units: pmol/L
Olanzapine EDTA (red) 20-40 μg/L Requires 5 days Referred to 0.5 mL separation within external lab 7h of venepuncture Trough level preferred
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Oligoclonal Bands CSF, 1mL See report 25 working In-house, Serum days Batched (brown), test 5 mL
Orexin (Hypocretin) CSF, 2 mL See report 42 working Referred to days external lab
Organic acid, urine Random Qualitative result Urine orotic acid 3 weeks Referred to urine, is included in this external lab 5 mL panel. If urine amino acids also requested, requires 10 mL urine.
Orosomucoid (Alpha- Serum See report Test no longer 7 days Referred to 1-Acid Glycoprotein) (brown), available unless external lab 2 mL clinical teams specifically make a request via Duty Biochemist
Orotic acid, urine Random < 5 µmol/mmol Part of profile for 4 weeks Referred to urine, creatinine urine organic external lab 2 mL acids.
Osmolality, serum Serum 275 - 295 3 hours In-house, (brown), mOsmol/kg 1 hour if Routine 5 mL Water Deprivation test
Osmolality, urine Random 100 - 1000 3 hours, In-house, urine, mOsmol/kg 1 hour if Routine 2 mL Water Deprivation test
Oxalate, 24-hour urine Male: 10 days Referred to urine in plain 80 - 490 µmol/day external lab container Female: (acidified on 40 - 320 µmol/day receipt)
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Oxysterols EDTA (red) See report To be received in 4 weeks Referred to 2 mL lab within 30 mins external lab of collection
Paracetamol Serum < 2 mg/L Treatment 1 hour In-house, (brown), nomogram in BNF Routine 5mL Collect samples > 4 h post- ingestion
Paraquat screen Random urine See report Refer to Duty Urgent Referred to (no Biochemist external lab preservative), 1 mL
Parathyroid Hormone Serum 2.0-9.3 pmol/L 3 hours In-house, (PTH intact) (brown), Routine 5 mL
Parathyoid Hormone Special tubes <1.8 pmol/L Contact Duty 4-6 weeks Referred to related peptide are available Biochemist prior external lab (PTHrP) from lab to collection. (EDTA tube Tubes must be containing kept cooled prior aprotinin), to collection. 5 mL Sample must be collected on ice and transported to the lab ASAP. pH (fluid) Blood gas Analysis of fluids Must be analysed 30 min In-house, syringe not CE marked or within 30 min Routine within scope of 1 mL ISO15189 accreditation
Phenobarbitone Serum Therapeutic range: Trough level 1 day Referred to (brown), 10.0 - 40.0 mg/L preferred external lab 0.2 mL
Phenylalanine/ Lithium See report To be received in 3 weeks Referred to Tyrosine Heparin lab within 30 mins external lab (orange), of collection 3 mL/Blood spot
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Phenytoin Serum Therapeutic range: Sampling time: Urgent: In-house, (brown), 5.0 - 20.0 mg/L pre-dose SRFT 1h Routine 5 mL WWL 3h Routine: SRFT 3 h WWL 5h
Phosphate, serum Serum < 4w: 1.3 - 2.6 Levels increase Urgent: In-house, (brown), 4w-1y: 1.3 - 2.4 with delayed 1 hour, Routine 5 mL 1-16y: 0.9 - 2.8 centrifugation and Routine: >16y: 0.8 - 1.5 haemolysis. 3 hours
Units: mmol/L
Phosphate, urine 24-hour urine 24-hour urine: Send concurrent 24 hours In-house, (no 15-50 serum sample to Routine preservative) mmol/24hours calculate TRP (tubular TRP: 84 - 95% reabsorption of phosphate)
Phytanic acid and EDTA (red), Age-dependent, 4 weeks Referred to Pristinic acid 5 mL see report. external lab
PLA2-R Serum See report 2 weeks Referred to (brown), external lab 2 mL
Porphobilinogen Random Urine PBG:Creat Sample must be Within In-house, (PBG)(Emergency urine, ration <1.5 protected from 24hrs of urgent Screen) 10 mL umol/mmol creat light. Avoid delay. receipt to Phone lab to the inform of arrival. referring lab Porphyrins, faecal Small faecal Total porphyrins: Sample must be 15 working In-house, sample, <200 nmol/g dried protected from days Batched 5 g weight. light. Avoid delay. test
Porphyrins, red cell EDTA (red) or RBC Sample must be 15 working In-house, Lithium protoporphyrin: protected from days Batched heparin <1.5 µmol/L RBC light. Avoid delay. test (orange), 2 mL
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Porphyrins, plasma EDTA (red) or Plasma porphyrin: Sample must be 15 working In-house, Lithium Negative protected from days Batched heparin light. Avoid delay. test (orange) 2 mL
Porphyrins, urine Random Reference range Sample must be 15 working In-house, (PBG, ALA and urine, for each individual protected from days Batched porphyrins) 10 mL porphyrin on light. Avoid delay. test report. PBG=Porphobilino gen ALA= Aminolevulinic acid
Potassium, serum Serum <4w: 3.4 - 6.0 Levels increase Urgent: In-house, (brown), 4w-1yr: 3.5 - 5.7 with delayed 1 hour, Routine 5 mL 1yr-16yr: 3.5 - 5.0 centrifugation and Routine: >16yr: 3.5 - 5.3 haemolysis. 3 hours
Units: mmol/L
Potassium, 24-hour urine 55 - 125 24 hours In-house, Urine (no mmol/24hours Routine preservative)
Procalcitonin Serum <0.1 g/L Not currently Urgent: In-house, (brown), or See report for under ISO15189 1 hour, Routine Lithium interpretation scope of Routine: Heparin accreditation 3 hours (orange), 1 mL
Prednisolone Serum See report 1 week Referred to (brown), external lab 1 mL
Procollagen Peptide Serum See report <5 days Referred to Type I (P1NP) (brown), external lab 2 mL
Procollagen Peptide Serum See report 4 weeks Referred to Type III (P3NP) (brown), external lab 0.5 mL
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Progesterone Serum 31 - 100 nmol/L Collect on day 21 Routine: In-house, (brown), of 28 day cycle to 3 hours Routine 5 mL >30nmol/L assess ovulation. suggestive of ovulation.
