Pathology Users Handbook

Pathology Directorate
PATHOLOGY USERS HANDBOOK

PATH-SOP-15
CONTENTS
1.0 INTRODUCTION
2.0 QUALITY ASSURANCE
2.1 DATA PROTECTION AND CONFIDENTIALITY
3.0 GENERAL INFORMATION
3.1 LOCATION OF PATHOLOGY CUMBERLAND INFIRMARY, CARLISLE
3.2 LOCATION OF PATHOLOGY WEST CUMBERLAND HOSPITAL,
WHITEHAVEN
4.0 SPECIMENS/REQUEST FORMS
4.1 SPECIMENS
4.2 REQUEST FORMS
4.3 HIGH RISK SPECIMENS AND SAFETY
4.4 RECEIPT OF SPECIMENS
4.5 GP SURGERIES AND OTHER HOSPITALS
4.6 VISITORS
4.7 PATIENTS
4.8 PATHOLOGY SUPPLIES
4.9 REPORTS
5.0 BIOCHEMISTRY DEPARTMENT
5.1 DEPARTMENTAL INFORMATION
5.2 SPECIMEN RECEPTION AND RESULT ENQUIRIES
5.3 SENIOR STAFF CONTACT DETAILS
5.4 LABORATORY OPENING HOURS
5.5 REQUEST FORMS AND SPECIMEN CONTAINERS
5.6 TURNAROUND TIMES
5.7 TIME LIMITS FOR REQUESTING ADDITIONAL TESTS
5.8 URGENT REQUESTS & TELEPHONING OF CRITICAL VALUES
5.9 SPECIAL ARRANGEMENTS FOR SPECIFIC TESTS
5.10 REFERRAL OF TESTS TO OTHER LABORATORIES
5.11 MINIMUM REQUEST INTERVALS (MRI)
5.12 INDIVIDUAL ASSAY INFORMATION
5.13 SAMPLE TYPE, REFERENCE RANGES AND TURNAROUND TIMES
6.0 HAEMATOLOGY AND TRANSFUSION DEPARTMENT
6.5 SCOPE OF LABORATORY SERVICE
6.7 TELEPHONING OF CRITICAL VALUES
6.8 ROUTINE HAEMATOLOGY SECTION
Pathology Users Handbook – V20

PATH-SOP-15 Page 1 of 138 Issued: 19.2.18
6.9 COAGULATION SECTION

6.10 KEY FACTORS KNOWN TO AFFECT THE PERFORMANCE OF TESTS
6.11 TIME LIMITS FOR REQUESTING ADDITIONAL EXAMINATIONS
6.12 REFERRAL OF SAMPLES TO OTHER LABORATORIES
6.14 THROMBOPHILIA REQUESTING
6.15 BLOOD TRANSFUSION SECTION
6.16 SPECIMEN REQUIREMENTS
6.17 SPECIMEN LABELLING
6.18 CROSSMATCHING
6.19 GROUP AND ANTIBODY SCREEN
6.20 STORAGE & HANDLING OF BLOOD FOR TRANSFUSION
6.21 TRANSFUSION REACTIONS AND INCIDENT REPORTING
6.22 BLOOD PRODUCTS AND COMPONENTS
6.23 REQUESTING PORTERING PICK UP OF BLOOD PRODUCTS
6.24 TRACEABILITY LABELS
6.25 SAMPLE TYPES, REFERENCE RANGES AND TURNAROUND TIMES
7.0 HISTOLOGY AND CYTOLOGY DEPARTMENT
7.6 SAMPLE TYPES
7.7 CYTOPATHOLOGY SERVICES
7.8 MORTUARY DEPARTMENT
7.9 ANDROLOGY (at the Cumberland Infirmary, Carlisle)
7.10 GOVERNANCE
8.0 MICROBIOLOGY, VIROLOGY AND IMMUNOLOGY
8.5 CLINICAL ADVICE
8.6 CLINICS
8.8 SPECIMEN COLLECTION
8.10 REPORTS
8.11 SAMPLE TYPES/REFERENCE RANGES/TURNAROUND TIMES
9.0 POINT OF CARE TESTING
9.2 CONTACT DETAILS
9.3 CLINICAL ADVICE
9.4 TECHNICAL ADVICE
9.5 NEW AND REPLACEMENT POCT DEVICES/TESTS
9.6 BLOOD GLUCOSE
9.7 URINANALYSIS TESTS
9.8 URINE PREGNANCY TESTS
9.9 BLOOD KETONE
9.10 BLOOD GAS ANALYSERS
9.11 INR TESTS FOR ANTI-COAGULATION
9.12 GLYCATED HAEMOGLOBIN (HBA1C)

1.0 INTRODUCTION
The aim of this Handbook is to present the Pathology departments at the

Cumberland Infirmary and the West Cumberland Hospital in a clear and concise
fashion. There is a section devoted to each department which contains detailed
information about what services are available and how best to use them.
North Cumbria University Hospitals NHS Trust Pathology consists of departments

of Blood Sciences (Biochemistry, Haematology and Transfusion), Cell Sciences
(Histology and Mortuary) and Infection Sciences (Microbiology, Virology, and
Immunology).
Our aim is to provide a wide range of high quality Pathology services for our users
and patients, in a timely manner and consistent with the needs of best clinical
practice. We are always pleased to hear any of your comments or suggestions
which may help us to improve the services that we offer. General comments should
be addressed to Francine Duncan, Pathology Services Manager. Should you have
any specific problems please contact the Head of the Department concerned.
Advice on voicing concerns and making a complaint

Sometimes things may not go as planned. Voicing your concerns or making a
complaint allows us to learn from your experience and improve the service for all of
our users.
If you wish to discuss any concerns you have you should speak to:
Pathology Service Manager
Mrs Francine Duncan MA, FIBMS

Tel: CIC Ext 14644/WCH Ext 23431
francine.duncan@ncuh.nhs.uk
Deputy Pathology Service Manager

(and Blood Sciences Service Manager)
Mrs Anne Pearson MSc FIBMS PGCert Management

Tel: CIC Ext 14540
anne.pearson@ncuh.nhs.uk
Information about other senior staff can be found under the individual departments.
The Trust Complaints Department can be contacted via:

http://nww.staffweb.cumbria.nhs.uk/trust-information/complaints-leaflet-2014.pdf
or
Complaints Department
Cumberland Infirmary Tel: 01228 814018

2.0 QUALITY ASSURANCE
All departments aim to give the highest quality of service with the minimum of delay.
To ensure this, all departments are UKAS accredited:
 Blood Sciences - UKAS accredited medical laboratory No. 8555
 Infection Sciences - UKAS accredited medical laboratory No. 8874
All work is subject to extensive internal quality control checks and laboratories
participate in external quality assurance (EQA) schemes.
2.1 DATA PROTECTION AND CONFIDENTIALITY

The data handled and processed in Pathology is, by its nature sensitive. Most data
relates to identifiable individuals. Even data that has personal identifiers removed may
be traceable to individual patients.
The information on patients and other individuals held in the laboratory is subject to
the Data Protection Act 2002, which controls the use of personal data in whatever
form it is held. Laboratory data is also likely to be subject to a Common Law duty of
confidentiality, and Caldicott guidelines. The Trust’s Caldicott guardian is Graham
Putnam. The Human Rights Act is also likely to cover the misuse of personal
information.
Therefore, both the laboratory and individual employees can be prosecuted if they are
found to have disclosed personal data without authorization. An unauthorised
disclosure is where identifiable personal details are given either, verbally,
electronically or in writing to anyone not authorised to receive them. Such disclosure
would be considered gross professional misconduct and consequently viewed
extremely seriously.
3.0 GENERAL INFORMATION
3.1 LOCATION OF PATHOLOGY CUMBERLAND INFIRMARY, CARLISLE
All the Pathology laboratories and the Mortuary are located on the lower ground
floor of the Cumberland Infirmary, shown on the plan B below.
Access for visitors is from Newtown Road.
If you are travelling by car and using satellite navigation, the postcode for the
Cumberland Infirmary is CA2 7HY.
From M6:
Exit M6 at Junction 43 and continue past Tesco on right and Rosehill Industrial
Estate on left. Continue forward and at the traffic lights turn right onto Victoria
Place. Follow road passing Carlisle College on right. At traffic lights turn right onto
Georgian Way (keep left). At roundabout (Hardwicke Circus) take the first left onto
Castle Way (A595).
Continue along Castle Way, onto Bridge Street moving into the right hand lane.
Straight ahead at traffic signals, at the roundabout take the second exit onto
Caldcotes, (signposted B5307 - Kirkbride) and continue past Port Road Industrial
Estate. Entrance to the Cumberland Infirmary is second right at the traffic signals.

The location of car parks for visitors is shown on Plan A.
Public Transport
Buses run frequently to the Cumberland Infirmary from the centre of Carlisle and
the surrounding area:
Stagecoach Bus Services No. 60, 67 and 68 run every 5-10 minutes but it is
recommended that you contact the local service provider to check on timetables as
they are subject to change. Stagecoach Ltd can be contacted on 0871 200 22 33.
(Calls cost 10p per minute from a BT landline, calls from other service providers
and calls from mobiles may vary). You can also download timetables from their
website.
Pathology Reception Cumberland Infirmary

Contact: Direct dial (01228) 814550 ext. 14550
Opening times: Weekdays 08:30-18:00

Saturdays 08:00-12:30
Plan A: Cumberland Infirmary site showing car parks

Plan B: Cumberland Infirmary Lower Ground Floor Map

3.2 LOCATION OF PATHOLOGY WEST CUMBERLAND HOSPITAL, WHITEHAVEN
The pathology department is on level 2 of the newly developed West Cumberland

Hospital.
If you are travelling by car and using satellite navigation, the postcode for the West
Cumberland Hospital is CA28 8JG. The location of car parks for visitors is shown on
Plan C.
From M6:
Exit M6 Junction 40, taking the A66 towards Keswick/Workington. This is the most
direct route avoiding the Lakes tourist routes. This route also by-passes the towns
of Penrith, Keswick and Cockermouth.
Public Transport
Buses run frequently to the West Cumberland Hospital but it is recommended that
you contact the local service provider to check on timetables as they are subject to
change. The local service provider is Stagecoach Ltd and can be contacted on
0871 200 22 33 (Calls cost 10p per minute from a BT landline, calls from other
service providers and calls from mobiles may vary). You can also download
timetables from their website.
Pathology Reception West Cumberland Hospital

Contact: Direct dial (01946) 523433 ext. 23433
Opening times: Weekdays 08:45-17:00

Staff
Disabled
Designated
Visitor
Plan C: West Cumberland Car Parks

Plan D: West Cumberland Hospital site
Level 3 WCH Level 4 WCH

4.0 SPECIMENS/REQUEST FORMS

The responsibility for requesting a laboratory service or test lies with an authorised
and trained practitioner (normally a clinician). It is the responsibility of the requester
to ensure that samples are correctly labelled and request forms are completed to
agreed standards in line with the NHS Operating Framework. Before accepting a
clinical specimen laboratory staff must ensure that certain minimum criteria for
sample identification are met.
To ensure that requests are dealt with effectively, it is essential to comply with the
following guidelines.
Important change to sample labelling policy in Pathology
As of 1 August 2015 ALL Pathology specimens and request forms MUST be

labelled with:
 Full patient name
 Date of birth
 NHS number (or CHI number if Scottish resident)
In exceptional circumstances where the NHS number is unavailable or not

established, a further unique identifier (hospital number or address) must be
provided on the specimen AND request form.
Samples failing to meet the acceptance criteria will not be processed
This requirement is met by using the ICE requesting system. An ICE request is
much more than a printed form.
Benefits of using ICE:

 Patient data and request sent electronically to pathology ensuring all
information required is provided and transcription errors are minimised.
 Improves data quality
 No more paper reports necessary
 Request form and specimen labels printed.
 All requests recorded in ICE preventing duplication.
 Information provided by ICE about samples required and correct
container/swab.
 Information provided by ICE about timing of samples.
 Minimises clerical work in pathology meaning that we can concentrate on
processing samples quickly and accurately.
4.1 SPECIMENS
When collecting blood samples bleed only one patient at a time. Positively identify
patient and label samples immediately at the bedside
Specimens should be placed in the appropriate container which must be securely

fastened. Specimen tubes must be filled in the correct order e.g. fill SST and plain
tubes before EDTA tubes to avoid EDTA interfering with Biochemistry assays:
always inoculate blood culture bottles first. Blood samples must not be transferred
between sample bottles.

The BD Vacutainer Tube Guide and Order of draw is available on request from
Pathology.
Vacutainers are used to collect most blood samples which obviate the need for
syringes. Please note that Vacutainers are not designed to have their tops removed
during blood collection and great care must be taken to ensure that, if this occurs,
tops are replaced securely, particularly if the sample is to be sent through the
pneumatic tube system. Specimens must be identifiable. Unlabelled samples are
not usually processed.
Small (38x20mm) pre-printed labels may be attached to the specimen bottles.
(Please do not use larger labels as these often obstruct our automated equipment
and delay result turnaround.)
Note that there are special instructions regarding requests and specimen labelling
for Blood Transfusion purposes.
All specimens must be labelled with:

 Date of birth
 NHS number
and should have

 Date and time of specimen
 Hospital number
 Location
Supplying the time of collection on the form is desirable as this allows correct
sequencing of results within the ICE results browser.
The container should be sealed, placed in the relevant bag, blue for Infection
Sciences (Microbiology/Virology/Immunology) and clear for all other samples, then
attached to the Pathology request form. Specimens should be transported to the
laboratory as rapidly as possible after collection to ensure that no significant
deterioration occurs before processing.
If a specimen is to be posted the packaging must comply with postal regulations.
Biohazard samples must be double bagged.
Supplies can be ordered from stores under the following codes:

 ICE labels WQG600
 ICE bags WQG601
 Blue ICE bags for Infection Sciences WQG605
4.2 REQUEST FORMS

All in-patient requests must be made via the ICE order communications system,
except for Blood Transfusion, as this supplies a high level of data quality and
printed labels to attach to sample containers.
Out-patient and A&E samples can still make requests using the manual forms
pending deployment of ICE to these areas.

If ICE is unavailable use a colour coded manual form or the reverse of the ICE
request form:
 Biochemistry/Haematology (green-red )
ANC booking bloods use special FOQ form.
 Microbiology (blue/white)
 Immunology/Virology (blue/pale blue)
 Histology/Non-Gynae Cytology (black/white)
 Blood Transfusion (red)
For further information on ICE requesting contact Ian Pearson ext. 14643
ian.pearson@ncuh.nhs.uk
It is essential that the correct request form be completed to ensure an efficient flow
of work. Please ensure that request forms and specimen labelling are completed as
specified below and that the writing is legible.
A completed request form must accompany each specimen sent to the laboratory. It
must clearly state the following legible information.
 Date of birth
 NHS number
 Sex
 PAS number
 Patient address including postcode
 The requesting location and address for report
 Relevant clinical information/drug therapy
 The tests being requested
 Type of specimen and date and time collected
 Indication if HIGH RISK status (see below)
Additional information may be required for some investigations, please see

departmental sections.
"Unknown" patients e.g. those admitted unconscious, unaccompanied and without
documentation, should have their specimens identified with the A&E unique
number.
Regrettably specimens may have to be discarded if they are so inadequately

labelled that the patient's identification is in doubt, or if they have leaked or been
contaminated. In these circumstances every effort is made to inform the requesting
doctor.
4.2.1 Clinical Details

When receiving a sample for analysis, it is very important that we are given
sufficient, relevant, clinical information for us to determine the type of examination
required. Certain samples require special techniques and may not be detected in
the routine examination of a sample.
Relevant details may include:
 Types of symptoms
 Other recent infections
 Date of onset of illness

 Underlying conditions eg diabetes, cystic fibrosis

 Pregnancy
 Foreign travel
 Mention of antibiotic therapy in diarrhoea will alert the laboratory to the
possibility of C.difficile.
Wherever possible specimens should be taken before the commencement of
antibiotic therapy
N.B. An important exception is in suspected meningitis where antibiotics should
always be given as soon as possible as it may be lifesaving.
4.2.2 Laboratory Chain of Evidence Samples

The Laboratory Chain of Evidence Form (LCOEF) is a legal concept which requires
that any sample which may be used as an exhibit in a court of law must follow an
unbroken chain from its origin to the court. All persons handling the sample and
storage conditions must be documented. The Trust protocol aims to ensure that the
risks to patients and staff associated with Chain of Evidence are minimised. The
protocol also enables the Trust to demonstrate that it is following legal guidance.
http://nww.staffweb.cumbria.nhs.uk/policies/categories/risk-
management/completion-of-laboratory-chain-of-evidence.pdf
4.2.3 Antenatal Screening

The NHS Sickle Cell and Thalassaemia Screening Programme requires that
antenatal haemoglobinopathy screening is offered to all eligible women and couples
in a timely manner in pregnancy. Such screening is offered to all pregnant women
at first booking, and the completed laboratory report is to be completed within 3
working days of receipt.
Laboratory testing for haemoglobin variants in this low prevalence area is based on
an assessment of individual risk- determined by completing a Family Origin
Questionnaire (FOQ) which asks women about their or their baby’s father’s family
origin, or for those women who request screening, and also on the results of a full
blood count performed on the mother.
At the time of booking all expectant mothers will have booking bloods taken and
complete the FOQ request form for Sickle Cell and Thalassaemia screening along
with antenatal booking bloods for infectious disease screening.
For further advice on completion of the FOQ please contact the Pathology
department on the numbers listed in section 3.1.
4.3 HIGH RISK SPECIMENS AND SAFETY

High-risk groups can include patients suffering or thought to be suffering from:
 HIV infection
 Hepatitis B
 Hepatitis C
 E.coli O157
 Mycobacterium tuberculosis (TB)
 Salmonella typhi (Typhoid fever)
 All other Category 3 and 4 organisms (Advisory Committee on Dangerous
Pathogens)

 Coccidioides immitis
 IV drug-use
 patients who have had recent foreign travel with unexplained high pyrexia
NB. Specimens and Request Forms MUST be labelled with “High Risk”. The form
must be folded to ensure confidentiality. The specimen must be sealed in the plastic
transport bag. The specimen must then be placed in a secondary biohazard plastic
bag and sealed.
To protect all health care workers requests for investigations on high risk samples
should be the minimum required for diagnosis and good management. Great care
must be taken in obtaining specimens, and equipment such as needles and blades
must be immediately disposed of safely, in approved sharps boxes. Should a
spillage of blood, fluids or tissue occur this should be made safe and disposed of,
no matter what the risk to the patient.
4.4 RECEIPT OF SPECIMENS
4.4.1 Cumberland Infirmary

During working hours all specimens should be delivered to Pathology reception.
For urgent specimens out of hours

Blood Sciences operate a 24 hour shift system.
Infection Sciences operate a 24 hour on call service. It is essential to contact the
BMS on call for the relevant department and to arrange for the specimen to be
delivered to Pathology rapidly.
If you wish to discuss the investigation of a specimen delivered personally, please
ask at reception. Laboratory personnel welcome direct clinical input.
4.4.2 Transport of Specimens

At the Cumberland Infirmary a pneumatic tube system has been installed to
enable the rapid transport of samples to the department.
Samples unsuitable for the pneumatic tube system e.g. blood culture bottles, 24
hour urine containers, histology samples etc must be delivered by hand to
Pathology reception. Please arrange for a porter or make other delivery
arrangements.
Outside the Cumberland Infirmary courier services operate to community

hospitals and general practice premises throughout North Cumbria. Please contact
Francine Duncan Pathology Services Manager, 01228 814644 or 01946 523431
with any enquires.
Blood Bikes
Blood Bikes Cumbria and South West Scotland is a “Not for Profit” charity staffed by
volunteers dedicated to provision of an out of hours courier service. They will
transport samples, reagents, medication and diagnostic material upon request
between NCUHT sites and referral laboratories. They will also transport blood and
blood products between CIC and WCH and NHSBT if required. Many of the
volunteers will utilise their own motorcycles and there will be access to emergency
liveried motorcycles for “blue light” transportation.
N.B. This service can only be utilised on authorisation by the laboratory staff.

4.4.3 Pneumatic Tube System - CIC

4.4.3.1 To send samples to the Pathology department
a. Ensure sample tube tops are secure.
b. Place specimen(s) in a specimen bag and seal the bag.
c. Place the request form and samples in a Pathology sample carrier
DO NOT use a Pharmacy carrier.
DO NOT use a damaged carrier.
d. Select the destination by pressing the appropriate number on the station
key pad:
 1003 or 1004 Pathology reception
 1005 Blood Sciences - Urgent Samples Only
 1023 or 1024 MVI reception
e. Check the display corresponds to the destination required.
f. Load the carrier into the station.
4.4.3.2 Receiving a carrier

a. Collect the carrier from the cupboard below the station.
Do not allow carriers to accumulate in the cupboard as they could
block the system.
b. Remove contents of the carrier, if any, and RETURN carrier immediately
to the sending department. The address code will be marked on the
carrier.
4.4.3.3 Faults/problems
Report immediately to Interserve Help Desk on ext. 13434
PNEUMATIC TUBE ISSUES

Green lamp on Address accepted
Green lamp flashing Incorrect address inserted
System is busy. Leave the carrier in the dispatch tube. It
Yellow lamp on
will go automatically when the system is free.
Red lamp on There is a fault. Contact the Help Desk on ext. 13434
SAMPLE ISSUES
Blood culture bottles Are NOT allowed
CSF Universals Samples for Xanthochromia should be sent by porter
May be transported in the system. Expel any air
Blood gas syringe bubbles, remove the needle and attach rubber stopper
securely.
Must be double bagged. First seal in a Bio-hazard bag
High risk samples then seal in the bag attached to the Pathology request
form, or one of the clear plastic bags supplied.
4.4.4 Pneumatic Tube System - WCH

4.4.4.1 To send samples to the Pathology department
a. Ensure sample tube tops are secure.
b. Place specimen(s) in a specimen bag and seal the bag.
c. Place the request form and samples in a Pathology (RED) sample carrier
DO NOT use a Pharmacy (GREEN) carrier.
DO NOT use a damaged carrier.
d. Enter the destination address code:
 911 or 912 - Pathology reception
e. Check the display corresponds to the destination required.
f. Confirm by pressing the ‘E’ key
g. If the display shows ‘Destination Accepted’ the pod will leave
automatically when the system has capacity to deal with it
Do not remove pod after confirmation of the send at step e.
4.4.4.2 Receiving a carrier

a. Remove the carrier from the basket.
Remove contents of the carrier, if any, and RETURN carrier immediately
to the sending department. The address code will be marked on the
carrier.
4.4.4.3 Faults/problems
Report all faults immediately to Estates Help Desk on ext. 23799
SAMPLE ISSUES
Blood culture bottles Are NOT allowed

Specimen bottles containing
Are NOT allowed
formalin
CSF Universals Samples for Xanthochromia should be sent by porter
May be transported in the system. Expel any air
Blood gas syringe bubbles, remove the needle and attach rubber stopper
securely.
Category III pathogens (e.g.
Are NOT allowed
Legionella, Ebola etc.)
Must be double bagged. First seal in a Bio-hazard bag
High risk samples then seal in the bag attached to the Pathology request
form, or one of the clear plastic bags supplied.
4.4.5 Phlebotomy Service

A limited service is available for in-patients at the Cumberland Infirmary. The
phlebotomists visit wards each day between 08:00 and 12:00.
On Saturdays, Sundays and Bank Holidays a limited service is provided between
08.00 and 12.00.
Should a patient be unavailable for venepuncture, or if a sample cannot be

obtained, the phlebotomist will notify ward staff as soon as is practicable.
Ward staff are requested to ensure that request forms are completed before
the phlebotomist arrives.

Urgent specimens should be taken by ward staff. Use the pneumatic tube system
to send the sample, if suitable, to the laboratory. Otherwise arrange for a porter to
deliver the sample. Alert the laboratory about urgent requests by telephone.
4.4.6 West Cumberland Hospital

There are routine collections from all wards by the portering staff several times per
day, Monday to Friday 09:00-17:00.
During these times, specific arrangement for the delivery of urgent specimens to the
laboratory must be made with the laboratory reception and not sent as part of the
routine collection.
Outside these hours samples should be taken to Blood Sciences Reception. If

urgent, the porters may be contacted by paging Ext. 15540.
4.5 GP SURGERIES AND OTHER HOSPITALS
There are scheduled collections via hospital transport.

Details of the current schedule can be obtained from the Pathology Reception.
4.6 VISITORS
To ensure safety, all visitors should introduce themselves at Pathology reception,
and wait there until they are met by the person they wish to see. It is best to make
appointments in advance, to ensure the right person is available.
4.7 PATIENTS
All patients should report to Pathology reception on arrival unless instructed
otherwise.
4.8 PATHOLOGY SUPPLIES

There is a ward top up system operated by the supplies department (CIC ext.
14568 or direct dial (01228) 814568) for the most commonly used sample
containers, including 24 hour urine, and request forms.
Other Pathology supplies may be collected from Pathology reception during working
hours. Please come in the morning if possible.
4.9 REPORTS
4.9.1 Printed reports

From 1st October 2015 paper pathology reports will no longer be printed out for
wards and departments at West Cumberland Hospital and Cumberland Infirmary.
ICE will therefore be the ONLY way to view a pathology report as of this date.
This excludes all Histopathology reports which will continue to be printed out for the
foreseeable future, and all pathology reports for outpatient departments that
currently do not have sufficient monitors to view reports electronically.
To ensure patient safety is not compromised we will continue to monitor the rate of
viewing of ICE reports to make sure this remains above 95% for ward areas.
Clinicians are reminded that they have a responsibility to act upon the results once
viewed, and reports should be electronically filed to demonstrate that this
responsibility has been accepted.

4.9.2 Electronic reports
ICE
Results are available via the ICE web browser. The Laboratory computer system
(Telepath) sends an update of recently authorised results to ICE every 10 minutes
every day. It is important for ward based staff to realize when using ICE that there
might be occasions when there are several individual records for one individual
patient. This undesirable occurrence is due to poor data quality supplied with
various requests, which do not allow lab data entry staff to match new requests to
previously received patient work.
Contact the Information Services help desk on ext. 14085 for further information on
access to Pathology results via ICE, to arrange training or if you have forgotten your
password.
Primary care (Lab link)

Results are sent each evening to GP practices. For further information contact Ian
Pearson (ext.14643).

