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Kingston Pathology User Guide 2015 Kingston Hospital 738, version 7.0 Author: David Greenwood Review Date; 1

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PATHOLOGY SERVICES USER GUIDE

Kingston Hospital Site

Introduction The following guide details the Pathology Services provided on the Kingston Hospital site. The guide is provided as a reference to the services available to you and we hope that it ensures the most effective use of both the diagnostic and clinical pathology services. We are committed to providing a high quality service that meets the needs and requirements of our users and we demonstrate this by:

Our laboratory services are clinically led

Ensuring that the wellbeing of our patients is at the forefront of everything we do

Continually improving the quality of services we provide

Seeking the views of the users of our service and we welcome feedback on the services we provide

Outside routine hours we provide a wide range of analytical services, but not all tests will be run as standard. We continue to develop a wide range of tests and patient services and our aim is to strive for excellence and to provide a commissioner focused patient orientated service.

IMPORTANT INFORMATION Please note the following changes to the Pathology service provided by Kingston Hospital;

From the 1st April 2014 the Pathology services based at Kingston Hospital will be

provided by South West London Pathology and not Kingston Hospital.

The exception to this will be the Cellular Pathology service which will continue to be provided by Kingston Hospital NHS Foundation Trust. Details of the Cellular Pathology service are available through the Cellular Pathology Services Handbook

Several changes to the service will occur in the next few months;

From the 31st March 2014 the Gynae Cytology Service will move from Kingston

Hospital NHS Foundation Trust to St George’s Healthcare NHS Trust and will be provided by South West London Pathology. The contact numbers for the St George’s laboratory are; 0208 725 5266/67/68

From the 15th December 2014 the Microbiology Service will be based at St

George’s Healthcare NHS Trust.

The contact number for the laboratory is 020 8725 5693.

You will be able to send in your specimens and order consumables for all of the Pathology departments in the same way as now.


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Overview of Services Provided At Kingston Hospital NHS Foundation Trust Location The Pathology Services for Kingston Hospital are located on Level 4 of the Bernard Meade Wing (Pathology Reception, Clinical Biochemistry, Immunology, Haematology, Blood Transfusion and Main Office) and Level 2, Esher Wing (Cellular Pathology). There is a satellite unit on the Queen Mary’s Hospital site at Roehampton providing both phlebotomy, and a local Pathology Reception situated on the Lower Ground Floor. Times of Opening

Department Monday - Friday Saturday Sunday Blood Transfusion

1

Haematology1

Clinical Biochemistry

1

08:00 – 20:00 09:00 – 18:00 09:00 – 18:00

Cellular Pathology 08:30 – 17:00 Closed Closed

Mortuary 08:00 – 16:00 Closed Closed

Queen Mary’s Hospital 09:00 – 17:00 Closed Closed

1 At other times an out of hours service operates, contacted through switchboard.

Service Provided We provide a comprehensive laboratory and clinical interpretive service with 24-hour cover, receiving in excess of 1,300,000 patient requests per annum, and undertaking over 8,500,000 investigations. Result Availability Most routine investigations are reported the same day or within 24 hours, with most microbiology results being available within 48 hours. Those areas using Order Communications (Cerner) to make requests for Pathology investigations will receive their results electronically several times each day. Computer terminals are located in wards and clinics to access results, and the principal mechanism for distributing pathology and radiology results to GP practices is via encrypted electronic transmission. Paper reports are distributed to those areas not using Order Comms and for all reports from Histopathology. Specialist Services We provide a service for the more specialised analyses to other hospitals in surrounding areas, as well as a service to private patients and private hospitals, executive screening, HIV testing and for occupational screening, industrial and pharmaceutical studies. Please contact the Pathology Manager if further information is required. Service Quality Our results are independently monitored by Regional, National and European quality assurance organisations and the laboratories are accredited by CPA (Clinical Laboratory Accreditation UK Ltd).


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Contents Page Introduction to Kingston Hospital Pathology Services 1 - 2 Pathology Telephone Directory 5 – 6 Quality Assurance 7 Guide To Pathology Request Forms 8 Labelling of Requests and Specimens 9 - 10 Ordering Supplies 11 - 12 Vacutainer Tube Guide (including order of draw) 13 Hospital Based Phlebotomy Service 14 Sample Containment and Transportation 15 Access to Results 16 Point of Care Testing 17 Blood and Body Fluid Precautions 18 Procedure for Making Requests 19 - 21 Routine Requesting 19 Criteria for Urgent Request 20 Making an Urgent Request Clinical Biochemistry, Haematology and BT 21 Clinical Biochemistry 22 - 31 Guidelines for Biochemical Investigations 22 Guidelines for the Use of Out of Hours Service 23 - 24 Turn Around Times and Sampling Instructions 25 List of Commonly Requested Investigations (Adult) 26 - 28 List of Investigations (Paediatrics) 29 List of Investigations (Urine) 30 List of Investigations (Miscellaneous Samples) 31 Immunology 32 - 33 Haematology 34 - 37 Guidelines for Haematology Investigations 34 Clinical Haematology Clinics 35 Guidelines for the Use of Out of Hours Service 36 Turn Around Times & List of Commonly Requested Investigations 37 Blood Transfusion 38 - 40 Guidelines for use of Blood Transfusion Laboratory 38 Labelling Requirements 38 Procedure for Making Urgent Requests 39 Blood Product Availability 40


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Page Microbiology 41 - 43 Cellular Pathology & Mortuary 44 Alphabetical List of Pathology Investigations (Adult) 45 - 70 Alphabetical List of Pathology Investigations (Paediatrics) 71 Appendix 1 List of Specialist Referral Centres Clinical Biochemistry 72 – 75 Appendix 2 List of Specialist Referral Centres Immunology 76 Appendix 3 List of Specialist Referral Centres Haematology and Blood Transfusion 77


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Telephone Numbers, Extensions and E-Mail Addresses

Kingston Hospital 020 8546 7711 Main Office FAX 0208 934 3289 Histology FAX 0208 934 3288

Queen Mary’s Hospital 020 8487 6390

Our clinical staff may also be contacted through the hospital switchboard If calling from outside dial 0208 934 followed by extension number

General Pathology Telephone number

Clinical Director for Pathology 2056

Clinical Director for Cellular Pathology 2240

PA to Pathology Manager 2027

Pathology IT Systems Manager 2055

Quality Manager 2055

Results Service

Biochemistry & Haematology 2029

Cellular Pathology 2239, 2238

Immunology 2490

General Pathology office 2013

Pathology Porter Bleep 820

Pathology Stores 2538, Bleep 205

Phlebotomy 3294

Phlebotomy – Queen Mary’s 020 8487 6391

Clinical Biochemistry / Immunology Telephone number

Consultant Chemical Pathologist 3292

Consultant Biochemist 2056

Consultant Immunologist (Tuesday only) 2057 (am), 2875 (pm)

Laboratory Manager 2051

Main Laboratory 2052

Urgent requests (Core hours) 2033

Immunology (enquiries & results) 2490

POCT Manager 3299

Out of Hours Laboratory Bleep 540

Haematology / Anticoagulation Telephone number

Secretary to Consultants 3515, 2032

Consultant Oncologist 3581


Haematology Laboratory 2044

Coagulation Laboratory 2045

Urgent requests (Core hours) 2033


A/C Lead Clinician 2043

A/C Nurse Specialists 3576, 2038

A/C Enquiries 2030


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Telephone Numbers, Extensions and E-Mail Addresses

Blood Transfusion Telephone number


Transfusion Laboratory 2046


Cellular Pathology / Mortuary Telephone number

Consultants 2239


Main Laboratory 2236, 2241

Secretaries (for reports) 2239

Mortuary Manager 2643, 2644

Microbiology / Infection Control Telephone number

Consultant Microbiologist Via Kingston switchboard

Results if not available elsewhere 020 8725 5693

Infection Control Nurses 2310, 3369 Bleep 667, 668

See Microbiology section for more details


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Quality Assurance We are committed to providing a high quality clinical and diagnostic service. Internal Quality assurance is guaranteed by strict adherence to analytical protocols and a comprehensive internal quality control programme. Pathology Services subscribes to all external National External Quality Assessment Schemes for the analytical repertoire we provide. We are also registered with Clinical Pathology Accreditation (UK) Ltd ensuring that we meet the stringent requirements expected from a pathology service. Pathology participates in the following External Quality Assurance Schemes

Biochemistry –WEQAS Biochemistry - UKNEQAS

General Chemistry Paediatric Bilirubin

Drugs (Paracetamol and Salicylate) Lipids

Bilirubin Thyroid Function

Steroid Hormones

Sweat Testing

Glycated Haemoglobin

Specific Proteins

Immunology – NEQAS for: Urinary Albumin

General autoimmune serology Urine Chemistries

Intrinsic Factor antibodies Tumour Markers

ANCA & GBM CSF

Antibodies in coeliac disease CRP

Antibodies in Bullous Dermatoses Allergy

Antibodies to Nuclear and Related Antigens Monoclonal Protein Identification

Phospholipid Antibodies Peptide Hormones

Fungal and Avian Antibodies Cardiac Markers

Tryptase Heathcontrol for Anticonvulsant, Respiratory and Cardiac Drugs

Haematology Blood Transfusion

General Haematology Blood Transfusion Laboratory Practice

Reticulocyte Count & Automated Leucocyte Differential Count

Feto-Maternal Haemorrhage Estimation

Coagulation Welsh Assessment of Serological Proficiency

Thrombophilia Profile

Blood Parasites / Blood Film

Haematinics


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Pathology Services

Guide To Requesting Pathology Investigations Kingston Hospital NHS Foundation Trust – Pathology Requesting There are two methods of requesting investigations from Pathology; firstly an electronic method and secondly using request forms. The preferred method, where available, is to use the Cerner Millennium, Order Comms system, which is an electronic system allowing for both a request to be made and the results to be received. This system is used extensively throughout the Trust and by many of the GP practices in the area. This system is used for requesting Biochemistry and Haematology investigations. Cellular Pathology does not use this system and any requests must be made using the department’s request form. In situations when Order Comms is not available, such as a failure of the system, requests must be made using the specifically designed downtime forms. These can be printed from the Trust’s intranet site under the Forms section. When requesting using one of these forms, ensure that ALL the required information is provided. GPs can use the request forms as supplied by Kingston Pathology. Guidance on the use of the Order Comms system within the Trust can be found on the following links: In-patient Pathology Ordering http://home/khintranet/documents/201008041121_CON10a_Inpatient_Pathology_ordering_v1.2.pdf

Cancelling a Pathology Order

http://home/khintranet/documents/200911131448_CON11_Cancelling_a_Pathology_Order_v1.0.pdf

Viewing Results in Powerchart

http://home/khintranet/documents/201004191546_CON13_Viewing_Results_from_PowerChart.pdf

Those GP practices where Order Comms is not available should complete the request forms for each department as supplied by Pathology. When completing these forms, ensure all the required information is provided, particularly the name of the requestor and address to which the report should be sent.

Send Away tests / Tests referred to other Laboratories A number of the tests that are requested through the Kingston laboratories are not performed at Kingston but sent to other laboratories for analysis. This may be because the test is rarely requested or requires specialist knowledge and skills to perform. In these cases the samples are sent to the referral laboratory where they are analysed, the results are sent back to Kingston, where they are reported using the normal systems. This obviously takes more time, so the turnaround times for these tests will often take several weeks. An indication of these times can be found in the List of Pathology Investigations on pages 45 – 70 of this guide. The contact details of laboratories to which tests are referred can be obtained from the Kingston laboratories.

http://home/khintranet/documents/201008041121_CON10a_Inpatient_Pathology_ordering_v1.2.pdf

http://home/khintranet/documents/200911131448_CON11_Cancelling_a_Pathology_Order_v1.0.pdf

http://home/khintranet/documents/201004191546_CON13_Viewing_Results_from_PowerChart.pdf


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Labelling of Requests and Specimens

Order Comms Requests A correctly completed request, using the Order Communications System (OCS) will print the correct number of labels required for all of the specimens for that request. These labels will show all the required information for the department to process the sample and return the result to the requestor. It is the responsibility of the person collecting the specimens that they are labelled correctly. Ensure that the correct label is attached to the correct sample e.g. the correct blood tube for the requested test or the correct site if collecting swabs. Labels should be attached along the length of the container, allowing for the barcode to be scanned later. The time of collection should be written on the specimen label. This can be very important when samples are taken from patients several times during a single day, as this information is used to show the results in the correct chronological order. The person collecting the specimen should also sign the label. Completion of Request Form In order for Pathology services to analyse or undertake investigations on samples provided it is essential that the request form is completed fully and legibly. Instructions for completing Blood Transfusion request forms are to be found on page 40 of this User Guide ID labels may be used but please ensure they are placed on ALL parts of the multi part forms. All request forms MUST show the following patient information;

The patient’s Family name and First name

The hospital or NHS number

The date of birth

The gender of the patient

Other information that MUST be included;

The GPs name and/or code

The address to which the report will be sent

Contact telephone number

Relevant clinical details, including drug treatment and travel details

Indication if request is from a private patient Labelling of the Specimens: The specimens MUST be labelled and match the accompanying request form. The patient information shown must include;

The patient’s Family name and First name

The hospital or NHS number

The date of birth

UNLABELLED / INCOMPLETELY LABELLED SPECIMENS WILL NOT BE ACCEPTED OR PROCESSED.


