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NAAS GENERAL HOSPITAL
Pathology Laboratory
PRIMARY SAMPLE
MANUAL
JANUARY 2008
NAAS GENERAL HOSPITAL
Pathology Laboratory
PRIMARY SAMPLE
MANUAL
JANUARY 2008
LABORATORY MISSION STATEMENT
“The Pathology Department are committed to provide a full and effective service to all
its users, by the use of examination procedures and methods that will ensure the
highest achievable quality of all tests performed, and will report results in ways which
are timely, confidential, accurate and clinically useful”.
1 INTRODUCTION
1.1
Guide to using this Manual
1.2
Location of Pathology Department
1.3
Pathology Department Opening Hours
1.4
Cut-Off Times for Routine Sample Acceptance
1.5
Designated Times for Obtaining Laboratory Results by Phone
1.6
Staffing
1.7
Pathology Department Telephone Numbers
1.8
Pathology Department Fax Number
1.9
Naas General Hospital Website
1.10
Phlebotomy
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7
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8
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2 LABORATORY REQUEST FORMS, SAMPLE BOTTLES AND CONTAINERS
2.1
General Information
2.2
Request Forms/Tests
2.3
Sample Acceptance Criteria for Hospital Patients
2.4
Sample Acceptance Criteria for GPs
9
9
9
9
11
3 DELIVERY, PACKING, TRANSPORT AND POSTAL REQUIREMENTS OF PATHOLOGY
SAMPLES
3.1
Health and Safety
3.2
Sample Delivery within the Hospital during Routine Hours
3.3
Sample Delivery within the Hospital outside Routine Hours
3.4
Sample Delivery from External Centres
3.5
Packing Procedure for the Transport of Diagnostic Samples (Non Infectious)
3.6
Transport of Infectious or Suspected Infectious Samples
3.7
Disposal of Waste Material Used in Sample Collection
3.8
Pneumatic Tube System (PTS)
3.9
System Operation of PTS
12
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13
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14
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4 REPORTING OF TEST RESULTS
4.1
Phoning Of Results (Hospital Patients)
16
16
5 EXTERNAL THIRD PARTY ASSESSMENT PROGRAMME
16
6 BLOOD TRANSFUSION
6.1
Introduction
6.2
Contact Numbers / Personnel List
6.3
Blood Transfusion Tests
6.4
Urgent Requests Policy
6.5
Requests for Uncrossmatched Blood - in an Emergency
6.6
Blood Products/Components for Transfusion
6.7
Blood Transfusion Laboratory Opening Hours
6.8
Emergency On-Call
6.9
Repeat Samples
6.10
Sample Request Form
6.11
Sample Labelling Policy
6.12
Sending the samples to Laboratory
6.13
Telephone Requests Policy
6.14
Emergency Transfusion Policy
6.15
Collection/Delivery Of Blood and Blood Products
6.16
Return of unused Blood/Products to Laboratory
6.17
Disposal of empty Blood/Product packs
6.18
Maximum Surgical Blood Ordering Schedule (M.S.B.O.S.)
6.19
Major Emergency Plan
17
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21
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7 HAEMATOLOGY
7.1
Introduction
7.2
Haematology Personnel
7.3
Contact Numbers/Personnel List
7.4
Useful Contact Numbers
7.5
Requesting Investigations
7.6
Health and Safety
7.7
Cut-off Times for Sample Processing and Referral
7.8
Laboratory Notification of Emergency Samples during Routine Hours
7.9
Special Protocols
7.10
Reporting of Results and Result Enquiries
7.11
Retrospective requesting
7.12
Telephoning Results
7.13
Pathology Department Emergency On-Call Services
7.14
Urgent Haematology Advice
7.15
Patients for Haematology Review
7.16
External Quality Control
7.17
Sample Guide for Tests Performed in Naas Laboratory
7.18
Referred Samples/Unusual Requests
7.19
Reference Values - Haematology
24
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25
25
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8 CLINICAL CHEMISTRY
8.1
Introduction
8.2
Clinical Chemistry Personnel
8.3
Personnel Contact Numbers
8.4
Useful Contact Numbers
8.5
Requesting Investigations
8.6
Health and Safety
8.7
Pathology Department Opening Times – Normal Hours
8.8
Special Protocols
8.9
Results and Enquiries
8.10
Retrospective requesting
8.11
Telephoning Results
8.12
Pathology Department – On-Call Services
8.13
Point of Care Testing (POCT)
8.14
External Quality Assurance Schemes
8.15
Sample Guide
8.16
Adult Reference Values
33
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34
35
35
35
35
36
36
36
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9 MICROBIOLOGY
9.1
Introduction
9.2
Microbiology Personnel Contact Numbers
9.3
Microbiology Routine hours
9.4
Laboratory Notification of Emergency Work
9.5
Laboratory Notification of Emergency Work Outside of Routine hours.
9.6
Clinical Consultation.
9.7
General Guidelines on Microbiological Samples.
9.8
Safety
9.9
Storage
9.10
Storage conditions for Microbiology samples
9.11
Retention times
9.12
Retention times
9.13
Samples Processed in Naas Microbiology Laboratory
42
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43
43
43
43
43
44
9.14
9.15
9.16
9.17
9.18
9.19
9.20
9.21
9.22
Referred Tests
Special investigations, other referred tests
Results and Reporting.
Which results are telephoned?
List of tests available outside of routine hours 17:00 – 09:30.
Infection Control.
External Quality Control
Useful Links
Turnaround times
45
45
45
45
46
46
46
46
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10 HISTOPATHOLOGY DEPARTMENT (AMNCH)
48
11 PATHOLOGY REFERRED TESTS
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NGH/QA/GDE/001
Ver.1
Effective date 01/01/08
Page 5 of 67
NAAS GENERAL HOSPITAL
PRIMARY SAMPLE MANUAL
Written/Revised by: _________________________________
Primary Sample Manual Committee
Date: ____/____/____
Reviewed by: _______________________________________
Laboratory Manager
Date: ____/____/____
Authorised by:_____________________________________
Laboratory Director
Date: ____/____/____
Effective Date: ____/____/____
Supersedes: None
Copy No.: ______________
Assigned to: ____________________
Change Control No.: ____________________
Document Review History
First Review Date: _____/_____/_____
Date
Reviewed by:
Document Amended
YES/NO
Page/s
Amended
Change Description:
Reason for Change:
PRODUCTION OF UNAUTHORISED COPIES OF THIS SOP IS FORBIDDEN
AUTHORISED COPY IF STAMPED IN RED - OFFICIAL COPY
5
Next Review
Date
1. INTRODUCTION
Naas General Hospital serves the catchment area of Kildare and West Wicklow, an area with a
rapidly growing population. It is a 279 bed acute general hospital which currently employs 815
people.
This manual is designed to give an overall view of the services available in the Pathology
Department. It is intended as a quick reference guide for all pathology users both within the
hospital and those from outside agencies.
All Pathology services undergo continuous review through quality assurance and audit activities.
The Laboratory is committed to performing its activities in accordance with the requirements of the
International Standard ISO 15189.
Laboratory Management are committed to:
• Staff recruitment, training, development and retention at all levels to provide a full and effective
service to its users.
• The proper procurement and maintenance of equipment and other resources as are needed for
the provision of the service.
• The collection, transport and handling of all samples in such a way as to ensure the correct
performance of laboratory examinations.
• The use of examination procedures and methods that will ensure the highest achievable quality
of all tests performed.
• Reporting results of examinations in ways which are timely, confidential, accurate and clinically
useful.
• The assessment of user satisfaction, in addition to internal audit and external quality
assessment, in order to produce continual quality improvement.
1.1 Guide to using this Manual
A controlled hardcopy of this manual has been issued to each ward and other relevant locations as
authorised by the Laboratory Manager.
An electronic version of this manual is accessible on the Intranet and on the Naas Hospital website:
www.naashospital.ie
1.2 Location of Pathology Department
The Pathology Department is located on Level 3 in the main hospital building.
1.3 Pathology Department Opening Hours
Department/Activity
Opening Hours
Pathology/Sample Reception
Monday to Friday 08:30 – 17:00
Routine Laboratory Diagnostic Service
Monday to Friday 09:30 – 17:00
Emergency Out of Hours Service
(On-Call Diagnostic Service)
Monday to Friday 17:00 – 09:30
Saturday and Sunday (24 Hours)
Bank Holidays (24 Hours)
6
1.4 Cut-Off Times for Routine Sample Acceptance
Source of Samples
Cut-Off Times
GP Samples
15:30
External Hospital Samples
15:30
All Blood Transfusion Samples
(Internal or External Sources)
15:45
In-Patient Naas Hospital Samples
excluding Blood Transfusion
16:00 *
*(Refer to each discipline for specific tests)
1.5 Designated Times for Obtaining Laboratory Results by Phone
Source of Samples
Designated Times (Monday – Friday)
Extension Numbers
*11:30 - 12:30
*15:30 - 16:30
3034/3035/3036/3037
GP/External
Healthlink Users
Naas Hospital Inpatients
Results available on-line
Not Applicable
Results available on LIS once authorised
Not Applicable
*Please adhere strictly to these times only.
Insert (045) 84 before extension number for direct access.
1.6 Staffing
The Laboratory Manager is Mr Pat Flynn.
The Pathology Department consists of:
• Director of Pathology
• Laboratory Manager
• Consultant Histopathologist
• Consultant Chemical Pathologist
• Consultant Haematologist
• Consultant Microbiologist
• Heads of Department
• Medical Scientists
• Specialist Scientist
• Quality Assurance Officer
• Haemovigilance Team
• Infection Control Team
• Laboratory Assistants
• Laboratory Attendants
• Clerical Staff
• Support Services
Phlebotomy
Information Technology
Household
7
1.7 Pathology Department Telephone Numbers
Section
Phone Number
Bleep Number
Sample Reception
3033
N/A
Laboratory Administration
3034/35/36/37
N/A
Phlebotomy
9883
142/212/204
Director of Pathology
Contact Laboratory
Administration AMNCH
N/A
Laboratory Manager
3046
N/A
Microbiology
3038/3039
N/A
Clinical Chemistry
3043/3044
N/A
Haematology
3041/3045
N/A
Coagulation
9849
N/A
Blood Transfusion Laboratory
3040
N/A
Medical Scientist Emergency On-Call
Clinical Chemistry/Microbiology
Contact Switch ‘0’
N/A
Medical Scientist Emergency On-Call
Haematology/Blood Transfusion
Contact Switch ‘0’
N/A
Infection Control Office
9935
225
Haemovigilance Office
3013
217
Insert (045) 84 before extension number for direct access.