Prolactin Serum Male: Macroprolactin Routine: In-house, (brown), 45 - 375 mU/L estimation may be 3 hours Routine 5 mL pe rformed if Female 9-54y: prolactin >1000 59 - 619 mU/L mU/L.
Female >54y: 38-430 mU/L
Prostate specific Serum ≤50y: ≤ 2.0 µg/L A prostate gland Routine: In-house, antigen (PSA) (brown), found to be 3 hours Routine 5mL 51-59y: ≤ 3.0 µg/L abnormal on DRE warrants prompt 60-69: ≤ 4.0 µg/L investigation, even if PSA level is ≥70: ≤5.0 µg/L not raised.
Protein, CSF CSF sample, 0.08 - 0.32 g/L 3 hours In-house, 1.5 mL Routine mL Protein, serum Serum 58-75 g/L 3 hours In-house, (brown), Routine 5 mL
Protein, urine 24-hour urine 24-hour urine: Significant 24 hours In-house, (no < 0.1 g/24 hours proteinuria: Routine preservative) ≥ 0.5g/24 hours or random Protein/creat ratio: Heavy urine, 1 mL <25 g/mol proteinuria: ≥ 1g/24 hours Protein, fluid Fluid (plain See report Analysis of fluids 3 hours In-house, container) not CE marked or Routine 5 mL within scope of ISO15189 accreditation
Purine/Pyrimidine Urine, 5mL See report Urine preferred 3 weeks Referred to screen (random) or for external lab EDTA (red), purine/pyrimidine 5 mL screen
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Reducing substances, Small faecal Qualitative Sample must 3 working Referred to faecal sample, arrive at lab <2 days external lab (lactose, maltose, 5 g hrs of collection sucrose, glucose, to prevent false galactose, fructose) negative results.
Reducing substances, Random Qualitative Sample must 3 working Referred to urine urine, arrive at lab <2 days external lab (lactose, maltose, 5 mL hrs of collection sucrose, glucose, to prevent false galactose, fructose) negative results.
Renal Stones (Calculi) Stones See report for 10 days Referred to composition external lab
Renin EDTA (red), 0.3 - 2.2 Requested as part 2 weeks Referred to (see also Aldosterone) 5 mL nmol/L/hour of Aldosterone external lab /Renin profile. Aldosterone/ Renin ratio (ARR) <1000: ACE-inhibitors, Primary hyper- angiotensin aldosteronism receptor blockers unlikely. and diuretics may lower ARR.
Salicylate Serum < 30 mg/L 1 hour In-house, (brown), Routine 5 mL
Selenium Serum 0.55 - 1.20 µmol/L Reference range 5 working In-house, (brown), applies to patients days Batched 5 mL with normal test serum albumin.
SHBG Serum Male: 7 working In-house, (sex-hormone binding (brown), 10 - 57 nmol/L days Batched globulin) 5 mL test Female: 18 - 144 nmol/L
Sirolimus EDTA (red), Units: ng/mL Sampling time: 1 day (same In-house, 3 mL pre-dose. day if Batched received test before 9 am)
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Sodium, serum Serum 133 - 146 mmol/L Urgent: In-house, (brown), 1 hour, Routine 5 mL Routine: 3 hours
Sodium, urine 24-hour urine 24-hour urine: Routine: In-house, (no 3 hours Routine preservative) 40 - 220 mmol/24 or random hours urine, 10 mL
Sodium fluid Fluid, See report Fluid analyses not Routine: In-house, 5 mL CE marked or 3 hours Routine within scope of ISO15189 accreditation
Soluble Transferrin Serum 8.7-28.1 nmol/L 7 days Referred to Receptors (brown), external lab 1 mL
Steroid Profile (urine) 24 hr urine See report 3 weeks Referred to (no external lab preservative)
Sterols (including 7 Lithium See report 3-6 weeks Referred to dehydrocholesterol) Heparin, external lab 1 mL
Sulphonylureas Serum See report 1 week Referred to (brown), external lab 0.6 mL Urine, 10 mL
Tacrolimus (FK506) EDTA (red), Units: µg/L Sampling time: 1 day (same In-house, 3 mL pre-dose. day if Batched received test before 9 am)
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Testosterone Serum Males: In females, Males: In-house, (brown), 8.4-28.7 nmol/L testosterone is 24 hours, Batched 5mL requested as part Females test (f) Females: of an androgen /children : Routine (m) <1.6 nmol/L profile which 10 working includes SHBG, days free androgen index and androstenedione.
Tetrasaccharides Random See report 4-6 weeks Referred to Urine, external lab 1 mL
Theophylline Serum Therapeutic range: Sampling time: Urgent: In-house, (brown), Phyllocontin: SRFT 1h Routine 5mL <3m: 10-14 mg/L 4 hrs post-dose, WWL 3h >3m: 10-20 mg/L Theodur/ Routine: uniphyllin: 6 hrs SRFT 3 h post-dose. WWL 5h
TPMT (Thiopurine EDTA (red), Deficient: < 10 Blood transfusions 1 day Referred to methyl transferase) 4 mL Low: 20-67 may produce external lab Normal: 68-150 misleading High: >150 results. DNA confirmatory Units: mU/L analysis is carried out on deficient results at no additional charge.