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Other information that should be provided includes:

Date and time the specimen was collected. This is very important

Initials of the person collecting the specimen

Instructions for labelling Blood Transfusion samples are to be found on page 40 of this User Guide. Required - Surname and first name or initial and DoB Supporting Information - NHS number and/or hospital number and source Date of Specimen (essential for tests which are not very stable in blood e.g. potassium,

coagulation studies, etc., we do not report on these tests if a date is not provided)

Time where the test interpretation is time related e.g. drug levels, cortisol, coagulation, and for unstable components such as Blood Gases. Do not pre-label sample tubes as mistakes can be easily made.


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Pathology Services

Ordering Supplies

Items Provided Pathology related consumables can be ordered directly from Pathology Services and items that Pathology Services will supply are listed below: Vacutainer Blood Collection Tubes Provided in sealed racks of 100 Yellow Top: Serum Gel Separator Tube Grey Top: Fluoride Oxalate Mauve Top: EDTA Pink Top: EDTA (For Cross Match) Vacutainer Guards and Needles are not supplied by Pathology Services Kingston Hospital NHS Foundation Trust Universal Containers Provided in the quantities specified by the GP Practice White Top Universal Containers: Urine and Sputum’s Blue Top Universal containers: Faecal Samples 24Hr Urine Containers As specialist preservatives are required – please specify the test(s) for which the sample is being collected Request Forms General Multi-part GP Request Form Ordering Process Supplies can be ordered directly over the phone 020 8546 7711 ext 2538, and there is an answerphone service. Practices can also complete a requisition form available from Pathology Services, when completed this can be returned via the hospital courier service or can be faxed directly to Pathology Services on 020 8934 3289. So that the requisition can be handled efficiently we would ask that the form is completed clearly and requestor name and GP Practice details are completed. This form can be accessed through the GP Microsite and when completed can be returned to a dedicated e-mail account.


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Delivery Process Supplies will be distributed via the Hospital Courier service. Where there is no provision for this service, supplies can be delivered to a nearby practice visited by the courier service, where local arrangements exist between the practices or we would require that a practice representative picks up from Pathology Services. Order Turn Around Times We would appreciate that practices manage their stocks effectively to allow time for re-supply, and we would request 5 working days’ notice under normal circumstances. Pathology Services will endeavour to ensure the order is fulfilled within 2 normal working days of receipt of the request. (Bank Holiday and Weekends are not considered normal working days). If there is an urgent requirement Pathology services will endeavour to fulfil the order the next working day, but it may require agreement with the practice over delivery arrangements. On the occasions where Pathology services are unable to supply an item, Pathology Services will contact the practice and indicate when re-supply will take place. If the missing items form part of a larger order container other items the remaining items will be supplied as normal.


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Pathology Services

Vacutainer Tube Guide FULL PID DETAILS ON FORM AND TUBE ESSENTIAL Catalogue Number

Specimen Volume

Hemogard Closure (Top)

Preservative Tests Instructions

39641 5 ml Mauve EDTA FBC, ESR Red cell folate, GF screen, Abnormal Hbs. HbA1c PTH Red Cell Porphyrins

Separate samples required for HbA1c and PTH

367691 Available from laboratory

4.5 ml Light Blue

Sodium Citrate

Coagulation Testing / Anticoagulant Control / D dimers

MUST be full. Date and time essential

39643 7 ml Red Plain (No Additive)

Preferred sample is SST tube but is an alternative for: B12, Ferritin, Antibiotic Assays, Virology, Non-Viral Serology, Immunology

Date and time essential

39840 5 ml Yellow S.S.T. Serum Separator Tube

Chemistry. B12, Ferritin, Antibiotic Assays, Virology, Non-Viral Serology, Immunology

One full Tube for UE, LFT, and Calcium. A second tube is required for investigations undertaken by Microbiology, cannot use the same tube as Chemistry. Date and time essential.

39642 5 ml Grey Fluoride Oxalate

Glucose, Alcohol, Lactate

357941 6 ml Pink K2 EDTA (Cross Match) ONLY

Blood Group, Antibodies, Kleihauer, Cross Match, Direct Antiglobulin Test

FULL PID DETAILS ON FORM AND TUBE ESSENTIAL

368380 Available from laboratory

7 ml Dark Blue

Plain (Trace elements)

Zinc, Copper, Selenium, Alpha-1 antitrypsin phenotype


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Pathology Services Phlebotomy Services

Phlebotomy Service

General Practitioners’ Patients

The phlebotomy service is available to GPs' patients on an open access basis Monday to Friday between 08:30 and 17:00 at Kingston Hospital and 08:30 and 17:00 at Queen Mary’s Hospital. Last patient seen 16:45. These patients will be bled on production of appropriately completed request form. Patients who require a Glucose Tolerance Test are required to contact the Phlebotomy Department at either hospital for an appointment. Phlebotomy Department: Kingston Hospital NHS Foundation Trust 020 8934 3294 Phlebotomy Department: Queen Mary’s Hospital 020 8487 6391


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Pathology Services Sample Containment and Transportation

It is the responsibility of the individual who collected the sample to ensure that the sample container is securely sealed and that it will not leak. Hospital couriers will check for leaking samples before they accept them. If a sample is leaking they will report this to local staff and will not accept the sample. Instruction for Transportation of Samples – Sample Containment Blood, Universal Containers containing liquid samples Ensure that the tops on the Universal Containers are hand tight. Clearly write required identifiers and sample collection information onto the label on the container. Place sample containers inside the integral sample bag attached to the request form. Remove the brown covering strip and fold back plastic sample bag edge against adhesive to seal. Place the request form and bag in a leak proof receptacle ready for collection. This receptacle must be placed on a flat area where it will not be knocked over. All specimens should be kept at room temperature if they are being transported to the laboratory that day. 24hr Urine Collection – Write patient identity details, collection dates and times and source clearly onto the container. Ensure that the top of container is securely fixed and check that material will not leak in transit. Tape the request form to container and place container in a plastic bag.


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Pathology Services Access to Results

Result Reporting Pathways Paper Reports Pathology Services are phasing out paper reports unless the practice has indicated a requirement to continue to receive paper reports Paper reports are delivered via the hospital courier service or via the postal service if the practice does not receive a courier service. Electronic Transmission of Results Pathology Services has set-up Trading Partner Agreements with each of the practices who send pathology requests into Kingston Hospital NHS Trust. This allows pathology results to be sent electronically to GP practice management systems for inclusion into the practice electronic record. Pathology sends message results out to practices 4 times a day and we recommend that practice systems are configured to pick up messages at least twice a day Telephone Enquiry Pathology results may also be obtained over the telephone and result enquiry telephone numbers are printed on the back of the request form.

Clinical Biochemistry and Haematology results; Contact 2029 08:30 to 20:00hrs – Monday to Friday Contact 2033 09:00 to 18:00hrs - Saturday and Sunday Immunology Contact 2490 09:00 to 17:00hrs – Monday to Friday Blood Transfusion Contact 2046 09:00 to 20:00hrs – Monday to Friday Due to the busy nature of the out of hour’s period, Biomedical Scientists will only provide results on samples they have processed

At Other Times Routine results will not be provided out of hours by the Pathology staff.

Faxed Results Pathology Services discourages the faxed transmission of results and will only provide results by this route if alternative options are not available. Results will only be faxed to ‘Safe Haven’ faxes (those fax machines sited in secure areas free from unauthorised access) where pathology has a record of location and fax number. The requestor must fax pathology to request that a faxed result be sent to them on headed notepaper with details of the request, including the fax number they wish the result to be faxed to. Pathology will respond if the fax number corresponds to our record of a safe haven fax.


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Pathology Services Point of Care Testing

Point of Care Testing at Kingston Hospital NHS Foundation Trust Point of care testing (POCT) is defined as any analytical testing undertaken outside the central laboratory and close to the patient and is usually carried out by non-laboratory staff. The key objective of POCT is to generate a result quickly so that appropriate treatment can be implemented leading to an improved clinical and/or economic outcome. The quality of the result is vital to the clinical management of the patient and is dependent on the member of staff carrying out the analysis. All staff carrying out POCT are responsible for the results they obtain and should be aware of the medico-legal implications of an erroneous result. Therefore it is mandatory that full training be undertaken with any POCT ranging from urine dipsticks to the more sophisticated analysers. As well as understanding the basic use of equipment there are often a number of clinical circumstances when it is NOT appropriate to use. These are the situations where lack of training could lead to the wrong result with a potentially fatal outcome. It is not acceptable to avoid training because of previous use of similar equipment/procedures in other hospitals. Training Training can be accessed via Link Trainers throughout the Trust, or through specific training sessions organised for junior doctors. Contact details of Link Trainers and further information regarding face to face training, online training modules and competency assessments can be found on the POCT Intranet pages. Click here http://home/khintranet/NEWdocview2.php?screenw=1280&DeptID=117 Quality Assurance POCT participates in the WEQAS and UKNEQAS external quality assurance schemes; details will be provided upon request. Other information At Kingston Hospital there is a multidisciplinary POCT Trust Group which oversees the use of POCT in the Trust. The Trust POCT Policy, Trust POCT Group Terms of Reference and Minutes of meetings are available on the POCT Intranet pages

Information for GPs If a GP practice is considering introducing or has introduced Point of Care testing, Pathology Services would recommend that the practice refers to these documents available from the Medicines and Healthcare Products Regulatory Authority (MHRA) website: Point of Care Testing: Top 10 Tips Aug 2004, Published Dec 2005 Management and use of IVD point of care test devices: DB2010(02), Published Feb 2010 These documents outline the decision making process to introduce POCT procedures and advises on processes to ensure the quality of results obtained. If a GP practice requires advice and guidance regarding POCT you are welcome to contact the Trust POCT Manager.

http://home/khintranet/NEWdocview2.php?screenw=1280&DeptID=117


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Pathology Services Blood and Body Fluid Precautions

There are many individuals in the community who are asymptomatically infected with Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV), and it is likely that these individuals are unaware of their infection. Consequently we are also unaware of their infection. It is therefore important that all staff take reasonable precautions against all exposure to blood and other body fluids / excretions from ALL PATIENTS, IN ALL DEPARTMENTS, ALL OF THE TIME, regardless of diagnosis of the patient. UNIVERSAL HANDLING PRECAUTIONS MUST ALWAYS BE FOLLOWED. Specimens of blood from all patients should be taken with particular care not to contaminate the operator or the exterior of the sample container with blood and to avoid dispersal of blood droplets. Specimens contaminated in such a way will usually be discarded without analysis. The department will not accept request forms contaminated with blood and we require that a copy form is written containing details from the original request form; the original will then be discarded. Blood contaminating the operator's skin should be washed off with soap and water and any spilt blood mopped up with Haz Tab solution (yielding 10,000 parts/million available chlorine). Cuts and scratches should be protected and neoprene gloves worn when collecting blood. The eyes may also be shielded with spectacles.


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Pathology Services Routine Requests

The scheduling of routine work is as advised in this User Guide.

‘ROUTINE’ request: Completion as advertised in this User Guide.

Routine samples should, wherever possible, arrive in the laboratory before 15.00hrs including weekends and Bank Holidays. The majority of samples for Clinical Biochemistry (except endocrinology) and Haematology will normally be processed on the day of receipt with results being available the following working day. Refer to the Departments own section of the User Guide for the turnaround time of specific tests.

Advice A consultant in each discipline is available at all times to advise the BMS or clinician on the appropriateness of investigations and result interpretation.


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Pathology Services Criteria for Making Urgent Requests

‘URGENT’ Request: Request Requiring an Immediate Response

On the occasion that an investigation is required urgent from primary care or community settings, it may be advisable to contact the specialist laboratory clinical staff before making the request, to see if the request is justified. Otherwise the clinician must telephone Pathology Reception (2033) or contact the duty BMS during the out of hours period in advance. Results will be phoned back to the requesting clinician or to requesting location.