1.8 Pathology Department Fax Number
045-843096
1.9 Naas General Hospital Website
Website: www.naashospital.ie
1.10 Phlebotomy
A Phlebotomy service operates on the hospital wards. Phlebotomy is available also in the
Outpatients Department for patients attending the Outpatients Clinic with pre-arranged
appointments only.
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2. LABORATORY REQUEST FORMS, SAMPLE BOTTLES AND CONTAINERS
2.1 General Information
This section deals with the information that is required to be documented on the laboratory request
form, and the sample bottle or container, prior to the analysis of samples.
The Laboratory has a number of different request forms. It is important that the correct form is
supplied for a particular test.
Blood Transfusion: Please refer to Blood Transfusion Section 6 for additional requirements for
sample and form labelling.
Histology: Please refer to Histology Section (AMNCH) Section 10 for AMNCH requirements for
sample and form labelling.
2.2 Request Forms/Tests
Tests
Request Form
1.
Blood Transfusion Tests
Pink and White
2.
Clinical Chemistry and Haematology Tests
Black and White
3.
Diabetes OPD
Green
4.
General Microbiology (Microbiology)
Pink
5.
Urine and Faeces (Microbiology)
Yellow
6.
CSF and Fluids (Microbiology)
Orange
7.
G.P / External Centres
Blue and White
8.
External Referrals
White
2.3.1 Completing the Request Form (Naas Hospital Patients)
The following information must be documented in a LEGIBLE manner on ALL SHEETS of the
request form. Addressograph labels may be used on all samples and forms except Blood
Transfusion samples. See Section 6 for Blood Transfusion requirements.
Request forms received with illegible details, for example, addressograph labels with
demographics cut off, will not be processed.
Items marked with an * are minimum identifiers and samples will not be processed without
this information.
1.
*Patient’s Hospital Number.
2.
*Patient’s Full Name (Surname and Forename. Initials are not acceptable).
3.
*Patient’s Date of Birth.
9
4.
Patient’s Gender.
5.
Patient’s Full Current Address.
6.
Patient’s Location (Hospital Ward).
7.
The name of the requesting Clinician.
8.
Sample type and anatomical site where appropriate.
9.
Test(s) required.
10.
Date and time of sample collection.
11.
Relevant clinical information appropriate to the test(s) requested must be supplied.
For example, relevant clinical details, antibiotic therapies or other therapies, cardiac
biomarker details on reverse of request form.
12.
A clear indication if the tests requested are urgent.
13.
The signature and bleep number of the person requesting the tests.
14.
The signature and bleep number of the person taking the bloods.
15.
Any samples from known infectious patients e.g. HIV, hepatitis or TB should have a red
sticker attached to both sample and form.
2.3.2 Labelling the Sample Container (Naas Hospital Patients)
Items marked with an * are minimum identifiers and samples will not be processed without this
information. The following information must be documented in a legible manner on the sample
container:
1.
*Patient’s Full Name. (Surname and Full Forename. Initials are not acceptable).
2.
*Hospital Number and / or Date of Birth.
3.
The initials of the person collecting the sample.
Please ensure the ward location on addressograph labels is current and correct.
10
2.3.3 Non Compliant Samples and Request forms (Naas Hospital Patients)
Sample / Form Issues
Action
Documentation
Samples unlabelled.
Samples will not be
processed. Ward will be
informed by Laboratory
Sample Reception.
Demographic details (from
request form) will be
entered on the LIS system
as non-compliant and
recorded in the Incident
Report Book.
Patient demographics on
sample and request form
differ.
Samples will not be
processed. Ward will be
contacted by Laboratory
Sample Reception.
Demographic details (from
sample) will be entered on
the LIS system as noncompliant and recorded in
the Incident Report Book.
Miscellaneous
sample/form issues.
A Senior member of staff
in the relevant department
will be contacted.
Details will be recorded in
the Incident Report Book.
Minimum identifier(s)
missing from samples or
request form.
Samples will not be
processed. Ward will be
contacted by Laboratory
Specimen Reception.
Demographic details (from
sample) will be entered on
the LIS system as noncompliant when supplied.
If samples are unlabelled
demographic details will
be entered from request
form. Details will be
recorded in the Incident
Report Book.
2.4 Sample Acceptance Criteria for External Sources
2.4.1 Completing the Request Form (External Sources)
The following information must be documented in a legible manner on all sheets of the request
form. Addressograph labels may be used on samples and forms. Items marked with an
* are minimum identifiers and samples will not be processed without this information.
1.
* Patient’s Full Name.
2.
* Patient’s Date of Birth and/or Hospital Number
3.
Patient’s Full Home Address.
4.
Patient’s Gender.
5.
Name of GP requesting tests.
6.
Sample type and anatomical site where appropriate.
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7.
Test(s) required.
8.
Date and time of sample collection.
9.
Relevant clinical information appropriate to the test(s) requested must be supplied.
For example, relevant clinical details, antibiotic therapies or other therapies, cardiac
biomarker details on reverse of request form.
10.
A clear indication if the tests requested are urgent.
11.
Any samples from known infectious patients e.g. HIV, Hepatitis or TB should have a
red sticker attached to both sample and form.
2.4.2 Labelling the Sample Container (External Sources)
Items marked with an * are minimum identifiers and samples will not be processed without this
information. The following information must be documented in a LEGIBLE manner on the sample
container:
1.
*Patient’s Full Name.
2.
*Date of Birth.
3.
Date sample drawn.
2.4.3 Non Compliant Samples and Request forms (External Centres)
Sample / Form Issues
Documentation
Action
Samples unlabelled.
Samples will not be
processed.
Demographic details
(from request form) will be
entered on the LIS system
as non-compliant and
recorded in the
Laboratory External NonCompliance Book.
Patient demographics on
sample and request form
differ.
Samples will not be
processed.
Demographic details (from
sample) will be entered on
the LIS system as noncompliant and recorded in
the Laboratory External
Non-Compliance Book.
Miscellaneous
sample/form issues.
A Senior member of staff
in the relevant department
will be contacted.
Details will be recorded in
the External Sample NonCompliance Book
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3. DELIVERY, PACKAGE, TRANSPORT AND POSTAL REQUIREMENTS OF PATHOLOGY
SAMPLES
3.1 Health and Safety
It is the policy of the Pathology Department to treat all samples as potentially infectious or high risk.
Therefore, it is advisable to take universal precautions in the collection, packaging and the delivery
of samples being sent to the Pathology Department for analysis.
3.2 Sample Delivery within the Hospital during Routine Hours
During routine phlebotomy times the Phlebotomy team collect blood samples. These samples are
usually delivered by the ward porters or sent via the Pneumatic Tube System. All other sample
types are collected and delivered by Non-Pathology staff. All samples being sent to the Laboratory
should be placed in a plastic sample bag. The sample bag may or may not be attached to a request
form. This depends on the form type.
3.3 Sample Delivery within the Hospital outside Routine Hours
Outside of routine phlebotomy times blood samples are taken by either medical doctors or nurses
on the ward. These samples are usually delivered by the ward porters or sent via the Pneumatic
Tube System.
Urgent samples delivered by designated hospital staff should be sent to the Pathology Department
via the Pneumatic Tube System (See section 3.8) or dropped off at Sample reception.
The relevant Scientist On-Call should be phoned immediately. Contact Switch.
The form should be marked as Urgent.
Non-urgent samples should be delivered to the Laboratory via Pneumatic Tube System or dropped
off at Sample Reception.
3.4 Sample Delivery from External Centres
The requirements stated below apply to all samples or samples directed to the Pathology
Department. These will be required to be packed and transported in accordance with the European
Agreement concerning the International Carriage of Dangerous Goods by Road (UNADR).
3.5 Packing Procedure for the Transport of Diagnostic Samples (Non Infectious)
1.
Samples to be sent should be stored in a secure (preferably plastic) primary container.
2.
Wrap the container in tissue or cotton wool which will act as absorbent material in event
of any spillages and place in a biohazard bag.
3.
Place the biohazard bag with the sample in a padded (jiffy bag) envelope.
4.
Label the envelope with a hazard-warning label, Biological Substance Category B.
5.
Place the name, address and contact number of the destination laboratory on the outside
of the envelope.
6.
Place the name, address and contact number of the originator on the outside of the
envelope.
7.
The sample can be transported or posted as appropriate.
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3.6 Transport of Infectious or Suspected Infectious Samples
Samples suspected or known to contain risk group 3 or 4 pathogens are classified as infectious and
are packaged and transported accordingly as outlined below.
1.
Samples to be sent should be stored in a secure (preferably plastic) primary container.
2.
Wrap the container in tissue or cotton wool that will act as an absorbent material in event
of any spillages.
3.
Place the wrapped primary sample inside a plastic container of the UN-approved Class
6.2 package type.
4.
Place the container inside the cardboard box.
5.
The box should contain a label “Infectious Substance”. Write the name of the suspected
microbe being transported in brackets.
6.
Place the name, address and contact number of the destination laboratory on the outside
of the box.
7.
Place the name, address and contact number of the originator on the outside of the box.
8.
Complete a transport document and provide a copy to the licensed courier.
A licensed courier must be used for the transport of infectious or suspected infectious
samples.
3.7 Disposal of Waste Material Used in Sample Collection
All materials used in sample collection should be treated as potentially hazardous and discarded
using sharps containers and other appropriate colour coded bins/bags. Please refer to the current
hospital guidelines for Waste Management prepared by the Infection Control Committee.
3.8 Pneumatic Tube System (PTS)
Brief operating instructions are located on cards at each Ward PTS station.
Yellow pods are for pharmacy only and should not be used for laboratory samples.
Red pods are for laboratory samples only and should not be used for drugs.
3.9 System Operation of PTS
1.
Place the sample correctly in the appropriate container and close the top.