TPMT (Thiopurine EDTA (red), See report 2 working Referred to methyl transferase) 4 mL days external lab Genotype
Thiopurine EDTA (red), 6-TGN: Levels may be 2 working Referred to Metabolites 4 mL 235-450 pmol 6- checked 4w after days external lab [6-Thioguanine TGN/8x108 cells commencing / Nucleotides (6-TGN) changing and 6- 6MMPN: Thiopurine drug Methylmercapto- <5700 pmol dose, (steady purine Nucleotides 6MMPN/8x108 cells state achieved) (6MMPN)] Time of sampling need not be related to the time of admin. of the parent drug. 49
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Thyroglobulin (and Serum See report Should only be 1 week Referred to anti-thyroglobulin (brown), requested in the external lab antibodies) 2 mL context of previous Thyroid cancers.
Tobramycin Serum Therapeutic levels: Only assayed in 2 hours In-house, (brown), Peak: 4.0–8.0 mg/L WWL Routine 5 mL Trough: 1.0-2.0 mg/L
Total CO2 Serum <16y: 19 - 28 Send to lab Urgent: In-house, (Bicarbonate) (brown), >16y: 22 - 29 without delay. 1 hour, Routine 5 mL Routine: Units: mmol/L 3 hours
Total protein Serum 58 - 75 g/L 3 hours In-house, (brown), Routine 5 mL
TPO Serum < 35 IU/mL 5 working In-house, (Thyroid peroxidase (brown), days Batched autoantibodies) 5 mL test
Transferrin Serum Males: 2.15 – 3.65 Urgent: In-house, (brown), Females: 2.5 – 3.8 1 hour, Routine 5 mL Routine: Units: g/L 3 hours
Transferrin Saturation Serum 16-45 % Urgent: In-house, (Iron saturation) (brown), 1 hour, Routine 5 mL Routine: 3 hours
Transferrin Serum See report 9 working Referred to glycoforms (brown), days external lab 1 mL
Triglycerides Serum < 1.7 mmol/L Fasting sample Urgent 1hr In-house, (brown), required. Routine 3 Routine 5mL hours
Trimethylamine Urine, 20 mL See report 6-8 weeks Referred to (no external lab preservative)
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Troponin I Serum Units ng/L Samples taken at 1 hour In-house, (brown), presentation and Routine 5 mL 2 hours. May also require 6 or 12 hour sample.
TSH Serum 0.35 – 5.5 mU/L TSH is first-line Urgent 1hr In-house, (thyroid stimulating (brown), test for GP Routine 3 Routine hormone) 5 mL samples. TSH and hours free T4 performed on all inpatient and outpatient samples.
Urea, serum Serum <4w: 0.8 - 5.5 Urgent: In-house, (brown), 4w – 1y: 1.0 - 5.5 1 hour, Routine 5mL 1y – 16y: 2.5 - 6.5 Routine: >16y: 2.5 - 7.8 3 hours
Units: mmol/L
Urea, urine Random None quoted 24 hours In-house, urine, Routine 10 mL
Uric Acid (Urate), Serum Males: Urgent 1hr In-house, serum (brown), 200 - 430 Routine 3 Routine 5 mL Females: hours 140 - 360
Units: μmol/L
Uric Acid (Urate), 24-hour urine 24-h urine urate: 24 hours In-house, urine (no 1.5-4.5 mmol/24 Routine preservative) hours or random urine, 10 mL
Valproate Serum 50 - 100 mg/L Routine Urgent: In-house, (brown), monitoring is not 2 hours, Routine 5 mL recommended. Routine: 3 hours Vancomycin Serum Refer to local For clinical advice In-house, (brown), antibiotic contact 2 hours, Routine 5 mL guidelines for microbiology target levels.
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Vasointestinal Serum See report 21 working Referred to Endothelial Growth (brown), days external lab Factor (VEGF) 1 mL
Vedolizumab Serum See report 4 weeks Referred to (brown), external lab 1 mL
Very Long Chain Fatty EDTA (red), C26: 0.3-4.0 Send to lab 4 weeks Referred to Acids (VLCFA) 5 mL C24/C22: 0.65-1.05 immediately external lab C26/C22: <0.033 (sample must Units: µmol/L reach referral lab within 72 hours).
Vitamin A Serum See report 3 weeks Referred to (retinol) (brown), external lab 0.5 mL
Vitamin B Lithium B1: 275 – 675 ng Whole blood 10 days Referred to B1: thiamine Heparin non- TDP/g Hb required. external lab B2: riboflavin gel (orange), Analyte has B6: pyridoxine 1 mL B2: 1.0 - 3.4 limited stability. nmol/g Hb Send to lab immediately. B6: 250 - 680 Protect vitamin B2 pmol/g Hb and B6 from light.
Vitamin B12 Serum 211-911 ng/L Urgent: In-house, (brown), 1 hour, Routine 5mL Routine: 3 hours
Vitamin C Lithium See report A secondary tube 4 weeks Referred to heparin is required in external lab (orange), advance of taking 5 mL blood for this test. Contact Duty Biochemist for information. Samples needs to be received in lab ASAP after collection.
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Test Sample Type Reference Range Comments Turnaround Referred / and volume and Units time Batched
Vitamin D Serum Serum total 25OHD If require Routine: In-house, (reported as total (brown), <30: deficient differentiation of 3 hours Routine 25-OH Vitamin D) 5 mL 30-50:may be D2 and D3- refer adequate in some request to the people Duty Biochemist >50: sufficient
Units: nmol/L
Vitamin E Serum See report 3 weeks Referred to (tocopherol) (brown), external lab 0.5 mL
Vitamin K EDTA (red) See report Protect sample 10 days Referred to 2 mL from light external lab 2 mL
White Cell Cystine Lithium See report Sample needs to 4 weeks Referred to Heparin reach referral lab external lab (orange), within 24hrs. 3 mL Contact lab prior to taking bloods
White Cell EDTA (red), Refer to report Send to lab 4 weeks Referred to Enzymes/Lysosomal 5 mL (2 tubes immediately external lab Enzymes required) (sample must reach referral lab within 72 hours).