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Pathology Services Procedure for Making Urgent Requests

Communications - In All urgent requests (as defined on page 22 of this guide) must be phoned to the laboratory reception area during the normal working day (ext. 2033) and the duty BMS must be contacted at other times to alert them to the need. Communications – Out Details of where to communicate results must accompany any urgent request. These must include details of any agencies covering the out of hours period. Results of all urgent investigations will be communicated back to the requesting clinician or authorised deputising service only.

Procedure for Making an Urgent Request to Clinical Biochemistry, Haematology and Blood Transfusion

Clinical Biochemistry and Haematology Departments are open 08:30 to 20:00 Monday to Friday and 09:00 to 18:00 on Saturday and Sunday ‘Urgent Request’ At the above times call ext. 3295 Clinical Biochemistry and Immunology ext. 2033 Haematology ext. 2046 Blood Transfusion Outside of these times bleep 540 Clinical Biochemistry bleep 541 Haematology and Blood Transfusion


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Pathology Services Department of Clinical Biochemistry & Immunology

The department is located on the top floor of the Bernard Meade Wing and open between 08:00 – 20:00 Monday to Friday and 09:00 – 18:00 on Saturday and Sunday. Outside these hours an emergency out of hours service operates. Refer to General Information Section. GUIDELINES FOR BIOCHEMICAL INVESTIGATION The laboratory’s clinical staff may be contacted on extensions 2056, 2057 or 3292 to advise generally on the investigation of patients and to discuss appropriate test strategies. The following guidelines are intended to optimise the use of the Biochemistry laboratory. 1. Adequate clinical details should always be included with any request. In the absence of

such details samples may be stored until this information is supplied. This will delay the analysis.

2. For urgent requests, telephone ext 3295 or bleep 540 if outside routine hours. Results will

be phoned back to the requesting clinician as soon as they are available. To avoid delays mark the request form clearly and send to the laboratory ahead of the ward collection.

3. It may not be appropriate to perform some investigations during acute illnesses - for

example thyroid function tests, lipid studies and glucose tolerance tests. If there is any doubt please consult laboratory clinical staff.

4. Blood samples should not be taken for estimation of paracetamol levels unless four hours

have elapsed since an overdose has been taken. 5. When serum drug levels are requested for therapeutic drug monitoring purposes, it is

important that the time and amount of the last dose as well as the time of sampling are given.

6. Sample requirements for the measurement of Troponin in the investigation of chest pain

can be found on page 26. Investigation protocols We have developed a number of protocols to assist with the diagnosis of particular conditions. Copies are held within the department, and are available on the Pathology pages of the GP Microsite.


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Guidelines for the Use of the Out of Hours Clinical Biochemistry Service The following guidelines cover the basic range of tests available "out of hours". Other tests may be requested where there is a clinical indication and the results are necessary for the immediate management of the patient. For the more unusual requests the duty BMS may ask that you contact the duty Biochemistry Consultant to discuss the case. Serum electrolytes

Myocardial infarction.

Chest infection, where dehydration is clinically suspected or where blood gas analysis is also indicated.

Suspicion of dehydration or renal failure.

Diabetic ketoacidosis.

Significant hypovolaemia e.g. in multiple injuries, severe diarrhoea or vomiting, intestinal obstruction, burns.

Clouding of consciousness, where the diagnosis is not obviously a basic neurological problem e.g. stroke.

Genuine suspicion of electrolyte disorder e.g. hypotonia, arrhythmias, tetany, ileus, muscle weakness, confusion.

Plasma glucose

Diabetic ketoacidosis

Myocardial infarction.

Convulsions or coma } only to confirm

Cerebrovascular Accident } abnormal BM

Symptoms of Hypoglycaemia with no history of insulin dependent diabetes

} stix readings

Serum Amylase

Suspected acute pancreatitis.

Acute abdomen, where diagnosis is in doubt.

Shock, where diagnosis is in doubt. Blood gases (please note: samples should be analysed at the POCT site by the requesting

clinician)

Chest problems with any of the following: respiratory distress, cyanosis, clouding of consciousness, apparent need for artificial ventilation. Severe chest injuries, flail chest, fat embolism, acute respiratory distress syndrome.

Diabetic ketoacidosis.

Salicylate poisoning, where plasma salicylate > 500mg/L or the patient is hyperventilating.

Acute pancreatitis.

Severe head injuries. Salicylate At least 4 hours after overdose, only where there is reasonable suspicion of salicylate ingestion. Paracetamol At least 4 hours after overdose, only where there is reasonable suspicion of paracetamol ingestion.


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CSF CSF glucose and protein are only rarely required if the diagnosis is uncertain after microbiology investigations. Troponin T Two measurements are required in the assessment of patients with chest pain. The second sample should be measured 6-9 hours after presentation. However if the second sample does not show an incremental rise yet clinical suspicion remains then a further sample should be taken at 12 hours after presentation. Patients will fall into one of three decision categories: Category a: < 20% change: not consistent with an acute event Category b: 20-100% change: Significant rise in Troponin T, suggest further evaluation to distinguish between acute causes and chronic elevation in Troponin T (but with one sample above 14 ng/L) Category c: Greater than 100% change: consistent with myocardial infarction (but with one sample above 14 ng/L)


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The most frequently used investigations are listed on the following pages under the headings: Blood specimens, including paediatric samples Urine specimens Miscellaneous specimens

95% of results of general investigations on urgent requests or those from acute care areas should be available within a target turnaround time of less than 2hr The availability codes used in the following tables are as follows:

A 90% of results available within 3 hrs of receipt of sample B Daily requested as routine (in normal lab hours only) - Results available the

following working day C More than one batch per week D One batch per week E Other work done on site F Work referred to other laboratories G Batch analysed every 2 weeks H One batch per month

A more comprehensive alphabetical list of tests is available on pages 57 to 83 in this booklet. Fasting Specimens Fasting specimens should be collected after a 12-hour overnight fast. Patients should be asked to take no food or drink, other than water, for this period. Where fasting lipid studies are required the patient should, in addition, be asked to abstain from alcohol for the 24 hours prior to sampling and to abstain from smoking for 12hr prior to test. Stability of Specimens Information is provided under 'Special Remarks' as to the stability of the analyte in whole blood, if stored away from sunlight and any sources of heat, or in a refrigerator as specified. Interferences It is important that blood samples are taken into the correct tubes and that blood tubes are filled in the correct order, as contamination from anticoagulants will affect results. Please provide full details of the patient’s medication as certain drugs will influence results and subsequent interpretative remarks. Haemolysis, Icterus and Lipaemia will interfere with a number of investigations and this will be indicated on the report. Requesting Additional Tests Samples sent to Clinical Biochemistry are kept for three days after analysis and it is not possible to request additional tests after this time. To request additional tests within three days, please contact the laboratory on extension 2052. We will then be able to advise if there are any stability issues that prevent a particular test being added.


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BLOOD SPECIMENS - COMMON SINGLE AND GROUP TESTS

Investigation Sample Bottle Required

Special Remarks Availability Code

Alcohol Grey top Clinical alcohols only. Stable overnight

A

Alkaline Phosphatase Yellow top Part of LFT and calcium studies. Stable overnight.

A/B

Alpha Fetoprotein Yellow top

C

Amylase Yellow top Stable overnight

A/B

Bilirubin (Total) (Conjugated)

Yellow top

See LFT and paediatric samples. Stable at 4'C overnight

A/B

CALCIUM STUDIES Calcium Phosphate Alkaline Phosphatase Albumin

Yellow top Collect blood without stasis. Preferably fasting Stable overnight except phosphate.

A/B

Carboxyhaemoglobin EDTA mauve top

Blood gas syringe, or EDTA mauve top

Samples from GP: send to Biochemistry

Inpatient samples: requestor to analyse at point of care site (AE, ITU, AAU, NNU, Maternity and Derwent - level 5 Esher Wing)

Carbamazepine Yellow top Immediately prior to next dose. Stable overnight

A/B

Cardiac Marker (Troponin T)

Yellow top Sample should be taken at least 6 hours after event

A

Cholesterol Yellow top See lipid studies Stable at 4'C overnight

A/B

Cortisol Yellow top Stable at 4'C overnight

B

C Reactive Protein Yellow top Stable overnight

A/B

Creatine Kinase Yellow top Not stable overnight A/B

Creatinine Yellow top See electrolytes. Stable overnight

A/B

Digoxin Yellow top Sample must be taken at least 6 hours after last dose. Stable overnight

A/B

Downs Screen Service delivered by ANC

ELECTROLYTES Sodium Potassium Urea. Creatinine

Yellow top A single specimen will suffice for UE, LFT Potassium not stable overnight.

A/B

Follicle Stimulating Hormone

Yellow top Stable overnight. B


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Gamma Glutamyl Transferase

Yellow top Stable overnight A/B

Glucose Grey top Stable overnight

A/B

Haemoglobin A1c EDTA mauve top Stable overnight

B

IMMUNOGL0BULINS IgG IgA IgM IgE

Yellow top Stable overnight B

Lactate Grey Top

A/B

Lithium. Yellow top Stable overnight. 12hrs Post Dose

A/B

LIPID STUDIES Triglycerides Cholesterol HDL Cholesterol LDL Cholesterol (Calculated) Total/HDL cholesterol

Yellow top Collect sample after fasting and no smoking for 12 hrs. No alcohol in previous 24hrs. Stable overnight at 4'C

A/B

LIVER FUNCTION Bilirubin Alkaline Phosphatase Alanine Aminotransferase Albumin

Yellow top A single specimen will suffice for UE. LFT and Troponin. Stable overnight at 4'C

A/B

Luteinising Hormone Yellow top Stable overnight

B

Magnesium Yellow top Stable overnight at 4'C

A/B

Osmolality Yellow top Urine required also. Stable overnight

B

Paracetamol Yellow top Sample at least 4-hrs post dose. Stable overnight

A

Phenobarbitone Yellow top Sample at least 6-hrs post dose. Stable overnight

F

Phenytoin Yellow tap Sample at least 6-hrs post dose. Stable overnight

A/B

Primidone Yellow top Sample at least 6-hrs post dose. Stable overnight

F

Progesterone Yellow top Sample taken in mid luteal phase (7days before period). Not useful in investigation of amenorrhoea. Stable overnight

B

Prolactin. Yellow top Give details of any medications. Stable overnight

B

Prostate Specific Antigen



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PROTEINS Total Protein Albumin


Serum Electrophoresis

Yellow top Stable overnight C

Salicylate Yellow top Sample at least 4-hrs post dose. Stable overnight

A

Sodium Valproate Yellow top Sample at least 6 hrs past dose. Stable overnight

B

Theophylline Yellow top Sample at least 6 hrs past dose. Stable overnight

A/B

Thyroid function. TSH Free T3 Free T4

Yellow top Stable overnight FT3 and FT4 measured at discretion of laboratory on basis of clinical details and TSH result

B

Troponin T Yellow top Sample should be taken at least 6 hours after event (see page 26 of User Guide for more details)

A

Urea Yellow top See electrolytes. Stable overnight

A/B

Uric Acid Yellow top Stable overnight

A/B


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BLOOD SPECIMENS- Paediatric Investigations Paediatric specimen containers are 1.3ml screw capped tubes available from the laboratory Clear top Serum, no additive Orange top Plasma, heparin Red top Whole blood, EDTA Yellow top Plasma, fluoride Minimum blood volumes are for guidance only as the amount of plasma or serum obtained depends on the haematocrit of the sample.

Test Tube Type Minimum Volume

Special Remarks

Ammonia 1ml EDTA (red top) or Full tube with minimal air space

Phone laboratory first if required urgently. Sample must be sent to laboratory without delay.

Bilirubin Serum or Heparin 500ul

Chloride 1ml Heparin (orange top) 500ul

C Reactive Protein Serum or Heparin 500ul

Calcium Magnesium Phosphate Alkaline Phosphatase Albumin

Serum or Heparin 1ml

ELECTROLYTES TCO2 Sodium Potassium Urea Creatinine

Serum or Heparin 500ul

Sodium Potassium Urea or Creatinine (state choice)


Glucose Fluoride (paediatric yellow top)

500ul

Lactate Fluoride (paediatric yellow top)

500ul

LIVER FUNCTION TESTS Bilirubin Alkaline Phosphatase ALT Albumin


IMMUNOGLOBULINS IgG, IgA & IgM

Serum (Clear top)

1ml

IgE & Specific allergens

Serum (Clear top) 1ml (for 5 specific allergens)

List suspected allergens in clinical details/notepad

Lead 1ml EDTA (red top) 1ml

TSH and FT4 Serum or Heparin 1ml

Theophylline Serum or Heparin 1ml Use capillary tube if necessary


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URINE SPECIMENS

Investigation Sample + bottle required Special Remarks Availability Code

Albumin / Creatinine Ratio (microalbumin)

EMU Preferred Random Sample is acceptable

B

Amino Acids EMU no preservative – Minimum volume 5mls

Send to lab as soon as possible

F

Bence Jones Protein EMU no preservative Request paraprotein studies. Send serum (Clear top)

C

Calcium and Phosphate For Renal stones

24hr Urine +acid Obtain bottle from laboratory

B

Calcium/Creatinine ratio for investigation of Hyperparathyroidism

Random urine Send to lab same day B

Cortisol 24hr Urine Obtain bottle from laboratory

F

Creatinine 24hr Urine Obtain bottle from laboratory For creatinine clearance send serum (yellow top) also.