2.
Enter the destination station code and the receiving area will be displayed.
3.
Immediately place the pod containing the sample into the sending funnel. A green light
indicates initiation of transport. The pod will automatically transfer when the system is
ready.
4.
All laboratory samples should be directed to Sample reception at 3033.
5.
The receiver should empty the pod and immediately return to sender station.
Please redirect misaddressed pods to the correct location.
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The following sample types MUST NOT BE SENT via the PTS
•
CSF
•
Arterial blood gas (ABG)
•
Bone Marrow Samples
•
Skin Scrapings for Meningococcal detection
•
24 hour urine containers
•
Histology samples
System Failure or Malfunction
In the event of a system failure or malfunction a coded red light will be displayed on the
workstation. In the event of a full malfunction the contact number for Technical Services is as
follows:
Advanced Pneumatics Technology (APT) - (01) 8413005
(24 Hour On-Call System)
Modem number if required to dial in: (045) 901079
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4. REPORTING OF TEST RESULTS
Reporting of Results within the Hospital
Results will be available for viewing on the LIS following authorisation. Printed reports will be
issued from the Pathology Department and delivered to the requesting location via the PTS.
4.1 Phoning Of Results (Naas Hospital Patients)
Abnormal results falling outside defined limits (as detailed in each section) will be telephoned to
the requesting source.
The following is the protocol for phoning abnormal results:
Naas General Hospital Laboratory Protocol for Phoning Abnormal Results
Abnormal results in
category for
phoning
In-patients
Out-patients
Mon-Fri
09:00-17:00
Out-patients
After 17:00
Phoned to
ward/location of
sampling
Phoned to Registrar on Clinical
Team. SHO phoned if
Registrar unavailable
Phoned to Medical
or Surgical
Registrar On-Call
Ward Manager responsible
for ensuring that clinical team
are informed
Person receiving the call is
responsible for informing other
team members
Registrar On-Call is
responsible for clinical
management
Note: If no member of the clinical team is available to receive the result, the relevant
Consultant or Consultant On-Call will be contacted.
5. EXTERNAL THIRD PARTY ASSESSMENT PROGRAMME
The Pathology Department participates in relevant available external third party assessment
schemes. This includes schemes operated by:• NEQAS (UK, National External Quality Assurance Scheme)
• IEQAS (Irish External Quality Assurance Scheme)
• WEQAS (Welsh External Quality Assurance Scheme)
• RIQAS (Randox International Quality Assurance Scheme)
• CQAS (Coagulation Quality Assurance Scheme)
The above schemes are fully CPA accredited.
A detailed list of assays and relevant schemes are available on request.
The Pathology Department is committed to participating in other schemes as they become
available and are required to ensure comprehensive assessment of the test repertoire.
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6. BLOOD TRANSFUSION
6.1 Introduction
The Blood Transfusion Laboratory is located in the Pathology Department on the third floor. Lists of
the various therapeutic and diagnostic services provided are listed below. For any queries
regarding Blood Transfusion, please contact extension 3040.
Documentation that will help you with blood transfusion therapy are:
•
NGH Guidelines on the administration of blood and blood products
(available at all nurses’ stations and on the desktop of all ward PC’s).
•
Patient Information Leaflet (available on all wards).
6.2 Contact Numbers / Personnel List
Position
Name
Contact Number
Consultant
Haematologist
Dr Niamh O’Connell
Routine: Via ext 3040
Emergency: On Call
Haematology Consultant
at 01-4142000
(AMNCH switch)
Fax: 01 4145908
Senior Medical
Scientist
Ms Caroline Kearney
Ext: 3040
09:30-17:00
Ext: 3040
09:30-17:00
Routine
Laboratory
Times
Emergency
On-Call
Scientist On-Call
Contact Switch “0”
Mon–Fri
17:00-09:30
Sat, Sun & Bank
Holidays 24hrs
Haemovigilance
Officers
Ms Ger Peelo/
Ms Maura Hennessy
Ext 3013
Bleep 217
Mon-Fri
08:45-17:15
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6.3 Blood Transfusion Tests
Test/Profile
Sample Type
Special Requirements
Routine Turnaround Times
Group and
Crossmatch
7.5 ml EDTA
None. Samples + forms
must be labelled as per
Section 6.12
1-2hrs if antibody screen is
negative
2-4 hrs if antibody present
Direct Coombs
Test
7.5 ml EDTA
None
1 hour
Group and
Antibody
Screen
7.5 ml EDTA
None. Samples + forms
must be labelled as per
Section 6.12
45 mins-1 hour if antibody
screen is negative
1-2 hrs if antibody present
Transfusion
Reaction
Investigation
7.5 ml EDTA
+ First urine
post incident
Lithium heparin
sample
Serum sample
Phone Blood Transfusion 7 days
Laboratory. Samples +
forms must be labelled as
per Section 6.12.
Complete transfusion
reaction incident form
(on ward).
All blood products and
packs to be returned to
Pathology Department
➝
➝
➝
Tests provided in the emergency On-Call service.
➝
6.4 Urgent Requests Policy
•
The Medical Doctor must phone the Laboratory (3040) explaining the urgency.
•
Blood Group can be provided in 10-15 mins.
•
Group and Antibody Screen (urgent) can be provided in 30–40 mins.
•
Group & Crossmatch can be provided in 45–60 mins.
•
Crossmatched units on a sample that is already on Group & Hold (Screen Negative) can be
provided in 30 mins.
•
Group specific blood cannot be issued without a current sample in Blood Transfusion
Laboratory.
•
If the antibody screen is positive there will be an increase in the time taken to provide
compatible units.
6.5 Requests for Uncrossmatched Blood - in an Emergency
•
Two units of O Rh D Negative, Kell Negative red cells are available in the Issue Fridge at all
times.
•
A Medical Doctor must make requests for uncrossmatched blood.
•
If the Laboratory has a current sample from the patient, group specific uncrossmatched
blood can be given.
•
If there is no current sample, O Rh D negative blood can be given, but a sample must be
taken prior to administration of Emergency O Negs and sent immmediately for group and
antibody screen so that the patients’ blood group can be established (Refer to Emergency
Transfusion Guidelines - Section 6.14)
Urgent requests for other Blood Products / Tests - Phone 3040 or contact the Haematology/Blood
Transfusion Medical Scientist on-call via switch.
18
6.6 Blood Products/Components for Transfusion
Blood Products
*
Sample Type
Requirements
Routine Turnaround Times
Red Cell Concentrate 7.5ml EDTA
New sample required
1-2hrs if antibody screen is
every 72 hrs. Check with negative
Transfusion Lab 3040
2-4 hrs if antibody present
for details.(See Section 6.9)
Platelets
7.5ml EDTA
(if group
unknown)
Phone request well in
advance of time required
No in-house stocks
Albumin
None
Refer to NGH Transfusion Immediately
Guidelines
Prothrombin complex None
concentrate
Refer to NGH Transfusion Immediately
Guidelines
Fibrinogen
None
Refer to NGH Transfusion Immediately
Guidelines
Octaplas
Solvent Detergent
Plasma (SDP) *
7.5ml EDTA
(if group
unknown)
Refer to NGH Transfusion 1-2 hours
Guidelines
2-4 hours
A blood sample is required if the blood group has not been tested by the Laboratory during the
current inpatient episode.
6.7 Blood Transfusion Laboratory Opening Hours
Routine Testing
09:30 - 17:00 Monday–Friday
Routine Cut-off Times for Sample Acceptance
The latest time for receipt of routine samples is 15:45.
Samples from patients for elective surgery should be received in the Blood Transfusion Laboratory
not later than 15:45 on the last normal working day prior to the scheduled operation. If a definite
date for an operation is not known, the sample should be sent to the Laboratory for a ‘Group and
Hold’. An antibody screen will then be performed and plasma retained. Subsequently, when the
operation date is known, blood may be ordered by phone up to 15:45 on the last normal working
day prior to the operation.
6.8 Emergency On-Call
An Emergency on-call service is available for all urgent requests from 17:00-09:30 each day and
24hrs on Saturday, Sunday and Bank Holidays.
6.9 Repeat Samples
A new sample is required if the patient was discharged since the last sample was taken or every 72
hours if a patient has been transfused or pregnant in the past three months. If the Laboratory has a
suitable sample a phoned request is acceptable.
19
6.10 Sample Request Form
The request form must be filled out properly and have the following details:
•
Patient Details Surname, First Name, Hospital Number, Date of Birth, Ward, (No
abbreviations) handwritten from the patients wristband.
•
Clinical Details Surgical procedure, disease state, transfusion and pregnancy history.
Clinical details are essential particularly for immunouppressed patients who may have
special requirements e.g. CMV and/or irradiated blood products.
•
Test & product details (tick the box)
•
Date & Time Required.
•
Special Requirements: It must be clearly stated on the request form if CMV Negative or
Irradiated products are required for particular patients.
•
Signature of person making the request.
Addressograph labels are not acceptable on the request form or sample.
6.11 Sample Labelling Policy
•
Sample must be hand labelled and signed, with details taken from the patient’s wristband
and confirmed verbally by the patient.
•
If there are any discrepancies, resolve them before taking the sample.
•
Sample tubes must not be prelabelled.
•
Addressograph labels must not be on the sample or request form. See Guidelines on the
administration of blood and blood products - Section 4 of NGH Transfusion Guidelines
(available in all clinical areas).
6.12 Sending the samples to Laboratory
•
Can be sent via Pneumatic Tube system to Sample Reception 3033.
•
Always place sample in plastic biohazard bag.
•
All urgent requests should be accompanied by a phone call to the Blood Transfusion
Laboratory or the Scientist On-Call.
The sample MUST be labelled with details below (taken from wristband not addressograph
labels in chart and confirmed verbally by the patient.):
Minimum Requirements
•
Surname
•
First name
•
Hospital number
•
Date of birth
•
The sample must be signed by person taking the sample
•
Both the person making the request and the person taking the sample must sign the
request form
Also include:
•
Location
•
Gender
•
Date and Time (sample taken)
NB
Information on patient’s wristband, request form, and sample must be identical – No abbreviations
to be used.
All writing on sample must be clear and legible.
Samples not meeting these minimum requirements will not be accepted and a new sample will
have to be obtained.