5.0 BIOCHEMISTRY DEPARTMENT

The Biochemistry Department at the Cumberland Infirmary and West Cumberland

Hospital provides an accessible and comprehensive diagnostic support service to
both hospital and primary care clinicians.
The Blood Sciences Department is a UKAS accredited medical laboratory No. 8555
and are also accredited for training Biomedical Scientists by the Institute of
Biomedical Science.
The quality of the service is continuously monitored by internal quality control

procedures and participation in National External Quality Assessment Schemes for
the range of analytes provided. In addition the department regularly participates in
clinical audit.
5.1.1 Clinical Advice

All consultants in Biochemistry welcome the opportunity to provide advice on
appropriate investigations and interpretation of results. Out of normal working hours
they may be contacted via the hospital switchboard for advice over urgent matters.
5.1.2 Lipid / Metabolic Clinics

Dr Luvai provides out-patient clinics at Cumberland Infirmary and West Cumberland
hospital on alternative Fridays mornings. Referrals can be made via Choose and
Book or via the Pathology secretaries.
Tel: CIC Ext 14541

WCH Ext 23433
Consultant Clinical Biochemist / Head of Department

Mr Wayne Bradbury BSc MSc CSci FRCPath EuSpLM
Tel: CIC Ext 14521
wayne.bradbury@ncuh.nhs.uk
Consultant Chemical Pathologist

Dr Ahai Luvai MBChB FRCP Edin FRCPath EuSpLM
Tel: CIC Ext 14028
ahai.luvai@ncuh.nhs.uk
Consultant Clinical Biochemist

Ms Sally Willett MBiochem MSc FRCPath
Tel: CIC Ext.14521/14028
sally.willett@ncuh.nhs.uk
The above attend WCH on at least Tuesdays and Thursdays.

Blood Sciences Service Manager

Mrs Anne Pearson MSc FIBMS PGCert Management
Tel: CIC Ext 14540 Tel: WCH Ext 13433
Operational Manager Blood Sciences

Mr Simon Lowes FIBMS PgDip Management
Tel: WCH Ext 23434/23432/23433
simon.lowes@ncuh.nhs.uk
Biochemistry Team Manager

Mrs Pamela Bowe MSc FIBMS
Tel: CIC Ext 14543
pamela.bowe@ncuh.nhs.uk
5.4.1 Cumberland Infirmary Carlisle

Open for the receipt and handling of specimens from 08:00 to 20:00, Monday to
Friday and from 08:00 to 17.00 on Saturday.
Out of hours i.e. between 20:00 and 08:00, Monday to Friday, 17.00 Saturday to
08:00 Monday and all day during Bank Holidays the Biochemistry laboratory is
staffed by a single BMS, primarily to provide a service for emergency and essential
work.

The laboratory is open for receipt of samples between the hours of 08:45 and 22:00
Monday to Friday and 09:00 am to 17:00 on Saturday, Sunday and Bank Holidays.
Outside these hours a multi-disciplinary service operates with one member of staff
covering Biochemistry, Haematology and Blood Transfusion.

Wherever possible we would ask that you give full clinical and drug therapy details -
this helps us process your request accurately and efficiently as well as allowing us
to add additional tests to facilitate patient management. The information helps us to
deal with abnormal results which may need urgent transmission e.g. out-of-hours.
Full information is given on the specimen requirements for the common

Biochemistry assays on the Vacutainer Tube Guide distributed to each ward and
practice.
5.6 TURNAROUND TIMES

The majority of commonly requested non-urgent tests will have results available
within 5 hours. See individual test details for further information. We aim to
turnaround the majority of urgent tests within 1 hour except Troponin where the
target is 1.5 hours.


Requests to add on additional tests to the original request should be made by
phoning laboratory reception. Samples are stored for up to 5 days. The decision to
perform add on tests will depend on the delay in receiving the request and the
stability of the analyte concerned.
5.8 URGENT REQUESTS & TELEPHONING OF CRITICAL VALUES

URGENT requests must be accompanied by a telephoned request from the
clinician indicating the degree of urgency and the form marked as Urgent, unless
there are agreed alternative arrangements in place e.g. sticker system in A/E, EAU
and CCU at CIC.
If you are sending a blood gas sample to the lab outside of Monday-Friday 8am-
8pm please phone and inform the lab.
Urgent tests required out of hours must have contacted the duty BMS. Request
forms marked ‘Urgent’ or ‘Please Phone’ and not accompanied by a telephone call
will be dealt with on the next scheduled batch.
Assays available under the Urgent System are:

Blood CSF
Alcohol Glucose
Ammonia Lactate
Amylase Protein
Blood Gases and Carboxy Hb Xanthochromia (Spectophotometry)
Calcium/Albumin
Carbamazepine
Creatine Kinase
Digoxin Urine
Gentamicin Albumin/Creatinine ratio
Glucose Osmolality
HCG Protein/Creatinine ratio (pregnancy)
Lactate U/E
Lithium
Liver function tests
Magnesium
Paracetamol
Salicylate
Theophylline
Troponin T
Urate
U/E, Bicarbonate and Chloride
Vancomycin
All routine samples from Primary Care are now processed at the Cumberland
Infirmary in Carlisle. In order to ensure delays are minimised for the small amount of
urgent Blood Sciences (Biochemistry, Haematology and Blood Transfusion) work
the following procedure should be followed:
 Seal samples and request form in a plastic bag and place in a cardboard
transport box.

 Arrange urgent transport to Pathology reception at your nearest laboratory

(West Cumberland Hospital or Cumberland Infirmary).
 Label box ‘Urgent Blood Sample’ or something similar.
 DO NOT PLACE THE BOX IN THE BAG WITH ROUTINE SAMPLES.
 Telephone the laboratory to inform them an urgent sample is on its way and
to arrange for the results to be telephoned.
The results telephoned are shown in table 1.

The values used are based on guidance from the Royal College of Pathologists.
Analyte Units Lower limit Upper limit Comments

Sodium mmol/L 120 160 If new finding
Potassium mmol/L 2.5 6.5 If new finding
Urea mmol/L 30.0 If new finding
If new finding. All new AKI 3
Creatinine µmol/L 500
results are phoned
This does not apply to CIC/WCH
CRP mg/L >300
inpatients
Glucose mmol/L 2.5 25.0 If new finding
Ammonia µmol/L 100 If new finding
Amylase U/L 500 If new finding
Calcium (adjusted) mmol/L 1.80 3.50 If new finding
Lactate mmol/L 5.0 If new finding
Magnesium mmol/L 0.3 If new finding
Phosphate mmol/L 0.3 If new finding
ALT U/L 1000 If new finding
CK U/L 5000 If new finding
If new finding and location not
Troponin T ng/L 15
CIC or WCH
TSH mU/L 25 If new GP finding phoned when
FT3 pmol/L 25 surgery next open
Drugs Units Lower limit Upper limit Comments
Carbamazepine mg/L 25.0
Digoxin µg/L 2.5
Ethanol mg/L 3000
Gentamicin mg/L 1.0
Lithium mmol/L 1.5
Paracetamol mg/L Telephoned if detected
Phenytoin mg/L 40
Salicylate mg/L 300
Theophylline mg/L 45
Vancomycin mg/L 15

5.9 SPECIAL ARRANGEMENTS FOR SPECIFIC TESTS
5.9.1 Biochemical Investigation Sheets (BIS)

Protocols for a range of endocrine and metabolic investigations including dynamic
function tests are available by contacting:
CIC Ext 14541 or WCH Ext 26132
These include:
 Short Synacthen Test
 Water Deprivation
 Glucose Tolerance Test
 Investigation of Hyponatraemia
The investigations in the tables for which ward procedure sheets are available are
marked BIS.
5.9.2 Glucose Load Test
Diagnosis of Diabetes Mellitus and Impaired Glucose Tolerance

Please follow the North Cumbria guidelines including ‘How to use HbA1c in the
diagnosis of diabetes mellitus’. Whole blood glucose measurements using near
patient testing meters are not recommended for diagnosis of diabetes.
Diagnosis of Gestational Diabetes (GDM)

North Cumbria Maternity Services Guidelines Group have published guidance on
the diagnosis of gestational diabetes with emphasis on performing a GTT in
patients at increased risk of developing GDM
5.9.3 Toxicology Requests
The departments provide a wide range of drug analyses either on site or from
reference laboratories. For therapeutic drug monitoring (see alphabetical listing)
pre-dose blood samples are usually required.
In cases where there is suspected drug abuse, qualitative drug screens on urine
samples can be obtained through the laboratory. Results are usually available
within 48 hours of despatch to the reference laboratory. If there is greater urgency
please discuss the case with a senior member of the laboratory staff. The following
groups of drugs are encompassed by a ‘drugs of abuse’ screen:
 amphetamines
 benzodiazepines
 cannabinoids
 cocaine metabolite
 methadone metabolite
 opiates
For further information, particularly on drugs not listed here, please phone the
department.

5.10 REFERRAL OF TESTS TO OTHER LABORATORIES

Where we cannot offer an assay on site, we will generally have arrangements with
reference laboratories. Turnaround time is necessarily longer for these more
specialised tests (see alphabetical test listing for requirements and any special
conditions that may apply).
Addresses and CPA registration numbers for referred tests:
Department Accreditation
Address Tests referred
Name Number
ACTH
Acylcarnitines
Aldosterone
Amino Acids
Androstenedione
Apolipoproteins
Apo E Phenotyping
Beta lipoprotein studies
Calcitonin
Cortisol (urine)
C-Peptide
7-Dehydrocholesterol
DHEAS
Royal Victoria Infirmary
Department of Growth Hormone
Queen Victoria Road Accredited
Clinical IGF-1
Newcastle upon Tyne 8543
Biochemistry Insulin
NE1 4LP
Lactate/Pyruvate(Inter.Metabolites)
Maternal Serum Screen
NEFA
NHDL-C/ApoB ratio
Organic acids
P3NP
Phenobarbitone
Renin
17-Hydroxyprogesterone
TRAb
Thyroglobulin
TSH (blood spot)
Urine Cysteine Screen
Alkaline Phosphatase Isoenzymes
Beta Crosslaps
Chromium
Ciclosporin
Cobalt
Freeman Hospital Copper
Department of
High Heaton Accredited Faecal Elastase
Clinical
Newcastle upon Tyne 925 5HIAA
Biochemistry
NE7 7DN Metadrenalines (urine and plasma)
Methotrexate
Selenium
Sirolimus
Tacrolimus
Zinc
Sunderland Royal Hospital
Department of Accredited
Kayll Road Calculus analysis
Clinical Chemistry 662
SR4 7TP

Name Number
Amiodarone
Ethosuximide
The Academic Centre Flecainide
Toxicology Accredited
Penarth Gabapentin
Laboratory 0841
CF64 2XX Lamotrigine
Levetiracetam
Vigabatrin
Department of Immunology
Alpha-1-acid glycoprotein
Protein Reference PO Box 894 Accredited
Alpha-1-antitrypsin phenotype
Unit Sheffield 113
Chromogranin A
S5 7YT
Wythenshawe Hospital
Southmoor Road
Dept of Clinical Accredited
Wythenshawe Everolimus
Biochemistry 0223
Manchester
M23 9LT
Royal Surrey County Hospital
Gastrin
Egerton Road Accredited
Clinical Laboratory IGF-BP3
Guildford, Surrey 1167
GU2 5XX
Dept of Newborn Birmingham Children’s Hospital
Screening & Steelhouse Lane Accredited Biotinidase
Biochemical Birmingham 1288 Very Long Chain Fatty Acids
Genetics B4 6NH
School of Biological Sciences Aluminium

Centre for Clinical Conditional
University of Surrey Lead
Science and Approval
Guildford Mercury
Measurement 1167
GU2 5XH
Selly Oak Hospital

Department of
Raddlebarn Road Accredited
Clinical Pituitary alpha sub-unit
Birmingham 333
Biochemistry
B29 6JD
Kings College Hospital
Department of
Denmark Hill Accredited
Clinical CDT
London 1245
Biochemistry
SE5 9RS
Glasgow Royal Infirmary
Clinical Vitamin B1
84 Castle Street Accredited
Biochemistry Vitamin B6
Glasgow 2335
Department 1,25 di-hydroxy Vitamin D
G4 0SF
International Centre for Life Haemochromatosis Genotyping
Northern Molecular Central Parkway Accredited Cystic Fibrosis Genotyping
Genetics Service Newcastle 925 Familial Hypercholesterolaemia
NE1 3BZ Genotyping
Fructosamine
City Hospital Laxative Screen
Department of Dudley Road Accredited Thiopurine Methyltransferase
Clinical Chemistry Birmingham 1267 Thiopurine metabolites
B18 7QH Vitamin A
Vitamin E

Name Number
Referred TSH, FT4 and FT3
Wansbeck General Hospital
Clinical Drugs of Abuse Screen
Woodhorn Lane Accredited
Biochemistry Ethylene Glycol
Ashington 1161
Department Methanol
NE63 9JJ
Toxicology
Department of Medical Citrate
Biochemistry Homocysteine
Special Chemistry Accredited
University Hospital of Wales Porphobilinogen
Section 841
Cardiff Porphyrins (blood, urine, faeces)
CF4 4XW Urine Oxalate
UCL
60 Whitfield Street Accredited
HSL Analytics Plasma Oxalate
London 1173
W1T 4EU
Royal Hospital for Sick Children
Biochemical Sciennes Road Accredited
Leucocyte lysosomal enzymes
Genetics Unit Edinburgh 0630
EH9 1LF
Bristol Royal Infirmary
Department of Marlborough Street Accredited
Mucopolysaccharides
Chemical Pathology Bristol UKAS 8227
BS2 8HW
Charing Cross Hospital
PLAP
Fulham Palace Road Accredited
SAS Reception SCC
London 1050
Gut Hormones
W6 8RF
Great Ormond Street Hospital
Chemical Pathology for Children Accredited
Amylase Isoenzymes
Department London 250
WC1N 3JH
Southmead Hospital Galactitol
Biochemical
Southmead Road Accredited Galatose –1-phosphate
Genetics
Bristol 34 Gal-1-PUT
Unit/Biochemistry
BS10 5NB Cholinesterase
Room 917
Clinical Institute of Neurology
Accredited Transferrin Glycoform Studies
Neuroimmunology Queen Square
1839 Asialotransferrin
Department London
WC1N 3BG
National Blood Newcastle-upon-Tyne Accredited
Tissue Typing / HLA analysis
Service NE2 4NQ 2823
Central Parkway
Institute of Human Accredited
Newcastle-Upon-Tyne Cytogenetics
Genetics 2212
NE1 3BZ
Cell markers / flow cytometry
CD61
Royal Victoria Infirmary EMA
Haematology
Queen Victoria Road Accredited Factor V Leiden
Specials
Newcastle-Upon-Tyne 8543 G6PD
Laboratory
NE1 4LP HIT screen
Prothrombin G20210A mutation
Von Willebrand factor
Liverpool School of Tropical
Diagnostic Medicine
Accredited Malaria Parasite
Parasitology Pembroke Place
4001 Identification/Confirmation
Laboratory Liverpool
L3 5QA
Haematology Lab Accredited BCR-ABL
NewGene Ltd st
1 floor Leech Building 0926 Calreticulin

Name Number
Medical School JAK 2 Gene
Queen Victoria Road
Newcastle-Upon-Tyne
NE1 4LP
5.11 MINIMUM RETESTING INTERVALS (MRI)

To minimise duplication of investigations we have introduced, after consultation,
minimum request intervals for a range of tests:
Test RRI
25-OH Vitamin D 365 days
Alpha -1 antitrypsin 999 days
Alpha -1 antitrypsin Phenotype 999 days
ACE 30 days
Anti-TPO Ab 999 days
B12/folate/ferritin 30/30/30 days
Caeruloplasmin 365 days
CDT 14 days
CRP 21 hours
Faecal elastase 6 months
HbA1c 60 days
HDL-Cholesterol 30 days
NT-proBNP 365 days
Procollagen Peptide 88 days
TRAb 365 days
Transferrin saturation 30 days
Thyroid function 24 days
Total cholesterol 30 days
TPMT 999 days
Tumour markers 13 days
If a test request is received within the MRI a report is generated indicating the short
interval, appending the most recent result to assist patient management. We retain
samples for up to six days. If there are special reasons for an early repeat assay,
please contact a senior member of Biochemistry staff.

5.12 INDIVIDUAL ASSAY INFORMATION

5.12.1 Sample Types
SST 5.0mL Gold cap – contains gel
Clotted 6mL Red cap (or 1mL Clear cap for Paediatrics)
EDTA 3.0mL Lilac cap (or 0.5mL Lilac cap for Paediatrics)
Fluoride/Oxalate 2.0mL Grey cap (or 1mL Yellow cap for Paediatrics)
Lithium-Heparin 4.0mL Green cap (or 1mL Orange cap for Paediatrics)
Universal 25mL White cap – for general urines and fluids
Vacuette 6mL White cap – for urine ACR and PCR
For most test profiles (e.g. U&E) or individual tests a minimum of 1.0mL blood is
required.
In general, a filled SST tube is sufficient for up to 12 tests e.g. U&E, LFT, Calcium
/Albumin, TFT and haematinics.
A few tests, in particular more specialised tests, require larger volumes and a
separate tube is required. These are indicated as (V+) on the main table of
Biochemistry investigations below.
Reference ranges quoted apply to adults unless stated otherwise.
Contact the laboratory for information on Paediatric reference ranges

(When unavailable from the supplier of the assay concerned they are sourced from
Paediatric Reference Intervals. 6th Edition. Edited by Steven J. Soldin, Carlo
Brugnara and Edward C. Wong AACCPress 2007. (BS-AUT-ED-26))
BIS – Biochemistry Information Sheet available

(V+) - Extra tube required
(Please note sample types marked with * are not currently accredited to ISO 15189)

ASSAY SAMPLE REF RANGE TURNAROUND TIME COMMENTS

2 blood spots on
Acylcarnitines Guthrie card or Turnaround time 7-21 days
0.5mL in EDTA
Contact Laboratory
Adrenocorticotrophin Turnaround time
EDTA 0-47 ng/L at 9am Deliver Immediately
(ACTH) 14-21 days
BIS24 BIS25
Alanine Transaminase
SST <40 U/L Assayed daily
(ALT)
Albumin SST 35-50 g/L Assayed daily
Normal (mg/mmol)
Male <2.5
Female <3.5
Albumin/ Creatinine Ratio Urine in Vacuette Assayed daily Preferred test for proteinuria
Microalbuminuria
(ACR) preferably first void (PCR for use in pregnancy)
up to 30
Proteinuria
>30
‘Medicolegal’ eg. Drink-
Alcohol ‘limit for driving’
SST Assayed daily driving samples should be
(Ethanol) < 800 mg/L
referred to a public analyst.
Supine
103-859 pmol/L Turnaround time Contact Laboratory
Aldosterone EDTA
Ambulant 14-21 days BIS23 BIS29
103-1197 pmol/L


Adult
up to 70 years 30-130-
U/L
Alkaline Phosphatase >70 years
SST Assayed daily
(ALP) 30-150-U/L
Pregnancy
up to 280 U/L in 3rd
Trimester.
Alkaline Phosphatase
SST Qualitative Assay Turnaround 14 days
Isoenzymes
Alpha-1-Acid
SST Age & Sex Dependant Turnaround 7-14 days
Glycoprotein
Samples will low results are
Alpha -1-Antitrypsin SST 1.10 – 2.10 g/L Turnaround 1-4 days
referred for phenotyping.
Alpha Fetoprotein (AFP) SST 0-8 µg/L Assayed daily Mon-Fri
Do not use Vacutainers

Blood
Aluminium 5mL blood in Universal. Turnaround 7-14 days which may contain trace
<0.4 µmol/L
metals
1mL Lithium-Heparin Detailed quantitative
Amino Acids blood or and interpretative Turnaround 14-21 days
5mL Urine in Universal report issued.
Adult:
<50 µmol/L
Contact Laboratory
Ammonia EDTA Neonate:
Send on ice immediately
<100 µmol/L

28 - 100 U/L Typically >500 in acute

Amylase (Serum) SST Assayed daily
pancreatitis
Amylase (Urine) Universal < 460 U/L Assayed daily

Adult Female:
1.4 – 14.3 nmol/L
Androstenedione Clotted Turnaround 7-14 days
Adult Male:
1.4 – 9.1 nmol/L
Angiotensin Converting
SST < 55 U/L Turnaround 1-4 days For Sarcoidosis
Enzyme (ACE)
See BIS 11 for initial
Antidiuretic hormone investigation of
(ADH) hyponatraemia
No longer routinely advised
<34 IU/mL regarded as
*Anti-TPO Ab SST Turnaround 7 days for further investigation of
negative
sub-clinical hypothyroidism
Aspartate Transaminase
SST < 40 U/L Assayed daily
(AST)
Suggest monitor Hb/MCV
B12, vitamin SST 197 - 771 ng/L Assayed daily Mon-Sat
response to B12 therapy.
< 0.5 µg/L Marker of bone resorption/
Beta-Crosslaps EDTA Male & post- Turnaround 7-14 days turnover. Used to monitor
menopausal female therapy in Paget’s disease.
Not part of the U&E profile.
Assayed automatically if
Bicarbonate SST 22 - 29 mmol/L Assayed daily.
significant abnormality of
creatinine or glucose.
For pruritus of pregnancy /
Bile Acids SST < 14 µmol/L Turnaround 1-4 days
obstetric cholestasis

Bilirubin (Total) SST < 21 µmol/L Assayed daily
Brown Micro-vette or See Paediatric

Bilirubin (Neonatal) Assayed daily
two Haematocrit tubes department protocol
Added when raised total
Bilirubin (Conjugated) SST < 10 µmol/L Assayed daily. bilirubin and LFT enzymes
normal.
0.5mL in Lithium – 2.5 – 10.0
Biotinidase Turnaround time 7-21 days
Heparin nmol PABA/min/L
Telephone laboratory
Label syringe
pH 7.35 - 7.46
**Remove needle**
pCO2 4.5 - 6.0 kPa
Blood Gases Heparinised syringe pO2 12.0 - 14.6 kPa Apply stopper
Std. Bicarbonate Transport to lab immediately
21 - 25 mmol/L (needs to be received within
10 minutes of collection)
Special request form
NT-pro BNP SST <400ng/L Turnaround 1-4 days required in Primary care if
not requested via ICE
CA 15-3 SST 0 - 28 kU/L Turnaround 1-3 days Breast Cancer marker
CA 125 SST 0 – 35 kU/L Assayed daily Mon-Fri Ovarian tumour marker.
CA19-9 SST 0 - 33 kU/L Assayed daily Mon-Fri Pancreatic tumour marker.