B

Drug Screen Random specimen at least 25ml

Give details of all medications and state suspected drugs

F

ELECTROLYTES Potassium Sodium Urea Creatinine

24hr Urine Obtain bottle from laboratory Greatly influenced by diet

B

5HIAA 24hr Urine + acid Obtain bottle form laboratory

F

Metanephrines 24hr Urine + acid Obtain bottle from laboratory

F

Organic Acids EMU no preservative Minimum volume 5mls

Send to lab as soon as possible

F

Osmolality Random specimen Blood(serum sample) required also

B

Porphyrins EMU preferred Keep in Dark F

Protein 24hr urine Obtain bottle from laboratory

B

Uric Acid 24hr urine +alkali Obtain bottle from Lab B


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MISCELLANEOUS SPECIMENS

Investigation Sample and bottle required Special remarks Availability code

Ascitic fluid Universal For protein and LDH only

B

Ascitic fluid pH Blood Gas Syringe If pH required, fluid must be taken anaerobically into a blood gas syringe

For pH Only Requestor to analyse pH at point of care site (AE, ITU, AAU, NNU, Maternity and Derwent -level 5 Esher Wing)

CSF: Glucose Protein

Fluoride + universal 2

nd Universal Sample

Not performed on blood stained samples

A

Paraprotein Studies Serum and EMU in universal

C

Pleural Fluid Universal If pH required, fluid must be taken anaerobically into a blood gas syringe

Protein Content Requestor to analyse pH at point of care site (AE, ITU, AAU, NNU, Maternity and Derwent -level 5 Esher Wing)

Sweat Conductivity Appointments are made via Children’s Investigation Clinic

E

Xanthochromia 4th CSF Sample Keep in Dark Contact Laboratory

Blood Sample also required for Total Bilirubin and Total Protein. Minimum of 0.5ml of sample required. Do not send in air tube system. Must be in the lab 1hr after sample has been taken

A


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Immunology Service A Consultant Immunologist Dr A Bansal, is available every Tuesday for discussion of results and problematic cases. On other days he can be contacted via his secretary at the Immunology Department, St Helier Hospital on 0208-296-2805/2808. A full description of this service can be accessed via dedicated pages on the GP Microsite Investigation of Systemic Auto-immune Disease

Disease Investigation(s) Sample + bottle required

Availability Code

Time Limit For Adding On Investigation

Inflammatory Arthritis

Rheumatoid Factor Serum Sample - Yellow

C 1 month

Systemic Connective Tissue Diseases

Anti-Nuclear Antibodies on HeEp2 Cells

Serum Sample - Yellow

C 1 month

SLE Antibodies to Double Stranded DNA


C 1 month

Systemic CTD Sjrogren’s, Scleroderma

Antibodies to Extractable Nuclear Antigens


C 1 month

Systemic Connective Tissue Diseases

ENA Typing Anti RO, La, Sm, RNP, SCL-70, JO


C 1 month

Anti-Phospholipid Syndrome Recurrent A/V Thrombosis or Miscarriage

Anti-Cardiolipin Antibody Serum Sample - Yellow

C 1 month

Wegener’s Granulomatosis Vasculitis

Anti-Neutrophil Cytoplasmic Antibody


C 1 month


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Investigation of Organ Specific Auto-immune Disease

Disease Investigation(s) Sample + bottle required

Availability Code

Time Limit For Adding On Investigation

Pernicious Anaemia

Gastric Parietal Cell Antibodies

Serum Sample – Yellow

C 1 month

Pernicious Anaemia

Intrinsic Factor Antibodies


G 1 month

Liver Associated Auto-Immune Disease

Anti-Mitochondrial Antibodies


C 1 month

Auto-Immune Liver Disease

Anti-Smooth Muscle Antibodies


C 1 month

Auto-Immune Liver Disease

Anti-Liver / Kidney Microsomal Antibodies


C 1 month

Coeliac Disease Screening & Monitoring

IgA Anti Tissue Transglutaminase Antibodies


C 1 month

If IgA deficiency is detected we will measure IgG deamidated gliadin antibody

Thyroid Disease Thyroid Peroxidase Antibodies


C 1 Month

Graves’ Disease TSH Receptor Antibodies


F 1 Month

Goodpasture’s Syndrome

Anti-Glomerular Basement Membrane Antibodies


C 1 Month

Auto-immune Adrenalitis

Anti-Adrenal Antibodies Serum Sample – Yellow

G 1 Month

Bullous Dermatoses

Indirect Skin Antibodies Serum Sample – Yellow

G 1 Month

Myasthenia Gravis

Acetyl Choline Receptor Antibodies


F 1 Month


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Pathology Services Department of Haematology

The department is located on the top floor of the Bernard Meade Wing and open between 08:00 – 20:00 Monday to Friday and 09:00 – 18:00 on Saturday and Sunday. Outside of these hours an emergency Out of Hours service operates. Refer to the General Information Section. The Department delivers a comprehensive diagnostic, clinical and advisory service, providing a diagnostic, prognostic and monitoring service to patients suffering from anaemia, leukaemia, coagulopathies and other conditions. An anticoagulant dosing and monitoring service supports clinics across both Queen Mary’s Hospital and Kingston Hospital NHS Foundation Trust and for general practice.

GUIDELINES FOR HAEMATOLOGY INVESTIGATIONS Clinical Haematologists may be contacted on ext. 2042, 3154, 2043 and 2706 to advise generally on the investigation of patients and to discuss appropriate test strategies. The following guidelines are intended to optimise the use of the Haematology laboratory.

Adequate clinical details should always be included with any request. In the absence of such details samples may be stored until this information is supplied. This will delay the analysis.

For urgent requests, telephone ext. 2033 or bleep 540 if outside routine hours. Results will be phoned back to the requesting MO as soon as they are available. To avoid delays mark the request form clearly and send to the laboratory ahead of the ward collection.

It may not be appropriate to perform some investigations during acute illnesses. If there is any doubt please consult clinical haematologists.

For urgent requests see the relevant section on pages 20-21.

GUIDELINES FOR THE USE OF THE OUT of HOURS and URGENT HAEMATOLOGY SERVICE The following guidelines cover the basic range of tests available "out of hours". Other tests may be requested where there is a clinical indication and the results are necessary for the immediate management of the patient. For the more unusual requests the duty BMS may ask that you contact the duty Haematology Consultant to discuss the need for the test.

URGENT REQUESTS Tests available include:

FBC ESR Coagulation studies (including D-dimers). Anticoagulant therapy control (please attach ward dosage chart). Blood group, antibody screen and save serum } see Cross matching } Transfusion Direct Antiglobulin test (DAT) } Department

In the light of the information provided, the medical staff of the department may discuss some of the investigations requested with you. Requests for bone marrow examinations should be made directly with the medical staff of the department, who are also available to discuss other haematological investigations appropriate to the clinical situation.


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RESULTS

Results on blood counts and most coagulation studies are normally available the same day, provided the samples are received in the laboratory by 15:00 including weekend and Bank Holidays. Other tests are performed in batches at intervals during the week. Results will be made available from either the WinPath Ward Enquiry applications, supported at most community hospital settings or via the GP Link result messaging service for primary care commissioners. Results are also available through Pathology Services results helpline. Haematology Clinics

At Kingston Hospital Clinics are held in the Out Patients Department (AREA D), timetable below for patients with a variety of haematological disorders. Kingston Hospital - Anticoagulant Clinics are also held in the, Ground Floor out patients department (AREA D) on Monday and Thursday mornings, 09:00 – 12:30 Queen Mary’s Hospital - Anticoagulant Clinic is held in the Upper Ground Floor Suite 5 out patients Department Tuesday morning, 09:00 – 12:30, for the control of patients on oral anticoagulant therapy. Referral letters must be sent to the Anticoagulant Service secretary (or faxed to 0208 934 3245) prior to the patient’s first clinic attendance. (In-Patients have their doses of warfarin prescribed on the appropriate white card, on which the date of the next test is also indicated). A full list of haematology clinics available at Kingston Hospital NHS Foundation Trust, which can be booked through ‘Choose and Book’, is listed; AM PM

Monday Anticoagulant Clinic Dr Zebari / Dr Jayakar

Tuesday Dr Atwal Dr Abboudi/Dr Partridge/ Dr Zebari / Dr Jayakar Wednesday --- New Patients Anticoagulation Clinic – Nurse Delivered Thursday Anticoagulant Clinic Dr Atwal / Dr Jayakar Friday ---- --- At Queen Mary’s Hospital, Roehampton Haematology clinics are held in the Outpatients Department as detailed below. Referrals should be made as above to the consultant’s secretaries at Kingston Hospital.

Tuesday am Anticoagulant Friday am General Haematology Dr Zebari / Dr Abboudi /

DrAtwal


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Guidelines for use of the “Out of Hours” Haematology Service

The following guidelines cover the basic range of tests available “Out of Hours”. For further advice on patient investigation/management, a consultant haematologist is also contactable through the hospital switchboard. Blood Counts The Hb level / PCV may be of value in

active/recent blood loss or trauma, impending surgery, dehydration,

symptoms suggesting a significant anaemia

If the patient is anaemic, the MCV/MCH may give an indication as to its nature and possible cause, The white cell count / differential is rarely a useful discriminant in early patient management. The platelet count is useful if;

there is significant bruising

there has been or is to be significant bleeding e.g., impending major surgery.

following massive blood transfusion Film inspection is necessary for the diagnosis of malaria. ESR determination is restricted to possible temporal arteritis in adults or possible Septic arthritis in children If the patient does not fulfil these criteria samples can still be taken, but will not be analysed until the next routine laboratory session. Coagulation Studies As far as practicable these should be performed during the normal working day. As the medical staff of the laboratory determine, or clinical (e.g. bleeding) need arises, laboratory tests for control of anticoagulation may be needed out of normal hours, particularly at weekends. Please give, with the appropriate citrate sample, full details of warfarin/heparin doses on the request form to enable the correct tests to be undertaken and for the interpretation of the results. Massive transfusion is usually accompanied by a need for FFP (for clotting factors) and platelets - monitor need by suitable tests and confer with the duty haematologist as required. D-dimers are used as a negative predictive test for AE, AAU and MGPU patients with suspected DVT or PE only Most other coagulation studies can, with foresight, be performed within normal hours. If in doubt confer with the duty haematologist or Principal Biomedical Scientist


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BLOOD SPECIMENS - COMMON SINGLE AND GROUP TESTS A list of common investigations provided from this department are listed below; The availability codes are as follows: 95% of results of general investigations on urgent requests or those from acute care areas will be available within a target turnaround time of less than 1hr

A - Daily requested urgently (including "out-of-hours "). - Results Available Within 2hrs of Receipt of Sample B - Daily (in normal lab hours only). - Results Available the Following Working Day C - More than one batch per week.

Investigation Sample + Bottle Required Special Remarks Availability

Code

FBC 5ml EDTA (mauve top) Minimum 3ml Stable overnight but blood film can be affected

A/B

ESR 5ml EDTA (mauve top) Minimum 3ml Stable overnight

B

Coagulation Studies 5ml Citrate (blue top) Must be full. Ideally tested within 4 hrs A/B

D-dimers XDP

5ml Citrate (blue top) Ideally tested within 4 hrs A/B

Anticoagulant Control

5ml Citrate (blue top) Ideally tested within 4hrs A/B

Hb variant testing 5ml EDTA (mauve top) FBC with ethnic origin. Stable overnight

C

Serum B12/Ferritin 5ml Clotted (yellow top) Stable overnight C

Red Cell Folate 5ml EDTA (mauve top) Serum Folate is not available routinely C

A more comprehensive alphabetical list of tests is printed on pages 45 – 70. The majority of results are available on a same-day-basis and are available via a direct computer link. Paediatric testing can be done on smaller amounts of blood than those specified above. Please see the Pathology Investigation Index or contact the laboratory. If a test is not listed it may still be available. Please telephone for further information. Stability of Specimen Information is provided under 'Special Remarks' as to the stability of whole blood samples if stored away from direct sunlight and any source of heat, or in a refrigerator as specified. Significant Haemolysis will interfere with most tests. Requesting Additional Tests Many investigations are preservative specific and some components are unstable. Contact the laboratory if additional tests are required. In most cases it is recommended that a repeat sample is taken.