Please do not label samples with fine/felt tip pens, as these tend to smudge.
20
6.13 Telephone Requests Policy
•
A crossmatch may be requested by phone if a suitable sample is still held in the laboratory.
Samples are held for 14 days.
•
A sample is suitable for crossmatching once the patient has not been transfused or become
pregnant in the previous 3 months or been discharged since the sample was drawn.
•
The following details must be given when phoning requests:
Patient’s Name and Hospital Number, Ward, Product, Amount Required, Date and Time required,
Reason for Transfusion and Name of Requesting Medical Doctor.
6.14 Emergency Transfusion Policy
O Rh D Negative uncrossmatched blood will be issued to all women of childbearing age and to all
children.
O Rh D Positive uncrossmatched blood may be issued to all women above childbearing age and to
all men when O Rh D neg blood is not available- but must only be transfused in Emergency
Transfusion situations after consultation with the National Blood Centre.
When Patient Blood Group becomes available, group specific blood will be issued.
6.15 Collection/Delivery Of Blood and Blood Products
•
Crossmatched blood will be placed in the Issue Fridge and the ward informed.
•
The Issue Fridge is only accessible to persons trained in operating Blood Track. For training
please contact the Haemovigilance office (3013) or the Blood Transfusion Laboratory
(3040).
•
Emergency access to O RhD negs is available.
•
Blood must be transported in special blood boxes, available in all Clinical Areas.
•
If blood is not required, please return to the Issue Fridge within 30 minutes of removal from
monitored Issue Fridge. (Inform Laboratory staff member)
•
Blood out of fridge for > 30 mins cannot be returned to the fridge. Contact Blood
Transfusion Laboratory staff member.
•
Platelets and Plasma will be delivered to ward if possible. If not possible, arrangements will
be made with ward for collection.
•
Albumin, Haemocompletten and Prothrombin Complex are available in the Blood
Transfusion Laboratory for collection. Please phone 3040 to arrange.
•
A pink traceability slip is attached to each blood product issued. The administrator of the
product must sign this slip with date and time and place in the red traceability label box in
each clinical area.
6.16 Return of unused Blood/Products to laboratory
It is important for accurate record keeping and reduction of wastage that all unused blood or blood
products are returned to the laboratory as soon as possible. Phone 3040 or call the Medical
Scientist On-Call to arrange return.
When returning Blood/Products for any reason to the blood transfusion laboratory, please inform a
member of the blood transfusion staff.
6.17 Disposal of empty Blood/Product packs
Following Uncomplicated Transfusion–Dispose at ward level. See NGH Guidelines for
administration of Blood and Blood Products (Ref: Section 9) available on each clinical area.
•
Following Suspected Transfusion Reaction
All Blood/Product packs with giving set attached must be returned to the Blood Transfusion
Laboratory accompanying the relevant samples and forms.
Refer to “Management of Adverse Transfusion Reactions and Events” in NGH Guidelines
for administration of Blood and Blood Products (Section 10) available in each clinical area.
21
6.18 Maximum Surgical Blood Ordering Schedule (M.S.B.O.S.)
These are guidelines for ordering of blood for surgical procedures.
•
A Group and Antibody screen system has proved efficient and cost effective for certain
procedures.
•
A sample for Group and antibody screen is taken in advance for specified procedures. If the
screen is negative crossmatched blood can be provided within 45 minutes of a phoned
request. If the screen is positive antigen negative blood will be made available in advance
of the procedure.
•
Procedures requiring provision of crossmatched blood in advance are detailed in the
M.S.B.O.S with the number of units to be requested.
•
A copy of the suggested ‘Maximum Surgical Blood Ordering Schedule’ (M.S.B.O.S.) is
posted in each surgical ward, and medical staff should refer to it when sending requests to
the Blood Transfusion Laboratory. Blood is reserved for patients, normally for a period of 48
hours, from the day of the operation, unless otherwise requested.
•
This maximum blood ordering can be bypassed (Consultant, anaesthetists or senior
registrar) by phoning the Blood Transfusion Laboratory at 3040.
•
The term “2 units” indicates a group and antibody screen is performed and 2 units of red
cells are cross matched, and held in the issue fridge for the patient.
•
A new sample is required for each in-patient episode.
•
Samples must be in Blood Transfusion by 15.45 on the last routine working day prior to
surgery.
Maximum Blood Ordering Schedule - Naas General Hospital
Procedure - General Surgery
Action
Procedure
Action
Abdominal Peritonal Resection
Anterior Resection
Laparotomy Elective
Exploratory Emergency
Gastrectomy Partial
Total
Oesophageal
Colostomy Closure/revision
Haemorrhoidectomy
Splenectomy Elective
Fundoplsty/fundiplication
Breast Biopsy
Appendicectomy
Ligation of Veins
2 units
2 units
G&H
2 units
2 units
4 units
4 units
G&H
G&H
G&H
None
None
None
None
Bowel Resection
Sigmoidcolectomy
Sigmoidectomy
G&H
2 units
2 units
Hemicolectomy
G&H
Sub cut Mastectomy
EUA
G&H
None
Thyroidectomy/Lobectomy
Liver Biopsy
Parathyroidectomy
Gastrojejunostomy
Laproscopic Procedures
Diagnostic Laproscopy
Lapcholecystectomy
Day Case
In-patient
Lap Nissen
Hernia/Inguinal
G&H
G&H
G&H
2 units
None
None
None
G&H
None
22
6.19 Major Emergency Plan
In the event of a major disaster the switchboard in NGH will inform the Haematology/Blood
Transfusion department or the Scientist On-Call.
Patient Charts
The A&E dept have charts made up to be used in event of Major Accident plan being implemented.
These charts have a hospital number attached to a prefixed number in place of patient name.
Sample Labelling Policy
The samples taken in A&E will be labelled as follows:
•
Hospital number: (From A&E ready made up charts).
•
Name – UNKNOWN XXX
•
Gender
•
DOB is given as NK (not known)
•
Signature of person taking the sample.
Addressograph labels are not acceptable on samples or request forms.
PAS/Footman Walker Down Time
In the event of PAS/Footman Walker down time, refer to A&E policy for labelling and identifying of
patient.
23
7. HAEMATOLOGY
7.1 Introduction
The Haematology Laboratory is located on the third floor of Naas General Hospital. Advice relating
to the haematology service offered or use of this manual should be addressed to the any of the staff
members listed below.
7.2 Haematology Personnel
Please dial appropriate members of staff directly for clinical enquiries and enquires regarding
service provision and operational issues.
7.3 Contact Numbers/Personnel List
Name
Position
Contact Number
Dr. Niamh O’Connell
Consultant Haematologist
Fax 01 4145908
Emergency: Contact
via switch at AMNCH
01 4142000
Ms. Mary Duggan
Chief Medical Scientist
*3041 or 3045
Ms. Marie Prendergast
Senior Medical Scientist
*3041 or 3045
Ms. Marie Goss
Senior Medical Scientist
*3041 or 3045
*Insert (045) 84 before extension number for direct access from outside.
Fax no. 045 843096
7.4 Useful Contact Numbers
Location
Result enquiries - Haem/Coag
Telephone
*3034/3035/3036/3037
Retrospective requesting
*3034/3035/3036/3037
General enquiries
* 3041/3045
Haematology Laboratory
*3041 or 3045
Coagulation Laboratory
*9849
*Insert (045) 84 before extension number for direct access from outside.
Referral Laboratories Contact Numbers
Location
AMNCH Coagulation
AMNCH Haematology
Claymon Laboratories
Telephone
(01) 4143963
(01) 4143961
(01) 2958545
Website Address
www.amnch.ie
www.amnch.ie
www.claymon.com
www.lab-merieux.com
National Centre for Medical
Genetics, Crumlin
(Haemachromatosis Testing)
National Coagulation Centre,
St James Hospital
(01) 4096840
www.genetics.ie/molecular/hh
(01) 4162956
St James Hospital,
Haematology
(01) 4162048
24
www.stjames.ie
7.5 Requesting Investigations
Completing the Request Form
Requests for haematology tests performed in Naas Laboratory (Section 7.17) should be completed
on black and white request forms. Requests for tests referred to external centres should be
completed on white external referral forms.
All sections of the request form should be completed legibly. See separate instructions, Section
2.3.1 for Naas Hospital patients and Section 2.4.1 for patients from external sources.
Sample Collection/labelling
Sample collection and labelling should comply with requirements stated by the sample guide. See
Section 2.0 - 2.4.
Sample Packaging
Sample packaging should comply with requirements stated in the Sample Guide in Section 3.
Transport of Sample to the Laboratory
See Section 3.
7.6 Health and Safety
Universal precautions should be observed when handling all pathological material. It is the
responsibility of the requesting clinician to ensure that samples which pose an infection risk to staff
are clearly identified by a RED STICKER attached to the request form.
7.7 Cut-off Times for Sample Processing and Referral
Day
Monday to Friday
Deadline Times
Samples for:
Monospots, Sickle Cell and Blood Films which reach lab by
will be reported by
13:00
17:00
FBC, ESR, Reticulocytes and Coagulation which reach lab by
will be reported by
16:00
17:00
Haptoglobins which reach lab Monday-Wednesday by
will be reported within 7 working days
13:00
Samples for Referral which reach lab by
will be referred on the same day
09:30
Routine samples arriving after the cut-off times may not be analysed until the next routine working
day.
7.8 Laboratory Notification of Emergency Samples during Routine Hours
Within routine hours please telephone the Haematology department at extension 3041 or 3045, to
ensure that the sample is expected and is handled as an emergency.
7.9 Special Protocols
The protocol for bone marrow sampling is available from the Haematology Laboratory.
7.10 Reporting of Results and Result Enquiries
Results will be available for viewing on wards following authorisation by the laboratory staff. Printed
reports will be issued twice daily from the laboratory and delivered to the named location on the
25
request form via the Pneumatic Tube System (PTS) or by external post. Participants in Healthlink
can obtain their results electronically. In addition, printed copies will also be issued to Healthlink
users.
All result enquiries should be made only during the designated times as outlined in Section 1.5.
Haematology general enquiries should be made to 3041 or 3045.
Coagulation general enquires should be made to 9849.