Not usually indicated >50yrs
Caeruloplasmin SST 0.18 - 0.58 g/L Turnaround 1-4 days
of age


Lithium-Heparin Male: 0 – 6 ng/L Contact Laboratory. Deliver
Calcitonin Turnaround 7-14 days
(V+) Female: 0 - 10 ng/L immediately to lab.
Calcium (Total serum) SST 2.10 - 2.60 mmol/L Assayed daily
Calcium (Urine) 24hr collection 2.5 - 7.5mmol/24hr Assayed daily Part of Stone Screen
Separate Plain Clotted

Calcium (Ionised) 1.14 - 1.32 mmol/L Assayed daily. Deliver to lab within 4 hrs.
Sample
Calculi Universal Qualitative report Turnaround 7-14 days
*Calprotectin Faeces in universal < 50 µg/L Turnaround 5 days Local guideline available
Target range
Carbamazepine SST Assayed daily Collect pre-dose sample
4 - 12 mg/L
Carbohydrate Deficient
SST < 1.6% Turnaround 7-14 days
Transferrin
Carbon Monoxide EDTA or blood gas Non-smokers < 2%
Assayed daily
(CarboxyHb) sample Smokers up to 10%
Carcino-embryonic antigen For monitoring colorectal
SST 0 - 5µg/L Assayed daily Mon-Fri
(CEA) carcinoma
Catecholamines (urine) See Metadrenalines Turnaround 7-14 days
Not part of standard U&E
Chloride (serum) SST 95 - 108mmol/L Assayed daily
profile.
Cholesterol SST Ideal < 5.0 mmol/L Assayed daily
Cholinesterase EDTA preferred > 5300 U/L Turnaround 7-14 days


EDTA (V+)
< 7 µg/L
Chromium 2 tubes labelled 1 & 2 in Turnaround 14 -17 days For MoM hips replacement
MRHA guideline
order of collection
Depends on transplant
Ciclosporin EDTA Turnaround 3-7 days Pre-dose sample required
type / clinical condition
EDTA (V+)
2 tubes labelled < 7 µg/L
Cobalt Turnaround 14 -17 days For MoM hip replacement
1 & 2 in order of MRHA guideline
collection
Adult only:
Male: 10.4–19.8
Caeruloplasmin provided as
Copper Clotted µmol/L Turnaround 7-14 days
first line test for ?Wilson’s
Female: 11.6-22.9
µmol/L
06:00 - 10:00 hrs
Cortisol (Plasma) SST Assayed daily Mon-Fri
172 - 497 nmol/L
First line investigation for
Cortisol (Urine) 24 hr collection < 132 nmol/24 hr Turnaround 7-14 days
?Cushing’s
Male: 40-320 U/L
Creatine Kinase SST Assayed daily
Female 25-200 U/L
Male: 64-104 µmol/L

Creatinine SST Assayed daily
Female: 49-90 µmol/L
Male: 13.2-7.6
mmol/24hr
Creatinine (Urine) 24hr collection Assayed daily
Female7.0-13.2
mmol/24hr


Concurrent blood sample.
90 - 130 mL/min
Creatinine Clearance SST and 24hr urine Consider clearance
Corrected to SA Assayed daily
(see EGFR) collection. calculation when EGFR may
1.73m2
be misleading.
C-Peptide Clotted Turnaround 14-21 days Contact Laboratory.
C-Reactive Protein (CRP) SST 0 - 5 mg/L Assayed daily
Contact laboratory
CSF Spectrophotometry Minimum 1 mL CSF Same day serum bilirubin
Qualitative report Assayed daily
(Xanthochromia) required in Universal required for interpretation.
BIS1
Cysteine Screen Urine Qualitative screen Turnaround 14-21 days Part of stone screen
Dehydro-epiandrosterone Age and sex

Clotted Turnaround 7-14 days Adrenal Androgen
sulphate (DHEAS) dependant
Investigation of
Diabetes Insipidus Polyuria/Polydipsia.
BIS26


Higher level may be required
Target range for atrial dysrhythmia.
0.5 –0.8 µg/L Risk of toxicity increases
Digoxin SST for sinus rhythm/ Assayed daily through the range 1.5-3.0
systolic dysfunction. ug/L (see BNF). Specimens
should be collected >6 hrs
post dose.
Amphetamines, Benzodiaze-
pines, Cannabinoids,Cocaine
Drugs of Abuse Urine in Universal Qualitative results Turnaround 7-14 days
metabolite, Methadone
metabolite and Opiates.
EGFR
Normal > Not validated in pregnancy or
(Estimated Glomerular SST Daily
90mL/min/1.732 children.
Filtration Rate)
Elastase Faeces in Universal > 200 µg/g Turnaround 7-10 days
Everolimus EDTA Patient Dependant Turnaround 7-10 days

Adult:
23 - 400 µg/L Monitor Hb/MCV response if
Ferritin SST Assayed daily Mon to Sat
Female < 50yrs on iron therapy
17 - 291 µg/L
FOB
See Occult Blood
(Faecal Occult Blood)
Monitor Hb/MCV response if
Folate SST >2.5 µg/L Assayed daily Mon-Sat
on Folate therapy


Female- follicular
Follicle Stimulating 2.0 - 12.5 IU/L Typically >20 IU/L post-
SST Assayed daily Mon-Fri
Hormone (FSH) Male menopause.
1.5 - 12.4 IU/L
Gamma Glutamyl Male < 70 U/L
SST Assayed daily
Transpeptidase (GGT) Female < 45 U/L
Contact Laboratory.
Fasting
Gastrin Clotted Turnaround 14 -21 days Deliver to lab immediately
< 100 mU/L
BIS9 BIS10
< 1.0 mg/L
Gentamicin SST Assayed daily See antibiotic guidelines
Pre-dose
Fasting
Random > 6.0mmol/L may
2.5 - 6.0 mmol/L
Glucose (plasma) Fluoride-Oxalate Assayed daily require
Random
further investigation.
2.5 -10.0 mmol/L
See Section 2.7.3
Glucose Load (GTT)
BIS6 BIS7
2.2 -4.4 mmol/L Concurrent plasma glucose

Glucose (CSF) Fluoride-Oxalate Assayed daily
(60% of plasma level required for interpretation.
Glycated Haemoglobin See HbA1c
Basal < 1.7 μg/L

Clotted or 1mL Lithium-
Growth Hormone (plasma) Post exercise Turnaround 7-14 days.
Heparin if child
(Children) > 5 μg/L

Gut Hormone profile

(VIP,Pancreatic Contact Laboratory
Turnaround 21-28 days
Polypeptide,Gastrin, 3 x EDTA tubes (V+) Deliver immediately
Glucagon,Somatostatin, BIS10
Chromogranin A & B)
Haemochromatosis
EDTA Turnaround 21-28 days
Genotype
Non diabetic Cut off for diagnosis
HbA1c (Glycated Hb) EDTA Assayed daily Mon-Fri.
< 42 mmol/mol 48 mmol/mol
Male
HDLC / High Density 1.1 - 2.4mmol/L Part of full lipid profile and
SST Assayed daily
Lipoprotein Cholesterol Female cholesterol monitoring profile
1.1 - 2.6mmol/L
Contact laboratory
Homocystine EDTA 8.0 – 16.0 umol/L Turnaround 5-12 days
Deliver immediately
Female < 50 yrs
0 - 5 IU/L
Human Chorionic
SST Female >50 yrs Assayed daily
Gonadotrophin (HCG)
0 - 8 IU/L
Male 0 - 3 IU/L
5 Hydroxyindoleacetic Acid. 24hr urine ACID BIS13
0 – 40 µmol/24 hr Turnaround 7-14 days
(5HIAA) preservative Diet sheet available from lab.


Female
17 Alpha Clotted 0.8 – 8.8 nmol/L
Turnaround 7-14 days
Hydroxyprogesterone Preferred Male
1.9 – 6.5 nmol/L
Dependant on Contact laboratory
Insulin Clotted
concurrent glucose Deliver immediately
Preferred ‘first line’ assay for
Insulin-like Growth Factor 1 Clotted
Age and sex related Turnaround 7-14 days the assessment of growth
(IGF-1) Preferred
hormone status
Iron Ferritin is a better index of
14 - 34 µmol/L iron stores/diagnosis of iron
Iron/Transferrin
deficiency.
Saturation SST Turnaround 1 – 4 days
Transferrin saturation Iron/Transferrin saturation is
20 - 50% for assessment of iron
overload.
Lactate Fluoride Oxalate 0.5 - 2.5 mmol/L Assayed daily
Lactate (CSF) Fluoride Oxalate 0.5 - 2.5 mmol/L Assayed daily
Lactate/Pyruvate
Special collection tube Turnaround 7-14 days Contact laboratory first.
(Intermediary Metabolites)
Lactate Dehydrogenase Of value in monitoring some
SST 240 - 480 U/L Assayed daily
(LDH) malignancies e.g. Lymphoma
Investigation of diarrhoea
Laxative Screen Urine in Universal Qualitative report Turnaround 14-21 days
and/or hypokalaemia.
Lead EDTA < 0.5 µmol/L Turnaround 7-14 days


LDLC
< 3.4mmol/L ideal Calculated as part of full lipid
Low density lipoprotein SST Assayed daily
profile
cholesterol
See Individual Analytes Total
Lipid Profile SST Cholesterol, HDLC, Non-
HDLC, LDLC, Triglycerides
Target range
Lithium SST Assayed daily Collect 12 hours post dose
0.4 - 1.0 mmol/L
See individual analytes.
Liver Function Tests SST Total Bilirubin, ALP, ALT,
GGT, Total Protein
Female -Follicular
Luteinising Hormone 2.0 – 12.5 IU/L
(LH) Male
1.7 – 8.6 IU/L
Magnesium (serum) SST 0.70 - 1.00 mmol/L Assayed daily
Magnesium (urine) 24 hour collection 3.0 – 6.0 mmol/24hrs Assayed daily
Maternal Serum Screen Reported to MSS

Clotted Turnaround 2-5 days Special request form
(Down’s/NTD) co-ordinator
Mercury (Blood) EDTA < 20 nmol/L Turnaround 7-14 days
Universal - <5.5 nmol/mmol

Mercury (Urine) Turnaround 7-14 days
Early morning sample creatinine


EDTA blood or blood
Methaemoglobin <2% Assayed Daily
gas sample
Normetadrenaline
Overnight or 0 – 0.35 µmol/mmol
Overnight collection is
24 hr urine collection creatinine
Metadrenalines Turnaround 7-14 days preferred and is more
with Metadrenaline
convenient for patients
ACID preservative 0 – 0.30µmol/mmol
creatinine
Mucopolysaccharides 5mL Urine in Universal Qualitative screen Turnaround 7-14 days
Non-HDL-Cholesterol SST Assayed daily Part of lipid profiles

3 consecutive motions for
assay advised. Ingestion of
Occult Blood Universal- at least 1cm3 Qualitative test Turnaround 1-5 days red meat may give positive
result
BIS2
Pre-menopausal
Female
Oestradiol SST Turnaround 1-4 days
45 - 1461 pmol/L
Male 95 - 223 pmol/L
Organic Acids 5mL Urine in Universal Qualitative report Turnaround 7-14 days
Osmolality SST Adult
Assayed daily
(serum) 275 - 295 mmol/kg
50 - 1200 mmol/kg
Osmolality
Universal dependant on fluid Assayed daily
(urine)
intake.


Male: 0.08 - 0.49
mmol/24hr
Oxalate (urine) 24hr Urine collection Turnaround 7-14 days Part of Stone Screen
Female: < 0.32
mmol/24hr
Reported in mg/L Specimen must be at least
Paracetamol SST See BNF for treatment Assayed daily 4 hrs post ingestion for
line graphs accurate interpretation.
1.6 – 6.9 pmol/L
Parathyroid Hormone
EDTA (with normal serum Turnaround 3-7 days
(PTH)
calcium).
Target range
Phenobarbitone Clotted Turnaround 7-14 days Collect pre-dose sample.
10 – 40 mg/L
Target range: Sample can be collected at
Phenytoin SST Assayed daily
5 - 20 mg/L any time in relation to dose
Phosphate (serum) SST 0.80 - 1.50 mmol/L Assayed daily
Phosphate (urine) 24 hour collection 16 - 50mmol/24hr Assayed daily

For detailed studies, contact
Porphyrins Urine in Universal
Qualitative test Turnaround 7-21 days laboratory. 24hr urine, faecal,
/Porphobilinogen protected from light
and blood samples required.
Please contact laboratory or
Pituitary Function tests
send referral letter
Haemolysis or Delay > 6hrs
Potassium (serum) SST 3.5 - 5.3 mmol/L Assayed daily
in separation interferes.
Potassium (Urine) 24hr collection 35 - 90 mmol/24hr Assayed daily
For quantitative serum test
Pregnancy test Urine in Universal Qualitative test Assayed daily
see HCG

Target range Collect pre-dose sample.

Primidone Clotted Assayed as its metabolite
10 – 40 mg/L Phenobarbitone
Procollagen Peptide type III Age and sex
Clotted Turnaround time 5-14 days
(PIIINP) dependant
Luteal peak in an
ovulatory cycle Collect mid-luteal sample
Progesterone Clotted Assayed daily Mon-Fri
(e.g. day 21) and quote LMP
>20 nmol/L
Female
102 - 496 IU/L Stress may elevate - up to
Prolactin (PRL) SST Assayed daily Mon-Fri
Male 1000 mU/L
86 - 324 IU/L
µg/L
<60yrs 0 - 3.00 Take sample prior to rectal
Prostate Specific Antigen SST Assayed daily Mon-Fri
60-69yrs 0 - 4.00 examination.
>70yrs 0 - 5.00
Neonates (<28 days)
0.65-1.5g/L
Infants (29-56 days)
0.5-0.9g/L
Children (2 months -
18 years)
Protein (CSF) Universal Assayed daily
0.05-0.35g/L
Adults (18 years - 60
years)
0.15-0.45g/L
Adults (>60 years)
0.15-0.6g/L

Protein (serum total) SST 60 - 80 g/L Assayed daily
Protein (other fluids) Plain universal Assayed daily

<15 mg/mmol
Protein:Creatinine Ratio Urine in Vacuette Preferred test for proteinuria
Significant Proteinuria: Assayed daily
(PCR) preferably first void in pregnancy.
>30 mg/mmol
Supine
Renin Contact Laboratory
< 59.7 mIU/L
(Plasma Renin Activity) EDTA Turnaround 14-21 days Deliver immediately
Ambulant
(PRA) BIS23 BIS29
5.3 - 99.1 mIU/L
Salicylate SST Reported in mg/L Assayed daily
Adult male:
Sex Hormone Binding 10 - 80 nmol/L
Globulin (SHBG) Adult female:
20 - 130 nmol/L
Range dependent on
Sirolimus EDTA transplant type/clinical Turnaround 3-7 days Collect pre-dose sample
condition
Sodium SST 133 - 146 mmol/L Assayed daily
Sodium (urine) 24hr collection 5 - 240 mmol/24hr Assayed daily Diet dependent
Stone (Calculus) Analysis Universal Qualitative report Turnaround 10-14 days

24hr urine
Includes Cystine, Urate,
Stone Screen Delivered to lab soon Turnaround 10-14 days
Calcium and Oxalate.
after completion


Sweat Test Special collection Chloride 50µL required for a
Assayed daily Mon-Fri
via Paediatric department system < 40 mmol/L representative sample.
EDTA Range dependent on
Tacrolimus (FK506) transplant type/ Turnaround 3-7 days Collect pre-dose sample
clinical condition
Male
9-29nmol/L in patients
<50 years
Testosterone SST 7-26nmol/L in patients Assayed daily Mon-Fri
>50 years
Female
< 1.7nmol/L
Target range
Theophylline SST Assayed daily
10-20 mg/L
TPMT
EDTA Sample prior to introduction
(Thiopurine 68 - 150 mU/L Turnaround 4-8 days
of Azathioprine.
MethylTransferase)
Please give details of
Thyroid Function Test
SST 0.3 - 4.5 mU/L Assayed daily Mon-Sat therapy
TSH
First line test
FT3 3.1 - 6.8 pmol/L Added if TSH low
FT4 11.0 - 22.0 pmol/L Added if TSH high

< 0.1 µg/L Monitoring thyroid
Thyroglobulin SST Turnaround 14-21 days
Treated thyroid cancer malignancy
TSH receptor antibodies For the assessment of
SST < 1.9 IU/L Turnaround 14-21 days
(TRAb) Grave’s disease.


Desirable
Part of full lipid profile.
< 2.3 mmol/L
Triglycerides SST Assayed daily Affected by recent food
Ideal
intake. Repeat fasting if high.
< 1.7 mmol/L
Marker of cardiac muscle
Troponin T SST < 15 ng/L Assayed daily
damage.
See individual Profile includes: Na, K, Urea
U&E SST Assayed daily
analytes. and Creatinine
Urea SST 2.5 - 7.8 mmol/L Assayed daily
Urea (urine) 24hr collection 166 - 580 mmol/24hr Assayed daily

Male
200 - 430 µmol/L
Uric Acid (serum) SST Assayed daily
Female
140 - 360 µmol/L
Uric Acid (urine) 24hr collection < 4.0 mmol/24hrs Assayed daily Part of Stone Screen
For hospital inpatients only to
Turnaround 4 hours (after
detect presence of opioid
*Urine Opioid Screen Random Urine discussion with consultant
N/A drugs prior to methadone
biochemist)
prescription.
Target Range
Routine monitoring not
Valproic acid SST 50 - 100 mg/L Assayed twice weekly
recommended (see BNF)
Vasoactive Intestinal Part of Gut Hormone Contact Laboratory
3 x EDTA tubes(V+)
Polypeptide (VIP) profile BIS10

10 - 15 mg/L
Vancomycin SST Assayed daily See antibiotic guidelines
Pre-dose
Very Long Chain Fatty 0.5mL in Lithium -
Turnaround time 7- 21 days
Acids Heparin
Adult Male:
Vitamin A Clotted 0.77 - 3.95 µmol/L Turnaround 7-14 days Protect from light
Adult Female:
0.99 -3.35 µmol/L
25 -50 nmol/L
Vitamin D SST indicates insufficiency
25 -150 nmol/L Assayed daily Mon-Fri
- 25 Hydroxy < 25 nmol/L indicates
deficiency
Adult: Protect from light
Vitamin E Clotted Turnaround 7-14 days
9.5 - 41.5 µmol/L
For diagnosis and monitoring
VMA (Urine) See Metadrenalines Turnaround 14-21 days of children with
neuroblastoma.
Investigation of
Water Deprivation Test Polyuria/Polydipsia.
BIS26
See CSF spectrophotometry
Xanthochromia
BIS1
10.7 – 19.5 µmol/L
Zinc (Serum) Clotted Turnaround 7-14 days
(Adult Only)

6.0 HAEMATOLOGY AND TRANSFUSION DEPARTMENT

The Haematology departments of both Cumberland Infirmary Carlisle and West
Cumberland Hospital offer a laboratory and clinical service to North Cumbria
University Hospitals NHS Trust, Cumbria Primary Care Trust and Cumbria
Partnership NHS Foundation Trust. The departments are fully UKAS accredited to
ISO 15189 (Ref No. 8555). The departments are recognised for training Biomedical
Scientists (BMS) by the Health and Care Professions Council and IBMS.
Outside routine hours the Department runs an emergency shift system so that the
service is provided 24 hours each day of the year. Both laboratory and clinical
advice are available at all times. The laboratories participate in all the national
quality assessment schemes which cover each area of Haematology and
Transfusion and the Consultant Haematologists regularly attend Regional clinical
meetings which include audit. Quality control is constantly monitored at both the
laboratory and clinical level to ensure that highest standards are maintained. Our
aim is to provide a friendly and accessible service both routine and emergency, with
minimal test turnaround times together with a full clinical service to which clinicians
and their patients have ready access.
Tel: CIC Ext 14541

WCH Ext 23434
TRANSFUSION RECEPTION
Tel: CIC Ext 14519
WCH Ext 23432
6.3.1 Cumberland Infirmary Haematology
Dr Roderick Oakes, Consultant Haematologist

Clinics held: Monday, Tuesday and Wednesday
Ext. 14512 Pager 157
roderick.oakes@ncuh.nhs.uk
Consultants on rotation from Northumbria:

Dr George Holmes
Clinics held: Tuesday
Ext. 14511
Dr Ian Neilly
Clinics held: Wednesday
Ext. 14511
Dr Simon Lyons
Clinics held: Thursday
Ext. 14511 Pager 157

Anne Pearson, Blood Sciences Services Manager

CIC Ext. 14540 WCH Ext. 13433
Steve Hurd, Haematology Team Manager

Ext. 14514
steve.hurd@ncuh.nhs.uk
John Sutton, Transfusion Team Manager

Ext 14519
john.sutton@ncuh.nhs.uk
Mrs Theresa Woodman, Haematology Specialist Nurse

Ext. 14604
theresa.woodman@ncuh.nhs.uk
Mrs Janet Nicholson, Transfusion Practitioner

Mob. 07717652620
janet.nicholson@ncuh.nhs.uk
6.3.2 West Cumberland Haematology Senior Staff Contact Details
Locum Consultant Haematologist

Ext. 13428 (+7 for pager)
Simon Lowes, Operational Manager Blood Sciences

Ext 23429
simon.lowes@ncuh.nhs.uk
Julie Kennedy, Haematology Specialist Nurse

Ext. 23428
julie.kennedy@ncuh.nhs.uk

Open for the receipt and handling of specimens from 08:00 to 20:00, Monday to
Friday and from 08:00 to 17.00 on Saturday.
Out of hours i.e. between 20:00 and 08:00, Monday to Friday, 17.00 Saturday to
08:00 Monday and all day during Bank Holidays the laboratory is staffed by a single
BMS, primarily to provide a service for emergency and essential work.

The laboratory is open for receipt of samples between the hours of 08:45 and 21:00
Monday to Friday and 09:00 am to 17:00 on Saturday, Sunday and Bank Holidays.
Outside these hours a multi-disciplinary service operates with one member of staff
covering Blood Sciences (Biochemistry, Haematology and Blood Transfusion).

Urgent Requests
For any urgent request the doctor concerned must telephone ext. 14514 at CIC or
ext. 23434 at WCH (which is also a pager). Outside normal working hours contact
the duty BMS via the pager.
Requests received without a telephone call but marked as “Urgent” or “please
phone” and not accompanied by a telephone call will be dealt with on the next
scheduled batch.
All routine samples from Primary Care are now processed at the Cumberland
Infirmary in Carlisle. In order to ensure delays are minimised for the small amount of
urgent Blood Sciences (Biochemistry, Haematology and Blood Transfusion) work
the following procedure should be followed:
 Seal samples and request form in a plastic bag and place in a cardboard
transport box.
 Arrange urgent transport to Pathology reception at your nearest laboratory
(West Cumberland Hospital or Cumberland Infirmary).
 Label box ‘Urgent Blood Sample’ or something similar.
 DO NOT PLACE THE BOX IN THE BAG WITH ROUTINE SAMPLES.
 Telephone the laboratory to inform them an urgent sample is on its way and
to arrange for the results to be telephoned.
6.5 SCOPE OF LABORATORY SERVICE
6.5.1 North Cumbria Clinical Haematology Service

The clinical service covers the diagnosis and management of all haematological
malignancies including leukaemia (acute and chronic), lymphoma, myeloma,
myeloproliferative disorders, myelodysplastic syndromes, ITP, clotting disorders,
etc. There is open access to Wards for in-patient treatment including a day-case red
cell transfusion service. The latter service often requires the GP to send a blood
count and a transfusion specimen to the Laboratory 48-hours prior to admission.
The care of haemophiliac patients and the young with acute leukaemia is shared
with the Department of Haematology, RVI, Newcastle. Patients undergoing
intensive chemotherapy or bone marrow transplantation receive treatment at the
Freeman Hospital in Newcastle, with shared care arrangements in Carlisle.
All Haematology patients, but in particular those undergoing chemotherapy, are

made aware of their access to clinical advice and care at all hours, including the
weekends. In an emergency patients are advised to contact Beech A ward (01228
814109).

During core working hours, (Monday to Friday, 0900-1700), the Consultant
Haematologist can be contacted by paging 157 or via the Cumberland Infirmary
switchboard. Alternatively contact the secretary (01228 814511).
Requests for in-patient review on either site should be discussed with the
Consultant Haematologist or faxed to 01228 814831. Please note that Consultant
Haematologist presence at West Cumberland Hospital is very limited.

Out of hours (i.e. Mon-Fri 17.00-09.00 and all day at weekends) contact the
Consultant Haematologist on-call via the Northumbria Hospitals switchboard. A
combined rota covering North Cumbria and Northumbria operates.
The Haematology nursing team are available to offer advice and support to
patients/carers and staff in all aspects of Haematology care.
The Transfusion Practitioner is available for advice of blood products.
6.5.3 Cumberland Infirmary Clinical Service Haematology

There are Haematology clinics held Monday to Thursday. For more information
contact Pathology Secretaries on ext. 14511
6.5.4 CIC Anticoagulant Service

New patients should be referred to their General Practitioner. Patients who currently
attend the Anticoagulant Clinic at the Cumberland Infirmary should be referred to
the Haematology nursing team (ext. 14604). On the first visit patients must bring
their anticoagulant record book, hospital discharge letter and medication.
The Haematology Nursing Team are happy see patients who attend the
Anticoagulant Clinic and have been recently discharged from hospital. Patients will
be seen within 24-hours, if necessary, on telephone request (ext: 14604 or bleep
226) as long as they are able to attend the hospital. If they cannot attend the
hospital then they must be referred to their G.P.
Dedicated anticoagulant clinics, for the monitoring of Warfarin treatment, are held
between 08:30 and 11:00 on Tuesday and Thursday in the out-patients department
of the Cumberland Infirmary. Patients requiring testing outwith clinic days must
have an appointment arranged through the Haematology Nursing team. The team
can also provide advice on managing anti-coagulation for in-patients.
6.5.5 WCH Clinical Haematology Service

Clinics are held in out-patients at WCH on Wednesdays and Thursdays.

6.6.1 Specimens
If addressograph labels are used, only SMALL (38x20 mm) ones may be attached
to the specimen bottles, as large ones will interfere with the analyser and may
cause damage.
Note: Inadequately labelled specimens or those with illegible writing that makes
positive identification uncertain may be discarded and a repeat requested.
6.6.2 Requests
Requests for FBC, Retics, ESR, D-Dimer, INR, and Coagulation Screen may be
requested by using tick boxes provided on the form. All other tests MUST BE
written in the “others” area of the Haematology or Coagulation section of the
request card. A film and other tests may be carried out if the FBC result or clinical
details indicate this would be useful.
Most tests are carried out in-house; other more specialised tests are sent to CIC or
regional centres for analysis.

6.6.3 Haematology Vacutainer Tube Guide
TUBE DETERMINATIONS COMMENTS FREQUENCY

LILAC
3.0 mL FBC - Profile will include WBC A blood film will be
and differential, RBC, HB, examined if count and/or
MCV, and Platelets. clinical details suggest.
Contact lab and inform of Daily

Malarial Parasite Screen
country visited.
Reticulocytes
EDTA Should be received same
One tube ESR
day.
BLUE INR Warfarin therapy
2.7mL
Coagulation Screen
(INR, PT, APTT)
APTR (Heparin Ratio) IV Heparin therapy
Daily
1 tube D-Dimer
Tube must be Individual Factor Assay

Discuss with lab
filled exactly to (performed at CIC)
marked line
BLUE Special collection
2.7 mL Thrombophilia Screen: -
procedure and request
Antithrombin, APCR
form. Samples required
Protein C and S
within 2 hours. Contact
Haematology Specialist Monthly at CIC
PG20210A for PCR analysis
Nurses for further
2 tubes and Factor V Leiden
information.
Tube must be
filled exactly to Should be received within
Lupus Anticoagulant
marked line 2 hours
Infrequent specialised tests:

Chromosomes, Fragile X, Cell markers, Karyotyping, DNA analysis/JAK2: contact lab
for information as special instruction may apply.
Specimens must be received before 3pm Thursday with full clinical reasons for
request.
Bone marrow: By arrangement with Consultant Haematologist.

6.7 TELEPHONING OF CRITICAL VALUES
The following is a guide to results which will be telephoned without delay (if the
patient has had a similar result within the previous seven days then the result will be
processed as normal).
TEST RANGE
<70g/L normochromic and normocytic

Hb
<50g/L microcytic and hypochromic or macrocytic
Neutrophils <0.5 x 109/L or >50.0 x 109/L
Platelets <30 x 109/L
Hct >0.600 if new finding

>6.5 (or lower if the INR is rising rapidly day on day)
INR >5.0 if Outlying Hospital/GP
>6.5 CHOC
APTR /
>5.0
Heparin Ratio
Malaria Screen All positive malaria screen results
Positive sickle screen results in patients about to undergo

Sickle Screen
anaesthesia.
6.8 ROUTINE HAEMATOLOGY SECTION
This section provides the full automated blood count which includes haemoglobin,
MCV, white count (with automated differential) and platelet count; this section also
performs ESR, reticulocytes and blood film examination (including screening for
malarial parasites).
Our aim here is to provide:
 A rapid screening service.
 Diagnosis of the simple anaemias backed up by the Biochemistry laboratory; in
particular we aim to help the clinician in differentiating the causes of a microcytic
anaemia (iron deficiency or chronic disorder) with the help of ESR and ferritin,
and the macrocytic anaemias. In both areas we usually ask the Biochemistry
laboratory to perform the relevant assay if they have a suitable sample with
them for other purposes.
 The diagnosis of primary haematological disorders.
 Some help for the clinician in highlighting where significant non-haematological
disease is present and manifest in either an abnormal blood count or ESR.
 Monitoring of treatment particularly in areas where the blood count may be
affected, such as chemotherapy.