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Pathology Services

Blood Transfusion Laboratory

The department is located on the top floor of the Bernard Meade Wing and open between 08:30 – 20:00 Monday to Friday and 09:00 – 18:00 on Saturday and Sunday. Outside of these hours an emergency Out of Hours service operates. Refer to the General Information Section. The Trust policy ‘Policy for the Safe and Effective Use of Blood Components and Blood Products’ describes in detail the process of prescribing, requesting and administering a blood transfusion and should be complied with at all times. Out of Hours Only request transfusion work that will not wait until the next day as routine work is not performed out of hours. The duty BMS may refer requests to the duty Consultant Haematologist if they appear to fall outside the agreed repertoire of out of hours works. Prescribing, Request Form Completion and Sample Labelling

Without exception, samples labelled with pre-printed labels will not be accepted for testing.

Only doctors with the appropriate training and competency assessment are allowed to prescribe blood or blood components. Requesting blood or blood components can only be performed by doctors and non-medical staff who have received appropriate training and competency assessment. CRS requests must be accompanied with a pathology Blood Transfusion request form – with the CRS produced specimen label attached and providing details of blood components required, amounts and time for availability Paper request forms from external sources must be completed as detailed below; EVERY sample and request form MUST be labelled with the patient's FULL NAME, HOSPITAL / A&E NUMBER, DATE OF BIRTH, WARD AND DATE, together with appropriate clinical information. Badly labelled samples will not be tested. Where there is a reasonable possibility the patient may need blood/products, send a sample to Transfusion for blood group and antibody testing. This sample can later be used if a crossmatch is required Blood samples used for blood transfusion purposes must only be taken by staff that are competent to do so. Anomalous results in crossmatches need full investigation and will delay the provision of blood. This situation is more likely to occur in previously transfused or in pregnant patients.

Requests and samples for routine crossmatching for elective surgery must be in the laboratory before 16.00 the day before the operation

(Friday for operations on Monday am)

Similarly requests and samples for routine crossmatching for ‘top-up’ transfusions must be in the laboratory before 16.00 on the day the blood is required

More notice will be required for patients with special requirements (e.g. antibodies)


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Pathology Services


Blood group and cross-matching samples for cold surgery can be taken and sent to the laboratory up to 10 days prior to operation, at the patient’s outpatient attendance. If sent more than 7 days prior to operation, a further routine group and save serum sample should be taken on admission so that a fresh one is available if further blood is required. URGENT TRANSFUSION REQUESTS A routine cross-match takes 45 minutes, but this can be reduced in emergencies. The responsibility for requesting this must be taken by the clinician. The less time allowed for the cross-match, the less effective it is at detecting incompatibility. In dire emergencies uncross-matched blood can be issued, the clinician taking full responsibility. All urgent requests must be telephoned to the laboratory by the medical officer concerned. Please take care to give sufficient information on sample and request form. Please keep telephone calls to an absolute minimum as they interrupt our work and hinder the provision of blood in an emergency. Return of Blood Product Labels The European Blood Safety and Quality Regulations of November 2005, now enshrined in UK Law requires that the fate of each unit of blood product must be recorded. It is expected that every transfusion event be recorded in the patient’s notes and the Trust must legally record the fate of each unit of blood product even if it is not used. Each unit of blood product will be issued with a multi-part label that includes the unit identifier, product type and details of the patient who will be receiving the product. After starting the transfusion the individual responsible for administering the transfusion must tear off the perforated section of the label and complete the following information

Your Name (not the patients)

Date of Transfusion

Time Transfusion Started This perforated section must be returned be returned to the Transfusion Department, either via the air tube system or it can collected by the pathology porter as part of their normal rounds. If you require further advice please phone ext. 2046 for assistance.

Investigations Available Investigation Sample + Bottle Required Special Remarks Availability

Code

Blood Group and Save

6ml EDTA (pink top) Samples are kept for 10 days A/B

Cross Matching 6ml EDTA (pink top) A/B

Direct Antiglobulin Test

6ml EDTA (pink top) A/B

Kleihauer 6ml EDTA (pink top) B

HLA 2 x 6ml EDTA (pink top) Please state HLA Ag required F


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Pathology Services


Products Available BLOOD PRODUCTS AVAILABLE Red Cells: Indicate any special requirements clearly on the

request. FFP: For use when coagulation tested and proved

abnormal. Adult dose is from 12 to 15ml/Kg body weight.

Cryoprecipitate: For use in-patients with low fibrinogen

levels (<0.5g/L). Factor VIII concentrate: (by special arrangement with a Haematology

Consultant) Prothrombin Complex Concentrate: (for reversal of warfarin anticoagulation – discuss

with duty Haematologist) Platelets: Ordered from NHSBT by special arrangement only - - order before 12:00 where possible. Anti Rh (D) Immunoglobulin: 250iu (<20 weeks gestation), 500iu and 1500iu (>20

weeks gestation) vials available - contact Transfusion (ext. 2046).

Albumin preparations: 4.5% Human albumin solution; 250ml.

20% Human albumin solution; 100ml.

Dose of albumin (g) = required increase in albumin level [g/l] x [0.08] x [patient's body weight (Kg)]


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Pathology Services Department of Microbiology

CHANGES TO MICROBIOLOGY LABORATORY SERVICES AT KINGSTON

CHANGES TO MICROBIOLOGY LABORATORY SERVICES AT KINGSTON From Monday 15 December microbiology laboratory services will be incorporated into the South West London Pathology hub laboratory (based at St George’s Hospital) as part of the transformation of services planned by South West London Pathology. South West London Pathology is a partnership between three leading Hospital Trusts - Croydon Health Services NHS Trust, Kingston Hospital NHS Foundation Trust and St George’s Healthcare NHS Trust - designed to provide an integrated, high quality pathology service for hospitals and GPs across South West London, by bringing together the best of each Trust’s service and providing them within a single organisation. For more information please visit our website www.swlpath.nhs.uk

ACCESS TO SERVICES

Laboratory services: You should continue to follow the same procedure for requesting tests that you currently follow now – send your sample to pathology specimen reception at Kingston.

Clinical advice: will continue to be obtained from consultants at Kingston Hospital and you can contact them via Kingston Hospital switchboard.

Infection control services: will be unaffected.

ROUTINE SAMPLES Normal working hours: Monday to Friday 8.30am to 5pm; Saturday 8.30am to 12.30pm You should continue to follow the same procedure for requesting tests that you currently follow now – send your sample to pathology specimen reception at Kingston. URGENT SAMPLES

Working hours: Monday to Friday 8.30am to 5pm; Saturday 8.30am to 12.30pm. The process for urgent samples will remain the same. Samples should be sent to pathology specimen reception at Kingston and specimen reception should be called on x2033 to be notified that an urgent sample has been sent.

Out of hours: Monday to Friday 5pm to 8.30am; Saturday from 12:30 pm and Sunday.

All out of hours requests for Microbiology tests should be made by contacting the Microbiology BMS on call based at the hub via St George’s switchboard 020 8672 1255 and air-call SG394.

http://www.swlpath.nhs.uk/


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The requesting clinician must give to the air-call switchboard their full contact telephone number and name and the on call BMS will phone back the requestor for full details of the request.

It is the responsibility of the requestor to ensure that the specimen is clearly marked as urgent and is promptly delivered to the Pathology Central Reception, Level 4, Bernard Meade Wing.

Bank holidays: From 8.30am – 12.30pm send sample to Kingston specimen reception and ring them on x2033. 12.30pm -8.30am follow the out of hours procedure EXCEPT Christmas Day - emergency work only.

RESULTS FOR URGENT SAMPLES All urgent results will be phoned back to the requestor. RESULTS FOR ROUTINE SAMPLES – GPs Practices which receive paper reports will continue to do so. Electronic results for Microbiology will be available via PMIP reports. The only difference you may notice is that from 15/12/14 the reports come from the hub at St George’s. If you cannot find results anywhere else, phone Microbiology general enquiries line at the SWLP hub: 020 8725 5693. NB In order for Kingston GPs to receive pathology results electronically via PMIP, practices were asked in 2014 to make a small one-off change to their systems to set up St George’s as a trading partner. If you are uncertain about this or you do not receive results please contact Mohamed Jaeffer, Pathology IT lead at Kingston Hospital, on 020 8934 2055. RESULTS FOR ROUTINE SAMPLES – HOSPITAL USERS From Monday 15 December Microbiology results will NO longer be available to view in WinPath Ward Enquiry. In order to see Microbiology results you will need to do one of the following:

Use CRS-Cerner Millennium Powerchart to view results.

Use the South West London Clinical Portal to view results.

If you cannot find results anywhere else phone Microbiology general enquiries line at the SWLP hub: 020 8725 5693.

How to get access to the South West London Clinical Portal (within Kingston Hospital) The South West London Clinical Portal allows health care professionals to access pathology results produced on their patients irrespective of where the testing was undertaken. In time more information will be posted on the portal. Information will be emailed to all current users of WinPath Ward Enquiry informing them that results will no longer be available in WinPath Ward Enquiry and will be


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given a login and password to access the South West London Clinical Portal. If you have not received this email by 11 December please contact your local IT Service Desk or the Kingston IT Service Desk ([email protected])

A link to the South West London Clinical Portal is available from the intranet

on the Applications page: https://swlclinicalportal.nhs.uk/concerto/Login.htm

A quick reference guide on how to use the South West London Clinical Portal is available from the intranet on the IT Training / All User Guides page: http://home/khintranet/documents/201412011519_SWL_Portal_QRG_P1R3_v1.0.docx

How to access historical/legacy results Results for microbiology prior to 15 December 2014 can be accessed on WinPath Ward Enquiry and CRS-Cerner Millennium Powerchart. OUTREACH SERVICES If you work at any of the outreach sites (Queen Mary’s, Teddington, Molesey, Surbiton Hospitals and Raynes Park, Glenlyn, Emberbrook, Ebbisham, Hawkes Road Health Centres) the way you currently make requests will remain the same. To access current Microbiology results you will need to do one of the following:

Use CRS-Cerner Millennium Powerchart if this is available at the outreach site

Use the South West London Clinical Portal to view results

If you cannot find results anywhere else phone microbiology general enquiries line at the SWLP hub: 020 8725 5693.

How to get access to the South West London Clinical Portal Information will be emailed to all current users of WinPath Ward Enquiry informing them that results will no longer be available in WinPath Ward Enquiry and will be given a login and password to access the South West London Clinical Portal. If you have not received this email by 11 December please contact your local IT Service Desk or the Kingston IT Service Desk ([email protected]) https://swlclinicalportal.nhs.uk/concerto/Login.htm The IT Service at the outreach site may add the above link to your PC desktop. However, if this is not visible then click on the link above to open a browser which can then be saved as a favourite.

https://swlclinicalportal.nhs.uk/concerto/Login.htm

http://home/khintranet/documents/201412011519_SWL_Portal_QRG_P1R3_v1.0.docx

http://home/khintranet/documents/201412011519_SWL_Portal_QRG_P1R3_v1.0.docx

https://swlclinicalportal.nhs.uk/concerto/Login.htm


st July 2015

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Pathology Services Cellular Pathology Department

See Cellular Pathology Services Handbook for details of service provided. http://home/khintranet/documents/201411281558_Users_guide_for_Intranet.pdf

http://home/khintranet/documents/201411281558_Users_guide_for_Intranet.pdf

Kingston Pathology User Guide 2015 Kingston Hospital 738, version 7.0 Author: David Greenwood Review Date; 1st July 2015

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PATHOLOGY INVESTIGATION INDEX – ALPHABETICAL LISTING Availability A = Daily Urgent (include Out

of Hours) B = Daily (Normal laboratory hours)

C = More than one batch per week

(shown in final column) D = One batch a week E = Other Work done on site F = Referred to other laboratories

The colour stated in the sample column indicates the colour of the vacutainer top.