*Insert (045) 84 before extension number for direct access from outside.
7.11 Retrospective requesting
Haematology and coagulation samples are usually kept for one week after processing. Blood Films
are usually kept for ten months after review. Analyses of additional tests are subject to stability of
analyte. Refer to Section 7.17 regarding time restraints from time of sampling to time of testing. If a
further test is required on a sample that is already in the laboratory which falls within the necessary
time limit for retrospective testing, please contact extension number 3034/3035/3036 or 3037.
7.12 Telephoning Results
Abnormal results falling outside defined limits will be telephoned to the requesting source, if the
specific abnormality hasn’t been notified in the past month.
Critical Values for phoning for Hospital Patients (Routine and On-Call hours) and for GP
Patients within GP hours
Analyte/Test
Haemoglobin
Neutrophils
Platelets
Monospots
PT
Result
< 8.0 g/dL
<1.0 x 109/L
< 50 x 109/L
Positive
>16 secs
APTT
>38 secs
INR results
APTT ratio
Fibrinogen
> 4.0
> 4.2
<1.4 g/L
Comment
If this is the first abnormal result and, if the patient is
not on warfarin
If this is the first abnormal result and, if the patient is
not on anticoagulation therapy.
For patients on warfarin.
For patients on heparin.
Results for hospital patients will be phoned to the relevant personnel in accordance with Section 4.1.
Critical Values for phoning for GP Patients Outside of GP Routine Hours
Analyte/Test
Haemoglobin
Neutrophils
Platelets
Suspicion of new leukaemia
INR
Result
<7.0 g/dL
<0.5 x 10/9L
<10 x 10/9L
Suspicion of new leukaemia
>6.0
26
7.13 Pathology Department Emergency On-Call Services
The On-Call service is available 365 days of the year. The range of tests outside routine hours is
restricted. Please refer to Haematology Blood Sample Guide (Section 7.17)
Emergency On-Call Hours
Day
Time
Monday to Friday
17:00 to 09:30
Saturday and Sunday
24 hours
Bank Holiday
24 hours
Contacting Haematology/Blood Transfusion Emergency On-Call Staff
The Medical Scientist on-call is responsible for Haematology, Coagulation and Blood Transfusion
Departments.
The On-call Medical Scientists ARE NOT in continuous attendance and require notification
for emergencies via the switchboard. Contact the Scientist On-Call through switch. Dial ‘0’ and
ask for the Haematology/Blood Transfusion Scientist On-Call.
Haematology/Coagulation Investigations During On-Call Hours
Refer to Haematology Blood Sample Guide (Section 7.17).
Results are available via the Laboratory Information System once authorised in the Laboratory.
7.14 Urgent Haematology Advice
Routine Hours (09:30 - 17:00)
If URGENT ADVICE is required during routine hours regarding a Haematological problem, please
contact the Haematology Laboratory in Naas Hospital at extension 3041/3045. Laboratory staff can
advise on how to contact the Haematology Team in AMNCH hospital or if necessary the Consultant
Haematologist.
On-Call Hours (17:00 to 09:30)
If URGENT ADVICE is required during emergency on-call hours, please dial ‘0’ and ask for the
Blood Transfusion/Haematology Medical Scientist On-Call. On-call staff can advise on how to
contact the Haematology Team in AMNCH hospital or if necessary the Consultant Haematologist.
7.15 Patients for Haematology Review
A clinical consultative service is available through the Consultant Haematologist, Dr. Niamh
O’Connell, by pre-arrangement only. Dr. O’Connell usually attends Naas Hospital on Wednesdays.
To send a referral, or to request a haematological review by Dr. O’Connell, please fax a brief letter
to 01 4145908 including the contact details of the requester. On review of the letter, Dr. O’Connell
will arrange to see patients in the Out Patients Department or in the Day Ward in AMNCH or in
NGH as clinically appropriate. If a patient is unfit to travel to AMNCH, please indicate this in the
referral letter.
7.16 External Quality Control
The Haematology Laboratory currently participates in a number of QC schemes including:
• Coagulation Quality Assurance Scheme (CQAS)
• Irish External Quality Assurance Scheme (IEQAS)
• UK National External Quality Assurance Scheme (NEQAS)
• Randox International Quality Assurance Scheme (RIQAS)
27
7.17 Sample Guide for Tests Performed in Naas Laboratory
Haematology Blood Samples Guide and Test Availability
Test
Sample Type
Sarstedt Tubes
Maximum Time
from Sampling
to Testing and
Special
Requirements
Frequency
Of Assay
Emergency
On Call
Test Availability
FBC
EDTA 2.7 ml
72 hrs
As required
Yes
Differential
EDTA 2.7 ml
24 hrs
As required
Yes
ESR
EDTA 2.7 ml
24 hrs
Batched
throughout day
Yes
Reticulocyte
EDTA 2.7 ml
48 hrs
As required
Yes
Monospot
EDTA 2.7 ml
48 hrs
Batched once
daily (pm)
Special request
only
Blood Films
EDTA 2.7 ml
24 hrs
As required
No
Sickle Screen
EDTA 2.7 ml
168 hrs
Batched once
daily (pm)
Special request
only
Haptoglobin
Serum
168 hrs (if frozen)
Batched once daily
Mon-Wed (pm)
Not available
Notify lab ASAP.
Immediate
delivery to lab.
A completed malaria
questionnaire is
essential and is
available from the
laboratory.
As required.
Please note this
screen is labour
intensive and time
consuming.
Special request
only
Malaria screen EDTA 2.7 ml
All samples can be sent in the pneumatic tube system (PTS).
28
Coagulation Sample Guide and Test Availability
Test
Sample Type
Special Requirements
Frequency
of Assay
Emergency
On Call
Test Availability
PT/INR
3ml trisodium
citrate
Test within 4 hrs of sampling
As required
Yes
APTT
APTTR
3ml trisodium
citrate
Test within 4 hrs of sampling
As required
Yes
Fibrinogen
3ml trisodium
citrate
Test within 4 hrs of sampling
As required
Yes
D-Dimer
3ml trisodium
citrate
Test within 24 hrs of sampling As required
Yes
Note: Overfilled and underfilled samples will not be tested.
7.18 Referred Samples/Unusual Requests
All haematology and coagulation tests not listed in Section 7.17 are referred to external sources.
A detailed list of all referred tests and their associated special requirements can be found in
Section 11 of this manual. Please refer to Section 11 before taking samples. Information on
special preanalytic requirements or pre-booking of assays can be found in this section.
Samples are referred Monday to Friday only. Samples for referral must be received in Naas
Laboratory no later than 09:30. Samples received after 09.30 will not be referred until the next
routine working day.
If a required haematology test is not listed in the referral section, please contact the Haematology
Laboratory at 3041/3045 where staff will assist you.
29
7.19 Reference Values
Note: All reference ranges listed are correct at time of going to press. Occasionally it may be
necessary to change various reference ranges. Always take note of reference ranges and
comments on individual reports.
Haematology Reference Ranges (3 months – 6 years)
3 Months - 4 yrs
RBC (x 1012/L)
HB (g/dL)
HCT (Ratio)
MCV (fl)
MCH (pg)
MCHC (g/dL)
RDW
PLT (x 109/L)
WCC (x 109/L)
NEU (x 109/L)
LYM (x 109/L)
MON (x 109/L)
EOS (x 109/L)
BAS (x 109/L)
ESR (mm)
Haptoglobin (g/L)
Reticulocyte (%)
4-6 yrs
Female
3.93-4.99
11.0-13.8
0.32-0.40
76 - 87
25.6-30.0
32.9-35.7
11.5 - 13.9
193-489
5.0-12.1
1.7-7.6
1.6-4.2
0.33-1.16
0.05-0.95
0.0-0.50
2-20
0.45-2.05
0.2 –2.0
3.7-5.3
10.5 –14.5
0.33 –0.45
70 - 87
23.0-31.0
30.0-36.5
11.5 -14.9
150-450
5.0-15.0
1.5-7.0
2.0-5.0
0.3-1.1
0.2-2.0
0.0-0.1
2-20
0.45-2.05
0.2 –2.0
Male
3.93-4.99
11.0-13.8
0.32-0.40
76 - 87
25.5-29.6
33.05-35.5
11.8 -14.94
205-450
4.8-11.5
1.7-7.6
1.6-4.2
0.33-1.16
0.05-0.95
0.0-0.50
2-20
0.45-2.05
0.2 –2.0
Haematology Reference Ranges (7 - 10 years)
RBC (x 1012/L)
HB (g/dL)
HCT (Ratio)
MCV (fl)
MCH (pg)
MCHC (g/dL)
RDW
PLT (x 109/L)
WCC (x 109/L)
NEU (x 109/L)
LYM (x 109/L)
MON (x 109/L)
EOS (x 109/L)
BAS (x 109/L)
ESR (mm)
Haptoglobin (g/L)
Reticulocyte (%)
7-8 yrs
Female
Male
3.98-5.11
3.98-5.11
11.3-14.2
11.3-14.2
0.33-0.41
0.33-0.41
77.4-88.3
75.4-87.3
26.3-31.1
25.5-30.4
33.2-36.2
33.4-35.7
11.4-13.68
11.5-14.1
191-439
194-420
5.2-11.7
4.5-10.5
1.8-7.42
1.7-5.9
1.8-4.3
1.7-3.7
0.32-1.21
0.32-1.21
0.08-1.07
0.08-1.07
0.02-0.60
0.01-0.62
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
30
9-10 yrs
Female
Male
4.08-5.06
4.08-5.06
11.9-14.5
11.9-14.5
0.34-0.42
0.34-0.42
77.1-88.6
76.3-89.5
26.8-31.1
26.3-30.7
33.3-35.7
33.3-35.5
11.2-13.3
11.6-13.4
201-384
174-415
4.7-10.0
4.4-10.6
1.7-6.4
1.7-6.1
1.7-3.9
1.4-3.9
0.33-0.99
0.33-0.99
0.06-1.03