 The blood film is still an essential diagnostic tool in haematology; it is in this area
that a few clinical details are particularly helpful to the microscopist.
6.8.1 Special Tests undertaken at Cumberland Infirmary

 Haemoglobin studies by HPLC for thalassaemia screening. If a
haemoglobinopathy is diagnosed, genetic advice is available to the patient and
family by the Consultant Haematologists.
 Urine haemosiderin staining.
6.9 COAGULATION SECTION

The following services are provided:
1. Monitoring Heparin and Warfarin treatment by the APTR (Heparin ratio) and INR
respectively. (Anti-Xa Heparin Assays may be performed by prior arrangement
with the Consultant Haematologist).
2. The diagnosis and management of either congenital or acquired bleeding
disorders; the former includes haemophilia, the latter the bleeding problems in
the critically ill, of obstetric patients and those with liver failure. Full range of
intrinsic pathway factor assays performed.
3. Thrombophilia screen, including the lupus anticoagulant, antithrombin, protein S,
protein C, resistance to activated protein C and anticardiolipin antibody
(Immunology dept) are performed on-site. Samples for factor V Leiden and
factor II mutations are sent to the RVI, Newcastle. N.B. These tests cannot be
fully performed if the patient is either on Heparin or Warfarin.
4. D-Dimer used as a negative predictor for DVT/PE
5. Routine coagulation screen (INR/PT/APTT)
6. Other diagnostic tests including Claus Fibrinogen, thrombin and reptilase times

1. Monitoring Heparin and Warfarin treatment by the APTR and INR, respectively
2. D-Dimer used as a negative predictor for DVT/PE
3. Routine coagulation screen INR/PT/APTT
4. Claus Fibrinogen
6.10 KEY FACTORS KNOWN TO AFFECT THE PERFORMANCE OF TESTS
6.10.1 Coagulation Samples

Specimens may be rejected if:
 Overfilled
 Underfilled
 Clotted
 Grossly haemolysed
 Activated
 Leaked
 > 24 hours old or for APTR (Heparin Ratio) > 4 hours old
6.10.2 EDTA Samples

 Insufficient
 Clotted
 Leaked
 > 24 hours old
6.10.3 ESR Samples

 Over filled
 Under filled
 Clotted
 Leaked
 > 24 hours old
The minimum sample requirements for a manual ESR is 1mL, as pediatric volume
manual ESR is no longer available. EDTA 3.5 mL tube with a minimum of 1.0 mL
will be processed for Alifax ESR or a manual ESR using the adult volume.
N.B. Samples should ideally be as fresh as possible. Where dispatch of specimens

to the laboratory is to be delayed then specimens should be kept refrigerated until
dispatch to slow any degenerative changes.
6.11 TIME LIMITS FOR REQUESTING ADDITIONAL EXAMINATIONS
Generally further tests may be requested if the sample is < 24 hours old. However
please not the following:
 APTR (Heparin Ratio) < 4 hours
 D-Dimer < 24 hours
 Samples for Thrombophilia / Lupus testing where the samples should be
received in the laboratory within 2 hours
 ESR <36 hours
1. Cell surface marker studies on peripheral blood and bone marrow; this can be of
particular help in differentiating between a reactive polyclonal and a monoclonal
neoplastic lymphocytosis. These are performed at the RVI, Newcastle.
2. Cytogenetics of peripheral blood and bone marrow in presumed bone marrow

disorders; these are performed by the Institute of Human Genetics in Newcastle.
3. Central review of bone marrow biopsies (including immunohistochemical

analysis of bone marrow trephines) is available via the North East
Haematological Oncology Diagnostic Service at the Royal Victoria Infirmary.
4. HLA typing / tissue typing service. These requests are forwarded to the tissue
typing laboratory of the regional transfusion service. Completed specific request
forms with samples will be forwarded by Haematology via the National Blood
Service delivery van or by 1st class post if a van is not available. Samples should
be stored at room temperature until their rapid delivery to Pathology.
5. Molecular testing (e.g. JAK2 V617F in myeloproliferative disorders, BCR-ABL for

monitoring of Chronic Myeloid Leukaemia). These tests are referred to
NewGene, Newcastle.
6. Referral of abnormal haemaglobins for confirmation of HPLC

results/identification to Manchester Royal Infirmary. Referral requires informed
consent, copies of the form are available from:
www.cmft.nhs.uk/haemoglobinopathy
Names and addresses of accredited referral laboratories used by the Haematology and
Transfusion departments are as follows:
ACCREDITATION
DEPARTMENT NAME ADDRESS TESTS REFERRED
NUMBER
Newcastle-upon-Tyne Accredited Tissue Typing / HLA
National Blood Service
NE2 4NQ 2823 analysis
Central Parkway
Institute of Human Accredited
Newcastle-Upon-Tyne Cytogenetics
Genetics 2212
NE1 3BZ
Cell markers / flow
cytometry
CD61
EMA
Haematology Specials Queen Victoria Road Accredited
Factor V Leiden
Laboratory Newcastle-Upon-Tyne 8543
G6PD
NE1 4LP
Prothrombin G20210A
mutation
Von Willebrand factor
Liverpool School of
Tropical Medicine Conditional
Diagnostic Parasitology Malaria Parasite
Pembroke Place Approval
Laboratory Identification/Confirmation
Liverpool 4001
L3 5QA
Haematology Lab
1st floor Leech Building
Medical School BCR-ABL
NewGene Ltd Royal Victoria Infirmary Calreticulin
Queen Victoria Road JAK 2 Gene
Newcastle-Upon-Tyne
NE1 4LP
Molecular Diagnostics
Centre
CADET and MDC
Molecular Diagnostics Building
Centre (Provider of Central Manchester Accredited Haemoglobinopathy
Molecular Haematology University Hospitals 0862 referrals
Service) NHS Foundation Trust
Oxford Road,
Manchester
M13 9WL

6.12.1 HLA B27 and other specific HLA types associated with disease states.
The Histocompatibility & Immunogenetics department, at Newcastle Blood
Transfusion Service, carry out these tests.
2 x 3.0 mL of EDTA blood is required (lilac topped FBC bottles)

or
1 x 6mL EDTA (pink topped sample)
All samples must be labelled, signed and dated by the sample taker.
Results from routine blood count and simple coagulation tests are available, usually
on the day of receipt of the sample and invariably within 24-hours. Most special
tests are available within 48-hours, other than those referred elsewhere.) See tables
below. Results are available via electronic reporting on the wards (Revive) or by GP
messaging. Some hard copy paper reports are still printed.
We aim to have all urgent requests available within 1 hour
(Please note sample types marked with * are not currently accredited to ISO 15189)

'ADD-ON'
TESTS
TURNAROUND
ASSAY TUBE TYPE TEST REFERENCE RANGES (time limit
INTERVAL
from sample
collection)
Assayed daily ADULT Ranges
Male 130-180g/L
HB
Female 115-165g/L
Male 0.40-0.54
HCT
Female 0.37-0.47
Male 4.5-6.3 x 1012/L
RBC
Female 3.8-5.8 x 1012/L
MCV 80-99 fL
Full Blood count Within 24 hrs
3mL EDTA
MCH 27-32 pg unless clinically Within 24 hrs
urgent
RDW 11.0-14.8
Platelets 150-400 x 109/L
WBC 4.0-11.0 x 109/L
Neutrophils 1.8-7.5 x 109/L
Lymphocytes 1.0-4.0 x 109/L
Monocytes 0.1-0.8 x 109/L
Eosinophils 0.0-0.5 x 109/L
Basophils 0.0-0.1 x 109/L

'ADD-ON'
TESTS
TURNAROUND
INTERVAL
from sample
collection)
Erythrocyte Male <15mm/hr Within 24 hrs
Sedimentation 3mL EDTA Assayed daily unless clinically Within 24 hrs
Rate (ESR) Female <20mm/hr urgent
1 x Coagulation Within 24 hrs

Prothrombin time
tube (note part of Assayed daily 9.4-12.5 sec unless clinically Within 24 hrs
(PT)
coagulation screen) urgent
1 x Coagulation
Activated Partial Within 24 hrs
tube
Thromboplastin Assayed daily 25.0-36.5 sec unless clinically Within 24 hrs
(note part of
Time (APTT) urgent
coagulation screen)
Within 24 hrs
1 x Coagulation
Fibrinogen Assayed daily 2.0-3.9 g/L unless clinically Within 24 hrs
tube
urgent
Up to 51 years - <500 µg/L

51 years and older - Age in years x 10 µg/L
See local PE & DVT guidelines:
1 x Coagulation http://nww.staffweb.cumbria.nhs.uk/clinical/clinical-
D-Dimer Assayed daily guidelines/repository/pe---pulmonary-embolism--- Within 2 hrs Within 24 hrs
tube
(ambulatory-care-pathway).pdf
http://nww.staffweb.cumbria.nhs.uk/clinical/clinical-
guidelines/repository/dvt---deep-vein-thrombosis---
(ambulatory-care-pathway).pdf

'ADD-ON'
TESTS
TURNAROUND
INTERVAL
from sample
collection)
Within 1 week
Factor VIII, IX, XI 2 x Coagulation
Assayed daily 50-150 IU/dL unless clinically Within 24 hrs
levels tubes
urgent
Within 1 week
2 x Coagulation
Factor XII Assayed daily 30-150 IU/dL unless clinically Within 24 hrs
tubes
urgent
APTR (Heparin Recommended therapeutic range:

Ratio) Within 4 hrs
1 x Coagulation
(for monitoring Assayed daily unless clinically Within 4 hrs
tube 1.5-2.5
unfractionated urgent
heparin therapy)
Lupus Contact lab first Within 5 weeks
2 x Coagulation
anticoagulant Assayed every 2 Lupus anticoagulant screen unless clinically N/A
tubes
screen weeks urgent
4 x Coagulation Protein C 70-140 IU/dL

tubes
Protein S
Within the Infirmary: Contact lab first –
Deliver to the lab assayed every 4 Male 74-146 IU/dL
Thrombophilia within 1 hours weeks Within 5 weeks N/A
tests
Outside the Infirmary:
Female 54-123 IU/dL
Contact Haematology
Specialist Nurse Antithrombin III 83-128 IU/dL
Special request form APCR >2.5

'ADD-ON'
TESTS
TURNAROUND
INTERVAL
from sample
collection)
Assayed daily
*Malarial parasite
3mL EDTA Please telephone Within 4 hrs N/A
screen
lab
Glucose 6- 7-10 days unless
phosphate Contact lab first clinically urgent
3mL EDTA Glucose 6-phosphate dehydrogenase (G6PDH) Within 4 hrs
dehydrogenase (screening test) Referred to RVI
(G6PDH) Newcastle
Within 1 week
Haemoglobin
3mL EDTA Contact lab first Haemoglobin HPLC unless clinically Within 24 hrs
HPLC
urgent
Within 24 hrs
Sickle cell
3mL EDTA Contact lab first unless clinically N/A
screening test
urgent
HLA/Tissue Sent via NBS
Typing (referred to delivery van daily
the National Blood 2 x 3mL EDTA or by 1st class Within 5 weeks N/A
Service in post Monday –
Newcastle ) Friday.
Within 24 hrs
Reticulocyte count 3mL EDTA Assayed daily 20-100 x 109/L unless clinically N/A
urgent

Paediatric Reference Ranges

CAUCASIAN INFANTS, CHILDREN AND ADOLESCENTS HAEMATOLOGY

REFERENCE RANGES
RBC x 1012/L Hb g/L HCT L/L MCV fL RETICS x 09/L
1 day 4.0 - 6.6 145 -250 0.45- 0.67 95 – 121 13-192
7 days 3.9 – 6.3 135 -215 0.42 - 0.66 88 – 126 11-159
14 days 3.6 - 6.2 125 -205 0.39 - 0.63 85 – 124 11-159
1 month 3.0 – 5.4 100 -180 0.31 - 0.55 85 – 123 10 -129
2 months 2.7 – 4.9 90 - 140 0.28 - 0.42 77 - 115 14 -150
3 months 3.1- 4.5 95 - 135 0.29 – 0.41 74 - 108 14-150
6 months 3.7 – 5.3 105 -135 0.33 - 0.39 70 - 86 16 -159
1 years 4.0 – 5.0 105 -135 0.33 - 0.39 70 – 86 16 -156
2 years 3.9 - 5.3 115 -135 0.34 - 0.40 75 - 87 16 -156
6 years 4.0 – 5.3 115 -155 0.40 - 0.53 77 - 87 16 -156

12 years
4.5 – 5.3 130 -160 0.37 – 0.49 78 – 98 20-100
male
12 years
4.1 – 5.1 120 -160 0.36 - 0.46 78 - 102 20-100
female

WBC X Neutrophils Lymphocytes Monocytes Eosinophils Basophils

Age
109/L x 109/L x 109/L x 109/L X 109/L x 109/L
Cord blood 5.0 - 23.0 5.0 – 17.1 1.0 – 11.0 0.1 – 3.7 0.0 – 2.0 0.0 – 0.1
1 day 9.4 -34.0 5.0 – 21.0 2.0 – 11.5 0.5 – 1.5 0.1 – 2.5 0.0 – 0.1
7 days 5.0 -21.0 1.5 – 10.0 2.0 – 17.0 0.3 – 1.1 0.2 – 2.0 0.0 – 0.1
14 days 5.0 – 20.0 1.0 – 9.5 2.0 – 17.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
1 month 5.0 – 19.5 1.0 – 9.0 2.5 – 16.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
2 months 5.0– 19.5 1.0 – 9.0 2.5 – 16.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
6 months 6.0– 17.5 1.0 – 8.5 4.0 – 13.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
1 year 6.0 – 17.5 1.5 – 8.5 4.0 – 10.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
2 years 6.0 – 17.0 1.5 – 8.5 3.0 – 9.5 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
4 years 5.5 – 15.5 1.5 – 8.5 2.0 – 8.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
6 years 5.0 – 14.5 1.5 – 8.0 1.5 – 7.0 0.7 – 1.5 0.3 – 0.8 0.0 – 0.1
8 years 4.5 – 13.5 1.5 - 8.0 1.5 - 6.8 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
10 years 4.5 -13.5 1.8 – 8.0 1.5 - 6.5 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
12 years 4.5 – 13.5 1.8 – 8.0 1.5 – 6.5 0.2 – 0.8 0.04 – 0.4 0.0 – 0.1
16 years 4.5 – 13.0 1.8 – 8.0 1.2 - 5.2 0.2 - 0.8 0.04 – 0.4 0.0 – 0.1

HAEMATOLOGICAL VARIABLES DURING PREGNANCY
Ninety five per cent ranges
Period of gestation 7 – 14 weeks 15 – 22 weeks 23 – 30 weeks 31 – 38 weeks
Hb g/L 128 – 136 114 – 138 109 – 138 111 – 136
Period of gestation First trimester Second trimester Third trimester
RBC x 1012/L 3.52 – 4.52 3.2 – 4.41 3.1 – 4.44
Hb g/dL 110 – 143 100 – 137 98 – 137
HCT L/L 0.31 – 0.41 0.30 – 0.38 0.28 – 0.39
MCV fL 81 - 96 82 - 97 91 – 99
WBC X 109/L 5.7 – 13.6 6.2 – 14.8 5.9 – 16.9
Neutrophils x 109/L 3.6 – 10.1 3.8 – 12.3 3.9 – 13.1
Lymphocytes x 109/L 1.1 – 3.5 0.9 – 3.9 1.0 – 3.6
Monocytes x 109/L 0 – 1.0 0.1 – 1.1 0.1 – 1.1
Eosinophils x 109/L 0 – 0.6 0 - 0.6 0 – 0.6
Basophils x 109/L 0 – 0.1 0 – 0.1 0 – 0.1
Platelet count x 109/L 174 - 391 171 - 409 155 – 429
6.14 THROMBOPHILIA REQUESTING
All thrombophilia requests must have an accompanying form filled in as below.
All requests must be discussed with either Theresa Woodman – Haematology

Specialist Nurse (Tel ext. 14604) or a Consultant Haematologist (Tel ext. 14512)
prior to submission
Any sample received without this form will be stored for a period of 28 days to allow
completion of the form. Samples will then be discarded if no form is received

Request for Testing for Heritable Thrombophilic Abnormalities

Patient details (apply sticker if available):
Name: DOB:
NHS Number:
Address:
Hospital Number:
Postcode: Date of sample:
Requesting Clinician:
Signature: Location:
Name: Title:
Request discussed with: Date discussed:

 Theresa Woodman Haematology Specialist Nurse
 Consultant Haematologist
Is this patient currently receiving anticoagulation? Y/N

Details:
Is this patient pregnant? Y/N
Other medication:
REASON FOR TESTING:

Purpura Fulminans? Y/N Skin necrosis associated with warfarin? Y/N
Personal history of VTE? Y/N Recurrent VTE? Y/N
Sites (Please circle):
Pulmonary
Lower limb (distal) Lower limb (proximal) Other:
embolism
Provoking factors(Please circle):
Major
Minor
(eg malignancy, Combined Oral
(eg travel, minor Pregnancy None
major trauma or Contraceptive
surgery)
surgery)
Details/Other information:
Family history of VTE? Y/N Number of affected first degree relations:
Details:
(eg age of onset, provoking factors)
Details:
Known heritable thrombophilic
Y/N
abnormalities?
How will the results of testing affect your management of this patient?
Note: This form is for requesting tests for heritable thrombophilic abnormalities, including currently
Antithrombin, Protein C and Protein S levels and the Factor V Leiden (F5G1691A) and Prothrombin Gene
mutations (F2G20210A). It is not required for antiphospholipid antibody (Lupus anticoagulant) testing, which
may be requested separately from the heritable thrombophilic abnormalities.

Recommendations for consideration of testing:
 Purpura fulminans requires urgent testing for protein C and S deficiency.

 Skin necrosis with warfarin should prompt testing for protein C and S deficiency after interval from
stopping warfarin.
 Thrombosis-prone families: testing for heritable thrombophilic abnormalities may be considered in
thrombosis-prone families with more than two symptomatic members or a known high-risk
thrombophilic abnormality (antithrombin, protein C or protein S deficiency).
 DVT/PE: The presence or absence of a detectable heritable thrombophilic abnormality very rarely
alters decisions regarding anticoagulation. The presence of the common thrombophilic abnormalities
has only a modest effect on the risk of recurrence of DVT and PE, insufficient to justify the risks of
long-term anticoagulation. Other factors such as provoking events or the extent of the thrombosis are
more pertinent for guiding decisions on long-term anticoagulation.
 VTE at other sites (e.g. upper limb or cerebral sinus thrombosis): there is insufficient evidence for
the effect of heritable thrombophilic abnormalities on recurrence to guide anticoagulation decisions.
 Arterial thrombosis (e.g. stroke): there is insufficient evidence for the role of heritable thrombophilia
testing in guiding anticoagulation decisions to be able to recommend testing.
 Recurrent pregnancy loss: although there is some evidence linking heritable thrombophilic
abnormalities with recurrent pregnancy loss, there is as yet insufficient evidence to guide
anticoagulation decisions on the basis of these results.
 Thromboprophylaxis in pregnancy and postpartum period: testing may be helpful for guiding
decisions in either asymptomatic women with a first degree relative affected by VTE (if unprovoked
or associated with pregnancy, combined oral contraceptive use or a minor provoking factor) or in
women with a single previous VTE associated with a minor (not pregnancy or COC associated)
provoking factor (see RCOG Green-top Guideline 37a).
 If in doubt, please discuss testing and management with a Consultant Haematologist.
Practicalities of testing:
 Please send four citrated blood samples (blue-top tubes) with this completed request form. If anti-
cardiolipin antibody is also required, please also send a serum sample (red-top tube). Samples
should reach the laboratory within two hours of venepuncture.
 Samples received without a completed request form will be frozen and stored. The requesting
clinician will be notified. If a valid request form is not received within 28 days, the samples will be
discarded.
 Warfarin (and other vitamin K antagonists) causes low levels of Protein C and S. Testing for these
should therefore be performed at least six weeks after cessation of warfarin.
 Pregnancy is associated with a fall in Protein S levels to 40-50% of normal levels. Therefore, testing
for Protein S deficiency should be performed at least 3-6 months post-partum.

6.15 BLOOD TRANSFUSION SECTION
TRANSFUSION RECEPTION
Tel: CIC Ext 14519
WCH Ext 23432
Consultant Haematologist: Dr Roderick Oakes
Blood Transfusion Team Manager: Mr John Sutton
Specialist Transfusion Practitioner: Mrs Janet Nicholson
Haematology and Transfusion Specialist Nurse: Ms Theresa Woodman
The transfusion department provides the following services:
 Blood grouping and antibody screening

 Referral of complex/atypical antibody screening to NHS Blood and
Transplant
 Routine blood component issue
 Urgent blood component issue
 Direct antiglobulin test
 Kleihauer testing
 Issue of anti-D Immunoglobulin
 Issue of blood proucts (i.e. Beriplex®, NovoSeven®, Haemophilia products)
6.16 SPECIMEN REQUIREMENTS

 A 6mL pink top K2 EDTA sample is required.
The sample should be filled to a minimum of 3mL
 A 6mL yellow top K2 EDTA sample (only available from the laboratory on an
individual basis) is required for urgent blood group and antibody screen samples
which have been telephoned to the laboratory where the patient has no historical
record (see section 6.18.1)
 A pink top K2 EDTA sample containing at least 1mL of blood is acceptable for
neonatal sampling
For details on how to complete the Request Form please refer to Section 4.2 above.
6.17 SPECIMEN LABELLING

BCSH Guidelines state that four core identifiers must be present on the blood
sample as follows:
 Last name
 First name
 Date of Birth

 Unique identification number: It is mandatory that the unique patient

identification number is the NHS number if available, the PAS Hospital
Number or an Emergency A&E number can be accepted as a fourth identifier
in the absence of the NHS number.
Minimum volume in K2E tube for automated use 3mL
In emergency situations where the patient cannot be immediately identified and the
core identifiers are unknown at least one unique identifier, usually a temporary (14
digit) A&E number must be present.
Additional Requirements:
 Date and time of sampling and identification of the person taking the sample
(initials or signature) must be present on the sample or form to identify who
has taken the sample.
 Samples must be handwritten, addressograph labels are not acceptable. A
handwritten plain label attached to a paediatric tube is acceptable.
 The request form accompanying the sample must also contain four core
identifiers as a minimum requirement.
Zero Tolerance:
NCUH Trust has a zero tolerance policy in regard to sample errors:
Any errors in or alterations to a sample are not acceptable and the sample will be
rejected and a repeat sample requested
6.18 BLOOD COMPONENT AND BLOOD PRODUCT ISSUE
Blood can only be issued on a transfusion sample less than 72 hours old and must
be transfused within 72 hours of sampling.
6.18.1 Routine blood issue
FOR PATIENTS WITH NO HISTORICAL BLOOD GROUP AT THIS TRUST (OR

>10 YEARS AGO), TWO SAMPLES TAKEN ON SEPARATE OCCASIONS ARE
REQUIRED FOR THE ISSUE OF BLOOD
FOR PATIENTS WITH A HISTORICAL BLOOD GROUP AT THIS TRUST, ONLY

ONE SAMPLE IS REQUIRED
Routine request with historical group:
 Send one 6mL pink top K2 EDTA sample to the laboratory
Routine request with no historical group:
 The phrase “2nd sample required if need for blood anticipated” will be written
on the electronic or paper report

 Send further one 6mL pink top K2 EDTA sample to the laboratory after a
minimum of 12 hours
6.18.2 Urgent blood issue
Urgent request with historical group:
 Indicate the requested blood components on the request form
Urgent request with no historical group:
 Indicate the requested blood components on the request form
 Telephone the laboratory to alert them of the urgent request
 The laboratory will inform you that the patient requires a blood group check
sample
 The laboratory will arrange for a 6mL yellow top K2 EDTA sample tube to be
sent to you via pneumatic tube or porter (or this can be collected from the
laboratory by a member of staff)
 Send the 6mL yellow top K2 EDTA sample back to the laboratory as soon as
possible
The yellow topped K2 EDTA sample tubes are held in the laboratory and will be
issued on a named patient basis following the receipt of a pink top K2 EDTA sample
accompanied by a telephone call of an urgent request from the requesting clinician
to the laboratory.
In a life threatening emergency, Group O red blood cells will be issued and can be
transfused under the clinical decision of the medical officer responsible for the
patient.
6.18.3 Major Haemorrhage Procedure
In the event of a major haemorrhage, please see Management of a Massive

Haemorrhage Procedure.
Up to four units of O RhD Negative blood can be issued immediately upon

activation of the Major Haemorrhage Procedure. This blood is not crossmatched
and compatibility therefore cannot be guaranteed. The decision to transfuse lies
with the Medical Officer in charge. The use of this non crossmatched blood should
be for acute life threatening situations only.
In a major haemorrhage situation, blood sampling for transfusion must be

undertaken in accordance with the urgent sampling section of this document
(6.18.2) as soon as possible.
6.18.4 Patients with Atypical Antibodies
If possible, 48 hours’ notice should be given for patients with known atypical
antibodies who require a transfusion of red cells. Compatible blood may only be
available by special order from the NHS Blood and Transplant (Newcastle) and a
considerable time delay may be inevitable.
The laboratory MUST always be informed if a patient requiring a transfusion has

known antibodies.
6.19 BLOOD GROUP and ANTIBODY SCREEN

Specimens for blood grouping and antibody screen (known colloquially as a group
and save) are routinely kept for 6 days and are then discarded.
A Blood Group and Antibody Screen sample will be valid for 72 hours only, for
purposes of blood component issue.
6.20 STORAGE & HANDLING OF BLOOD FOR TRANSFUSION
 Blood MUST NOT be taken to the clinical area until the patient is ready i.e.
cannula in-situ and the patient has been assessed for blood transfusion
 In the event that blood components have been received in the clinical area but
the transfusion cannot be commenced, the blood must be returned to the
laboratory within thirty minutes
 Blood components returned to the laboratory after thirty minutes will be

destroyed
 Blood components delivered to the clinical area must be used within four hours
of removal from controlled storage (i.e. refrigerator) with the exception of
platelets which must be transfused within one hour of removal from controlled
storage
 Blood components and blood products MUST NEVER be stored in ANY clinical
area except the laboratory
6.20.1 De-reservation of blood
Blood will be held for 24 hours after the time it was requested. It will then be
withdrawn and returned to stock unless the laboratory is informed of any extended
requirement. Occasionally blood may be required for longer periods of time, e.g. to
cover a placenta praevia. This should be arranged with the laboratory.