Test Dept Sample Comments Adult Reference Range Avail

1,25 Vitamin D Chem Yellow or EDTA Mauve

43 – 143 pmol/L F

11 De-oxy Cortisol Chem Yellow 1 – 5 nmol/L F

17 Alpha Hydroxy-progesterone

Chem Yellow Infants must be >48hrs old F

ACE Chem Yellow Haemolysis and lipaemia interferes 20 - 70 U/L C

Acetyl Choline Receptor Ab

Immuno Yellow Qualitative C

ACTH Chem EDTA Mauve Refer to Laboratory for advice. Specimen must be received within 30 minutes of collection

7-62 ng/L F

Albumin Chem Yellow 35 - 50 g/L A/B

Albumin Creatinine Ratio

Chem Random Urine Male - Up to 3.5 mg/mmol Female - Up to 2.5 mg/mmol

B

Alcohol (Clinical) Chem Fluoride Grey Clinical alcohols only A/B


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Alkaline Phosphatase Chem Yellow See also LFT and Calcium 30 –130 IU/L A/B

Alkaline Phosphatase isoenzymes

Chem Yellow Contact Laboratory F

Aldosterone / Renin Chem Lithium Heparin Green

Contact laboratory for advice. Protocol available for ?hyperaldosteronism

Aldo 100–800 pmol/L Renin 0.5–3.1 pmol/mL/hr

F

Aldosterone – Urine Chem Contact Laboratory F

Alpha1 antitrypsin Chem Yellow 1.1-2.1 g/L C

Alpha1 antitrypsin phenotype

Chem Dark Blue Refer to report F

Alpha 1 acid Glycoprotein

Chem Yellow 0.4 - 1.0 g/L

F

Apha 1 Antichymotrypsin

Chem Yellow 0.3 – 0.6 g/L F

Alpha fetoprotein (serum)

Chem Yellow Tumour marker Up to 6 kU/L non pregnant C

Aldosterone Chem Yellow 100 – 800 pmol/L F

Alpha 1 Antitrypsin

Chem Faecal Sterile Universal – Freeze As Soon As Possible

Up to 0.48 mg/g F

Alpha Galactosidase Chem Green Whole Blood – Contact laboratory For Tube – Follow up with hair root maybe required for females

Refer to Report F

Alpha Sub Unit Chem Yellow 0.0 – 1.0 IU/L F


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ALT Chem Yellow See also LFT Female Up to 33 IU/L Male Up to 41 IU/L

A/B

Aluminium Chem Trace Metal / Blue Up to 0.4 µmol/L F

Amino Acids Chem Yellow Urine sample may also be required Refer to Report F

Amino Acids (Urine) Chem EMU (send asap) Qualitative Refer to Report F

Amiodarone Chem Yellow Pre dose sample required 0.5-2.0 µg/L F

Ammonia Chem EDTA Fresh sample to be in lab within 30 minutes Up to 50 µmol/L A

Amylase Chem Yellow 25-150 IU/L A/B

Androstenedione Chem Yellow Female 2-5.4 nmol/L F

Antibiotic assays Chem Yellow B

Angiotensin Converting Enzyme

Chem

Yellow

20 – 70 U/L

C

Also CSF Chem Universal Refer To Report

Anticoagulant Control Haem Citrate Blue Precise volume

Test within 4 hours Send ward chart and give drug details

A/B

Anti Cardiolipin Ab Immun Yellow 1-10 GpIU/ml C

Anti-Adrenal Ab Immun Yellow Analysed fortnightly Qualitative

Anti IgG Deaminated Gliadin Ab

Immun Yellow IgG Ab’s 0-10 U/ml


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PATHOLOGY INVESTIGATION INDEX – ALPHABETICAL LISTING

Availability A = Daily Urgent (include Out of Hours)

B = Daily (Normal laboratory hours)





Anti-Glomerular Basement

Immun Yellow Analysed as required Qualitative C

Anti-Islet Cell Ab Immun Yellow Qualitative F

Anti-Liver Kidney Microsomal Ab

Immun Yellow Qualitative C

Anti-Mitochondrial Ab Immun Yellow Qualitative C

Anti-Myeloperoxidase Ab

Immun Yellow <3.5IU/ml C

Anti Mullerian Hormone Chem Yellow ACU only, others by private request only Refer to report F

ANCA Anti Neutrophil Cytoplasmic Ab

Immun Yellow Contact duty clinician if urgent Myeloperoxidase Ab <3.5IU/ml Proteinase III Ab <2 IU/ml

C

ANA on Hep2 Immun Yellow Qualitative C

Anti-Phospholipid Ab Immun Yellow

Anti PR3 Ab Immun Yellow <2 IU/ml C

Anti-Smooth Muscle Ab Immun Yellow Qualitative C

Anti-Sperm Ab Immun Yellow Qualitative C

Antithrombin III Haem Yellow 75 – 150iu/dL B

ANCA Immun Yellow Contact duty Clinician if urgent C

ANF Immun Yellow See ANA on HEp2 C

APCR Haem Citrate / Blue Part of Thrombophilia Screen 2.0 – 2.8 Ratio A/B

APTR Haem Citrate / Blue Heparin monitoring only 1.5-2.5 A/B


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Apolipoprotein A1 Chem Yellow M 0.94 - 1.78 g/L F 0.94 - 1.98 g/L

F

Apolipoprotein B Chem Yellow M 0.52 - 1.01 g/L F 0.49 - 1.03 g/L

F

APO (E) Phenotyping Chem Yellow Refer to Report F

Arsenic Chem Universal Urine Refer To Report F

Aryl Sulphatase Chem Green Whole Blood – Refer to Reference Centre On Day of Collection

4.2 – 25.2 nmol/hr/mg F

AST Chem Yellow Up to 40 IU/L A/B

Aspergillus pptns Chem Yellow 0-41 mg/l C

Avian Precipitins Chem Yellow Refer To Report F

Beta Carotene Chem Yellow Keep in Dark. 0.19 – 1.58 mg/L F

B2 Microglobulin Chem Yellow 1.2 – 2.4 ng/L F

Bence Jones Protein Chem Yellow + EMU Instructions from laboratory B

Bile Acids Chem Yellow Less than 14.0 µmol/L C

Bilirubin Chem Yellow See also LFT/paed Total 0 – 21 µmol/L Conjugated 0 - 9 µmol/L

A/B

Biotinidase Chem Yellow 4-15 nmol/mL/min F

Blood group Trans 6ml Pink EDTA Full patient ID required A/B


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Blood Spot Carnitines Chem Refer To Laboratory F

NT Pro BNP Chem Yellow Refer To Report C

Bone Marrow examination

Haem Contact duty Consultant Haematologist

E

C-Peptide Chem Yellow Send Sample For Glucose Refer to Report F

Cadmium (Plasma) Chem EDTA Mauve / Green Up to 27 nmol/L F

Cadmium (Urine) Chem Universal Container Refer To Report F

Catecholamines (Plasma)

Chem Contact laboratory Contact laboratory Noradrenaline 0.1 - 4.0 nmol/L Adrenaline up to 1.5 nmol/L

F

Catecholamines (urine)

Chem 24hr urine, acid preservative

State all medications on request form

Noradrenaline Up to 500 nmol/24hr Adrenaline Up to 100 nmol/24hr Dopamine Up to 3000 nmol/24hr

Metanephrines (Urine) Chem 24hr urine, acid preservative

State all medications on request form

Normet Up to 3.3 µmol/24hr Metadrenaline Up to 1.2 µmol/24hr Methyoytyramine Up to 2.5 µmol/24hr

F

CEA Chem Yellow For monitoring GI/breast cancer Up to 5 µg/L C

Chloride Chem Yellow 95-108 mmol/L A/B


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C1 Esterase Inhibitor Chem Yellow Contact Laboratory C1 Mass 0.15-0.35g/L C1 Functional 0.7-1.3 U/ml

F

C3 / C4 Chem Yellow C3 0.73-1.66 g/L C4 0.17-0.66 g/L

C

CRP Chem Yellow 0-10 mg/L A/B

CA 12-5 Chem Yellow For monitoring ovarian cancer Up to 35 kU/L C

CA 15-3 Chem Yellow For monitoring breast cancer Up to 25 kU/L C

CA 19-9 Chem Yellow For monitoring pancreatic/GI cancer Up to 34 kU/L C

CD48 Haem EDTA Contact Laboratory F

CDT Chem Yellow Also Send ALT/GGT and Details of Alcohol Intake

Refer To Report F

Caffeine Chem Yellow Neonates only 5-20 µg/L F

Calcium Studies Chem Yellow Collect without stasis preferably fasting. Includes Ca/PO4/AlkP/Alb

Calcium 2.20-2.60 mmol/L Phosphate 0.8-1.5 mmol/L

A/B

CH100 Chem Yellow Freeze within 3 hrs of collection 40 – 200 U/mL F

Chromium Chem EDTA

Cobalt Chem EDTA

Cortisol (Urine) Chem 24hr urine Container from laboratory 25-280 nmol/24hr F

Creatine Kinase Chem Yellow Should not be used as a cardiac marker F 25-200, M 40-320 IU/L A/B


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Creatinine Chem Yellow See also U and E 44-108 µmol/L A/B

Creatinine (Urine) Chem 24hr urine Container from laboratory 6.0-17.0 mmol/24hr B

Creatinine Clearance Chem Yellow and 24hr urine at same time

60-120 mL/min B

Cross Match Trans 6ml Pink EDTA *** FULL PATIENT ID PLEASE *** A/B

CRP Chem Yellow Up to 10 mg/L A/B

Cryoglobulin Chem Red Top Serum Contact Laboratory B

CSF Glucose Chem Fluoride Grey / Paediatric Yellow

2.5-5.0 mmol/L A

CSF Total Protein Chem Universal sample 2

Not available if specimen is blood stained Up to 0.45 g/L A

Calcium / PO4 (Urine) Chem 24hr, acid preservative

Container available from laboratory Calcium 2.5-7.5 mmol/24hr Phosphate 15-50.0 mmol/24hr

B

Calcitonin Chem Contact laboratory Contact Laboratory F


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Cannabis Chem Random Urine Qualitative F

Carbamazepine Chem Yellow Immediately prior to next dose/ 6 hour post dose

4-12 mg/L B

Caeruloplasmin Chem Yellow 0.20 - 0.60 g/L F

Carboxyhaemoglobin Chem EDTA Mauve Samples from GPs only: send to laboratory (see p28)

A

Cardiac Marker Chem Yellow Troponin T Up to 14 ng/L A

Cholesterol Chem Yellow See also Lipids Up to 5.2 desirable A/B

Chromosome Studies Cytogenetics

Contact St George’s Hospital on 0208 672 9944 ext. 5332

Clonazepam Chem Grey 25 – 85 µg/L F

Clozaril Chem EDTA Mauve Trough Sample Required Refer To Report F

Coagulation Factor Assays

Haem Citrate Blue *2 Precise volume

Contact Coagulation Specialist Ext 2040 E/F

Coagulation Inhibitor Screening

Haem Citrate Blue *2 Precise volume

Contact Coagulation Specialist Ext 2040 E

Coagulation Screen Haem Citrate Blue Precise volume

Test within 4 hours A/B

Cold Agglutinins Trans 6ml Pink EDTA Take, keep and deliver to lab at 370C E

Copper with Caeruloplasmin

Chem Trace element Copper 11-20 µmol/L Caeruloplasmin 0.20-0.60 g/L

F

Copper – Urine Chem Acid Washed Container

Collect Container from Laboratory Up to 0.9 umol/24hrs F

Cortisol Chem Yellow Various protocols for investigation of HPA axis

140-690 nmol/L @ 09.00 A/B

Cyclosporin Chem EDTA Mauve Refer To Report F


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DAT (Coombs Test) Trans EDTA

D-Dimer Haem Citrate Blue Requests as part of DVT and PE Protocols A

DHAS Chem Yellow Female 1.6-7.8 µmol/L F

Digoxin Chem Yellow 6 hours after last dose 0.5-1.0 µg/L B

Down’s Screen Chem Yellow Handled by ANC F

Drug Screen (Urine) Chem Universal *2 State medications F

Ds DNA Immun Yellow <10 IU/ml C

Elastase (Faecal) Chem Universal Container

Refer to Report F


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Electrolytes Chem Yellow Includes Na, K, urea, creatinine Potassium will only be reported if sample is dated and sample is analysed on day of collection

Sodium 133-146 mmol/L Potassium 3.5-5.3 mmol/L Urea 2.5-7.8 mmol/L Creatinine 44-108 µmol/L

A/B

Electrolytes (Urine) Chem Random urine Greatly influenced by diet. Refer to report

B

ENA – Extractable Nuclear Antigen Screen

Immun Yellow 0-1.0 units C

ENA Typing Anti Ro abs Immun Yellow 0-10 U/ml C

ENA Typing Anti La abs Immun Yellow 0-10 U/ml C

ENA Typing Anti Sm abs

Immun Yellow 0-10 U/ml C

ENA Typing Anti RNP abs


ENA Typing Anti SCL abs


ENA Typing Anti Jo-1 abs


ESR Haem EDTA Mauve Separate sample not req. if FBC also sent provided sample is adequately filled

B

Ethosuximide Chem Yellow Up to 100mg/L F


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FT3 Chem Yellow Measured at discretion of laboratory on basis of clinical details and TSH result