Xanthochromia CSF, Qualitative Patient must be 2 hours In-house, 1.0 mL and CT-scan negative. (Test Routine Serum Serum bilirubin performed (brown), needed for weekdays 5 mL interpretation. 9am- Sample must 5.30pm) be 12 h post- Currently not onset of within ISO15189 symptoms. scope of Protect CSF accreditation from light to prevent false negatives. Zinc Serum 10.0 - 21.0 µmol/L Reference range 5 working In-house, (brown), applies to patients days Batched 5mL with normal test serum albumin.
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Protocol for the collection and handling of CSF Specimens for detection of Bilirubin (Xanthochromia) in suspected Subarachnoid haemorrhage (SAH)
Sample collection
• The patient must have had had the suspected SAH more than 12 hours prior to sampling the CSF for screening – this allows for degradation of haemoglobin to bilirubin. • The patient must have had a Negative CT scan • Time/date of onset of symptoms must be given
• CSF samples for Xanthochromia must be shielded from light.
• CSF samples must not be sent via pneumatic tube (pod) system as this may lead to cell lysis and erroneous results.
• Visual inspection of CSF is not an acceptable method for assessing the presence or absence of Xanthochromia.
Order of Sampling
Min. Volume Sample Container Analysis (ml) Fluoride Oxalate – CSF 1 0.5 CSF Glucose Yellow top CSF 2 White top Universal 0.5 Cell count (1) Cell Count (2) CSF 3 White top Universal 1.0 CSF Protein Cell Count (3) Bilirubin/Xanthochromia CSF 4 White top Universal 1.0 shield from light & do not use pneumatic tube system
Blood Gel Tube/Brown Top 1.0 Bilirubin & Protein Blood Fluoride/Yellow Top 1.0 Glucose
CSF
Label four sterile universal containers (1 x Fluoride oxalate, 3 x white top) with patient’s details and the sequence order of sampling (1, 2, 3 & 4).
If examination for xanthochromia is required then ensure at least 1ml is placed in the final universal labelled (4). This sample should be shielded from light and placed in the specimen bag.
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Blood
Specimens of peripheral blood for bilirubin (Gel Tube/Brown Top) and glucose (Fluoride Oxalate / Yellow Top) estimation should be obtained simultaneously with the CSF samples and sent directly to Biochemistry.
Reporting of Xanthochromia Results
Spectrophotometric analysis is performed 9.00am – 5.00pm five days per week. Currently an out-of- hours service is not provided. Results of spectrophotometric examination will normally be available within 24 hours except at weekends. All positive results will be communicated to the requesting clinician or ward staff.
If screening is required at weekends or Bank Holidays then the Duty Biochemist must be contacted in advance of the weekend on 0161 206 8212 to discuss the request.
Reference Revised National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage, Cruickshank et al UK NEQAS Specialist Advisory Group for external quality assurance of CSF proteins and biochemistry, Ann Clin. Biochem. 2008; 45 (3): 238-244
Troponin I interpretation
The biochemical marker offered by the Clinical Biochemistry Department to detect myocardial damage is Troponin I (TnI) high sensitivity
• it is specific for cardiac muscle damage • It can be detected at 2 to 6 hours following onset of chest pain with peak concentrations at 12 to 16 hours, and remains elevated for 5 to 9 days
Timing of specimens
In cases of suspected MI samples should be taken on admission (or onset of symptoms if in-patient) and 2 hours later. Further samples may be taken at 6 and 12 hours if interpretation unclear (see algorithm).
Specimen requirements
• Clotted blood in a brown-topped container (same specimen as for U&E etc.) • time of specimen and time of chest pain must be noted on request form
Service provision
TnI is available 24 hours a day, 7 days a week across both SRFT and WWL sites
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Interpretation
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Blood gases: Reference range in Arterial/Venous/Capillary Blood
Units Arterial Range Venous Capillary Measured Analyte pH 7.35 – 7.45 7.32 – 7.43 7.35 – 7.45
pCO2 kPa 4.6 – 6.4 5.4 – 7.2 4.6 – 6.4
pO2 kPa 11.0 – 14.4 2.3 – 5.5 11.0 – 14.4 Na+ mmol/L 136 -145 136 - 145 136 -145 K+ mmol/L 3.5 – 5.1 3.5 – 5.1 3.5 – 5.1 Ca++ mmol/L 1.15 – 1.33 1.16 – 1.32 1.15 – 1.33 Cl- mmol/L 98 – 107 98 - 107 98 – 107 Glu mmol/L 3.6 – 5.3 3.6 – 5.3 3.6 – 5.3 Lactate mmol/L 0.4-0.8 0.6 – 1.4 0.4 – 1.8 Hct % 37 – 50 37 - 50 37 - 50 tHb g/L 117 – 174 117 – 174 117 – 174
O2Hb % 90 - 95 90 - 95 90 - 95 COHb % 0.5 – 1.5 0.5 – 1.5 0.0 – 1.5 MetHb % 0.0 – 1.5 0.0 – 1.5 0.0 – 1.5 SO2 % 94 – 98 94 – 98 94 – 98 Bicarbonate mmol/L 21.0 – 28.0 21.0 – 28.0 21.0 – 28.0 BE mmol/L -2.0 – 3.0 -2.0 – 3.0 -2.0 – 3.0
Procalcitonin
As part of the response to Covid-19, procalcitonin is now available to clinicians at SRFT and WWL for use in critical care settings or in complex cases.
Procalcitonin may be a useful adjunct to clinical evaluation for coexisting bacterial infection: • <0.5 μg/L: lower risk for bacterial co-infection and adverse outcome • ≥0.5 μg/L: higher risk patients, bacterial co-infection more likely
Service provision
Procalcitonin is available on the Salford site only. Samples from Wigan will be transferred to Salford during routine working hours (9-5.30pm). Any samples collected at Wigan outside these hours will be transferred to Salford the following morning.
