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 1 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 2 of 68 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 2 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 3 of 68 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 3 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 4 of 68 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. 4 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 5 of 68 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. 5 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 6 of 68 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