3.9-6.7 pmol/L B

FT4 Chem Yellow Measured at discretion of laboratory on basis of clinical details and TSH result

12-22 pmol/L B

Factor V Leiden Haem Citrate Blue (x4)

FDP’s (XDP’s) Haem Citrate Blue Precise volume A

Ferritin Haem Yellow/Red Requests vetted C

Film (Blood) Haem EDTA Mauve A/B

Flecainade Chem Yellow 200 – 700 µg/L F

Free Fatty Acid Chem Yellow/Green Send To Laboratory Immediately After Collection

Refer To Report F

FSH Chem Yellow Contact laboratory B

Full Blood Count (FBC) Haem EDTA Mauve Minimum 3 ml A/B

G-6PD Haem EDTA Mauve With FBC and history B

Gabapentin Chem Yellow Up to 24 µg/L F

Galactose 1 Phosphate Chem Green Contact Laboratory For Tube Up to 0.1 µmol/gHb F

Galactose 1 Phos Uridyl Transferase

Chem Green Contact Laboratory For Tube 13-25 U/gHb F

Gamma-GT Chem Yellow Female 9-47, Male 12-86 IU/L A/B


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Gases POCT Arterial blood Minimum volume 0.7 ml analyse within 10 mins at room temp or 30 min if preserved on ice

Requestor to analyse at point of care site: (AE, ITU, AAU, NNU, Maternity and Derwent - level 5 Esher Wing) DO NOT SEND TO LABORATORY

PH 7.35-7.42 PCO2 4.1-6.1 kPa Base excess +/- 2.5 Bicarbonate 21-27 mmol/L PO2 11.5-15.0 kPa

Gastric Parietal Cell Ab Immun Yellow Qualitative C

Gastrin Chem EDTA – Mauve Chilled

Unstable –contact laboratory and send to laboratory on ice - immediately

Up to 40 pmol/L F

Gentamicin Assay Chem Yellow Pre dose B

Glandular Fever Screen Haem EDTA Mauve A/B

Glucagon Chem EDTA – Mauve Chilled

Unstable –contact laboratory and send to laboratory on ice - immediately

Up to 50 pmol/L F

Glucose Chem Fluoride Grey Fasted 3.5-6.0, random 3.5-8.0 mmol/L

A/B

Glyosaminoglycans Chem Random Urine Fresh Urine Sample Required F

Group and Save Trans 6ml Pink EDTA Full patient ID A/B

Gut Hormones Chem 2 x EDTA Mauve Chilled

Contact Laboratory For Instructions Before Proceeding With Test – Patient Must Be fasting – Return Samples Immediately on Ice

Refer To Report F

Haptoglobin Haem Yellow Female 387 – 2108 mg/l Male 300 – 1700 mg/l

C


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Hemochromatosis gene Haem EDTA Mauve Assay performed once per month D

HCG Chem Yellow Pregnancy monitoring and tumour marker 0-5 U/L non pregnant B

Human Growth Hormone

Chem Yellow Usually done as part of dynamic function test Contact laboratory F

HDLC Chem Yellow See Lipids F 1.3-2.2, M 1.1-2.2 mmol/L B

HLA Typing Trans 2x6ml Pink EDTA Mon – Thur only (contact ext 2046) F

Hb A1c Chem EDTA Mauve For monitoring diabetic control Less than 58mmol/l/molHb for ‘ideal’ control.

B

HbA2 Haem EDTA Mauve See Hb electrophoresis D

Hb Electrophoresis Haem EDTA Mauve FBC and ethnic origin C

HbF Haem EDTA Mauve See Hb electrophoresis D

HbH Haem EDTA Mauve See Hb electrophoresis D

Heparin Control Haem Citrate Blue Precise volume

Test within 4 hours – DO NOT REQUEST COAG SCREEN APTR ONLY

A/B

5HIAA (Urine) Chem 24hr urine in acid bottle

Container from laboratory Less than 47 µmol/24hr F


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Homocysteine (Plasma) Chem EDTA Mauve Separate and Freeze Within 60 Minutes Of Collection

5.0 – 15.0 µmol/L

F

Homocysteine (Urine) Chem Universal Container Random Urine – Freeze on Receipt In Laboratory

Refer To Report F

IgA Anti Endomysial Ab Immun Yellow Qualitative D

IgE Total and specific Allergens

Chem Yellow List specific allergens required in clinical details

Up to 41 kU/L E

Immunoglobulins Chem Yellow Includes IgG, A, M and serum electrophoresis

IgG 4.8-15.4 g/L IgA 0.99-4.46 g/L IgM 0.45-1.62 g/L

C

Immunoglobulin G subclasses

Chem Yellow Contact laboratory F


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Indirect Skin Ab for Bullous Dermatosis

Immun Yellow Qualitative G

Insulin Chem Yellow We must receive sample with 15 mins of collection. Require Glucose Sample

Refer To Report F

Insulin like Growth Factor 1

Chem Yellow Freeze On Day of Collection Refer To Report F

Insulin like Growth Factor BP3

Chem Yellow Freeze On Day of Collection Refer To Report F

INR Haem Citrate Blue Warfarin Monitoring Only 2.5 – 4.5 A/B

Intrinsic Factor Ab Immun Yellow Analysed fortnightly 0-5 U/ml G

Jo-1 Immun Yellow 0-20 units

Kleihauer Trans 6ml Pink EDTA B

Lactate Chem Grey – Adult Yellow -Paediatric

0.5 – 2.2mmol/l B

Lamotrigine Chem Yellow Up to 15 µg/L F

Lead (Plasma) Chem EDTA Mauve Up to 0.5 µmol/L F

Lead (Urine) Chem 24hr Urine Collection

Refer To Report F


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Leptin Chem Yellow Refer To Report

LDH Chem Yellow 240 – 480 IU/L B

LDLC Chem Yellow See Lipids LDL cholesterol up to 4.0 mmol/L

B

Lipid Studies Chem Yellow Fasting, no smoking for 12 hours, no alcohol for 24 hours.

Triglyceride 0.2-1.7 mmol/L Total chol up to 5.2 mmol/L HDL F 1.3-2.2 M 1.1-2.2 mmol/L LDL up to 4.0 mmol/L

A/B

Lithium Chem Yellow Sample must be 12 hours after last dose 0.4-1.0 mmol/L A/B

Lipoprotein A Chem Yellow Up to 300mg/L F

Liver Function Chem Yellow Bili/AlkP/ALT/Alb Bilirubin and ALT will only be reported if sample is analysed on day of collection

Total bilirubin up to 21 µmol/L Alk phosphatase 30-130 IU/L ALT F 0-33, M 0-41U/L Albumin 35-50 g/L

A/B

Luteinising Hormone Chem Yellow Contact laboratory B

Lysosomal Enzymes Chem Green Send To Referral Lab Within 24hrs of Collection

Refer To Report

F


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The colour stated in the sample column indicates the colour of the vacutainer top Test Dept Sample Comments Adult Reference Range Avail

Malaria film Haem EDTA Mauve Fresh specimen only. Travel and drug details required.

A/B

Manganese – Blood Chem Red Top Serum 72.8 – 218.5 nmol/L F

Manganese - Serum Chem Red Top Serum 9.1 – 23.7 nmol/L F

Magnesium Chem Yellow 0.7-1.0 mmol/L A/B

Magnesium – Urine Chem 24hr Urine Collection

Contact Laboratory for Container Refer To Report

Mercury - Blood Chem EDTA or urine Contact Laboratory for Advice Up to 30 nmol/L

F

Mercury – Urine Chem 24hr Urine Collection

Contact Laboratory for Container Up to 50 nmol/24hr F

Metanephrines (urine)

Chem 24hr Urine Collection

Normeta… Up to 3.30 µmol/24hr Metadrenaline Up to 1.2 µmol/24hr Methoxy… Up to 2.5µmol/24hr

F

Methyl malonic Acid Chem Universal Container

Random Urine – Freeze on Same Day of Collection

0-30 µmol/mmol F

Microalbumin (Urine) ACR

Chem Universal or timed collection

M up to 2.5 mg/mmol creat F up to 3.5 mg/mmol creat AER up to 20 µg/min

B

Mucopolysaccharides Chem Universal Container

Random Urine – Freeze on Same Day of Collection

Refer To Report F

Mycophenalate Chem Yellow Send To Referral Lab within 24hrs of Collection

Refer To Report F


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Neurone Specific Enolase

Chem Yellow 0 – 13 mg/ml F

Neurotensin Chem Green Special request only. Up to 100 pmol/L F

Neutrophil Oxidative Burst

Chem EDTA mauve Send To Referral Lab By Noon The Same Day

Refer To Report F

Nitrazepam Chem Yellow Refer To Report F

Oestradiol Chem Yellow Not helpful in HRT with conjugated oestrogens

Contact laboratory B

Oligoclonal Studies Chem CSF + SST Yellow

Collect Samples At Same Time Refer To Report F

Oligosaccharides Chem Universal Container

Random Urine – Freeze on Day of Collection Refer To Report F

Organic Acids Chem Universal Container

Random Urine – Freeze on Receipt In Laboratory

Refer To Report F

Osmolality (Serum) Chem Yellow Send urine at same time 275-295 mosmol/Kg B

Osmolality (Urine) Chem Universal Send serum at same time Refer To Laboratory B

Oxalate Chem 24hr Urine Collection

Contact laboratory for containers 0.1 – 0.46 mmol/24hrs F

Pancreatic Polypeptide Chem Green Contact Laboratory For Container Up to 300 pmol/L F

Paracetamol Chem Yellow At least FOUR hours post OD A/B

Paraproteins Chem Blood and Urine C

Parathyroid Hormone Chem EDTA Mauve Take serum sample for calcium at same time. Send Separate Sample for FBC

1.6-6.9 pmol/L D


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Phenobarbitone Chem Yellow Collect >6hrs after last dose or immediately before next dose

Adults 10-40 mg/L Neonates up to 30 mg/L

F

Phenytoin Chem Yellow Collect >6hrs after last dose or immediately before next dose

Adults 5- 20 mg/L Neonates up to 14 mg/L

B

Phytanic Acid Chem Yellow Refer to report F

Platelet antibody tests Trans 20ml EDTA blood Contact duty Consultant Haematologist F

Platelet Function Tests Haem Citrate Blue Precise volume

Contact duty Consultant Haematologist

PK Screen Haem EDTA Mauve With FBC and History B

Porphyrins – Red Cell Chem EDTA Mauve Keep Sample in Dark Refer To Report F

Porphyrins (Urine) Chem 24hr Urine + preservative

Keep Sample in Dark Send PBG sample ASAP Contact laboratory for advice

Refer To Report F

Prednisilone Chem Yellow Refer To Report F

Primidone Chem Yellow Collect >6hrs after last dose Up to 11 mg/L F

Progesterone Chem Yellow Mid luteal phase sample (7days before period)

>30 nmol/L = ovulation B


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The colour stated in the sample column indicates the colour of the vacutainer top. Test Dept Sample Comments Adult Reference Range Avail

Procollagen III N-Terminal

Chem Yellow 1.2 – 4.2 µg/L F

Prolactin Chem Yellow F up to 500, M up to 324 mU/L B

Protein Electrophoresis Chem Yellow See also Bence Jones Protein C

Proteins Chem Yellow Protein and Albumin Total Prot 60-80 g/L, Albumin 30-50 g/L

B

Protein (24hr Urine) Chem 24hr Urine Container from Laboratory Up to 0.100 g/24hr C

PSA Chem Yellow Male only 0-2.5 µg/L age dependent B

Pseudocholinesterase Chem Yellow Laboratory will interpret probable genotype Greater than 5300 IU/L F

Pyruvate ( Plasma) Chem Special Contact Laboratory To Arrange Test Less Than 0.18mmol/L F

Pyruvate ( CSF) Chem CSF Contact Laboratory To Arrange Test Refer To Report F

Pyruvate Dehydrogenase Antibodies

Immun Yellow Refer To Report F

Rhesus Antibodies Trans 6ml Pink EDTA FULL PATIENT ID A/B

RBC Folate Haem EDTA Mauve Batched E

Retic Count Haem EDTA Mauve Sample Must Be Less Than 24hrs Old B

Renin Chem Green Contact Laboratory To Arrange Test Sample Must Be Brought To Laboratory Immediately

0.5 – 3.1pmo/ml/hr F


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Rheumatoid Factor RF Immun Yellow 0-13 IU/mL C

Salicylate Chem Yellow Sample at least 4 hours after OD A/B

Selenium Chem Trace Metal / Blue

Contact Laboratory 0.89 – 1.65 nmol/L F

Sex Hormone Binding Protein

Chem Yellow/Red Batched Female 26 – 110 nmol/L C

Sickle Cell Screen Haem EDTA Mauve With FBC A/B

Sirolimus Chem EDTA Mauve Send To Reference Laboratory Immediately Refer To Report F