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Tumour Markers
In general, tumour markers are of limited utility in the diagnosis of cancer; they are of most use in assessing prognosis/monitoring disease only. A negative result does not rule out malignancy.
The measured tumour marker value of a patient’s sample can vary depending on the testing procedure used by a laboratory. Values determined on patient samples by different testing methods or laboratories cannot be directly compared with one another and could be the cause of erroneous medical interpretations.
A guide to the appropriate use of each tumour marker is shown below:
Alpha-fetoprotein (AFP) AFP is raised in hepatocellular carcinoma, hepatoblastoma and nonseminomatous germ-cell carcinomas. May also be raised in: hepatitis, cirrhosis, biliary tract obstruction, alcoholic liver disease, ataxia telangiectasia, tyrosinaemia, pregnancy and infants (up to 1 year).
β2-microglobulin (B2M) B2M is used to stage and monitor treatment of blood malignancies such as multiple myeloma, lymphoma and leukaemia. B2M can be raised in conditions associated with an increased rate of cell production/destruction, viral infections, inflammatory conditions and autoimmune disorders. Certain immunosuppressant drugs can also cause raised levels of B2M. Cancer antigen 125 (CA125) CA 125 should be used to monitor ovarian cancer, check for recurrence and to aid diagnosis/referral in those patients with appropriate symptoms in primary care (NICE CG122). CA125 may be raised due to benign conditions including ascites, endometriosis, cirrhosis, heart failure, acute pancreatitis and peritonitis. Slightly raised levels (<100 KU/L) are seen in pregnancy and menstruation, therefore samples should not be taken immediately before, during or after menstruation. Cancer antigen 15.3 (CA15.3) CA 15.3 may be used for monitoring treatment of breast cancer. Levels may be raised in benign and malignant disease of the long GI tract and reproductive systems as well as in liver disease, chronic renal disease and dermatological conditions. Cancer antigen 19.9 (CA19.9) CA 19.9 may be raised in pancreatic adenocarcinomas, in approximately 30-50% of gastric carcinomas and 30% of colorectal carcinomas. It is important to note that CA19.9 can be low even in pancreatic cancer. CA19.9 within the reference range does not exclude pancreatic or hepatobiliary tumours. CA19.9 may be raised in benign conditions including acute and chronic pancreatitis, hepatocellular jaundice, cirrhosis, acute cholangitis, cholecystitis and cystic fibrosis. CA19.9 may also be raised in patients with ovarian dermoid cysts.
Carcinoembryonic antigen (CEA) CEA can be raised in any adenocarcinoma, however its use is principally directed towards monitoring colorectal cancer and should ONLY be used in the monitoring of treatment of established malignancy. It should not be used for screening or diagnosis. CEA may be raised in benign conditions including hepatitis, cirrhosis, pancreatitis, alcoholic liver disease, obstructive jaundice, ulcerative colitis,
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Crohn’s disease, bronchitis, emphysema, renal disease and pregnancy. Levels may also be mildly elevated in apparently healthy individuals who smoke.
Human Chorionic Gonadotrophin (HCG) HCG is mainly used to monitor gestational trophoblastic disease and germ cell tumours. HCG is also raised in pregnancy. Prostate specific antigen (PSA) PSA may be raised in prostate cancer but also in Benign Prostate Hyperplasia, Urinary tract infection, Prostatitis, ejaculation and following catheterisation and other urological manipulations (PSA should not be measured for 6 weeks after TURP or needle biopsy). Objective information for asymptomatic men requesting PSA measurement is available from www.cancerscreening.nhs.uk
References Duffy MJ and McGing P (2010) Guidelines for the use of tumour markers. Association of Clinical Biochemists in Ireland. http://www.acbi.ie/Downloads/Guideline-tumour-markets-4th.pdf (accessed 11.12.13) Sturgeon CM, Lai LC and Duffy MJ (2009) Serum tumour markers: how to order and interpret them. BMJ 2009;339:b3527
FIT (Faecal Immunochemical Test)
FIT can be used to guide Primary Care referral for suspected colorectal cancer. Adults without rectal bleeding with unexplained symptoms BUT who do NOT meet the referral criteria for outlined in NICE guidance on suspected cancer (DG12) should be given a FIT testing kit. FIT testing is is also indicated in in patients referred for urgent endoscopy on a 2WW pathway to aid triage and prioritisation of referrals during the covid pandemic.
Specimen requirements
Testing kits are provided to GP surgeries by both Salford and Wigan laboratories, please contact 0161 206 4958. The patient collects the sample at home following the instructions provided in the kit and returns it to the GP surgery who will send it to the laboratory. All samples collected will be referred to Royal Oldham Hospital for analysis via the Salford Royal laboratory.
Service Provision
Results are available within 7 days from receipt on the sample by the laboratory.
Interpretation of Results
Test Negative (<10ug Hb/g) If your patient has already been referred via the 2WW Lower GI pathway because of other worrying clinical features, then no further action is required. If you have arranged this test to help you decide on further management, then the correct interpretation is: Low risk of significant pathology, but not completely excluded. Further investigation may be warranted particularly if on-going, changing or worsening symptoms.
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Test Positive (≥10ug Hb/g) Increased risk of significant pathology. Referral via 2WW Lower GI pathway indicated. Dependent on the clinical context, your patient may already have been referred or may still require a referral. Please check and action accordingly.
Clinical Toxicology service
Salford Royal Foundation Trust offers a clinical toxicology service to primary and secondary care, Salford Mental Health Trusts, Drug and Alcohol liaison services within the Greater Manchester Area and receives work referred from outside the region.
Toxicology Contact Information
Telephone: 0161 206 4954 (9:00 to 17:30 pm). A voicemail system is in operation outside these times.