6.21 TRANSFUSION REACTIONS AND INCIDENT REPORTING
It is a legal requirement for all transfusion related adverse events or reactions

(suspected or confirmed) to be reported to the Blood Transfusion laboratory as
soon as possible. This should be done over the phone or in person and a
“Transfusion reaction investigation” form (obtainable from the laboratory) must be
completed in full. Further blood samples must be taken and sent to the laboratory –
details of which can be found on the transfusion reaction investigation form.
6.22 BLOOD PRODUCTS AND COMPONENTS
Blood Components
Definition:
A therapeutic constituent of human blood (Blood Safety and Quality Regulations

(BSQR) 2005)
Types:
Red blood cells

Platelets
Fresh Frozen Plasma
Cryoprecipitate
Blood Products
Definition:
Any therapeutic product derived from human blood or plasma (BSQR 2005)
Types:
Anti-D Immunoglobulin
Prothrombin complex concentrates (i.e. Beriplex®)
Haemophilia factor concentrates (i.e. Haemate-P®)
Activated FactorVIIa (i.e. NovoSeven®)
Requests for blood components or blood products (with the exception of red blood
cells) should be made by telephone request to the laboratory. Some of these may
warrant discussion with the consultant haematologist.
6.22.1 Patients born on or after 1st January 1996
It is recommended that patients born on or after 1st January 1996 should only
receive Methylene Blue treated fresh frozen plasma (MBFFP).
6.22.2 Irradiated Blood Components

It is essential that the requirement for irradiated blood components be assessed for
each patient and documented on the Blood Transfusion Chart and blood
component request form.
Up to date guidelines for the use of irradiated blood products can be found at:
http://www.bcshguidelines.com/documents/Irradiation_BJH_2011.pdf
The laboratory will use irradiated blood according to these guidelines unless
informed otherwise. The irradiation of blood reduces the shelf life to 14 days. The
irradiation of platelet concentrates does not affect the shelf life. Fatal Transfusion
Associated Graft-versus-Host Disease can occur if non-irradiated components are
transfused into immunocompromised patients.
6.23 REQUESTING PORTERING PICK UP OF BLOOD COMPONENTS
Porters will not pick up any blood component from Pathology without a completed
blood product request sheet which must have the full patient details present. Only
Porters who have been trained and competency assessed may remove blood
components or blood products from the pathology department.
6.24 TRACEABILITY LABELS
All blood components and some blood products will have a traceability label
attached. This is a legal document and 100% traceability must be maintained.
The following fields of the traceability label must be completed:
 Date & Time taken from Fridge and Initials (portering staff)
 Date & Time receive on Ward and Initials (registered professional in clinical
area)
 Date & Time transfused and Signature(s) (registered professionals
administering and checking blood component in clinical area)
 Administered by (registered professionals administering and checking blood
component in clinical area)
 Ward (patient location)
 Date (date patient transfused)
 Time (time patient transfused)
The detachable sticky label on the traceability label must be applied to the relevant
section on the Blood Transfusion Chart.
The detachable section of the traceability label must be returned to the laboratory
as soon as is reasonably possible, preferably via the pneumatic tube system.
Non-returns will be followed up until each unit has been recorded as used or
returned/discarded.

6.25 SAMPLE TYPES, REFERENCE RANGES AND TURNAROUND TIMES
TURNAROUND
TEST TUBE TYPE COMMENTS
TIME
Specimen labelling: Forename, Surname,

Routine 6 hours
Date of Birth, NHS Number (handwritten)
Blood group and antibody screen 6mL pink top Vacutainer (EDTA)
The laboratory must be phoned for urgent Urgent 1 hour
requests
6mL lemon yellow top
Blood Group Check sample Blood group check sample requested by the Urgent 1 hour
Vacutainer (EDTA)
laboratory following an urgent request
accompanied by a telephone call for a patient
with no historical blood group

Direct antiglobulin test 6mL pink top Vacutainer (EDTA) 6 hours
Kleihauer test for the investigation of Specimen labelling: Forename, Surname,

6mL pink top Vacutainer (EDTA) 48 hours
foeto-maternal haemorrhage Date of Birth, NHS Number (handwritten)

7.0 HISTOLOGY AND CYTOLOGY DEPARTMENT

The Cell Sciences Department is a UKAS accredited medical laboratory No. 8874
and are also accredited for training Biomedical Scientists by the Institute of
Biomedical Science
The Histopathology service is located at the Cumberland Infirmary, Carlisle.
Internal 14535
External (01228) 814535
Dr Fergus Young – Head of Department

01228 814534 CIC Ext 14534
Fergus.Young@ncuh.nhs.uk
Dr Joanne Wilkinson
01228 814361 CIC Ext 14361
Joanne.Wilkinson@ncuh.nhs.uk
Dr Zouheir Maarouf
01228 814106 CIC Ext 14106
Zouheir.Maarouf@ncuh.nhs.uk
Dr Susan Davies
01228 814532 Ext 14532
Susan.davies@ncuh.nhs.uk
Dr David Rosero
01228 814044 Ext 14044
David.rosero@ncuh.nhs.uk
Dr Seema Rana
01228 814877 Ext 14677
Seema.dana@ncuh.nhs.uk
Dr Soumit Dey
01228 816894 Ext 16894
Soumit.dey@ncuh.nhs.uk
Cell Science Operational Manager

Ms Karen Simpson
01228 814515 CIC Ext 14515
Karen.Simpson@ncuh.nhs.uk


Consultants are available for advice, please contact the relevant Consultant on the
extension listed above.

Cumberland Infirmary laboratory opening hours 08:30 to 17:00
Specimens are accepted between 08:30 and 17:00 at CIC Monday to Friday and
8:45 and 17:00 at WCH (except Bank Holidays)
7.5.1 Specimen Containers

Disposable containers are used in a variety of sizes. Please select the most
appropriate size for the specimen. Specimens should not be crammed into the
container and should be immersed in at least 10 times its volume of 10%
neutral buffered formalin.
Specimens, which will not fit into the largest histology containers, should be placed
into leak proof, opaque plastic bags, labelled, sealed and delivered to Pathology
reception without delay. Outside of normal working hours, a member of the
portering staff should take these specimens to the Mortuary refrigerated body store
with their accompanying request form and a note left at Pathology Reception,
stating specimen in body store refrigerator.
Histology samples must not go into the pneumatic air system
7.5.1.1 Cumberland Infirmary

Specimen containers can be obtained from the Stores department.
7.5.1.2 West Cumberland Hospital

Specimen containers can be obtained from Pathology Reception at West
Cumberland Hospital.
7.5.2 Request Forms

Histology and Non Gynae Cytology request forms (WQG531) should be used, and
are available from the Stores Department. Histology Order Comms request forms
can be obtained from the Stores Department.
7.6 SAMPLE TYPES
7.6.1 Routine Histology
Fixative – 10% NEUTRAL BUFFERED FORMALIN
Histology reports are issued as soon as possible after receipt of the specimen. The
department aims to issue all reports within 99% of all reports within 6 weeks of
receipt.

7.6.2 Urgent Histology
Fixation – 10% NEUTRAL BUFFERED FORMALIN
Urgent specimens should be delivered directly to the laboratory, and must be

clearly marked as urgent. The department aims to issue 99% of all urgent reports
within 4 weeks of receipt
The Histology department should be contacted with the details. Please telephone
01228 814535, or a Consultant Histopathologist to discuss the degree of urgency. It
may be necessary to arrange transport from WCH to CIC. Please discuss with the
laboratory staff.
7.6.3 Frozen Sections
Fixation – NO FIXATIVE REQUIRED
Frozen sections ideally should be arranged with the department at least 24hours in
advance to confirm Consultant availability.
Cumberland Infirmary
Specimens for frozen section should be delivered directly to the Histology
Department.
West Cumberland Hospital

Specimens for frozen section should be delivered by urgent taxi directly to the
Histology Department.
Contact details including a telephone number should be included on the request

form.
7.6.4 Renal Biopsies
Renal biopsies must be arranged with the department at least 24 hours in advance.
The sample should be placed onto a piece of cotton wool moistened with normal
saline, and sealed into the lid of a small specimen container.
Renal biopsies must not be delivered by the pneumatic air tube system.
7.6.5 Skin Biopsies for Immunofluorescence
The sample should be placed into Michel’s media which can be requested from the
laboratory; alternatively the sample should be transported to the laboratory
immediately after the biopsy has been taken.
The request form must clearly state that immunofluorescence is required.

7.6.6 High Risk Specimens
Fixation – 10% NEUTRAL BUFFERED FORMALIN
Infection risk cases for histology will be allowed to fix in formalin for an extra 24
hours before processing. High-risk cases should therefore be clearly labelled as
such, and should be immersed in an ample volume of fixative.
7.6.7 Referred histology cases
There may be a requirement to send histology cases away for reporting. Urgent
histology cases remain reported in-house, unless there are extenuating
circumstances, with routine histology cases being sent away.
Referral Provider Report Format Accreditation Status

Cases reported by GMC
Histology report registered professionals
Reporting of H&Es Backlogs Ltd
On ICE working in UK
accredited laboratories
Her2,Gastric Her2, Newcastle Supplementary
UKAS 8534
Braf melanoma, ICC Foundation Trust report issued on ICE
Supplementary
Royal Liverpool report issued on ICE
EGFR,K-ras, PDL1 Currently not accredited
Foundation Trust and report issued to
Oncology
Genomic Health Report issued direct
Oncocyte DX testing
USA to Oncology
Skin Newcastle Supplementary
UKAS 8534
Immunofluorescence Foundation Trust report issued on ICE
Renal ICC and Newcastle Supplementary
UKAS 8534
Electron Microscopy Foundation Trust report issued on ICE
Oxford Supplementary
Renal ICC UKAS 8415
Foundation Trust report issued on ICE
The department is responsible for all the work that is outsourced for reporting.
Accreditation status of the referral laboratories is checked and where a non-
accredited laboratory is used for a referred test, this will be recorded in the report
issued by the department.

7.7 CYTOPATHOLOGY SERVICES
The cytopathology service is located at the Cumberland Infirmary, Carlisle.

The department processes NON - GYNAE CYTOLOGY ONLY
7.7.1 Request Forms and Specimen Containers

All samples should be placed into clean, dry containers. The containers need not be
sterile unless the sample is also for microbiological analysis
Pre-prepared slides should be placed into plastic slide transport boxes.
See specimen types below for specific requirements
Use the Histology and Non- Gynae Cytology request forms (WQG531).
7.7.2 Non-Gynaecological Specimens

The table below show the specific requirements for the various specimen types.
Where a sample is required for analysis by a second department e.g. microbiology

for CSF, it should be sent to that department first.
When preparing slides, good technique is essential otherwise it may inhibit

subsequent diagnosis.
To fix slides; a spray fixative is preferred, and is available from the Histology
department at CIC.
1. Place the nozzle of the spray about 6 inches from the slide and apply a
liberal amount of fixative to the surface.
2. Ensure all the material on the slide is well covered
3. Allow to dry before transferring to a slide transport box.
Air-dried slides should be allowed to dry thoroughly before placing in the slide
transport box.
If there is likely to be a delay in getting fresh samples to the laboratory, they should
be placed into a refrigerator.
SPECIMEN TYPE CONTAINER NOTES

FNA - Cystic lesions Universal
At least two slides should be labelled
FNA - Solid Breast lesions Prepare air-dried slides
and prepared
FNA Prepare air-dried and fixed At least two slide should be labelled
Other Solid Breast Lesions slide and prepared
Universal containing 10%
Endoscopic Brushings
Neutral Buffered Formalin
Do not send bulk quantities.
Serous/Body Cavity Fluids Universal A representative 20ml sample is
sufficient
Urine Universal Mid-morning specimen is preferred

Samples for the examination of

Joint Fluid Universal crystals should be sent to
Microbiology.
Universal or other small
Sputum Early morning sample preferred
container
Samples for microbiological analysis
should be sent to Microbiology first
CSF Sterile universal
as urgent samples to prevent cell
degradation.
Bronchial aspirate Universal or collection trap
Spread the contents of the brush
Bronchial Brush Prepare fixed slides onto a labelled slide, and fix
immediately using spray fixative
7.8 Uncertainty of Measurement
The department have reviewed uncertainty of measurement with reference to

ISO15189 and the Royal College of Pathologists publication: An approach to
uncertainty of measurement for cellular pathology laboratories, published May
2015.
There are areas of potentially significant variation for several reasons:
Potential source of variation Variation
Formalin fixation 10-20% shrinkage

Technical difficulties in assessing 3
dimensional tumour sizes, including tissue unknown but possibly 10-20%
handling
Lack of tissue homogeneity leading to
unknown possibly 10-20%
random sampling
Observer variation unknown possibly 10-20%
Variable proportion of stroma attached to
alter weight by up to 50%
parathyroid glands
Mitotic count variation due to lack of
unknown possibly 10-20%
homogeneity
Review of uncertainty of measurement will take place at least annually.

7.8 MORTUARY DEPARTMENT
7.8.1 OPENING HOURS

Cumberland Infirmary 08:00 to 16:00 Monday to Friday
West Cumberland Hospital 08:00 to 16:00 Monday to Friday
Outside of these hours the on call mortuary technician is contactable for urgent
enquiries via hospital switchboard.
7.8.2 Senior Staff Contact Details
Cell Science Operational Manager

Ms Karen Simpson
01228 814515
Karen.simpson@ncuh.nhs.uk
WCH –Mortuary Practitioner

Mr Terry Baxter
01946 5233438
Terry.baxter@ncuh.nhs.uk
CIC – Lead APT

Mrs Toni Ackrill
01228 814522
Toni.ackrill@ncuh.nhs.uk
7.8.3 When to Request a PM

It is a statutory obligation of a doctor who has attended a patient who dies, to issue
a Death Certificate without delay, unless the death falls within the categories
requiring it to be reported to Her Majesty’s Coroner. Reporting a death to the
Coroner MUST be done without delay in order that the funeral arrangements and/or
Post Mortems can proceed quickly.
These are:
1. Death from unknown causes.
2. All cases seen only after death
3. Deaths that occur within 24 hours of an anaesthetic or operative/investigative
procedure.
4. The Coroner wishes to be informed about such deaths although he may
authorise the reporting doctor to issue a Death Certificate.
5. All deaths that occur within 24hours of admission to hospital.
6. Similarly, it may be that, after discussion, the Coroner will authorise the
reporting doctor to issue a Death Certificate.
7. All violent and unnatural deaths related to:
a. Poisoning or drug mishap
b. Criminal abortions
c. Assault or accident – irrespective of the timeline interval between the
event and death
d. Want, exposure or neglect
e. Industrial diseases e.g. Pneumoconiosis

f. Inmates of prisons
g. If there is any suggestion or allegations of neglect or malpractice
against hospital or medical staff.
7.8.4 Hospital Post Mortems

The procedure for obtaining permission for a post mortem in those cases that are
not reportable to the Coroner is as follows:
 At the time of completing the Death Certificate the Clinician seeks permission
for an autopsy from the bereaved relatives.
 A consent form must be signed and any restrictions in the autopsy procedure
(e.g. no examination of the head) must be clearly indicated.
 The requesting Clinician must complete the request for Hospital post mortem
and supply full clinical information.
 This should be submitted immediately with the case notes and x-rays to the
Pathology Secretaries.
 The Clinician who signs a post mortem request form should be present
during the post mortem examination.
 A written report of the post mortem findings is sent directly to the Consultant
in charge of the case and to the deceased’s General Practitioner.
7.8.5 Coroners Post Mortems

Usually the post mortem will be performed within 24 hours of the request by the
Coroner.
Case notes and x-rays will be requested in all cases.
A written report will be sent to HM Coroner, and the General Practitioner and where
applicable the hospital Consultant.
7.8.6 High Risk Post Mortems

If a patient is suffering from a communicable disease (as specified in the Trust
Control of Infection Manual), or there is significant leakage of fluids e.g. blood,
vomit, excretia, from the patient, then a cadaver bag MUST be used to transport the
body to the mortuary, whether a post mortem is required or not.
It is the responsibility of the nurse in charge to telephone the mortuary staff to

inform them that the body has a potential risk of infection.
An identity card MUST be put inside the plastic patient sleeve on the outside of the
cadaver bag. A BIOHAZARD label need only be attached to the outside of the
plastic sleeve if the patient has died from one of the listed communicable diseases.
All information must be dealt with the strictest confidence.

There is no risk to staff transferring the patient to the mortuary, but non-sterile
gloves MUST be available for the porters to wear when they transfer the body to the
mortuary.
ALL HIGH RISK CASES FOR POST MORTEM EXAMINATION MUST BE

BROUGHT TO THE ATTENTION OF THE PATHOLOGIST IMMEDIATELY
AFTER CONSENT HAS BEEN OBTAINED.
7.8.7 Removal of Catheters, Tubes etc. Before Post Mortem

Where possible, catheters, naso-gastric tubes, endo-tracheal tubes, drains
pacemaker wires etc should be left insitu, as the position of these objects may have
a direct bearing on the cause of death.
This is particularly important if there is a complaint pending. If such an object

interferes with the viewing and the cause of death is natural and straightforward,
then these objects can be removed and placed in a sealed bag. This should be
forwarded to the mortuary with the body.
If any doubt arises about the correct action to be taken, then contact the mortuary
staff before removal of the body.
7.8.8 Attendance at Post Mortems

Visitors must abide by the Health and Safety rules that apply within the mortuary
and in particular, must wear appropriate protective gowns and footwear
People under the age of 18 will not normally be permitted to attend a post mortem
Persons with no medical training, such as police officers and trainee hospital
personnel will only be permitted to attend a post mortem by prior arrangement with
the duty Consultant Pathologist.
7.8.9 Viewings
The hospital Mortuary is not officially a Viewing Chapel and relatives should make
arrangements with their Funeral Director in order to view a body at their premises.
However there are occasions when viewing of the deceased in the mortuary is
unavoidable. In such cases prior arrangements must be made with the mortuary
staff.
Official police identifications will be carried out by similar prior arrangement.
7.8.10 Cremation Forms

It is important that cremation forms are signed by a clinician as soon as possible
and are sent to, or collected by the Mortuary staff. Unnecessary delays must be
avoided, as this can cause unacceptable difficulties with funeral arrangements.
7.8.11 Further Information & Consultant Advice
The Consultant Histopathologists are happy to advise about certification and

referral of cases to the Coroner

7.9 ANDROLOGY (at the Cumberland Infirmary, Carlisle)

The Andrology department is a sub section of the Histopathology department at the
Cumberland Infirmary. The department offers Infertility Analysis only.
Infertility analysis should only be performed as part of an integrated referral process

to clinical fertility services. It is recommended that interpretation of results requires
the appropriate investigation protocol, if further advice is required on interpretation
of infertility analysis this should be sought from the Clinical Fertility Service. Please
contact Mr Haissam Moukarram (WCH) on 01946 693181 ex 4228 or Dr Laura
Hipple (CIC) on 01228 814264.
7.9.1 Opening Hours
Monday to Friday 08:30 to 15:30

Thursday By appointment only
Please contact the department on 01228 814535
(for production of a sample onsite)
7.9.2 Request Forms and Specimen Containers

Toxicity tested/pre-weighed sample containers are supplied by the Histopathology
Department.
Telephone - 01228 814520
OrderComms request forms are available from the Stores department.
7.9.3 Where to take your sample

The laboratory reception is located on the lower ground floor of the Cumberland
Infirmary.
Specimens maybe delivered to the department within the opening hours above.
Delivery times outside of these hours should be confirmed with the department and
within 1 hour of production.
Patients who have difficulty delivering their sample within an hour of production can,
by appointment only, arrange to produce their sample onsite.
On arrival at pathology reception patients should complete an abstinence form

which confirms whether the whole sample has been collected and the number of
days since the previous ejaculate.
7.9.4 Acceptance Criteria

Request forms must have the name (in full), date of birth, NHS number, and
address, postcode and GP/Clinic details
Date and time of collection must be added to the request form following production
of the sample.
The sample must be delivered within 1 hour of collection, if not produced onsite

7.9.5 Rejection criteria

The sample will be rejected if
 The sample pot and request form do not match
 The sample is leaking
 The sample has been collected into a container unsuitable for analysis
 No request form with the sample
 Request form does not meet the minimum acceptance criteria, full name,
date of birth and NHS number
 The sample is incomplete
7.9.6 Turnaround times

The turnaround time for the report will be issued to the GP or clinic for infertility
analysis is 7 days,
7.9.7 Reference Range for Infertility Samples
TEST NORMAL RANGES
pH ≥7.2
Volume 1.5mL
Sperm Concentration 15 million spermatozoa/mL
Total sperm numbers 39 million per mL

Total Motility
40%
(PR +NP)
Progressive motility 32%
Sperm normal forms 4%
7.9.8 Uncertainty of Measurement

A measurement result can only be regarded as complete if there is also a statement
of the uncertainty in the measurement. There are a number of possible sources of
uncertainty – from the operator or from any measuring instruments. The uncertainty
of measurement for infertility analysis has been determined and is available on
request. Please contact the Andrology Laboratory on 01228 814515.
7.9.9 Post Vasectomy Analysis

The department no longer processes post vasectomy samples.

7.10 GOVERNANCE
The Cell Sciences Department is a UKAS accredited medical laboratory No. 8874
It holds a licence to practice as accredited by the Human Tissue Authority - Licence
number 12091
The department and its staff adhere to the Trust’s Information Governance,
Confidentiality and Freedom of Information polices. All staff are required to
undertake training annually.
7.10.1 Quality & Performance
Regular quality checks and audit procedures are carried out to ensure that the
quality and safety of the results provided as follows:-
Internal Quality Checks

 Integrity of patient/sample details
o Adequate/meet acceptance criteria
 Audit of quality: equipment, procedures, staff competency and reporting
procedures (including external providers)
 User satisfaction surveys
 Key Performance Indicators
o Performance
o Staffing
o Documentation
o Turnaround times
External Quality Checks – the department participates in the following schemes

 UK NEQAS for Cellular Pathology Technique
 UKNEQAS for Renal biopsies
 UKNEQAS for Immunocytochemistry – general and breast
 UKNEQAS for Andrology
 UKNEQAS for Non Gynae Cytology
 EQA – General Histopathology, Breast Pathology, Renal Pathology, GI
Pathology, Uropathology, Gynae Pathology and Bowel Cancer Screening.