Sodium Valproate Chem Yellow Collect >6hrs post dose or immediately prior to next dose

Up to 100 mg/L B


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Stone Chem Universal Container

Refer To Report F

Sulphite Chem Universal Container

Random Urine – Freeze Within 30minutes of Collection

Refer To Report F

Sulphonylurea Chem Universal Container

Random Urine - Freeze on Day of Collection

Refer To Report F

Sweat Test (Conductivity)

Chem Prior Appointment Required - Contact Children’s Investigation Clinic

E

Tacrolimus Chem EDTA Mauve COP, Dolphin and Beaver Wards Refer Directly To Reference Laboratory

Refer To Report

Testosterone Chem Yellow F 0.1-1.7, M 6.7-25.8 nmol/L B

Theophylline Chem Child 2ml Orange Adult Yellow

Collect 6 hrs post dose Adults 10-20 mg/L Neonates 5-11 mg/L

A/B

Thiopurine Methyl Transfersae

Chem EDTA Mauve 68-150 mU/L F


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Thrombophilia Screen Haem Citrate Blue x 4 EDTA Mauve x1

Full History, contact duty Consultant Haematologist

Do not do if patient on anticoagulants

B/D

Thyroglobulin Chem Yellow Refer to report F

Thyroid Function, TSH Free T3 Free T4

Chem Chem Chem

Yellow Yellow Yellow

Discretionary Discretionary

0.27-4.20 U/L 3.9-6.7 pmol/L 12.0-22.0 pmol/L

B B B

Thyroid Peroxidase Ab Immun Yellow Less than 60 IU/mL D

Topiramate Chem Yellow 5.0 – 20.0 mg/L F

Total CO2 Chem Yellow Discretionary 22 – 29 mmol/L A/B

Troponin T Chem Yellow See page 26 for specimen requirements Up to 14 ng/L A

Triglyceride Chem Yellow See Lipid Studies 0.2-1.7 mmol/L B

Trimethylamine Chem Urine 24Hr Collection No Preservative Neonates – Random Urine Acceptable

Refer To Report F

Tryptase Chem Yellow or EDTA Mauve

Freeze on Day of Collection 2 – 14 µgLl E

TSH Receptor AB Immun Yellow 0-0.4 u/l F

Tissue Transglutaminase abs IgA

Immun Yellow Less than 7 U/mL C


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The colour stated in the sample column indicates the colour of the vacutainer top Test Dept Sample Comments Adult Reference Range Avail

Urea and Electrolytes Chem Yellow Urea 2.5-7.8 mmol/L Sodium 133 – 146 mmol/l Potassium 3.5 – 5.3 mmol/l Creatinine 44-108 µmol/l

A/B

Uric Acid Chem Yellow F 140-360, M 200-430 µmol/L B

Uric Acid (Urine) Chem 24hr Urine (alk) Container from laboratory 1.5-4.5 mmol/24hr B

Urine Toxicology Screen Chem Universal Refer To Report F

Valproate Chem Yellow Collect >6hrs after last dose Up to 100 mg/l B

Vancomycin Chem Yellow B

Very Long Chain fatty Acids

Chem Green Contact Laboratory For Container and To Arrange Test– Freeze on Day of Collection

Refer To Report F

VIP Chem Green Contact Laboratory For Container and To Arrange Test

Up to 30 pmol/L F

Vitamin A Chem Yellow Contact Laboratory For Container and To Arrange Test – Keep in Dark

1.4 – 3.84 µmol/L F

Vitamin B2 Chem EDTA Mauve Protect From Light 220-750 nmol/L

F

Vitamin B6 Chem EDTA Mauve Freeze Whole Blood Immediately After Collection

40-100 nmol/L F

Vitamin B12 Haem Yellow Part of Haematinic Screen 160-900 ng/L B


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Vitamin B1(Thiamine) Chem Green Contact Laboratory to Arrange Test 50-220 nmol/L F

Vitamin D Chem Yellow 75 -200 nmol/L B

Vitamin E Chem Yellow Contact Laboratory – Fasting – Keep in Dark 11.6 – 41.8 µmol/L F

Warfarin Monitoring Haem Citrate – Blue Do Not Request Coag Screen - Request INR only

A/B

Xanthochromia Chem Universal Container

CSF Sample Number 4 – Keep in Dark. Do Not Send By Air Tube. Contact Laboratory To Arrange Test

Refer To Report F

Zinc Chem Trace Element Navy

11-24 µmol/L F

Transfusion Reaction Trans 6ml EDTA Pink + EDTA Mauve

Discuss on ext. 2046 A/B


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PAEDIATRIC PATHOLOGY INVESTIGATION INDEX – ALPHABETICAL LISTING Availability A = Daily Urgent (include Out





Test Dept Sample Comments Reference Range Avail

Ammonia Chem Hep capillary tube fill: no air space

Contact Laboratory First Send to Laboratory IMMEDIATELY Send Separate Sample For FBC

Contact laboratory A/B

Bilirubin Chem Hep capillary tube Refer To Report A/B

Blood Culture Micro Paed B/C bottle Deliver to laboratory promptly A/B

Blood Gases POCT Hep capillary / Hep arterial syringe

Full and capped Requestor to analyse at point of care site (AE, ITU, AAU, NNU, Maternity and Derwent - level 5 Esher Wing) DO NOT SEND TO LABORATORY

Contact laboratory

Blood Group & DAT Trans EDTA 2ml (red) 1 ml minimum; we cannot share FBC samples

A/B

Calcium Studies Chem Serum Refer To Report A/B

Chloride Chem Hep/orange 1ml Refer To Report A/B

Coagulation Haem Special bottle 1ml Exact quantity. Contact laboratory for bottle Refer To Report A/B

CRP Chem Serum Refer To Report A/B

Electrolytes Chem Serum 0.5ml minimum Refer To Report A/B

ESR Haem EDTA Red 1ml x 2 Refer To Report A/B

FBC / Retic Count Haem EDTA Red 0.5ml minimum Refer To Report A/B

Gentamicin levels Chem Hep/orange 1ml Pre dose samples Refer To Report A/B

Immunoglobulins Chem Plain 2ml IgG, A, M, Total Protein, Albumin Refer To Report E

Lead Chem EDTA red Contact Laboratory first Refer To Report F

LFT Chem Serum Includes Bilirubin, Alkaline Phosphatase, ALT, Albumin

Refer To Report A/B

Free T4 Chem Serum Refer To Report B

Theophylline Chem Serum Refer To Report A/B

TSH Chem Serum Refer To Report B


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Appendix 1 - List of Specialist Referral Centres –Clinical Biochemistry

REFERENCE LABORATORIES Addenbrook’s Hospital NHS Trust Department of Clinical Biochemistry Neo-natal Screening Service Selly Oak Hospital Hills Rd Raddlebarn Rd Cambridge Birmingham CB2 2QQ B9 6JD Medical Oncology Unit Department of Clinical Pathology Charing Cross Hospital Glasgow Royal Infirmary Fulham Place Rd University Hospital NHS Trust London 84 Castle Street W6 3RF Glasgow G4 0SF Protein Reference Unit Molecular Genetics Unit 2

nd Floor, Medical School 2

nd Floor, Medical School

St. George’s Hospital St George’s Hospital Cranmer Terrace Cranmer Terrace PO Box 10295 PO Box 10295 London SW17 0NH London SW17 0NH Microbiology Department Biochemistry Department Camelia Botnar Laboratory Analytical Laboratory Hospital for Sick children Hospital for Sick Children Great Ormond Street Great Ormond Street London WC1N 3JH London. WC1N 3JH Department of Chemical Pathology Dr. N. Dalton 5

th Floor Department of Paediatrics

Thomas Guy House 12th Floor Guy’s Tower

Guy’s Hospital Guy’s Hospital London SE1 9RT London SE1 9RT


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REFERENCE LABORATORIES Supra Regional Laboratory Biochemical Endocrinology For Genetic Enzyme Defects Pathology Centre, G Block (S.E. Thames) Hammersmith Hospital 8

th Floor Guy’s Tower Du Cane Rd

Guy’s Hospital London London SE1 9RT W12 0HS Clinical Chemistry Enzyme Laboratory Pathology Centre, Area G Division of Biochemistry & Genetics Hammersmith Hospital Institute of Child Health Du Cane Rd 30 Guildford Street London W12 0HS London WC1 1EH Department of Clinical Biochemistry SAS Laboratory Kings College Hospital Rm M1/242 Medical School Denmark Hill Royal Victoria Infirmary London Newcastle upon Tyne SE5 9PJ NE1 4LP Department of Clinical Chemistry Hospital for Nervous Diseases Queen’s Square London WC1N 3BG Biochemistry Department Clinical Laboratory Rotherham General Hospital Royal Surrey County Hospital Moorgate Rd Egerton Rd Rotherham Guildford South Yorkshire GU2 5XX S60 2UD


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REFERENCE LABORATORIES Department of Clinical Pathology Supra Regional Protein Sheffield Children’s Hospital NHS Trust Reference Centre Western Bank Dept. of Immunology Sheffield PO Box 894 S10 2TH Sheffield S5 7YT Endocrine Department Ms Roberta Goodall Clinical Biochemistry Dept. of Clinical Biochemistry Level D The Lewis Laboratory South Pathology Block Southmead Hospital Southampton University NHS Trust Bristol Tremona Rd BS10 5NB Southampton SO16 6YD Antenatal Screening Service Analytical Services (DEPM) Wolfson Inst. Cardiological Sciences St. Bart’s & Royal London 2

nd Floor, Medical School

School of Medicine St George’s Hospital Charterhouse Sq. Cranmer Terrace London EC1M 6BQ PO Box 10295 London SW17 0NH Chemical Pathology Biochemistry Department 2

nd Floor, Jenner Wing St. Helier Hospital

St George’s Hospital Wrythe Lane Cranmer Terrace Carshalton PO Box 10295 Surrey London SW17 0NH SM5 1AA Immunology Department Aldst/Renin & Bone Marker St. Helier Hospital SAS Lab Wrythe Lane Diagnostic Chemical Pathology Carshalton Basement Wright Fleming Inst. Surrey St. Mary’s Hospital SM5 1AA Praed Street London W2 1NY


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REFERENCE LABORATORIES Clinical Biochemistry Centre for Clinical Science UCL Hospitals & Measurement 60 Whitfield Street School of Biological Science London University of Surrey W1T 4EU Guildford Surrey

GU2 5XH The Porphyria Service Biochemistry Dept Dept. of Medical Biochemistry West Park Hospital University Hosp of Wales Horton Lane Healthcare NHS Trust Surrey Heath Park KT19 8PB Cardiff CF4 4XW


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Appendix 2 - List of Specialist Referral Centres - Immunology

REFERENCE LABORATORIES Regional Immunology Lab Department of Immunology Birmingham Heartlands Hosp PO Box 894 Birmingham B9 5SS Sheffield S5 7YT Department of Immunology Manchester Subfertility Lab St. Helier Hospital 1

st Floor Old Building

Wrythe Lane St. Mary’s Hospital Carshalton Heathersage Road Surrey SM5 1AA Manchester M13 0JH

John Radcliffe Hospital Department of Clinical Chemistry Neuro-Immunology Hospital For Nervous Diseases Headley Way Queen’s Square Headington London WC1N 3BG Oxford OX 3 9DU

Department of Biochemistry Dept of Immunology and Haematology St. John’s Inst. Of Dermatology Queen Elizabeth Hosp. St Thomas’ Hospital Stadium Rd London SE1 7 EH Woolwich London SE18 4QH


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Appendix 3 - List of Specialist Referral Centres – Department of Haematology and Blood Transfusion

REFERENCE LABORATORIES Haematology Department Immunology Department St. George’s Hospital St. Helier Hospital Blackshaw Rd Wrythe Lane Tooting Carshalton London SW17 0NH Surrey SM5 1AA Cytogenetics Laboratory Regional Cytogenetics Pathology (2

nd Floor) Unit

Mayday University Hospital Jenner Wing London Rd St. George’s Medical School Croydon Cranmer Terrace Surrey CR7 7YE London SW17 0RE Leukaemia Diagnosis Section Department of Haematology Department of Haematology The Hammersmith Hospital St. George’s Medical School DuCane Rd Cranmer Terrace London W12 0HS London SW17 0RE Histocompatibility & Immunogenetics Red Cell Immunohaematology National Blood Service National Blood Service 75, Cranmer Terrace 75, Cranmer Terrace Tooting Tooting London SW17 0RB London SW17 0RB

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