Services Offered and Sample Requirements for Urine Toxicology Analyses
Request Screen Components Sample Volume Required
Routine Drug Opiates (Morphine, Codeine, Monoacetyl Morphine, Acetyl At least 10 ml Screen Codeine), Methadone and Methadone Metabolite (EDDP), Amphetamine group, Benzodiazepine group, Cocaine metabolite (EDDP), Buprenorphine and Nor Buprenorphine.
Ethanol and Cannabis are only performed on request. Please An additional 5 make clear on the request form if these are required. ml
Extended Search for unknown drugs 10 ml Toxicology Screen Benzodiazepine Including: Temazepam, Diazepam, Nitrazepam, Oxazepam, 10 ml Differentiation Clobazam, Flunitrazepam, Midazolam, Chlordiazepoxide, Zopliclone.
Amphetamine Including Amphetamine, Methylamphetamine, MDA, MDMA 10 ml Screen (Ecstasy), MDEA, Methylphenidate, Mephedrone, Phentermine, Fenfluramine
Stimulant Screen Benzylpiperazine (BZP), Ketamine, Phencyclidine (PCP), 10 ml Benzoylecognine (BEC), Tramadol, MDMA (Ecstasy), Methylamphetamine, LSD and Gamma Hydroxybutyric acid (GHB).
Laxative Screen Bisacodyl (Dulcolax), Danthron, Rhein (Senokot), 20 ml Phenolpthalein. 60
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Turnaround Times
Routine drug screens have a turnaround time of 5 days. This may be longer if extended drug screens are warranted based either on findings of the routine drug screen or by request from the clinician. Urine Toxicology analyses are not performed outside of normal working hours. Please contact the Clinical Scientist / Chief Biomedical Scientist in Toxicology on 0161 206 4954 if you wish to discuss your request in more detail or you wish to screen for a particular drug.
Porphyrin service
OUT OF HOURS URGENT URINE PORPHOBILINOGEN (PBG)
The Department of Clinical Biochemistry offers a 7 day service for urgent urinary PBG to Salford Royal NHS Foundation Trust (SRFT) and other North West hospitals
We aim to meet the 2016 British and Irish Porphyria Network (BIPNET) standard that results will be available to the requesting clinician within 24h of sample receipt in the admitting laboratory.
(BIPNET Guidelines on first line laboratory testing for porphyria downloadable from: http://journals.sagepub.com/doi/pdf/10.1177/0004563216667965 )
Indications for the Test • Clinical suspicion of an acute attack of porphyria as a new diagnosis. • Confirmation of an acute attack in a patient known to have Acute Intermittent Porphyria, Variegate Porphyria, Hereditary Coproporphyria or ALAD Porphyria.
Specimen Requirements • Freshly collected random urine. • Specimen must be protected from light. Label the container and wrap immediately in black plastic or tin foil.
Request form: key information Please ensure the following details are provided: • Complete PID • Reason for urgent PBG request (include porphyria diagnosis if known) • Name of clinician and telephone/pager numbers for receipt of results • Date/time of sample collection and date/time of receipt in your own lab (this is needed to monitor compliance with the BIPNET turnaround time standard)
Cost of urgent PBG testing: The charge for urgent, quantitative urinary PBG is £135 per sample.
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How to arrange urgent PBG analysis • Urgent PBG analysis is available 7 days a week. • ALL URGENT PBG REQUESTS MUST BE PRE-ARRANGED BY TELEPHONE TO OUR LABORATORY. • During core working hours (Monday-Friday 09.00-17.30h), please request urgent PBG through the Duty Biochemist on 0161 206 8212 • Out of hours, urgent PBG should be requested by clinical scientist or medical staff on-call for Clinical Biochemistry or a senior clinician (normally ST doctor or above) with clinical responsibility for the patient. To contact our on-call staff, please telephone SRFT switchboard on 0161 789 7373 and ask for the BMS on-call for Clinical Biochemistry. • Arrange to transfer the specimen by taxi to Salford Royal. Taxi driver should deliver the specimen to Pathology Specimen Reception, 2nd Floor, Turnberg Building, (Red Area). • Referring laboratories making requests out of hours or late in a working day will be advised to despatch samples in a timely manner so that the 24h turnaround time can be met.
Processing of urgent PBG requests • On weekdays, samples will be processed if they arrive in the laboratory before 5.30pm. On weekends and bank holidays, samples will be processed between 9am and 5:30pm. Outside these hours, samples will be stored at –20°C pending analysis as soon as possible after 09.00h the following morning. • Quantitative urinary PBG will be analysed by the BioRad anion exchange column method and urinary creatinine by Siemens ADVIA method. • Results will be reported as a ratio of PBG:creatinine (reference range up to 1.8 umol/mmol).
Clinical Interpretation • A normal urinary PBG:creatinine result excludes an acute porphyria attack as the cause of current symptoms • An abnormally raised PBG:creatinine ratio provides key supportive evidence for the clinical diagnosis of an acute porphyria attack in symptomatic patients • Urinary PBG:creatinine ratio is usually grossly raised (often >10 x ULN) in an acute porphyria attack but it is important to recognize that there is no clear threshold above which symptoms occur. The extent of PBG elevation in an individual patient is variable and must be interpreted along with clinical findings. • Interpretation of abnormally raised PBG:creatinine ratio can be very complex in patients who have had previous acute attacks. • The National Acute Porphyria Service (NAPS) is available 24h per day and provides expert clinical advice and supplies haem arginate for treatment of acute porphyria attacks. The clinical team should contact NAPS urgently to discuss the management of any patient (new or previously known) admitted with an acute porphyria attack. The NAPS out of hours service is provided in rotation from one of two centres (Cardiff and King’s College Hospital, London) and can be contacted through the University Hospital of Wales switchboard: 029 2184 7747. For more information see the following link: https://cavuhb.nhs.wales/our-services/laboratory-medicine/medical-biochemistry-and- immunology/porphyria-service-cardiff/national-acute-porphyria-service-naps/
Guidelines for the biochemical diagnosis of Porphyria are available on request from the laboratory.