0.06-1.03
0.02-0.54
0.01.0.35
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
Haematology Reference Ranges (11 years - 14 years)
RBC (x 1012/L)
HB (g/dL)
HCT (Ratio)
MCV (fl)
MCH (pg)
MCHC (g/dL)
RDW
PLT (x 109/L)
WCC (x 109/L)
NEU (x 109/L)
LYM (x 109/L)
MON (x 109/L)
EOS (x 109/L)
BAS (x 109/L)
ESR (mm)
Haptoglobin (g/L)
Reticulocyte (%)
11-12 yrs
Female
Male
4.13-5.19
4.13-5.19
12.1-14.7
12.1-14.7
0.350-0.426
0.350-0.426
77.5-89.6
78.0-89.5
26.0-31.2
26.6-30.9
33.0-35.6
33.0-35.6
11.2-13.13
11.5-13.43
180-387
178-382
4.8-10.4
4.0-9.6
1.6-6.2
1.6-5.6
1.5-3.7
1.5-3.7
0.36-1.0
0.31-0.92
0.06-1.12
0.06-1.12
0.01-0.38
0.01-0.38
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
13-14yrs
Female
Male
4.03-5.05
4.33-5.42
12.1-14.6
12.4-15.6
0.352-0.43
0.355-0.454
79.7-93.0
78.8-91.5
27.3-32.3
26.9-31.8
33.2-35.2
33.42-35.38
11.5-14.63
11.8-14.1
188-429
183-370
4.5-10.7
4.2-9.3
1.8-7.2
1.7-5.4
1.4-3.6
1.4-3.6
0.38-1.0
0.26-0.87
0.05-0.64
0.05-0.64
0.01-0.43
0.01-0.43
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
Haematology Reference Ranges (15 years - Adult)
RBC (x 1012/L)
HB (g/dL)
HCT (Ratio)
MCV (fl)
MCH (pg)
MCHC (g/dL)
RDW
PLT (x 109/L)
WCC (x 109/L)
NEU (x 109/L)
LYM (x 109/L)
MON (x 109/L)
EOS (x 109/L)
BAS (x 109/L)
ESR (mm)
Haptoglobin (g/L)
Reticulocyte (%)
15-18 Yrs
Female
Male
4.06-5.07
4.46-5.61
11.8-15.1
13.2-16.6
0.352-0.440
0.385-0.490
79.0-93.7
78.9-92.5
26.7-32.5
26.9-31.9
33.0-35.5
33.49-35.2
11.4-14.28
11.7-13.91
170-359
189-374
4.2-10.6
4.2-12.2
1.8-6.5
1.8-6.1
1.3-3.4
1.3-3.4
0.35-1.06
0.31-0.86
0.05-0.57
0.05-0.57
0.01-0.17
0.01-0.29
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
31
Adult
Female
Male
3.8-5.8
4.5-6.5
11.5-16.5
13.0-18.0
0.37-0.47
0.4-0.54
76-96
76-96
27-32
27-32
30-35
30-35
10.0-14.5
10.0-14.5
150-400
150-400
4.0-11.0
4.0-11.0
2.0-7.5
2.0-7.5
1.5-4.0
1.5-4.0
0.2-0.8
0.2-0.8
0.04-0.4
0.04-0.4
0.01-0.1
0.01-0.1
2-20
2-20
0.45-2.05
0.45-2.05
0.2 –2.0
0.2 –2.0
Coagulation Reference Ranges
Test/Units
Range
Comment
PT (secs)
12-14
APTT (secs)
23-33
Fibrinogen (g/L)
1.4-4.0
D- Dimer (µgFEU/ml)
0-0.4µgFEU/ml
The cut off value for
outruling DVT, in conjunction with
a low probability score only, is
0.35µgFEU/ml
Coagulation Therapeutic Ranges
Test/Units
Comment
INR
Diagnosis dependent
APTT Ratio
Diagnosis dependent
32
8. CLINICAL CHEMISTRY
8.1 Introduction
The Clinical Chemistry Laboratory is located on the third floor of Naas General Hospital. Advice
relating to the service or this manual should be addressed to the Consultant Chemical Pathologist,
Dr Gerard Boran, Locum Consultant Chemical Pathologist Dr. Margaret Sinnott or other senior staff.
8.2 Clinical Chemistry Personnel
Please dial appropriate members of staff directly for clinical enquiries and enquires regarding
service provision and operational issues.
8.3 Personnel Contact Numbers
Name
Position
Contact Number
Dr. Gerard Boran
Consultant Chemical Pathologist
01 4143911(at AMNCH)
Dr. Margaret Sinnott
Part-time Consultant Chemical
Pathologist
01 4143911 (at AMNCH)
Chemical Pathology Registrar
01 4143930 (at AMNCH)
01 4142000 & bleep 7285
Ms. Deirdre Geoghegan
Chief Medical Scientist
*3044
Ms. Nora Keogh
Senior Medical Scientist
*3034 or 3044
Ms. Bernadette Jackson
Senior Medical Scientist
*3034 or 3044
*Insert (045) 84 before extension number for direct access from outside.
Fax no. 045 843096
8.4 Useful Contact Numbers
Telephone
Result enquires, retrospective requesting
*Extensions: 3034/3035/3036/3037
Clinical Chemistry general enquiries
*Extensions 3043 or 3044
Referral Laboratories
Claymon Laboratories
(01) 2958545
AMNCH(AMNCH) Biochemistry
(01) 4143951
AMNCH(AMNCH) Endocrinology
(01) 4143955
Beaumont - Toxicology
(01) 8092675
*Insert (045) 84 before extension number for direct access from outside.
33
8.5 Requesting Investigations
Completing Request Form
All sections of the request form should be completed legibly; full surname, forename, hospital
number and date of birth, are mimimun requirements. Addressograph labels are acceptable. Refer
to Section 2.3.1/2.4.1.
Sample Collection/Labelling
Sample collection should comply with requirements stated by the sample guide. Refer to Section 10.
All sections of the sample should be completed legibly; full name, hospital number and/or date of
birth are mimimun requirements.
Refer to Section 2.3.2/2.4.2
Sample Packaging
Packing procedure for transport of samples within the hospital. Refer to Section 3.2/3.3.
Packing procedure for transport of samples from outside the hospital. Refer to Section 3.4.
Transport of Sample to the Laboratory
Samples within the hospital should normally be despatched to the laboratory using the Pneumatic
Tube System (PTS). Refer to Section 3.8.
Transport of samples from outside the hospital should be in accordance with the European
Agreement concerning the International Carriage of Dangerous Goods by Road. (UNADR) Refer to
Section 3.6.
8.6 Health and Safety
Universal precautions should be observed when handling all pathological material. It is the
responsibility of the requesting clinician to ensure that samples which pose an infection risk to staff
are clearly identified by a RED STICKER attached to the request form and sample.
8.7 Pathology Department Opening Times – Normal Hours
Day
Monday to Friday
Time
09:30 – 17:00
Deadline
Deadline:
Samples for General Chemistry
Inpatient samples which reach lab by
will be reported by
Samples for referral
Inpatient sample which reach lab by
will be referred the same day
34
15:30
17:00
09:30
8.8 Special Protocols
The following protocols are available from the Laboratory
• Cardiac Biomarker Testing
• Glucose Tolerance Tests
• Tumour Marker Testing
• Estimated Glomerular Filtration Rate
8.9 Results and Enquiries
Results will be available for viewing on wards following authorisation by the laboratory staff.
Printed reports will be issued twice daily from the laboratory and delivered to wards via the
Pneumatic Tube System (PTS).
All result enquiries should be made to 3034/3035/3036 or 3037, only during the designated times as
outlined in Section 1.5.
Clinical Chemistry general enquiries to 3043 or 3044.
Advice on interpretation of results and sampling procedures will be directed to the appropriate person.
8.10 Retrospective requesting
Clinical Chemistry samples are usually kept for two weeks. Analyses of additional tests are subject
to stability of analyte. If a further test is required on a sample that is already in the laboratory please
contact clinical chemistry department on 3034/3035/3036 or 3037.
8.11 Telephoning Results
Abnormal results falling outside defined limits will be telephoned to the requesting source.
Critical Values for Specific Serum Analytes for phoning.
Analyte
Sodium
Potassium
Urea/Creatinine
Plasma Glucose
Calcium (Corrected )
Phosphate
Magnesium
Amylase
Non ICU Total Protein
Non ICU Albumin
T.Bili
ALT/AST
Urate
Troponin
CK
Ethanol
Paracetamol
Salicylate
CSF Glucose /Protein
ABG’s
Results to be Phoned
<125 mmol/L
>150 mmol/L
<2.50 mmol/L (inpatients)
>6.00 mmol/L
<2.8mmol/L (OPD/GP patients)
<3.5 mmmol/L with any haemolysis
All Grossly Haemolysed
Urea > 12.0 mmol/L with normal creatinine
Urea > 12.0 mmol/L with Creatinine >200 umol/L(First occurrence )
<2.80 mmol/L
> 20.0 mmol/L
<1.90 mmol/L
> 2.90 mmol/L
<0.50 mmol/L
>3.00 mmol/L
<0.60 mmol/L
>1.80 mmol/L
>200 IU/L
<50 g/L and
>100g/L (If first occurrence)
<25g/L
> 250 umol/L ( first time)
>500 IU/L (if first time )
>750 umol/L
All >0.1 ng/ml
>5000 IU/L (500 if first time)
>250 mg/dl
All detectable mg/L
All detectable mg/L
All
All
35
Serum Therapeutic drug critical levels for phoning
Drug
Lithium
Results for Phoning
<0.25 mmol/L
>1.00 mmol/L
Endocrinology critical levels for phoning
Hormone
TSH,FT4
Results for Phoning
Grossly abnormal
8.12 Pathology Department – On-Call Services
The On-Call service is available 365 days of the year. The range of tests outside routine hours is
restricted – see Table below.
Opening Times
Day
Monday to Friday
Saturday and Sunday
Bank Holiday
Time
17:00 to 09:30 the following morning
24 hours
24 hours
Contacting Staff Out Of Hours
The Medical Scientist on-call is responsible for both the Clinical Chemistry and Microbiology
Department.
Contact the Scientist on-call through switch, dial ‘0’
Clinical Chemistry Investigations During On-Call Hours
Common Biochemical Blood Profiles are available.
Exception: Li analysis requires prior consultation with the Consultant Chemical Pathologist.