8.0 MICROBIOLOGY, VIROLOGY AND IMMUNOLOGY

The Infection Sciences Department provide an extensive clinical diagnostic service,
including Bacteriology, Virology, Serology, Parasitology, Mycology and
Immunology. The department serves hospitals, general practitioners, environmental
health departments and also provide Infection Control services and advice.
The department also provides epidemiological surveillance data for Public Health
England, and investigate outbreaks of infectious disease in the community in
support of local Public Health England.
Infection Sciences are committed to providing the highest quality of laboratory

service. The Infection Sciences Department is a UKAS accredited medical
laboratory No. 8874 and are also accredited for training Biomedical Scientists by the
Institute of Biomedical Science.
Microbiology
Ext: 14642
Direct dial: (01228) 814642
Virology/Immunology
Ext: 14649
Direct dial: (01228) 814649
Fax (CIC) (01228) 814864
Head of Department - Consultant Medical Microbiologist

Dr Clare Hamson
E-mail: clare.hamson@ncuh.nhs.uk
Ext: 14648
Direct dial: (01228) 814648
Consultant Medical Microbiologist

Dr Clive Graham
E-mail: clive.graham@ncuh.nhs.uk
Ext: 14648
Direct dial (01228) 814648
Mobile: 07787518562
Consultant Microbiologist
Dr Edward Barton
E-mail: Edward.Barton@ncuh.nhs.uk
Ext: 14640
Direct dial: (01228) 814640

Consultant Immunologist
Dr Adrian Heaps PhD FRCPath
Email: Adrian.Heaps@ncuh.nhs.uk
Ext: 14367 / 14649
Direct dial: (01228) 814367
CIC Hospital bleep 704
Clinical Scientist (Immunology)

Miss Caroline Evans
Email: Caroline.Evans@ncuh.nhs.uk
Ext: 14645 / 14649
Direct dial: (01228) 814645
Laboratory Operational Manager

Mrs Debra Padgett CSci, FIBMS
E-mail: Debra.Padgett@ncuh.nhs.uk
Ext: 14333
Direct dial: (01228) 814333
Laboratory Secretary
Miss Pat Finnemore
E-mail: Pat.Finnemore@ncuh.nhs.uk
Ext. 14641
Direct dial: (01228) 814641
Matron Infection Control

Nicola O’Reilly
E-mail: Nicola.O’Reilly@ncuh.nhs.uk
Mobile: 0798681146
Ext. WCH 3399
8.4.1 Microbiology
8.4.1.1Routine specimens
All Microbiology samples are processed on the CIC site. Routine samples are
accepted between:
Monday to Friday 08.30 - 19.00
Saturday 08.30 - 17.00
Sundays 09.00 - 17.00 (for emergency samples only)
To ensure routine processing on day of receipt, samples should arrive before 18.00
weekdays and 16.00 Saturdays.
8.4.1.2Urgent and Emergency Specimens

There is a 24 hour on call service. Round the clock availability of a microbiology
laboratory service is necessary to support the hospital’s clinical services.
Processing of samples outside of routine laboratory opening hours (08:30 – 19:00
on weekdays and 08:30 – 17:00 on weekends and bank holidays hours) is intended

for emergency specimens only where the results will affect the patient’s immediate
management.
The on call BMS should be contacted through the Consultant Microbiologist. The
Blood Sciences Laboratory at the Cumberland Infirmary has a copy of the weekly on
call rota and will contact the on call BMS directly should an urgent sample be received
from West Cumberland Hospital. For on call samples originating from WCH, staff in
the Blood sciences department will package the sample in the containers provided
and make arrangements for transporting the sample to Blood sciences at CIC.
There is also always a Consultant Microbiologist on call for advice on microbiological

and infection control matters.
Laboratory users are given advance warning of reduced laboratory opening hours
over public holidays.
Please support the laboratory staff by considering the following before contacting
the Consultant Microbiologist:
Please call for:

 Processing of urgent samples which will have immediate impact on patient
management e.g. CSF
Please do not call for:

 Results look up – BMS staff do not have access to results out of hours
 Infection control or clinical advice – contact the on call Microbiologist
 Non urgent samples which will not affect patient management – if in doubt
discuss with Microbiologist or senior member of the clinical team
 Blood cultures
During normal working hours please telephone urgent requests to the laboratory to
ensure priority processing and arrange for the specimen to be taken rapidly to
laboratory reception.
8.4.2 Immunology/Virology
The opening hours for the Immunology/Virology section are:
Mon-Fri 08.30 - 17.00
Saturday 08.30 - 12.30
Please note there is no out-of-hours laboratory service for Immunology or Virology:

Should clinical advice be required out of hours please contact the Cumberland
Infirmary switchboard.
8.5 CLINICAL ADVICE
The department encourages consultation about investigations, management of

infection and antimicrobial use and welcome requests for advice. Early liaison over
infection control matters is also valuable. There is always a Consultant
Microbiologist on duty. Out of normal working hours the Consultant can be
contacted through the Cumberland Infirmary or West Cumberland Hospital
Switchboard.
Dr Banerjee (Microbiology & Virology) and Dr Heaps (Immunology) both welcome

the opportunity to provide advice on appropriate investigations and interpretation of
Virology and Immunology results. Outside of normal working hours they may be
contacted via the Cumberland Infirmary hospital switchboard for advice over urgent
matters.
8.6 CLINICS
Adult Immunology and allergy out patients’ clinics are provided by Consultant
Clinical Immunologists at the Royal Victoria Infirmary in Newcastle as part of the
North East Regional Immunology and Allergy Unit. Available clinics include
Immunoglobulin Infusion, Primary Immunodeficiency, Autoimmune Disease, Allergy
Assessment, Immunotherapy, Drug Allergy, Chronic Fatigue Syndrome and
Hereditary Angioedema clinics.
Adult Immunology & Allergy Referral Guidelines can be found here:
Adult Immunology &

Allergy Referral Guidelines V8
Paediatric Immunology clinics are provided by visiting paediatric immunologists

from the RVI:
Consultant Paediatric Immunologist

Dr Mario Abinun
0191 273 8811 Ext. 22669
0191 233 6161
Appointments are arranged through the Royal Victoria Infirmary
8.7.1 Request Forms

Please use ICE order communications to make requests. Using ICE will ensure that
all the appropriate details are collected and will give guidance on appropriate tests
and the specimen containers required. If ICE is unavailable there are two request
forms available as a backup: one for bacteriology and the other for virology/serology
and immunology.
For safety and to ensure reliable reporting, it is essential that patient identification
details are included on both the request and specimen. Unlabelled specimens or
specimens with inadequately completed forms will be discarded.
The clinical details included in requests make a significant difference to the way in
which specimens are investigated. We use the information to ensure that
appropriate tests are performed and that the required results are obtained in a
timely manner. Important details may include:

 date of onset and duration of illness

 antibiotic treatment
 travel history
 occupation/school
 associated cases
 site of wound swabs
 recent surgery
If in doubt, the department are happy to advise about the most appropriate
investigation, and prefer to be involved early. Please indicate if the specimens are
HIGH RISK, see “General Information”
8.8 SPECIMEN COLLECTION

The best results are obtained when an appropriate, well taken specimen, in the
proper container, is delivered to the laboratory promptly and relevant clinical
information is provided on the request form.
8.8.1 Guidelines on Specimen Collection – Microbiology Specimens
Please contact the laboratory if there is any doubt about the best specimen to take
or concerning the availability of a test.
 Use sterile containers for microbiological investigations as indicated in the

table below
 Specimens should be obtained before antimicrobial agents have been
administered whenever possible.
 An adequate quantity of material should be obtained for complete
examination.
 Always send pus rather than a swab of the pus
 The specimen taken should be representative of the disease process. For
example, material swabbed from the opening of a sinus tract is more likely to
yield commensal micro-organisms on the skin than would material obtained
by curettage or biopsy of the base of the tract
 Care must be taken to avoid contamination of the specimen by micro-
organisms normally found on the skin and mucus membranes. Sterile
equipment and aseptic technique must be used for collecting specimens,
particularly for those from normally sterile sites
Material must be transported promptly to the laboratory. Fastidious organisms may

not survive even moderate storage or may be overgrown by less fastidious
organisms before culturing. With the exception of cerebrospinal fluid, blood cultures
and samples for dermatophyte investigations, it is preferable to refrigerate
microbiology samples requiring culture, if there is to be any delay in sending to the
laboratory. The maximum time for which samples may be stored before
examination commences is indicated in the table below. When taking samples,
requestors should have regard to the laboratory opening hours and availability of
transport for samples, particularly at weekends.

8.8.2 Guidelines on Specimen Collection – Virology Samples
Diagnosis early in the course of an infection may be possible by visualization of

virus particles in an electron microscope, or detecting antigen (viral or bacterial),
usually by ELISA or immunofluorescence and now PCR. The latter methods can
give rapid results, available in emergency to influence management.
Specific IgM can also give information early, which may influence management. An
IgM response is present early in the clinical course of some infections, when
symptoms and signs first appear, for example in hepatitis A. Serology also gives a
retrospective diagnosis, by detecting a rise in antibodies to the infecting agent. This
may be particularly helpful when post infectious complications occur, e.g. arthritis.
The date of onset is critical to interpreting serological tests. Serum should be taken
as early as possible in the illness and during convalescence, 10 to 14 days later, in
order to detect rising antibody levels.
Many infections investigated by serological methods have relatively non-specific

symptoms and signs, which could be caused by a range of infectious agents. In
such cases practitioners often ask the laboratory to select the most appropriate
battery of tests. While the laboratory is happy to do this, complete clinical
information is required, including the symptoms, signs, duration and any other
relevant information such as travel. Discussion is welcomed. Alternatively specific
tests can be requested.
If urgent investigation is required, especially by PCR or related technology please

discuss the request with a Consultant Microbiologist.
8.8.3 Specimen containers

The following containers are used by the laboratory. Supplies can be obtained from
stores CIC (ext. 14569, direct dial (01228) 814569) or the laboratory office WCH
(ext. 13424 hospital users only - community and GP users contact WCH stores
utilising order form). Forms for ICE order communications may also be ordered on
these numbers.
Failure to use the correct container may result in the specimen being rejected.

Microbiology Containers
Maximum storage time

Acceptable
Specified between sample collection
Specimen Type Alternative
Container and examination
Container
commencement
Swab in Amies
Superficial WS
Transport Medium
MRSA Screen N/A 48 hrs
with Charcoal
(Black Cap)
Swab in Amies
48 hrs*
Deep Seated Wound Transport Medium
N/A *3 hrs for culture of anaerobic
Swab with Charcoal
organisms
(Black Cap)
48 hrs*
Swab in Amies
*24 hrs for Neisseria
Transport Medium
Genital swabs N/A gonorrhoeae investigations
with Charcoal
*2 hrs for Trichomonas
(Black Cap)
investigation
Swab in Amies
Liquid transport
Transport Medium
GC Screen swab 24 hrs
with Charcoal
(Orange Cap)
(Black Cap)
Per-nasal swab for Per-nasal Swab
Bordetella species (Blue Cap with thin N/A 24 hrs
(Whooping cough). wire shaft)
Tissue
Pus 30 mL Universal 48hrs*
N/A
Bile (White Cap) *3hrs for culture of anaerobic
Fluids from sterile sites organisms
Drain Fluids
Cerebrospinal Fuid 30 mL Universal

N/A 2 hrs
(CSF) (White Cap)
30 mL Universal
CAPD Fluid Dialysate Bag (White Cap) 2 hrs
(Cell count only)
60 mL sample
30 mL Universal
Sputum/BAL container (White or 24 hrs
(White Cap)
Silver Cap)
For CF patient Cough Swab Amies

(Only if patient cannot Transport with 48 hrs
expectorate) Charcoal
30 mL Universal with 24 hrs*

30 mL Universal
Faeces integral spoon (Blue *2 hrs for Clostridium difficile
(White Cap)
Cap) investigations

Maximum storage time

Acceptable
Specified between sample collection
Specimen Type Alternative
Container and examination
Container
commencement
10 mL urine
collection tube with
boric acid. Supplied
with collection cup.
30 mL Universal with
(Red Cap)
Urine boric acid. 96 hrs
(Red Cap)
5 mL urine collection
tube with boric acid
(Paediatric)
(Red Cap)
Samples for
30 mL Universal Stored dry at room temperature
investigation of Dermapak
(White Cap) 96 hrs
dermatophytes
Aerobic (Blue Cap)
Paediatric (Yellow
and Anaerobic Despatch to the laboratory
Blood Cultures Cap) blood culture
(Purple Cap) blood immediately - do not refrigerate
bottles (Children)
culture bottles.
Virology & Immunology Containers
Please can we remind you that a separate blood sample and request form is
required for Virology and Immunology requests.
Separate request forms are automatically generated by ICE.
Serum blood tests for

Immunology and Virology:
Please send SERUM SST tubes
(Yellow Haemogard Tubes).
In addition, please can you send a second SST sample if serum free light
chain analysis is required.
Other sample containers include:
SAMPLE CONTAINER TYPE
Viral swab/transport media Remel Microtest. Red lid-4 mL pink fluid
Roche COBAS buffer 4.3mL

Chlamydia swabs
Yellow cap-clear fluid
Universal container (25mLs) WHITE CAP

8.8.4 Key Factors Known to Affect the Performance of Tests

 Overfilled
 Underfilled
 Haemolysed
 Icteric
 Lipaemic
8.9.1 Microbiology
Additional examinations can be performed on the following specimen types:-
SAMPLE TYPE TIME LIMIT
Urines up to 24hrs after receipt in the laboratory
Sputum up to 24hrs after receipt in the laboratory
Swabs up to 48hrs after receipt in the laboratory
Faeces up to 48hrs after receipt in the laboratory
Sterile fluids including CSF up to 1 week after receipt in the laboratory
Please note, due to the instability of bacteria over time and the processing
undertaken for some samples, requesting additional tests on submitted samples is
not advised. Wherever possible a repeat sample should be collected.
Requests to add on additional tests to the original sample should be made by
phoning the laboratory. The decision to perform additional tests will depend on the
delay in receiving the request and whether there is sufficient sample stored. In
general samples less than two weeks old or requests passed by Consultant staff
will be accepted.
8.10 REPORTS
8.10.1 Written results

Reports are printed and dispatched every working day, including Saturdays.
Electronic reports are sent out on the same schedule at approximately midday.
Authorised results are sent to the hospital web browser (Revive) every 30 minutes.
With the exception of negative urines, which can be reported after one working day,
most bacteriology culture results are reported after 2-5 working days, depending on
the investigation. Intermediate reports may be issued for complex investigations.

Serology, virology and immunology reporting depends on the frequency of testing,

and the urgency of the request, please refer to the tables that follow.
Interpretation of results, and the reference range (where appropriate), is given as a

comment on the report.
8.10.2 Telephone results

Results of urgent investigations and positive results which may affect immediate
patient management will be telephoned. This includes all positive blood cultures
and CSFs.
We appreciate it if telephone enquiries are limited to those results that are urgent or
delayed. Please check that there is no written report before enquiring over the
telephone.
8.11 MEASUREMENT OF UNCERTAINTY IN CELL COUNTS
A measurement result can only be regarded as complete if there is also a statement

of the uncertainty in the measurement. There are a number of possible sources of
uncertainty – for example from the environment; from the operator or from any
measuring instruments. The uncertainty of measurement for cell counts on urines,
CSF, ascites and CAPD fluids has been determined and is available on request.
Please contact the Microbiology Laboratory on 01228 814856.
8.12 SAMPLE TYPES/REFERENCE RANGES/TURNAROUND TIMES

The following tables show which investigations are routinely available.
8.12.1 Immunology
Frequently requested tests are run daily/weekly, but others may be performed less
often, depending on demand. For urgent investigations please telephone Dr Heaps.
If primary immunodeficiency is suspected please contact the Consultant

Immunologist to discuss appropriate investigations.

(Please note sample types marked with ^ are not currently UKAS accredited)
TEST REFERENCE RANGE TURNAROUND TIME COMMENT
These tests require 6mLs of SERUM SST tubes unless stated otherwise (Yellow Haemogard Tubes).
AUTO-ANTIBODIES
For paediatric cases less sample may be acceptable (clear capped tubes).
Rheumatoid factor Negative <20 IU/mL Please note that ~20% of RA patient will
Neg. <7 U/mL; equiv. 7–10 U/mL; tested daily not have RhF/CCP antibodies
Anti-Cyclic Citrullinated Peptide (CCP) (seronegative RA).
pos. >10 U/mL
Auto-antibody screen Anti-nuclear antibodies performed by

Anti-nuclear antibody (ANA) indirect immunofluorescence (IFA) on
Anti-mitochondrial (AMA) Not applicable tested daily HEp 2 cell line. Tissue antibodies
Anti-liver cytosol (LC) performed by IFA using rodent liver,
Anti-liver/kidney microsomal (LKM) kidney and stomach sections.
Anti-smooth muscle (SMA)
Anti-gastric parietal cell (GPC) Negative <10 U/mL tested daily
Anti-endomysial (EMA) / tissue Serum total IgA concentration assayed in
Negative <10 U/mL (IgA TTG) tested twice weekly
transglutaminase (IgA TTG) conjunction with IgA TTG antibodies.
Anti-thyroid antibodies (TPO) Negative < 50 IU/mL tested weekly
Anti-double stranded DNA (dsDNA) Neg. <10 IU/mL; equiv. 10–15
tested daily
(quantitative) IU/mL; pos. >15 IU/m
ENA screen includes: Ro(52 + 60), La,
Anti-Extractable Nuclear Antigens
Not applicable tested daily RNP (U1 A + C), Sm, Scl70, Jo-1 and
(ENA) screen (x7 anti-ENA antibodies)
Centromere antibodies.
ENA typing
Anti-Ro (SSA/Ro60 and Ro52)
Anti-La (SSB) Not applicable tested weekly
Anti-Smith (Sm), Anti-RNPAnti-Scl70, Anti-Jo1
Anti-Centromere (CENP-B)


Additional (Extended ENA/CTD panel)
Anti-Centromere
Anti-Jo1 (Histidyl tRNA synthetase)
Anti-Scl 70 (Topoisomerase 1)
Anti-PM-Scl
Anti-Ribosomal-P Antibodies
Not applicable tested daily
Anti-Fibrillarin (U3-RNP)
Anti RNA polymerase (III)
Anti-PCNA
Anti-Mi2
Anti-Nucleosome
Anti-Histone
Other extractable nuclear antibodies available on request: Please contact the Consultant Immunologist
Please contact the Consultant
Extended inflammatory myositis antibody Immunologist to discuss requests
immunoblot (Mi2, Ku, Pm-Scl100, Pm-Scl75, Not applicable Tested weekly Additional Inflammatory Myositis / anti-
Jo1, SRP, PL7, PL12, EJ, OJ, Ro52) Synthetase Syndrome antibodies
available on request.
Extended systemic sclerosis / scleroderma
amtibody immunoblot (Scl70, CENP-A, CENP- Please contact the Consultant
Not applicable Tested weekly
B, RP11, RP155, Fibrillarin, Nor90, Th/To, Immunologist to discuss requests
Pm-Scl100, Pm-Scl75, Ku, PDGFR, Ro52)
Extended anti-nuclear antibody immunoblot
(nRNP/Sm, Sm, RNP 70 –A, -C, SSA (Ro60),
Please contact the Consultant
Ro52, SSB (La), Scl70, Pm-Scl, Jo1, CENP-B, Not applicable Tested weekly
Immunologist to discuss requests
PCNA, Nucleosome, dsDNA, Histone,
Ribosomal P, AMA-M2)
Anti-Neutrophil Cytoplasmic Antibodies Urgent samples should be discussed with
Not applicable tested daily
(ANCA) the laboratory.


Neg. <7 U/mL; equiv. 7–10 U/mL; Urgent samples should be discussed with
Anti-Glomerular Basement membrane (GBM) tested daily
pos. >10 U/mL the laboratory
Neg. <10 GPL U/mL; equiv. 10–20 Please contact the Consultant
Anti-Cardiolipin antibodies (IgG) tested weekly
GPL U/mL; pos. >20 GPL U/mL Immunologist if IgM antibodies required.
Neg. <7 U/mL; equiv. 7–10 U/mL; Please contact the Consultant
Anti-Beta 2 Glycoprotein I (IgG) tested weekly
pos. >10 U/mL Immunologist if IgM antibodies required
Neg. <3.5 IU/mL; equiv. 3.5 – 5.0 Urgent samples should be discussed with
Anti-Myeloperoxidase (MPOS) tested daily
IU/mL; pos. >5.0 IU/mL the laboratory
Neg. <2.0 IU/mL; equiv. 2.0 – 3.0 Urgent samples should be discussed with
Anti-Proteinase 3 (PR3S) tested daily
IU/mL; pos. >3.0 IU/mL the laboratory
Anti-Intrinsic Factor Negative <6 U/mL tested weekly
Anti-Glutamic Acid Decarboxylase (GAD) /

Negative <10 IU/mL tested weekly
Islet Cell (IC)
Anti-adrenal cortex (adrenocortical) Not applicable tested on request
Anti-pyruvate dehydrogenase E2
Negative <10 IU/mL tested weekly
(AMA-M2 markers)
Soluble Liver Antibodies (SLA)
Not applicable tested weekly
Liver Cytosol 1 (LC1)
Extended anti-liver antibody immunoblot Please contact the Consultant
(AMA-M2, M2-3E (BPO), Sp100, PML, Gp210, Not applicable tested weekly Immunologist to discuss requests.
LKM1, LC1, SLA/LP, Ro52) Additional liver autoantibodies available.
Anti-complement C1q antibodies Negative <10 IU/mL Referred Include complement C3C4 testing.

Miscellaneous autoantibodies
Anti-ovarian antibodies Please contact the Consultant
Anti-sperm / testicular antibodies Immunologist if specialist autoantibody
Anti-skeletal/striated muscle antibodies testing required.
Anti-cardiac muscle antibodies
Anti-epidermal/skin antibodies Epidermal antibodies performed by
Anti-parathyroid antibodies indirect immunofluorescence. Specific
referred
Anti-Insulin antibodies antibody testing for Basement Proteins
(approx. 2-3 weeks)
Anti-IA2 & ZnT8 antibodies and Desmogleins available on request.
Anti-C1-esterase inhibitor (C1-INH) antibodies Please contact the Consultant
Anti-salivary gland antibodies Immunologist.
Anti-endothelial antibodies
Anti-Phospholipase A2 Receptor antibodies If direct immunofluorescence staining of
Anti-Type II Collagen antibodies skin, muscle or renal biopsy is required
Anti-Hsp70 (inner ear) antibodies please contact the Department of Cell
Anti-HMG-CoA reductase antibodies Sciences / Histopathology.
Anti-Mutated Citrullinated Vimentin (MCV)
For autoantibodies associated with autoimmune haemolytic anaemia / cytopenias and transfusion
Autoimmune cytopenias / AIHA reactions including cold-agglutinins, anti-platelet, anti-neutrophil, anti-coagulation factors, lymphocytotoxic
and anti-erythrocyte antibodies please contact the Blood Sciences department.
Lupus anti-coagulant antibodies Please contact the Blood Sciences department to arrange Lupus Anti-coagulant testing.


Biological drug neutralizing antibodies and therapeutic levels
Infliximab (Remicade, Inflectra, Remsima)

neutralizing antibodies + serum Infliximab
concentration
Adalimumab (Humira, Exemptia) neutralizing

antibodies + serum Adalimumab concentration For monoclonal anti-TNF drugs: Serum
samples should be taken just BEFORE
Golimumab (Simponi) neutralizing antibodies the next anti-TNF infusion (maintenance
+ serum Golimumab concentration dose) is given to provide trough levels.
Sampling should be a minimum of 6
Etanacept (Enbrel) neutralizing antibodies + weeks post previous infusion.
serum Etanacept concentration Neutralizing antibodies are NOT assayed
if anti-TNF drug levels are within the
Certolizumab Pegol (Cimzia) neutralizing therapeutic range.
referred
antibodies + serum Certolizumab
(approx. 3-4 weeks)
concentration For other biological drug-neutralizing
antibodies please contact the Consultant
Interferon beta (Avonex/Rebif) neutralizing Immunologist.
antibodies
**For Natalizumab (Tysabri)
Natalizumab (Tysabri) neutralizing neutralizing antibodies> please
antibodies** contact the Immunology laboratory in
advance: Blood samples must arrive in
Vedolizumab (Entyvio) – please contact the the Immunology laboratory within 1
Immunology department to discuss HOUR of being taken for this test.


Paraneoplastic / Neuronal autoantibodies
Paraneoplastic neuronal antibodies (Hu,Yo,Ri,
Ma, Amphiphysin, CRMP5/CV2, Tr)
Paraneoplastic antibodies assayed by
Anti-Aquaporin 4 (NMO)
immunofluorescence screen and RAVO
Anti-Myelin Associated Glycoprotein (MAG
immunoblot
IgM)
Anti-NMDA receptor referred
For specialist / rare neuronal antibodies
Anti-Acetyl choline receptor (AchR) (approx. 2-3 weeks)
including AChR/MuSK-clusters, MOG,
Anti-Muscle Specific Kinase (MuSK)
LGI1, CASPR2, GABAb receptor, AMPA
Anti-Voltage-gated Calcium Channel (VGCC)
receptor 1/2 and glycine receptor
Anti-Voltage-gated Potassium Channel
antibodies please contact the Consultant
(VGKC)
Immunologist to discuss.
Anti-Gangliosides (anti-GM1, GM2, GD1a,
GD1b, GQ1b (IgG & IgM isotypes tested))
Further specific auto-antibodies available on request: Please contact the Consultant Immunologist
These tests require 6mls SERUM SST
COMPLEMENT
tubes unless stated otherwise
C3c 0.68 - 1.80 g/L
tested daily
C4 0.18 - 0.60 g/L
Blood must be kept cool, and received in
CH100/Alternate Pathway (AP100) Not applicable Referred
the laboratory within 4 hours of sampling
C1 esterase Inhibitor (C1-INH) quantitation 0.18 - 0.54 g/L tested daily

C1 esterase Inhibitor (C1-INH) function

C1q Please contact the Consultant
C2 Immunologist to discuss requests for
C3 nephritic factor (C3NeF) specialist complement assays,
C3d (C3 breakdown products) complement genotyping or Eculizumab
Factor B, D, H, I therapy monitoring
referred
Anti-factor H antibodies
See reports (approx. 3-4 weeks)
Anti-C1 inhibitor antibodies C3d/C3NeF estimation must be arranged
Properdin (Factor P) in advance.5ml sample in EDTA tube,
Terminal pathway components (C5, C6, C7, kept cool and transported immediately to
C8, C9) the laboratory
Manose Binding Lectin (MBL)
Terminal Complement Complex (sC5b-9) *Referred to Sheffield
Complement genotyping
Other complement investigations available on request: please contact the Consultant Immunologist.
These tests require 6mls SERUM SST

PROTEINS/IMMUNOGLOBULINS tubes unless stated otherwise, but less
may be acceptable from pediatric cases.
Beta 2 microglobulin 1.0 - 3.5 mg/L tested daily
Immunoglobulins A, G, & M
see below tested daily
and serum protein electrophoresis
1-14 days 0.01 - 0.08 g/L Serum IgA measurements also included
in Coeliac serological screen.
2-6 weeks 0.02 - 0.15 g/L
Immunoglobulin A (IgA) tested daily
6-12 weeks 0.05 - 0.40 g/L Please note the serum IgA values are
suppressed if an IgA paraprotein
3-6 months 0.10 - 0.50 g/L (monoclonal protein) is present.


6-9 months 0.15 - 0.70 g/L
Usually tested in conjunction with serum
9-12 months 0.25 - 0.74 g/L protein electrophoresis and serum IgG
and IgM.
1-2 years 0.30 - 1.29 g/L
2-3 years 0.35 - 1.39 g/L
3-6 years 0.40 - 2.18 g/L
6-9 years 0.54 - 2.48 g/L
9-12 years 0.64 - 2.48 g/L
12-15years 0.64 - 2.97 g/L
1 -14 days 4.8 - 17.3 g/L
2-6 weeks 3.7 - 12.6 g/L
6-12 weeks 2.0 - 7.5 g/L
3-6 months 2.3 - 8.5 g/L Please note the serum IgG values are
6-9 months 2.9 - 8.6 g/L suppressed if an IgG paraprotein
(monoclonal protein) is present.
Immunoglobulin G (IgG) 9-12 months 3.0 - 10.6 g/L tested daily
Usually tested in conjunction with serum
1-2 years 3.0 - 13.3 g/L protein electrophoresis and serum IgA
2-9 years 3.6 - 15.2 g/L and IgM.
9-12 years 3.8 - 15.2 g/L

12-15 years 4.8 - 15.2 g/L
15-99 years 5.8 - 15.4 g/L
1 – 14 days 0.05 - 0.19 g/L Please note the serum IgM values are
Immunoglobulin M (IgM) tested daily suppressed if an IgM paraprotein
2 – 4 weeks 0.05 - 0.29 g/L (monoclonal protein) is present.