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List of Referral Laboratories
A number of specialised tests are available from external laboratories. If you require a test that is not listed please contact the Duty Biochemist (0161 206 8212). Clinical details are essential for the interpretation of referred tests. Lack of clinical details may mean that requests may not routinely referred. Referred tests have a variety of turnaround times depending on referral lab and specialty. ISO15189 accreditation status for referral tests may change. Please contact the lab if you wish to find out more about accreditation status of any referred test.
Referral Laboratory Analyte referred Regional Toxicology Laboratory, Kelvin NSAID screen (urine) Building, Royal Hospitals Belfast health and Social Care Trust, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA Tel: 02890 631 906
Dept. Clinical Biochemistry, TPMT City Hospital Birmingham, Thiopurine Metabolites Dudley Road, Birmingham, B18 7QH Gilberts Genotype Tel: 0121 507 5162 TPMT Genotype Toxicology Laboratory Toxic alcohols Tel: 0121 507 4138 Amphetamine Isomers Paraquat
Clinical Chemistry, D-Lactate Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH Tel: 0121 333 9912/9922
Dept. Clinical Biochemistry First Trimester antenatal screening Royal Bolton Hospital, Minerva Road, ALP Isoenzymes Farnworth, Bolton, BL4 0JR Tel: 01204 390 414
Dept. Medical Biochemistry University of Homocysteine Wales, Heath Park, Cardiff, CF14 4XW Methylmalonic acid Tel: 029 20 743560 / 7443565 Porphyrin Genotype
Cardiff Toxicology Laboratory, The Academic Olanzapine centre, Llandough Hospital, Penarth, CF64 2XX Tel: 029 2071 6893/6894
TDM Unit, Chalfont Centre for Epilepsy, Ethosuximide Chesham Lane, Chalfont St Peter, Buckinghamshire, SL9 0RJ Tel: 01494 601423 63
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Referral Laboratory Analyte referred Dept. Clinical Chemistry, Gut Hormones Charing Cross Hospital, Fulham Palace Road, Gastrin London, W6 8RF Tel: 0203 313 5353
Dept Biochemistry, Christie Hospital NHS Calcitonin Trust, Wilmslow Road, Withington, Methotrexate Manchester, M204BX Chromogranin A Tel: 0161 446 3298 Lipase Macroprolactin
Clinical Laboratory Immunology, Churchill Orexin Hospital, Churchill Drive, Old Road, Headington, Oxford, OX3 7LE Tel: 01865 225995
Blood Sciences Laboratory Area A2 Urine C-Peptide:Creatinine ratio Royal Devon and Exeter NHS FT Vedolizumab Barrack Road Exeter EX2 5DW Tel: 01392402934
Dept. Clinical Biochemistry, MacEwan Apoprotein A / B building, Glasgow Royal Infirmary, 84 Castle Lipoprotein (a) Street, Glasgow, G4 0SF Vitamin B1, B2, B6, K Tel: 0141 211 4003
North East Scotland Genetic Service Apo E genotyping Aberdeen Royal Hospitals NHS Grampian Polwarth Building Foresterhill Aberdeen AB25 2ZD
SAS Trace Element Laboratory, Surrey Cadmium Research Park, 15 Frederick Sanger Road, Chromium and Cobalt Guildford, Surrey, GU2 7YD Lead Tel: 01483 689 978 Mercury Toxic Heavy metal screen
Dept Chemical Pathology, Level 1, Camelia Urine Tetrasacchrides Botnar building, Great Ormond Street GB-3 (Fabry monitoring) Hospital, Great Ormond Street, London, WC1 Macroamylase/Amylase Isoenzymes 3JH GSD Enzyme screen Tel: 020 7405 9200 ext 5009 Keratan Sulphate 020 7762 6751
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Referral Laboratory Analyte referred SAS Peptide Hormone section, Clinical Insulin and C-Peptide Laboratory, Royal Surrey County Hospital, Insulin (only) Egerton Road, Guildford, Surrey, GU2 7XX Proinsulin Tel: 01483 406 715 Sulphonlyureas
SAS Genetic Enzyme lab, Biochemical Galactokinase Genetics, 5th Floor Tower Wing, Guy’s Hospital, London, SE1 9RT Tel: 0207 188 2591/2592
Dept. Clinical Biochemistry, Viapath Kings 11-deoxycortisol College Hospital, Denmark Hill, London, SE5 Clozapine 9RS Erythropoietin Tel: 020 3299 4126 Soluble Transferrin receptors Steroid profile
Biochemical Genetics, Block 46, GAA/Creatinine St James’ Hospital, Leeds, LS9 7TF White cell cystine Tel: 0113 206 4256
Dept. Clinical Chemistry, Royal Liverpool Aluminium University Hospital, 4th Floor Duncan Building, Manganese Prescot Street, Liverpool, L7 8XP 1,25 dihydroxy Vitamin D Tel: 0151 706 4230/4755 βCTX P1NP Urine Copper
Dept. Clinical Biochemistry, Alder Hey Faecal reducing substances Children’s Hospital Eaton Road, West Derby, Urine Reducing substances Liverpool L12 2AP Flecainide Tel: 0151 252 5486 Vitamin A Vitamin E
Merseyside and Cheshire Regional Geentics Cadasil Laboratory Liverpool Women’s NHS FT Crown Street, Liverpool, L8 7SS Tel: 0151 702 4228/0151 802 5001
Dept. Clinical Biochemistry, Manchester Anti Mullerian Hormone University NHS Foundation Trust, Oxford Cholinesterase (+ red cell) Road, Manchester, M13 9WL Tel: 0161 276 4699