Results are available via the Laboratory Information System once authorised in the laboratory.
8.13 Point of Care Testing (POCT)
Near patient testing devices situated outside the laboratory give high quality results if used and
maintained correctly. The laboratory presently only supports POCT for blood gas analyers in ICU,
CCU and A&E. All blood gas analysers are password protected and therefore should only be used
by staff that have been trained and issued with their own personal password. Please contact 3043
to arrange training when required. All users are personally accountable for any testing performed
under their password
The laboratory does not currently provide support for other POCT devices e.g. glucometers.
8.14 External Quality Assurance Schemes
The Clinical Chemistry laboratory participates in relevant external third party assurance schemes.
This includes schemes operated by:
UKNEQAS (UK, National External Quality Assurance Scheme)
WEQAS (Welch External Quality Assurance Scheme)
The above schemes are fully CPA Accredited
36
8.15 Sample Guide
Blood Samples
The common sample requirements are heparinised plasma, serum, fluoride-oxalate plasma and
EDTA whole blood.
Sample Guide: Blood Tubes
Tube Type
Lithium Heparin
Tube
Fluoride Oxalate
Tube
EDTA Tube
Plain, Clotted Tube
Yellow Top
Tests
Electrolytes, Urea and Creatinine
Liver function tests
Bone Profile
Lipid Profile
Magnesium, Uric Acid, C-Reactive protein
Alcohol, Paracetamol and Salicylate
Cardiac Biomarkers Thyroid Function tests PSA
Glucose
Pink Top
White Top
HbA1c
Lithium
Orange Top
Urine Samples
Analytes in urine are usually determined in one of the following:(1) timed collection (e.g. 24 hour),
(2) random/spot urine, (3) random urine with results expressed as a ratio with creatinine.
Care should be taken to ensure adequate collection and preservation of the sample.
Urine Containers and Collection Instructions can be obtained from Sample Reception.
Sample Guide: Urine Containers
Test
Calcium
Creatinine*
Micro albumin
Phosphate
Potassium
Protein
Sodium
Urea
Storage
(Refrigerate)
(Refrigerate)
(Refrigerate)
(Refrigerate)
(Refrigerate)
(Refrigerate)
(Refrigerate)
Container Requirements
ACID
PLAIN
24hr. urine with
24hr. urine
10 mL HCL
container
SPOT /RANDOM
Universal
Container
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
*For Creatinine Clearance: Serum for creatinine determination must be taken during the 24 hr urine
collection.
Referred samples/ Unusual Requests
Samples for some specialised analysis are referred to external laboratories.
Please contact a senior member of laboratory staff to discuss any unusual requests before sending
the sample.Some analyses have preanalytic requirements e.g. fasting or special transport
requirements. i.e. may have to be transported frozen, or frozen within a specified time frame of
receipt in the laboratory.
37
8.16 Adult Reference Values
Adult reference values for investigations analysed in the biochemistry laboratory are tabulated
below. Please note that reference intervals for urine vary markedly with body size (hence with sex
and age), diet and renal function.
Reference ranges are method dependent and can change if there has been a change in assay
methodology. Changes in reference ranges will be highlighted on report forms.
Adult Reference Values
General Clinical Chemistry – Common Profiles
General Clinical Chemistry – Common Profiles
Analyte
Reference Ranges
Renal Profile - Plasma
Sodium
135-145
Potassium
3.5-5.0
Chloride
95-105
Urea
2.1 – 7.1
Creatinine
62-106 (M)
44-80 (F)
Liver Profile - Plasma
Total Protein
Albumin - plasma
Total Bilirubin - plasma
Gamma Glutamyltransferase (GGT)
Alkaline Phosphatase (ALK)
(Age related ranges available from Lab)
Alanine Aminitransferase (ALT) -plasma
Bone Profile - Plasma
Calcium – plasma
Albumin - plasma
Phosphate – plasma
Alkaline Phosphatase (ALK) – plasma
(Age related reference ranges available)
Lipid Profile - Plasma
Cholesterol - plasma
Triglyceride - plasma
High Density Lipoprotein (HDL) - plasma
Low Density Lipoprotein (LDL) - plasma
Units
mmol/L
mmol/L
mmol/L
mmol/L
µmol/L
64-83
34-48
1.0 – 17.0
< 60 (M)
< 40 (F)
53-128 (M)
42-98 (F)
1.0 –41.0 (M)
1.0-31.0 (F)
g/L
g/L
µmol/L
2.20-2.70
34-48
0.87-1.45
53-128 (M)
42-98 (F)
mmol/L
g/L
U/L
Target Levels
1.0-5.2
<2.1
>1.5 (M)
>1.7 (F)
<3.3
38
U/L
U/L
U/L
U/L
mmol/L
mmol/L
mmol/L
mmol/L
Additional Blood Chemistries Adult Reference Ranges
Additional Blood Chemistries
Magnesium - plasma
Uric Acid - plasma
C- Reactive Protein (CRP) - plasma
Additional Enzymes - Plasma
Amylase
Lactate Dehydrogenase (LDH)
Aspartate Aminitransferase (AST)
Cardiac Markers - Plasma
Creatinine Kinase (CK)
Reference Ranges
0.65-1.05
0.201- 0.413 (M)
0.142 – 0.336 (F)
<6
28-100
135-225
135-214
1.0-37.0
1.0-31.0
Units
mmol/L
mmol/L
mmol/L
U/L
(M)
(F)
(M)
(F)
U/L
U/L
CKMB index
Troponin T
39-308 u/l (M)
26-192 u/l (F)
<4%
<0.1ng/ml
U/L
%
ng/mL
Therapeutic Drug monitoring
Lithium - serum
0.8- 1.2
mmol/L
Toxicology Adult Decision Levels
Toxicology Plasma
Alcohol
Adult Decision Levels
Up to 100mg/dl:
Euphoric changes, some impairment
100-300mg/dl:
Drowsiness, confusion
>300mg/dlL
Impaired consciousness, coma
Paracetamol
Refer to nomogram:- (available from the Clinical Chemistry
Department)
Toxic:
>200mg/l at 4 hours post ingestion.
>30mg/l at 15 hours post ingestion.
Salicylate
Non detected:
Therapeutic:
Toxic: Mild
Toxic: Moderate
Toxic: Major
<5mg/dl
15-29 mg/dl
30-44mg/dl
45-70 mg/dl
>70mg/dl
39
Endocrinology Adult Reference Ranges
Endocrinology - Plasma
Free Thyroxine (Free T4)
Thyroid Stimulating Hormone (TSH)
Total PSA
Reference Range
12-22
0.4-4.0
0-4.0
Units
pmol/L
mU/L
ng/mL
CSF Adult Reference Ranges
CSF
Reference Range
Units
CSF Glucose
CSF Protein
2/3 of contemporary glucose concentration
15-45
mmol/L
mg/dL
Blood Gas
Reference Range
Units
pH
Hydrogen ion concentration
PCO2
PO2
Actual Bicarbonate
Standard Bicarbonate
Base excess
Oxygen saturation
Carboxyhaemoglobin (as % Hb)
Lactate
7.35-7.45
35 – 45
4.67-6.40
11.1-14.4
24-31
22.5-26.9
-2.7- +2.5
0.95-0.99
0.000-0.008
0.5-1.6
nmol/L
kPa
kPa
mmol/L
mmol/L
mmol/L
%
%
mmol/L
Blood Gas Adult Reference Ranges
Urine Chemistries Adult Reference Ranges
Analyte
Sodium
Potassium
Calcium
Phosphate
Creatinine
Urea
Protein
Sodium
Potassium
Microalbumin
Sample
24hr. Plain
24hr. Plain
24hr. Acid
24hr. Acid/Plain
24hr. Plain
24hr. Plain
24hr. Plain
Random
Random
Early Morning
Mid-Stream
Reference Range
40-220
25-125
2.5-8.0
13-42
90000-190000
250-580
0.028-0.141
Decision point < or > 20
Decision point < or > 20
Units
mmol/day
mmol/day
mmol/day
mmol/day
umol/day
mmol/day
g/day
<2.5
mg/mmol
CSF Adult Reference Ranges
Interference
Many tests are subject to interference. This may be due to biological/day-to-day variation, preanalytical variation e.g. haemolysis, analytical variation e.g. specific method used and interactions with
various drugs. The report may mention common interferences e.g. haemolysis, lipaemia and icterus. A
list of substances known to interfere with each method is available in the Clinical Chemistry Laboratory.
40
Glucose Adult Reference Ranges
Glucose Levels
Fasting Glucose
Random Glucose
Post-Prandial Glucose
Reference Ranges
2.8-6.0
2.8-7.8
2.8-7.8
Units
mmol/L
mmol/L
mmol/L
Diabetes and Hypoglycaemia
The following table summarises the 2006 WHO Recommendations for the diagnosis of
diabetes and intermediate hyperglycaemia
Diabetes
(a) Fasting plasma glucose
or
(b) 2-h plasma glucose*
or
(c) A random venous plasma concentration
> 7.0 mmol/L
≥ 11.1mmol/L
≥ 11.1mmol/L
Symptoms + 1 of the above or asymptomatic + 2 of the above are diagnostic.
Impaired Glucose Tolerance (IGT)
Fasting plasma glucose < 7.0 mmol/L
And
2-h plasma glucose*
>7.8 and < 11.1mmol/L
Impaired Fasting Glucose
(IFG)
Fasting plasma glucose
6.1- 6.9 mmol/L
All those with IFG should have an Oral Glucose Tolerance Test (OGTT), to exclude the
diagnosis of diabetes.
* Venous plasma glucose 2-h after ingestion of 75g oral glucose load/ Oral Glucose
Tolerance Test.
Procedure For Performing OGTT can be obtained from the Clinical Chemistry Laboratory
Unexplained Hypoglycaemia below the following cut-off should be considered for further
investigation:
• Fasting venous plasma glucose ≤ 2.5mmo/l
Albumin/Creatinine ratio
>2.5mg/mmol indicates microalbuminuria
Haemoglobin A1c
4.6-5.8% (DCCT Calibrated)
41
9. MICROBIOLOGY
9.1 Introduction
The Microbiology Laboratory is located in the Pathology Dept on Level 3.