4 – 6 weeks 0.10 - 0.48 g/L
6 – 12 weeks 0.14 - 0.67 g/L Tested in conjunction with serum protein
electrophoresis and serum IgA and IgG.
3 – 6 months 0.19 - 0.86 g/L
6 – 9 months 0.33 - 1.43 g/L
9 – 12
0.43 - 1.90 g/L
months
1 – 15 years 0.43 - 1.90 g/L
15 -99 years:
male 0.43 - 1.90 g/L
female 0.71 - 2.30 g/L
IF PRIMARY IMMUNODEFICIENCY IS SUSPECTED PLEASE CONTACT THE CONSULTANT IMMUNOLOGIST TO DISCUSS APPROPRIATE INVESTIGATIONS
1 - 7 days 3.6 - 8.4 g/L

1 - 26 days 1.5 - 3.0 g/L
6 - 24 months 2.3 - 5.8 g/L
Immunoglobulin G1 subclass (IgG1) 2 - 5 years 2.3 - 6.4 g/L Tested twice weekly
5 -10 years 3.6 - 7.3 g/L
10 - 15 years 3.8 - 7.7 g/L
15 - 99 years 2.0 - 10.0 g/L
1 - 7 days 1.2 - 4.0 g/L
Immunoglobulin G2 subclass (IgG2) 1 - 26 days 0.3 - 1.5 g/L Tested twice weekly
6 - 24 months 0.3 - 2.9 g/L


2 - 5 years 0.7 - 4.5 g/L
5 -10 years 1.4 - 4.5 g/L
10 - 15 years 1.3 - 4.6 g/L
15 - 99 years 0.5 - 7.5 g/L
1 - 7 days 0.3 - 1.5 g/L
1 - 26 days 0.1 - 0.6 g/L
6 - 24 months 0.1 - 0.8 g/L
Immunoglobulin G3 subclass (IgG3) 2 - 5 years 0.1 - 1.1 g/L Tested twice weekly
5 -10 years 0.3 - 1.1 g/L
10 - 15 years 0.2 - 1.2 g/L
15 - 99 years 0.05 - 0.9 g/L
1 - 7 days 0.0 - 0.5 g/L
1 - 26 days 0.0 - 0.1 g/L
6 - 24 months 0.0 - 0.5 g/L
If IgG4-related systemic disease is
Immunoglobulin G4 subclass (IgG4) 2 - 5 years 0.0 - 0.8 g/L Tested twice weekly suspected please discuss with the
Consultant Immunologist.
5 -10 years 0.0 - 1.0 g/L
10 - 15 years 0.0 - 1.1 g/L
15 - 99 years 0.0 - 2.2 g/L
1 – 12 months 0 -11 kU/L
Tested three times per
IgE Total 1 – 2 years 0 - 29 kU/L
week
2 – 3 years 0 - 42 kU/L


3 – 5 years 0 - 52 kU/L
5 – 7 years 0 - 56 kU/L
7 – 10 years 0 - 63 kU/L
10 -12 years 0 - 45 kU/L
12 - 15 years 0 - 70 kU/L
15- 99 years 0 - 150 kU/L
Grade 0 <0.35 kUA/L
Grade 1 0.35-0.70 kUA/L Please specify individual allergens
when requesting. Allergen-specific IgE
Grade 2 0.70-3.50 kUA/L Tested three times per
antibodies can be found without clinical
week
Allergen-specific IgE antibodies (RAST) and reactions, especially in atopic individuals.
Grade 3 3.50-17.5 kUA/L
allergen molecular components They are NOT proof of allergy and are not
Some specific IgE
Grade 4 17.5-50.0 kUA/L useful for screening.
antibodies referred.
Component Resolved Diagnostics (CRD)
Grade 5 50.0-100.0 kUA/L available on request
Grade 6 >100.0 kUA/L
Serum protein electrophoresis Not applicable Tested daily.
^ Urine protein electrophoresis(Bence Jones Early morning urine sample in white top
Not applicable Tested twice weekly
protein) plain universal container.
^ Immunofixation (IgG, IgA, IgM and kappa
lambda) for paraprotein typing in serum or Not applicable as required IgD and IgE analysis also available.
urine.
Serum paraprotein quantification Not applicable as required Scanning densitometry method


Kappa: 3.3 - 19.4 mg/L
Serum Free Light Chain quantification and tested three times per
Lambda: 5.7 - 26.3 mg/L Freelite method (Binding Site)
Kappa/Lambda ratio week
K/L ratio: 0.26 - 1.65
Tests available include:
tested daily Aspergillus spp, Cladosporium,

some specific IgG tests Penicillium, Alternaria, Fusarium,
Specific IgG Immunoassay (for the
may be referred Cephalosporium, T.vulgaris, M.faeni,
investigation of hypersensitivity pneumonitis / <40 mgA/L (A. fumigatus)
Nationally and may S.atra.
extrinsic allergic alveolitis / ABPA)
take several weeks for
results to return Bird components (Parrot, Budgie, Canary,
Pigeon, Finch, Fowl, Goose, Parakeet
and Turkey)
Mast Cell Tryptase 2 - 14 µg/L As required See anaesthetic / anaphylactic reactions
Oligoclonal bands
CSF Oligoclonal bands (must have paired Referred
3mLs of CSF and 6mLs SERUM SST
CSF & serum sample for comparison) (approx. 3-4 weeks)
tubes
2 x 6mLs of clotted blood must
** Cryoglobulins must be arranged
Cryoglobulins be kept at 37oC – contact lab for
vacuum flask for sample transport
with the laboratory in advance **
SPECIFIC ANTIBODY / VACCINE RESPONSES

Specific IgG antibody assays to Tetanus, HiB & Pneumococcus
Tetanus toxoid IgG antibodies >0.1 IU/mL used to determine protective immunity following vaccination.
Performed fortnightly,
Streptococcus pneumoniae pneumococcal
>20* mg/L / >35* mg/L in asplenics
capsular polysaccharide (PCP/PPV23) IgG Pneumovax II vaccine containing 23 Streptococcus pneumoniae
(*putative protective levels)
antibodies (Pneumovax II). serotypes 1-5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F,


18C, 19F, 19A, 20, 22F, 23F and 33F (Danish nomenclature). For
individual pneumococcal serotype measurements please contact
> 0.15 mg/L (minimum protective the Consultant Immunologist.
Haemophilus influenzae Type B IgG level at a given time point). The ability to respond to polysaccharide antigens starts to mature
antibodies (protein conjugate vaccine) > 1.0 mg/L required for long term from the age of 2 – 3 years until adulthood. Measurement of
protection. Pneumovax PPV23 responses of questionable value in individuals
who’ve received Prevnar (PCV7/PCV13) pneumococcal conjugate
vaccine.
COUNTER CURRENT IMMUNOELECTROPHORESIS FOR PRECIPITATING ANTIBODIES
Counter Current Immunoelectrophoresis (CIE)
Antigens available include A.fumigatus
for the detection of precipitating antibodies in
(somatic and filtrate), M.faeni, Pigeon
Hypersensitivity Pneumonitis / Extrinsic tested twice weekly
(serum and faeces), Budgie (serum and
Allergic Alveolitis: (e.g. Bird Fancier’s Lung,
faeces) and Fowl (serum).
Farmer’s Lung, ABPA)
6mLs SERUM SST tubes taken as soon as possible after the
commencement of the suspected anaphylactic reaction. Further
5mL samples should be taken at 1-2 hours (but not later than 4
hours) AND 24 hours post reaction. The time of blood sampling in
Suspected anaphylactic reactions &
relation to the reaction must be recorded on the request form.
anaesthetic adverse reactions (Serum Mast MCT reference range: 2 - 14 µg/L
Send samples immediately to Immunology marked Urgent for
Cell Tryptase)
separation.
Please note that serum Mast Cell Tryptase measurements are NOT
useful in the context of suspected food-related anaphylaxis in
children.
Lymphocyte subsets and CD4 T cell
Only by prior arrangement with the
enumeration (% and absolute values).
Referred laboratory, 1x5mLs SERUM SST tubes
Tube 1: CD4s (CD45, CD3, CD4, CD8) See reports
(approx. 1 weeks) Other cellular immunology investigations
Tube 2: included for full lymphocyte subsets
available on request.
(CD45, CD3, CD56, CD19)
Please discuss with the Consultant
Referred
Neutrophil oxidative burst testing (DHR/NBT) Not applicable Immunologist. Only by prior arrangement
(approx. 2 weeks)
with the laboratory.

8.12.2 Microbiology
Many of these investigations involve culturing organisms. This may take anything from a few hours to weeks in case of
mycobacteria. Antibiotic substances in the specimen or fixative in containers will interfere with culture. The following list is not
exhaustive. For tests not listed above, please contact the laboratory.
SPECIMEN/
SAMPLE TYPE COMMENTS TURNAROUND TIMES
INVESTIGATION
Written report / Electronic report: 2 -
Adenovirus Sterile universal container 72h stating, if appropriate, that a further
report will be issued
Clinically significant bacterial isolates
are tested for susceptibility to
antimicrobials. The range tested and
reported depends on many factors Written report / Electronic report: 16 -
^ Antibiotic
All including the specimen, organisms 72h stating, if appropriate, that a further
Sensitivity tests
isolated, current antibiotic policies, and report will be issued
the patients age, allergies etc. Please
give details of current antibiotic therapy
and any allergies the patient may have.
Antral washings Sterile universal container 72h stating, if appropriate, that a further
20 mLs of fluid (minimum 10mL) in a
sterile universal container (not blood
culture bottles) for gram stain and Spontaneous Bacterial Peritonitis (SBP)
culture. is diagnosed by the presence of >250
Ascitic fluid 72h stating, if appropriate, that a further
State whether investigation for TB polymorphs/mm3 in a sample of ascitic
required. fluid.
Send separate samples for protein and
cytology to the relevant laboratories.

Use a swab in transport media (black

Pus, fluid (peritoneal, pleural, joint etc.) Written report / Electronic report: 16 -
Swab of pus or fluid cap) if necessary, but this is second
or a biopsy of infected tissue are better 72h stating, if appropriate, that a further
(Bacterial culture) best and may not allow for the isolation
specimens than swabs report will be issued
of all bacteria present.
A small amount of sterile saline maybe
In sterile universal container ensure used when dealing with very small
Biopsy specimen 72h stating, if appropriate, that a further
no fixative. amounts of tissue to prevent
dehydration.
A blood culture set comprises two Refer to the Trust’s current guidelines
bottles (Anaerobic – Purple Bottle & for details of blood culture collection Written and electronic reports should be
Aerobic – Blue Bottle) procedures. issued 16-24h after bottles flag positive.
Blood Culture
http://nww.staffweb.cumbria.nhs.uk/clini
For paediatric patients use a single cal/clinical-guidelines/repository/Blood- Negative results should be reported at 5
yellow bottle Cultures---Taking-of.pdf – 14 days
Use the cap provided to securely close

the container. It is essential to label the
specimen accurately as it is cultured
differently from sputum. Indicate if TB
Bronchial washings/ These specimens should be collected in culture or Pneumocystis carinii Written report / Electronic report: 16 -
brochoalveolar a specimen trap on the suction detection is required. Please discuss 72h stating, if appropriate, that a further
lavage apparatus. with the Consultant Microbiologist to report will be issued
arrange urgent processing and/or
additional tests as appropriate, if the
patient is immunosuppressed or
critically ill.
For culture and cell count send the
whole CAPD bag to the laboratory in a Written report / Electronic report: 16 -
CAPD fluid leak proof container. If cell count only 72h stating, if appropriate, that a further
required, 25 mL in a sterile universal is report will be issued
adequate.

Take swabs for bacterial culture first.

Swabs from conjunctiva, urethra and
Chlamydia Swab in Amies Transport Medium with endocervix should be placed in
72h stating, if appropriate, that a further
trachomatis Charcoal (Black Cap) chlamydia tubes. See virology section
for details of NAAT testing for
Chlamydia and Gonococcus.
Endocervical swabs are needed for
gonococcal or chlamydial infections,
and investigation of PID. A High Vaginal
Swab is NOT equivalent. For the
diagnosis of gonorrhoea swabs should
be transported to the laboratory
immediately; urethral, rectal and throat
swabs may also be appropriate. Ensure
Swab in Amies Transport Medium with correct swabs and transport media are
Cervical swab 72h stating, if appropriate, that a further
Charcoal (Black Cap) used. Chlamydia swabs should be
taken after the bacteriology swab.
Remove mucous or pus from the cervix
before taking the chlamydia specimen
by rotating the swab in the endocervical
canal, and placing it in the Chlamydia
swab container.
See virology section for details of NAAT
testing for Chlamydia and Gonococcus.

If meningitis is suspected, contact the

laboratory immediately after the
specimen has been taken and deliver
the specimen without delay. Culture for
virus/ TB or other tests are undertaken
if indicated by clinical information/ cell
For cell count, gram film and bacterial count. Please send separate
Cerebrospinal Fluid culture send at least 2-3 mL of CSF in biochemistry request forms for protein
(CSF) EACH of three sterile universal and glucose. Samples of CSF and
containers, labelled 1,2,3 in order. blood should be sent in fluoride-
oxalate containers for glucose
measurement.
See the biochemistry section for
information on determination of
xanthochromia. If cytology is required
an additional sample should be sent.

Stool specimens must be obtained and

sent promptly when infective diarrhoea
is suspected.
Stool samples must only be sent from
symptomatic patients i.e. only
liquid/loose stools that take the shape of
the container or Bristol Stool Chart
types 5-7. In suspected cases of silent
CDI such as ileus, toxic mega colon, or
pseudo-membranous colitis without
diarrhoea, other diagnostic procedures,
such as colonoscopy and abdominal CT
scan may be helpful.
Clostridium difficile There is no need to ascertain clearance
antigen (GDH) and of infection as toxin test can remain
24h
toxin detection positive for up to 4 weeks.
It is not advisable to test children less
than 2 years of age in whom toxigenic
strains of C.difficile may be present in
the absence of symptoms. In patients
less than 16 years old, samples are
tested following discussion with
requesting doctor.
Please also refer to Trust Clostridium
difficile guideline.
http://nww.staffweb.cumbria.nhs.uk/poli
cies/categories/infection-
prevention/clostridium-difficile-policy.pdf

Use bacteriology swab in transport
Ear swab 72h stating, if appropriate, that a further
medium

Bacteriology swab for routine culture.

A second swab from the conjunctiva, Written report / Electronic report: 16 -
Eye swab sent in chlamydia swab is required if 72h stating, if appropriate, that a further
ophthalmia neonatorum or Chlamydia report will be issued
infection is suspected.
Rectal swabs are generally

unsatisfactory. Routine investigations
are antigen detection tests for
Cryptosporidium andGiardia, and
culture for Salmonella, Shigella,
Campylobacter and E. coli O157.
Additional tests are added depending
on clinical details e.g. foreign travel
Ask the patient to defecate into a clean
(e.g. vibrio). Microscopy for ova, cysts
bedpan, or alternative suitable container
and parasites should be requested if
at home. With the spatula provided put
required (ie travel history or Written report / Electronic report: 16 -
a grape sized specimen, or fluid
Faeces immunosuppressed) however other 72h stating, if appropriate, that a further
equivalent, in a sterile universal
causes of diarrhoea should be excluded report will be issued
container. White topped or blue with
first unless symptoms indicate parasitic
integral scoop. Include mucous, blood
infection. If amoebic dysentery is
or pus.
suspected inform the laboratory and
deliver the specimen within 1 hour.
Specimens from in-patients, on wards
other than admission wards, will
normally only be tested for Clostridium
difficile. Please discuss with the
microbiologist or infection prevention if
full culture is required.
Faeces -
Helicobacter Antigen Sterile universal container
72h
detection

For all urgent samples please

contact the laboratory immediately Written report / Electronic report: 16 -
Send 20mLs in sterile universal
Fluid specimens after the specimen has been taken 72h stating, if appropriate, that a further
container
and deliver the specimen without report will be issued
delay.
For skin scrapes at least 5mm2 with a
blade from the edge of a lesion. Hair Written report 24 - 48 h
should be plucked from affected areas. Written report at one, two or three
For invasive or systemic fungal
Nail clippings should be full thickness weeks stating, as appropriate, that a
Fungal Culture infections please discuss investigations
and extend as far back as possible from further report will be issued.
with a Consultant Microbiologist.
the edge. Use the black envelopes
(Dermapak) supplied. Take
bacteriology swabs for Candida.
Gentamicin These tests are performed in Biochemistry. Please use a Biochemistry/Haematology form
For PID, gonorrhoea/chlamydia a

cervical swab is required, HVS is
unsuitable. Examination for Written report / Electronic report: 16 -
High Vaginal swab For Candida, Trichomonas and
Trichomonas is unlikely to be 72h stating, if appropriate, that a further
(HVS) Vaginosis.
successful on samples that are not report will be issued
received on the same day preferably
within 2 hrs.
Intra Uterine Examined for Actinomyces send device Written report / Electronic report: 16 -
Contraceptive in sterile universal container NO 72h stating, if appropriate, that a further
Device fixative. report will be issued
Please indicate if examination for
crystals and/or TB is required.
Sterile universal container for routine For all urgent samples please contact
Joint fluid 72h stating, if appropriate, that a further
gram film and bacterial culture. the laboratory immediately after the
the specimen without delay.

Urinary antigen testing is the preferred

Legionella
method of diagnosis.
Light microscopy of unstained and
stained preparations. Also available
polarised and immunofluorescent
Microscopy
microscopy. Microscopy forms part of
many routine investigations. Please
discuss special requirements.
Send 20mLs of human milk in sterile
Milk- Human 72h stating, if appropriate, that a further
universal container
Please refer to the Trust MRSA
screening policy for further details: Written report / Electronic report: 16 -
Use bacteriology swab in transport
MRSA http://nww.staffweb.cumbria.nhs.uk/poli 72h stating, if appropriate, that a further
medium
cies/categories/infection- report will be issued
prevention/mrsa-screening-policy.pdf
Use bacteriology swab in transport Usually for staphylococcal or Written report / Electronic report: 16 -
Nasal Swab medium, gently rotate in the anterior meningococcal carriage. Please 72h stating, if appropriate, that a further
nares on both sides. indicate which in request. report will be issued
Norovirus Sterile universal container 72h stating, if appropriate, that a further
Please discuss examination of fresh
Ova, Cysts and Send faeces. Three samples on stool for amoeba. Other causes of
Parasites consecutive days is advised. diarrhoea should be excluded first,
please state reason for submission.
Malaria and Filaria - send appropriate
films to Haematology (EDTA tube), Many serological tests are available Written report / Electronic report: 16 -
Parasites discuss timing for Filaria. Send faeces please discuss investigation with a 72h stating, if appropriate, that a further
for intestinal parasites (sterile Consultant Microbiologist report will be issued
universal container).

Rapid delivery to the lab oratory is

Swab on a fine wire, for whooping essential for successful culture.
cough (Bordetella pertussis) diagnosis. Beware that taking the sample may
Pass the swab gently along the floor of precipitate a coughing paroxysm, and
Pernasal swab the nose and place in transport care must be taken to maintain the Written report, up to 7 days
medium. Normal bacteriology swabs airway. These fine wire swabs are also
are not suitable and will not be useful for delicate sampling, e.g. of
accepted. sinus tract.
Routinely examined for bacteria but

NOT tuberculosis. If TB is likely, culture Written report / Electronic report: 16 -
Pleural fluid 20mLs in sterile universal container, of a pleural biopsy is advised, as this 72h stating, if appropriate, that a further
has a much higher yield, and histology report will be issued
can be helpful.
Other specimen types will not be
Bronchoalveolar lavage fluid
Pneumocystis carinii examined without discussion with
required.
Microbiologist
For all urgent samples please contact
the laboratory immediately after the
the specimen without delay.
Aspirate with a sterile syringe and Only use Bacteriology swabs as last
Pus 72h stating, if appropriate, that a further
transfer to sterile universal container. resort. Best specimen for bacterial
culture, essential for mycobacterial and
fungal examination. Indicate if
examination for hydatid or amoebae
required.
Rotavirus Sterile universal container 72h stating, if appropriate, that a further

Peak egg excretion in urine is from

Collect a midday sample in a sterile Written report / Electronic report: 16 -
Schistosomiasis noon to 15:00. If haematuria is present,
universal container, NO 72h stating, if appropriate, that a further
(urine) eggs are found in blood and mucous in
PRESERVATIVE. report will be issued
the portion of urine.
Sputum examination is difficult to
interpret, and only true sputum from Written report / Electronic report: 16 -
Sterile 60 mL container or 30 mL
Sputum deep expectoration is worth examining. 72h stating, if appropriate, that a further
universal container
For TB send 3 consecutive early report will be issued
morning specimens.
For surface and skin swabs rotate the

swab on the required site and place in
Skin and Superficial transport medium.
Always state the site and clinical details. 72h stating, if appropriate, that a further
Wounds If there is sufficient pus this should be
aspirated with a sterile syringe and put
into a sterile universal container.
Moisten a swab in sterile saline and

swab the perianal area. Break off the
Threadworms 72h stating, if appropriate, that a further
swab into a sterile universal container
with 10ml of saline added.

Depress tongue with spatula. For

bacterial specimens sample tonsillar
areas, and areas of ulceration,
exudation or membrane formation.
Use bacteriology swab in transport Avoid touching lips, tongue, mouth or
Throat swab 72h stating, if appropriate, that a further
medium saliva. For viruses, sample same areas
but use virology swabs.
Please indicate in request if looking for
staphylococcal, gonococcal or
meningococcal carriage.
Written and electronic reports (positives

Best specimens are (depending on the If sputum is not produced consider and negatives) 16 – 72 h
site of infection); 3 early morning gastric aspirates. Blood cultures for
sputum, early morning urine specimens mycobacteria should be arranged Urgent microscopy report as soon as
Tuberculosis/ possible
taken on consecutive days, pus or through the laboratory. Please note that
Mycobacteria
tissue as appropriate. this test is sent away to the
Urine samples must be in plain white Mycobacterial Reference Laboratory, Issue at 10 - 12 weeks if solid culture
topped universal. Newcastle Upon Tyne media is used.
Vancomycin NB. These tests are performed in Biochemistry. Please use a Biochemistry/Haematology form

Correct labelling of urine samples is

important because the different types of
sample are handled differently in the
laboratory. For reliable results avoid
contamination and transport to
laboratory promptly. If specimens
Urine sample in 10mL boric acid tube
cannot be transported to the laboratory
the same day they should be
(Paediatric 7mL boric acid tube
refrigerated at 4-8oC.
available) Written report / Electronic report: 16 -
Urine 72h stating, if appropriate, that a further
Routine urine samples are screened
Urine in white topped universals will not report will be issued
using automated microscopy. In the
be accepted
absence of white cells or bacteria
samples are reported directly with "no
Correct collection procedure is essential
evidence of infection" and culture is not
performed. Exceptions to this rule are
urine samples from paediatrics,
pregnant and immunosuppressed
patients when culture is performed
regardless of microscopy result.
Clean catheter specimen port and take
Patients with long term catheters have
urine (CSU) from the port with sterile
urine colonised with one or more micro- Written report / Electronic report: 16 -
Catheter specimen needle and syringe, transfer to boric
organisms, therefore routine culture is 72h stating, if appropriate, that a further
of urine (CSU) acid tube, filling to the 10mL mark.
rarely indicated in the absence of report will be issued
CSU in white topped universal will not
systemic signs of infection.
be accepted

Remove stoma appliance carefully,

clean around stoma and dry thoroughly.
Gently insert a urinary catheter 2.5 to
5cm into the stoma. Drain sufficient Written report / Electronic report: 16 -
Ileal conduit urine urine into a receiver. Remove the 72h stating, if appropriate, that a further
catheter and pour urine into a boric report will be issued
acid tube, filling to the 10mL mark.
CSU in white topped universal will not
be accepted
Nappy samples are not an appropriate sample for this investigation.
Nappy urine sample
Please contact the paediatric department for further information.

Supra pubic aspirate Use Sterile universal container. Send
(SPA) to laboratory within 4 hrs
Use sterile universal container. Send
Ureteric urine 72h stating, if appropriate, that a further
to laboratory within 4 hrs
For investigation of sexually transmitted
diseases. For gonorrhoea a
bacteriology swab in transport medium
should be transported to the laboratory
Urethral swab 72h stating, if appropriate, that a further
as soon as possible. Send chlamydia
swab also.
See virology section for details of NAAT
testing for Chlamydia and Gonococcus.