Specialist Assay Laboratory, 2nd floor CBS 3, P3NP Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL Tel: 0161 276 4699
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Referral Laboratory Analyte referred Paediatric Specimen reception, Ground Floor Beta Hydroxybutyrate CSB 3, Royal Manchester Children’s Hospital, Paediatric Catecholamines Oxford Road, Manchester, M13 9WL Cystatin C Tel: 0161 901 2333/276 8766 Free Fatty Acids 17-OH Progesterone Lamotrigine Phenobarbitone
Department of Blood Sciences, Royal Victoria Co-peptin Infirmary, Queen Victoria Road, Newcastle Thyroglobulin Upon Tyne, NE1 4LP Tel: 0191 282 4027/9719
Dept. Clinical Biochemistry, Norfolk and PTHrP Norwich University Hospitals, Level 1 East Block, Colney Lane, Norwich, NR4 7UY Tel: 01603 286 929/01603 287 495
Neurometabolic Unit, Box 105, The National CSF ACE Hospital for Neurology and Neurosurgery , CSF Neurotransmitters Queen Square, London, WC1N 3BG Tel: 020 344 83818
Neuroimmunology & CSF Laboratory, The Total Tau protein, Phospho-Tau and Amyloid National Hospital for Neurology and beta Neurosurgery, Queen Square, London, WC1N Transferrin Glycoforms 3BG Vasendothelial Growth Factor Tel: 020 3448 3812/3814
Dept. Clinical Chemistry, Royal Oldham Faecal Immunochemical Test (FIT) Hospital, Rochdale Road, Oldham, OL1 2JH Tel: 0161 656 1515
Dept. Biochemistry, Rotherham General Vitamin C Hospital NHS Trust, Moorgate Road, Rotherham, S60 2UD Tel: 01709 304 241
Dept. Clinical Chemistry, Pathology Block, Trimethylamine Sheffield Children’s Hospital, Western Bank, Trimethylene Genotype Sheffield, South Yorkshire, S10 2TH Sterols (7-dehydrocholesterol) Tel: 0114 271 7445
Diagnostic Genetics Service, Sheffield Fatty Acid Oxidation studies in skin fibroblasts Children’s Hospital, Western Bank, Sheffield, South Yorkshire, S10 2TH Tel: 0114 226 0972
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Referral Laboratory Analyte referred Department of Immunology/SAS Protein Alpha 1 Antitrypsin Genotype Reference Unit, Sheffield Teaching Hospitals Alpha 1 Antitrypsin Phenotype NHS FT, Northern General Hospital, PO Box Amyloid A 894, Herries Road, Sheffield, S5 7YT Carbohydrate deficient Transferrin Tel: 0114 271 5552 Free PSA Inhibin Myoglobin Neurone Specific Enolase Orosomucoid PLA2R
Dept. Clinical Chemistry, Sheffield Teaching HCG (molar) Hospitals NHS FT Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF Tel: 0114 271 2214.
Division for Metabolic diseases, University Vitamin B studies in skin fibroblasts Children’s Hospital, Steinwiesstrasse 75, CH8032, Zurich, Switzerland,
Department of Clinical Biochemistry, Stepping Bile Acids Hill Hospital, Stockport, SK2 7JE Tel: 0161 419 4919
Protein Reference Unit, St Georges University Alpha 1 Antitrypsin (faeces) Hospital NHS FT, P.O. Box 10295, Cranmer Terrace, London, SW17 ONH Tel: 020 8725 0025
Chemical Pathology Department Beta Carotene St Helier Hospital, Wythe Lane, Carshalton, Surrey, SM5 1AA Tel: 0208 296 2825/ 07975 232 440
Viapath, Reference Chemistry Laboratory, Anti-TNFα drugs (Infliximab/Adalimumab) 4th Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH Tel: 0207 188 1264
Purine Research laboratory, 4th Floor North Purine/Pyrimidine Screen Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH Tel: 0207 188 1266
Dept. Clinical Biochemistry, Calculi (stones) HSL analytics LLP Whitefield Street, London, W1T 4EU Tel: 020 344 72955 67
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Referral Laboratory Analyte referred HaemOnc Group, 5th floor Molecular Fabry screening Pathology/Genetics, HSL analytics LLP, The Halo building, 1 Mabledon Place, London, WC1H 9AX Tel: 0203 908 1292
University College London, Institute of Child Alpha amino adipic semialdehyde Health, 30 Guildofrd Street, London, WC1N 1EH Tel: 020 7905 2628
The Neurosciences Laboratories, The Walton Leviteracetam Centre NHS FT, Lower Lane, Fazakerley, Liverpool, L9 7JL Tel: 0151 529 5577
Willink Biochemical Genetics Laboratory, Acyl Carnitine Genomic Diagnostics Laboratories, Alpha/Beta Glucosidase Manchester Centre for Genomic Medicine, 6th Beta Galactosidase Floor Pod 1, St Mary’s Hospital, Oxford Road, Amino acids (CSF, plasma and Urine) Manchester, M13 9WL Aryl sulphatase Tel: 0161 701 2137/2138 Biotinidase Chitotriosidase Cholestanol Galactosemia screen Galactose-1-Phosphate(adult metabolic) Homocysteine (adult metabolic) Methylmalonic acid (adult metabolic) Muco/Oligosaccharides Organic acids Orotic acid Oxysterols Phenylalanine/Tyrosine Phytanic/Pristinic acid Very Long Chain Fatty Acids White Cell Enzymes
Dept. Clinical Biochemistry, Wythenshawe Aldosterone/Renin Hospital, Southmoor Road, Manchester, M23 Citrate 9LT Cystine Tel: 0161 291 2126 Everolimus Faecal Elastase Mycophenalate Oxalate Prednisolone Salivary Cortisol
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