8.12.3 Virology
Most tests are run weekly. Some tests are batched and run less frequently. Urgent cases are managed as necessary, and urgent
testing can usually be arranged during normal working hours.
(Please note sample types marked with * are not validated and must be interpreted in conjunction with clinical findings)
TURNAROUND TIME
INVESTIGATION SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
any urgency, as early testing may be possible.
ANTIGEN DETECTION
Swabs/Urines
Endocervix, vaginal, vulvo-vaginal*, urethral*,
rectal*, throat swabs*. Cells are required so
swabs must be taken firmly.
a) Swabs: Appropriate plastic, stemmed swabs
Chlamydia trachomatis PCR
from collection packs. After swabbing, place
Neisseria gonorrhoea PCR 2 working days for a negative result – positive
swab in the Chlamydia transport media.
samples will require longer for confirmation.
(Yellow topped tube).
b) First-Void Urines: Pipette urine using pipette
from urine collection pack into Chlamydia
transport media (Yellow topped tube) as per
instructions. Urine in a plain sterile universal
can be used.
CSF samples & vesicle fluid/scab, genital, skin
3 working days, except CSF samples which are
Herpes simplex PCR (as requested) & eye swabs in Transport Media – red topped
processed on arrival
tube (viral transport)
CSF samples & swabs from lesions, vesicle
3 working days, except CSF samples which are
Varicella PCR (as requested) fluid/scab in Transport Media – red topped tube
processed on arrival
(viral transport)

TURNAROUND TIME
^Influenza A/Swine Flu PCR (as requested) Nose and Throat swabs As requested
Early morning urine. (Blood samples are NOT
Pneumococcal antigen appropriate for this test)
As requested
Legionella antigen Urine antigen testing is the appropriate
investigation for ACUTE Legionella diagnosis
^Respiratory Syncytial Virus (RSV) antigen
NPA sample As requested
detection
TURNAROUND TIME
SEROLOGY SAMPLE TYPE/COMMENTS It is always best to discuss an investigation if there is
^Cytomegalovirus (CMV) IgM & IgG 6mL Serum SST 3 working days
EB Virus IgM 6mL Serum SST 8 working days
EBV nuclear antigen IgG 6mL Serum SST 8 working days
^Hepatitis A IgM & IgG 6mL Serum SST 2 working day

^Hepatitis B
 surface antigen
 surface antibody 6mL Serum SST 2 working days
 core antibody
 core IgM
^Hepatitis C antibody 6mL Serum SST 2 working days
^HIVantibody &p24 antigen 6mL Serum SST 2 working days
Lyme 6mL Serum SST 8 working days

TURNAROUND TIME
Measles IgG 6mL Serum SST 8 working days

8 working days – only tested for in patients >16
Mycoplasma IgM 6mL Serum SST
years old
^Parvovirus IgM & IgG 6mL Serum SST 8 working days
Pertussis antibodies 6mL Serum SST 8 working days
^Rubella IgM & IgG 6mL Serum SST 2 working days
^Syphilis IgG 6mL Serum SST 2 working days
^Toxoplasma IgM & IgG 6mL Serum SST 2 working days

Pregnant contacts of chicken pox/Shingles are
Varicella IgG 6mL Serum SST
tested on receipt. Others 8 working days
Varicella IgG - Immunity screen 6mL Serum SST 8 working days


Some tests are routinely referred to other laboratories as stated below:
8.13.1 Microbiology
Test Referral Facility
16s PCR Great Ormond Street

Amoebae (excluding Acanthamoeba keratitis) Acanthamoeba Reference Lab
Anaerobic Reference Unit NPHS Microbiology Cardiff
Antibiotic Assays Bristol Southmead
C.difficile Reference Unit - Typing Manchester Medical Microbiology
Cryptosporidium Reference Unit - Confirmation NPHS Microbiology Swansea
Enteric Virus Unit PHE Colindale - SRMD (VRD)
Faecal sample referral for confirmation/typing - Bacillus, C. botulinum, C. perfringens, C. tetani,

PHE Colindale - Gastrointestinal Bacteria Culture Referral
Campylobacter, E. coli, Helicobacter, Listeria, Salmonella, Shigella, Vibrio and Yersinia
Meningococcal Reference Unit – Confirmation/typing Manchester Medical Microbiology

Mycology Reference Unit HPA South West, Bristol
Neisseria gonorrhoeae Isolate Referral PHE Colindale - STBRU (Neisseria Referral)
Organism Identification - MALDI North Tyneside General Hospital
Parasites, intestinal protozoa and helminths, blood and tissue protozoa and helminths Dept of Clinical Parasitology, Hospital of Tropical Diseases
Respiratory and Systemic Bacteria Section - Streptococcus, Legionella, Mycoplasma, Ureaplasma &
PHE Colindale - RVPBRU
Bartonella
Staphylococcus - PVL PHE Colindale - AMRHAI
TB Newcastle Microbiology Services - TB Reference Lab
Vaccine Preventable Bacteria Section - Haemophilus influenzae, Streptococcus pneumoniae,
PHE Colindale - RVPBRU
Bordetella, Diphtheria & Tetanus

Turnaround
Time
16S PCR Great Ormond Street 7
Acetyl choline receptor autoantibodies (ACHR) Immunology Department, Churchill Hospital, Oxford 14
Acyclovir/Gancyclovir Bristol Southmead 14
Adalimumab levels and neutralizing antibodies Clinical Chemistry, City Hospital, Birmingham 7
Adenovirus PCR Newcastle PHE Molecular 5
Adrenal autoantibodies Blood Sciences, RVI, Newcastle 21
Amoebic London School of Tropical Medicine 2
Anti-Streptococcal DNAase B antibodies No longer available – test withdrawn
Anthrax EDTA Porton Down, Salisbury 7
Alternative Complement Pathway function (AP100) (contact Immunology in advance) Blood Sciences, RVI, Newcastle 14
Aquaporin 4 (NMO) autoantibodies (contact Immunology in advance) Immunology Department, Churchill Hospital, Oxford 14
ASO Hyaluronidase No longer available – test withdrawn
Aspergillus galactomannan antigen Freeman Hospital, Newcastle (Microbiology)
Aspergillus PCR Mycology Reference Centre Manchester 7
Basal Ganglia autoantibodies Institute of Neurology, Queens Square, London 10
Basement Membrane Protein autoantibodies (Epidermal, BP180 and 230) Immunodermatology Department, St. Johns Hospital, London 8
Beta Glucan Bristol PHE Mycology Reference Lab 3
BK PCR - (EDTA/Urine) Micropathology Coventry 1
Brucella Liverpool Virology Lab
C1 Esterase Inhibitor Function (contact Immunology in advance) Blood Sciences, RVI, Newcastle 21
C1 Esterase Inhibitor autoantibodies (contact Immunology in advance) Immunology, City Hospital, Birmingham 21
C1q autoantibodies PRU, Northern General, Sheffield 10
C1q quantification PRU, Northern General, Sheffield 20
C3 nephritic factor (C3NeF) (contact Immunology in advance) Blood Sciences, RVI, Newcastle 14
C3d (C3 breakdown products) (contact Immunology in advance) Blood Sciences, RVI, Newcastle
Campylobacter Serology Preston 14

Turnaround
Time
Cardiac Muscle autoantibodies Blood Sciences, RVI, Newcastle 21
Cat Scratch (Bartonella) No longer available – test withdrawn
CD4 count (CD3, CD4, CD8 lymphocytes) Dawn Barge, Blood Sciences, RVI, Newcastle 2
Classical Complement Pathway function (CH100) (contact Immunology in advance) Blood Sciences, RVI, Newcastle 14
Chickungunya Porton Down, Salisbury 7
Chlamydia PCR Confirmation STBRU Colindale 6
CMV PCR Newcastle PHE Molecular 5
Coccidio mycosis Bristol PHE Mycology Reference Lab
Cryptococcus Ag (needs at least 300µl) Newcastle Mycobacterial 2
Dengue Abs/PCR Porton Down, Salisbury 7
Desmosome autoantibodies (Epidermal, Desmoglein-1, Desmoglein-3) Immunodermatology Department, St. Johns Hospital, London 8
Diptheria antibody titre RVPBRU Colindale 21
EBV PCR Newcastle PHE Molecular 6
EBV IgG Leeds & Bradford Microbiology 5
E.coli 157 Abs GBRU Colindale 14
E.coli PCR Microbiology GOSH
Enterocyte autoantibodies (contact Immunology to discuss) PRU, Northern General, Sheffield 5
Enterovirus PCR Newcastle PHE Molecular 5
Eosinophillic Cationic Protein (contact Immunology to discuss) PRU, Northern General, Sheffield 5
Epidermal autoantibodies (Pemphigus/Pemphigoid indirect immunofluorescence) Blood Sciences, RVI, Newcastle 21
Erlichia Southampton
Filaria London School of Tropical Medicine 10
GABA-B receptor & AMPA Receptor 1/2 autoantibodies Immunology Department, Churchill Hospital, Oxford 21
Gancyclovir Bristol Southmead
Galactomannan Newcastle Serology - DW Microbiologist 14
Ganglioside autoantibodies (Inc.anti-GM1, GM2, GD1a, GD1b & GQ1b IgG & IgM) Neuroimmunology, Southern General Hospital, Glasgow 7
GBM confirmation by Indirect Immunofluorescence Immunology PRU, St Georges, London 14
GC PCR Confirmation STBRU Colindale 6

Turnaround
Time
Goblet Cell autoantibodies (contact Immunology to discuss) PRU, Northern General, Sheffield 5
Hantavirus Porton Down, Salisbury 7
Hep B Core confirmation Newcastle Mycobacterial 4
Hep B DNA/PCR (ensure sample separated immediately on receipt) Newcastle PHE Molecular 10
Hep Be Abs/Ag Newcastle Mycobacterial 4
Hep C PCR Quantitative (ensure sample separated immediately on receipt) Newcastle PHE Molecular 8
HCV Genotype (ensure sample separated immediately on receipt) Newcastle PHE Molecular 14
Hep D (delta Virus) VRD Colindale 14
Hep E IgG & IgM Manchester Virology 4
HEV PCR (ensure sample separated immediately on receipt) VRD Colindale 14
HH8 (whole EDTA sample required) Warwick University
HHV6 Royal Free, London
HHV6 PCR (EDTA) Newcastle PHE Molecular 7
HHV7 Royal Free, London
Histoplasma Bristol PHE Mycology Reference Lab
HIV Confirmation VRD Colindale 8
HIV PCR Quantitation (ensure sample separated immediately on receipt) Newcastle PHE Molecular 7
HIV Sensitivity (Genotype) Lab 21 Cambridge 14
HMGCR(Statin Trial) Churchill Hospital Oxford 14
HLAB5701 Lab 21 Cambridge 7
HSV PCR (EDTA) Manchester Virology 3
HSV Serology Newcastle Serology 5
HTLV I & II Newcastle Serology 5
Human Herpes hominis Newcastle PHE Molecular 7
Human Papiloma Virus Manchester Virology 4
Hydatid London School of Tropical Medicine 10
IA2 autoantibodies PRU, Northern General, Sheffield 10
IgD quantitation PRU, Northern General, Sheffield 14

Turnaround
Time
Infliximab / Inflectra levels and neutralizing antibodies Viapath, St Thomas’, London 14
Influenza A Serotyping Newcastle PHE Molecular 21
Insulin autontibodies PRU, Northern General, Sheffield 5
Interferon Beta levels and neutralizing antibodies Institute of Neurology, Queens Square, London
JC Virus PCR (Urine/EDTA) Micropathology Coventry 1
Legionella Conf. RVPBRU Colindale 8
Lepotspira (all tests) Porton Down, Salisbury 7
Leishmania London School of Tropical Medicine 6
LGV Swab PCR STBRU Colindale 6
Lymes confirmation Porton Down, Salisbury 7
Lymphocyte subsets (CD3, CD4, CD8, CD56, CD19) (contact Immunology in advance) Dawn Barge, Blood Sciences, RVI, Newcastle 2
Myelin Associated Glycoprotein (MAG) autontibodies Immunology Department, Churchill Hospital, Oxford 14
Malaria Antibodies London School of Tropical Medicine 10
Malaria PCR London School of Tropical Medicine
Mannose Binding Lectin (MBL) Blood Sciences, RVI, Newcastle 14
Measles PCR Manchester Virology 3
Meningococcal & Pneumococcal PCR Manchester Meningococcal Reference Unit 3
Meningococcal Vaccine Functional Titres (A,B,C,W & Y) Medical Microbiology PHE Vaccine Evaluation Unit Manchester 28
Mumps IgG & IgM Newcastle Serology 5
Myelin oligodendrocyte glycoprotein (MOG) autoantibodies Immunology Department, Churchill Hospital, Oxford 14
Mumps PCR VRD Colindale 10
Muscle specific kinase (MuSK) autoantibodies Immunology Department, Churchill Hospital, Oxford 21
Mycoplasma IgM RVPBRU Colindale 8
Myelin Antibodies PRU Northern General Sheffield - DW AGH 3
Neuronal (Hu, Yo, Ri, CV2, Ma1/Ma2, Tr, Zic4, SOX1 and Ampiphysin) autoantibodies Immunology Department, Churchill Hospital, Oxford 14
Natalizumab levels and neutralizing antibodies Immunology Laboratory, Royal London
Neutrophil Function (NBT/DHR) (contact Immunology in advance) Blood Sciences, RVI, Newcastle
NMDA-receptor autoantibodies (Serum +/- CSF) Immunology Department, Churchill Hospital, Oxford 14

Turnaround
Time
Oligoclonal Bands (IgG) (Paired CSF & Serum) Blood Sciences, RVI, Newcastle 14
Orf VRD Colindale 4
Ovarian autoantibodies Blood Sciences, RVI, Newcastle 21
Parathyroid autoantibodies PRU, Northern General, Sheffield 5
Parvovirus PCR VRD Colindale 10
Pertussis Swab Newcastle PHE Molecular
Phospholipase A2 receptor (PLA2-R) autoantibodies PRU, Northern General, Sheffield 14
Pneumococcal antibody serotyping Medical Microbiology PHE Vaccine Evaluation Unit Manchester 28
Pneumocystis PCR Manchester Virology 4
Polio Ab VRD Colindale
Pseudomonas Leeds General Infirmary 14
Q Fever Serology Bristol PHE Mycology Reference Lab 5
Rabies Addlestone 20
Rare Pathogens Porton Down, Salisbury 7
Specific IgE (Allergy RAST) referrals Blood Sciences, RVI, Newcastle / PRU, Northern General, Sheffield 5
Respiratory PCR Manchester Virology 3
Rickettsias Porton Down, Salisbury 7
Ross River Virus Porton Down, Salisbury 7
Rubella Avidity Manchester Virology
Rubella PCR VRD Colindale 10
Salivary Duct autoantibodies (contact Immunology to discuss) PRU, Northern General, Sheffield 10
Schistosoma London School of Tropical Medicine 7
Skeletal/Striated Muscle autoantibodies Immunology Department, Churchill Hospital, Oxford 14
Soluble CD25 (contact Immunology in advance) Immunology Department, Great Ormond Street Hospital
Sperm autoantibodies Andrology, Hammersmith Hospital, London 14
Strongyloides London School of Tropical Medicine 7
Syphilis PCR Manchester Virology 4
T-Spot -Interferon Gamma Release Assay (IGRA) for Latent TB investigations ONLY Oxford Diagnostics Lab, Abingdon 2

Turnaround
Time
TDM Lab 21 Cambridge 14
Toxoplasma Dye Test Swansea 7
Toxocara London School of Tropical Medicine 7
Syphilis IgM or Confirmation Newcastle PHE Molecular 3
Typhus Porton Down, Salisbury 7
Valgancyclovir Bristol Southmead
Viral respiratory PCR Manchester Virology 3
Viral Haemorrhagic Porton Down, Salisbury 7
Voltage Gated Calcium channel (VGCC) autoantibodies Immunology Department, Churchill Hospital, Oxford 21
Voltage Gated Potassium channel (VGKC) autoantibody screen Immunology Department, Churchill Hospital, Oxford 14
VGKC autoantibody typing (anti-CASPR2 & LGI1 antibodies) Immunology Department, Churchill Hospital, Oxford 14
VZV PCR (EDTA) Manchester Virology 4
West Nile Virus Porton Down, Salisbury 7
Widal Newcastle PHE Molecular
Yellow Fever Porton Down, Salisbury 7
Zika virus Porton Down, Salisbury 7

9.0 POINT OF CARE TESTING

Point of Care Testing (PoCT) is defined as medical testing either at or near the site
of the patient by specifically trained healthcare professionals. The main benefit of
PoCT is that results are available immediately enhancing patient care and leading
to better clinical outcomes.
9.2 CONTACT DETAILS

Clinical lead: Consultant Clinical Biochemist
Ms Sally Willett MBIOCHEM MSc FRCPath
Tel: CIC Ext.14028
sally.willett@ncuh.nhs.uk
Point of Care Testing Manager: Liz Berry MSc FIBMS

Tel: 07769936027
liz.berry@ncuh.nhs.uk
Blood Sciences Laboratory : CIC Ext: 14541

WCH Ext 13433
9.3 CLINICAL ADVICE

Clinical advice regarding PoCT can be sought from contacting either the Clinical
lead for PoCT or the laboratory on the contact numbers/email above.
9.4 TECHNICAL ADVICE

Technical advice regarding PoCT can be sought from either the PoCT manager or
the laboratory on the contact numbers/email above.
9.5 NEW AND REPLACEMENT POCT DEVICES/TESTS

There is an application form entitled Application for Approval of Point of Care
Testing (PoCT) device for use in North Cumbria University Hospitals NHS Trust.
This can be found either as Appendix 1 of the Point of Care Testing Policy or by
contacting the PoCT Manager. Any application for new/replacement PoCT
devices/tests must be passed by the PoCT Committee. The application form will be
used to assess the effectiveness of the proposal and does not constitute an
application for funding. A separate capital requisition and supporting business case
will be required once approval is granted by the PoCT Committee.
9.6 BLOOD GLUCOSE
9.6.1 General Information

Meters available in the Trust Roche Accu-Chek Inform II
Replacement meters are available through the Blood Sciences Department.
Accu-Chek Inform II test strips are available through Pharmacy.
Internal quality control solutions are available through the Blood Sciences
Department and are delivered to all Roche users in the Trust on a three monthly
basis.
Workstations are available through the Blood Sciences Department.
9.6.2 Result ranges

Blood glucose levels <4 mmol/L are indicative of Hypoglycaemia.
Blood glucose levels >11.0mmol/L are indicative of Hyperglycaemia.
If considering a diagnosis of HSS or DKA a blood gas should be obtained and

ketones tested (using a blood ketone meter (if available) or a urine dipstick).
The meter will only give a result for glucose in the range of 0.6 - 33.3 mmol/L
Outside of this range the meter will either state “Hi” or “Lo”. In these cases the test
should be repeated. If the same result is given then a blood sample must be sent to
the laboratory urgently for confirmatory reporting.
9.6.3 External Quality Assurance Scheme

All meters are registered with the WEQAS Blood Glucose/Ketone Scheme.
Distribution for Trust is on a monthly basis. The PoCT Manager organises and
manages this scheme.
9.7 URINANALYSIS TESTS

Urinanalysis test strips routinely available throughout the Trust – Combur 7 Test
Combur 7 test strips are available through Pharmacy Departments.
The test strip has 7 test patches on it and is used for the semi quantitative
determination of pH, glucose, ketones, leukocytes, nitrate, protein, and blood in
urine by visual reading.
9.7.2 Collection of Sample

 Only use fresh urine samples.
 If the sample has been allowed to stand for a few minutes it must be mixed prior
to testing.
 Collection must be in a sterile container without preservative.
 Samples must not be placed in direct sunlight.
 All of the test patches must be covered with urine.
 Excess urine is to be wiped off the test strip using the rim of the sample
container.
 At 60 seconds read the test strip
9.7.3 Result ranges

The colouration of the patches on the test strip are compared to the colour scales
shown on the side of the test strip container.
Colouration that occurs after 2 minutes has no diagnostic significance.

9.7.4 External Quality Assurance

Currently there is no scheme being offered although this is being reviewed.
9.8 URINE PREGNANCY TESTS

The Trust currently uses Alere hCG Cassette for pregnancy testing. All ward/clinical
areas are to order their own supply via NEP/Oracle. The NHS Supply Chain code
for these HHH913
9.8.2 Result ranges

The lower range of detection is 25mlU/mL. However if pregnancy is suspected and
the result from the pregnancy test is negative, it is recommended that a blood
sample is taken from the patient using a SST vacutainer (yellow top) and is sent to
the laboratory for confirmation.

Areas have been registered on the WEQAS Urine Pregnancy Scheme. Distribution
is on a bi-monthly basis. The POCT Manager organises and manages this scheme.
9.9 BLOOD KETONE

Meters available in the Trust: VTrust Ketone meters – Supplied by Roche
Meters have only been placed in emergency care settings.
Replacement meters are available through the PoCT Manager
VTrust ketone test strips are available through Pharmacy.
Internal quality control solutions are distributed on a quarterly basis by the PoCT
Manager to all ketone meter users.
USB cables are available from the PoCT Manager.
9.9.2 Result ranges

Capillary ketones >3 mmol/L in the presence of hyperglycaemia and a pH<7.3 or
HCO3- <15mmol/L is consistent with DKA.
In the cases where the blood ketone level is >3mmol/L the Trust DKA Policies
(Adults and Paediatrics) must be followed.

Participation is in the WEQAS Blood Glucose/Ketone Scheme. Distribution for this
scheme is monthly. The PoCT Manager organises and manages this scheme.

9.10 BLOOD GAS ANALYSERS

Analysers in use in the Trust: Radiometer ABL800, ABL825 and
ABL90Flex
Abbott iSTAT
All consumables are the responsibility of each ward/clinical area. Service Level
Agreements (between the clinical area and the Blood Sciences Department) are in
place for general maintenance and troubleshooting for some clinical areas. For
assistance out of hours please contact Radiometer directly on 01293 517599.
9.10.2 Result Ranges

Refer to section 5.15 for reference ranges

All Blood Gas Analysers have been enrolled in the NEQAS Blood Gas Scheme on a
monthly basis. This is organised and managed by the PoCT Manager
9.11 INR TESTS FOR ANTI-COAGULATION

Meters available in the Trust: Roche CoaguChek XS Plus/Pro
Meters are only placed in agreed areas with strict levels of use.
Meters are not normally replaced. However, if the meter is broken or the error
message cannot be fixed, the meter must be sent to the PoCT manager who will
arrange for this to be sent to Roche for examination.
It is each department’s responsibility to purchase the necessary consumables for

the meters.
9.11.2 Result Ranges

Dependent on the type of use
Please refer to in-house procedures

Participation is in the NEQAS Blood Coagulation NEQAS Scheme. Distribution is a
minimum of once a quarter. It is each clinical areas responsibility for ensuring their
meter is enrolled on the scheme. The PoCT Manager organises and manages this
scheme.
9.12 GLYCATED HAEMOGLOBIN (HBA1C)

Analysers available in the Trust: Siemens DCA Vantage

Located in the Children’s Out Patients Department at CIC and with the Paediatric
Diabetes Specialist Nurse at WCH
It is each department’s responsibility to purchase the necessary consumables for

the analysers.
9.12.2 Result ranges

Results are used to assess the patient’s control of diabetes mellitus. All results will
have an individual management plan, specific to that patient’s needs and
requirements, which will be subsequently reviewed again according to local
procedures.

Participation is in the WEQAS Glycated Haemoglobin Scheme. Distribution is
monthly. The PoCT Manager organises and manages this scheme.
9.13 FOETAL FIBRONECTIN

Analysers available in the Trust Hologic Rapid fFN Q Analyser
Located in the Delivery Suites at CIC and WCH
It is the departments’ responsibility to purchase the necessary consumables for the

analysers, although stock management is carried out by the PoCT Manager and
sampling kits and cassettes are held in stock in the Pathology General Store.
Results help to predict the likelihood of preterm delivery.
Concentration Risk of Delivery ≤14 days Risk of Delivery ≤34 weeks
98% chance delivery will NOT 99% chance delivery will NOT
<10ng/mL
occur <14 days occur <34 weeks
98% chance delivery will NOT 92% chance delivery will NOT
10-49ng/mL
occur <14 days occur <34 weeks
8% chance delivery WILL occur 12% chance delivery WILL occur

50-199ng/mL
<14 days <34 weeks
200-499ng/mL
<14 days <34 weeks
≥500ng/mL
<14 days <34 weeks

Participation is in the WEQAS Preterm Delivery Marker Scheme. Distribution is bi-

monthly. The PoCT Manager organises and manages this scheme.
9.14 ACTIM PROM

This test is used on the maternity units at CIC and WCH to determine if a patients
waters have broken by detecting IGFBP-1, a major protein in amniotic fluid and
therefore a marker of the amniotic fluid in a vaginal sample.
It is the departments’ responsibility to purchase the necessary consumables for this

test, although stock management is carried out by the PoCT Manager and sampling
kits are held in stock in the Pathology General Store.

Tests will show either positive or negative.

Currently there is no EQA scheme available.


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Pathology Directorate

PATHOLOGY USERS HANDBOOK

Pathology Users Handbook – V20

6.9 COAGULATION SECTION

Pathology Users Handbook – V20

The aim of this Handbook is to present the Pathology departments at the

North Cumbria University Hospitals NHS Trust Pathology consists of departments

Advice on voicing concerns and making a complaint

Pathology Service Manager

Mrs Francine Duncan MA, FIBMS

Deputy Pathology Service Manager

Mrs Anne Pearson MSc FIBMS PGCert Management

The Trust Complaints Department can be contacted via:

Pathology Users Handbook – V20

2.0 QUALITY ASSURANCE

2.1 DATA PROTECTION AND CONFIDENTIALITY

3.0 GENERAL INFORMATION

3.1 LOCATION OF PATHOLOGY CUMBERLAND INFIRMARY, CARLISLE

Pathology Users Handbook – V20

The location of car parks for visitors is shown on Plan A.

Pathology Reception Cumberland Infirmary

Opening times: Weekdays 08:30-18:00

Plan A: Cumberland Infirmary site showing car parks

Pathology Users Handbook – V20

Plan B: Cumberland Infirmary Lower Ground Floor Map

Pathology Users Handbook – V20

3.2 LOCATION OF PATHOLOGY WEST CUMBERLAND HOSPITAL, WHITEHAVEN

The pathology department is on level 2 of the newly developed West Cumberland

Pathology Reception West Cumberland Hospital

Opening times: Weekdays 08:45-17:00

Pathology Users Handbook – V20

Plan C: West Cumberland Car Parks

Pathology Users Handbook – V20

Plan D: West Cumberland Hospital site

Level 3 WCH Level 4 WCH

Pathology Users Handbook – V20

4.0 SPECIMENS/REQUEST FORMS

Important change to sample labelling policy in Pathology

As of 1 August 2015 ALL Pathology specimens and request forms MUST be

In exceptional circumstances where the NHS number is unavailable or not

Samples failing to meet the acceptance criteria will not be processed

Benefits of using ICE:

Specimens should be placed in the appropriate container which must be securely

Pathology Users Handbook – V20

All specimens must be labelled with:

and should have

If a specimen is to be posted the packaging must comply with postal regulations.

Biohazard samples must be double bagged.

Supplies can be ordered from stores under the following codes:

4.2 REQUEST FORMS

Pathology Users Handbook – V20

Additional information may be required for some investigations, please see

Regrettably specimens may have to be discarded if they are so inadequately

4.2.1 Clinical Details

Pathology Users Handbook – V20

 Underlying conditions eg diabetes, cystic fibrosis

4.2.2 Laboratory Chain of Evidence Samples

4.2.3 Antenatal Screening

4.3 HIGH RISK SPECIMENS AND SAFETY

Pathology Users Handbook – V20

4.4 RECEIPT OF SPECIMENS

4.4.1 Cumberland Infirmary

For urgent specimens out of hours

4.4.2 Transport of Specimens