9.2 Microbiology Personnel Contact Numbers
Various therapeutic and diagnostic services are listed below:
Name
Position
Contact Nunber
Consultant Microbiologist
Prof. Philip Murphy (AMNCH)
01- 4143352
Chief Medical Scientist
Ms. Maria Quinn
Ext. 3039
Senior Medical Scientist
Ms. Sarah Hendrick
Ext. 3039
Infection control Nurse Manager
Ms. Fiona Doyle
Ms. Fiona Conway
Ext. 9935
Bleep #225
Microbiology enquiries /
reports / results
Ext. 3036/3037
Sample reception
Ext. 3033
Microbiology main lab
Ext 3038/ 3039
Microbiology on-call
Contact switch
9.3 Microbiology Routine hours
Day
Monday to Friday
Monday to Friday
Time
09:30 – 17:00
09:30 – 17:00
Deadline
Samples in lab by 16:00
Referred samples in lab by 09:30
Routine samples arriving after the cut-off times will be analysed during the next working day.
9.4 Laboratory Notification of Emergency Work.
Laboratory Notification of Emergency Work During Routine Hours.
Within routine hours please telephone the Microbiology laboratory (Ext. 3038 / 3039) or sample
reception (3033). This is essential to ensure that the sample is expected and is handled as an
emergency test. Please note that marking a sample “Urgent” will not cause it to be handled urgently
unless the Microbiology laboratory has been telephoned.
9.5 Laboratory Notification of Emergency Work Outside of Routine hours.
The emergency service is available on a 24-hr. basis and is restricted to true emergencies. Other
tests may be requested but these would require validation by the laboratory medical staff on duty.
* There is no routine microbiology service available on Saturdays and Sundays, only emergency
work will be processed.
To request emergency work outside normal working hours, i.e. from 17:00 until 09.30 Monday to
Friday and 24 hours on Saturday and Sunday, contact switch to call the scientist on-call for
Microbiology / Clinical Chemistry.
42
9.6 Clinical Consultation.
A clinical consultative service is available through the consultant microbiologist during routine hours
at 01- 4143352. The consultant Microbiologist may be contacted out of hours via the on-call
scientist.
9.7 General Guidelines on Microbiological Samples.
Microbiology results depend critically on the type and quality of the material received. Therefore this
material should be both representative and fresh. All samples should have their container lids
securely tightened prior to transportation to ensure safe arrival in the laboratory. Package all
samples in zip lock bags before being sent through the Pneumatic Tube System (PTS).
9.8 Safety
Any samples from known infectious patients e.g. HIV, hepatitis or TB should have a red sticker
attached to both sample and form. Transmissible spongiform encephalopathy agents (CJD) samples should be marked with a “Bio-Hazard” label.
For safety reasons sample containers, request forms, or plastic transport bags which are
contaminated with either blood or urine will not be accepted for processing by the Laboratory.
The following items are not to be sent through the PTS in any situation
• CSF samples.
• Skin scrapings for meningococcal detection.
9.9 Storage
Should there be any delay in the transport of any sample to the Microbiology Laboratory the
following storage will be required.
9.10 Storage conditions for Microbiology samples
Sample type
Trans swabs/ Blood samples / Mycology
Blood Cultures
Urines/Faeces/Sputa/Fluids
CSF samples
Semen samples
Storage conditions
Room temperature (RT°C)
Room temperature.
Refrigerate at 4˚C.
Deliver to lab immediately.
Deliver to lab within one hour of producing sample.
9.11 Retention times
After processing, microbiological samples will be retained for a certain period of time should further
analysis be required.
9.12 Retention times
Microbiologial samples
Microbiological samples
(excluding Urines & CSFs)
Urines
CSF for Microbiology
Positive Blood culture bottles
Blood culture isolates
Microbiological slides
Retention time
One week after processing at RT°C
One week after processing at 4°C
One month at 4°C
Three months at RT°C
One year (frozen)
One year after processing
43
9.13 Samples Processed in Naas Microbiology Laboratory
Urine: Routine Culture and Sensitivity (C/S) testing: Clean mid-stream sample (MSU) or catheter
sample (CSU) in a sterile urine container. It is essential to tighten container lids to prevent
leakages. Urinary catheter tips are not suitable for analysis of suspected urinary tract infection
(UTI).
Faeces: Routine Culture and Sensitivity (C/S), Ova and Parasites, Clostridium difficile culture and
toxin testing, occult blood testing: Faeces container. Ensure sufficient sample is provided if more
than one test is requested.
Sputum: Routine Culture and Sensitivity (C/S) testing. Sterile universal container. (Salivary
samples are not suitable for microbiological investigation). Samples should be purulent /
mucopurulent. Separate samples are required for Zn and Cytology investigations.
General wound swabs: Transwabs (Blue) i.e. in their own transport medium.
I.V Tips: 4 cm tip in a sterile universal container.
Pus / Fluids: Sterile universal container. If glucose and protein testing is required this should be
indicated on the form and will be processed in the Clinical Chemistry laboratory.
Blood culture: A blood culture set consists of an aerobic (blue) bottle and an anaerobic (maroon)
bottle. Ensure strict aseptic technique is used when inoculating the blood culture bottles.
CSF: Sterile universal container. Please indicate the order in which the samples are taken i.e. 1, 2,
3. These samples are never sent via the PTS. Glucose and protein testing is performed in the
Clinical Chemistry laboratory.
MRSA screens: Surveillance swabs from a patient with known or suspected MRSA colonisation or
infection: Refer to Infection Control Manual Section 3.
• Swab right and left nostrils (one swab only)
• Swab groin / perineum (one swab only)
Semen analysis: Infertility assessment and post-vasectomy analysis. Sterile universal container.
Sample must be received in the laboratory within one hour of the sample being produced. Cut off
time of 15:00, Monday to Friday. Morphology assessment is performed in the Endocrinology
laboratory in the Mater hospital. For further details on sample collection please contact the
Microbiology Laboratory.
Antibiotic assays (vancomycin and gentamicin levels during routine hours Monday to
Friday): Serum samples (White Top) vancomycin and gentamicin peak levels should be taken 1
hour post administration of antibiotic dose. Trough levels should be taken immediately prior to the
administration of the next dose. Details of dose and timing should be recorded on the request form
and samples. Random levels are difficult to interpret. If taken to determine whether another dose
should be given they should be considered trough levels and the time from last dose recorded on
the request form. Outside routine hours these assays are performed in AMNCH.
44
9.14 Referred Tests
Samples for some specialised analyses are referred to external laboratories. The time and
frequency of dispatch varies. All microbiological referred samples are to be processed through the
Microbiology Laboratory.
Urine: ZN / TB testing: Performed in AMNCH when clinically indicated.
Meningococcal PCR: EDTA whole blood and CSF. This test is performed in the Irish
Meningococcal and Meningitis Reference Laboratory, Children’s University Hospital, Temple St.
Antibiotic assays: Serum samples (White Top), Teicoplanin, Amikacin and Tobramycin levels are
performed in AMNCH. Peak levels should be taken 1 hour post administration of antibiotic dose.
Trough levels should be taken immediately prior to the administration of the next dose. Details of
dose and timing should be recorded on the request form and samples. Random levels are difficult
to interpret. If taken to determine whether another dose should be given they should be considered
trough levels and the time from last dose recorded on the request form.
Virology/Serology: Serum sample (White Top).
Mycology: Sterile universal container. This test is performed by Claymon laboratories.
Chlamydia: Chlamydia swabs are available on request from the Microbiology laboratory. Females
– endocervical swab and/or first catch urine for PCR. Males – first catch urine/ urethral swab for
PCR. This test is performed in the National Viral Reference Laboratory (NVRL).
Faeces: Viral studies: A separate sample and request form is required for viral studies as this test
is performed in the NVRL. If only one sample is received with multiple requests it will cause delays
in referring samples to outside laboratories
Faeces: Reducing substances: Sample must be in Temple St. within 2 hours of taking. Send
directly from requesting ward / GP and do not send through the laboratory.
Sputum: ZN/TB testing. A separate sample and request form are required. This test is performed in
AMNCH.
Virology swabs: Viral transport swabs are available from the Microbiology laboratory.
9.15 Special investigations, other referred tests
This is not a complete list of all microbiological analyses available.
All samples undergo routine culture and sensitivity (C/S), if other specific investigations are
required, please contact the Microbiology laboratory.
9.16 Results and Reporting.
Individual reports are issued for each sample. They are delivered to the given location via the PTS.
Results are available on the ward terminals immediately they are authorised.
9.17 Which results are telephoned?
All positive CSF samples, all skin scrapings positive for Meningococcal disease, all positive Blood
Cultures and all abnormal Antibiotic Assays. All other results will be available on the ward terminals.
45
9.18 List of tests available outside of routine hours 17:00 – 09:30.
• All CSF samples where a diagnosis of infectious meningitis is suspected.
• All Skin scraping samples where a diagnosis of Meningococcal septicaemia is suspected.
• Blood cultures.
• Urgent urine samples.
• Emergency antibiotic assay which cannot wait until the following morning - Contact the
Consultant Microbiologist.
• Hepatitis B/C: Acute pre-dialysis patients or Hepatitis B needlestick injuries. Need to contact
the NVRL person On-Call once approved by a Consultant Microbiologist / Pathologist at the
requesting hospital. The on-call service can be accessed outside normal hours by contacting
and leaving a concise message (contact name/Hospital / Tel No. / Ext) at Airpage relays Tel.
No: 01-2830800, bleep No. 140898.
9.19 Infection Control.
There is an Infection Control Committee (ICC) responsible for hospital infection control policy and
an Infection Control Team (ICT) responsible for the day-to-day control of hospital infection. The ICT
is committed to the provision of quality healthcare to all patients. The ICT will facilitate the effective
prevention, detection and control of hospital infection in patients, staff and visitors. There is an
infection control manual which describes the objectives and content of the infection control
programme and contains all policies and procedures. This manual is available in all clinical areas.
9.20 External Quality Control
The microbiology laboratory currently participates in the UK National External Quality Assessment
Service for Microbiology (UKNEQAS).
The areas covered include:
• General bacteriology
• Antimicrobial susceptibility
• Faecal parasitology
• Antibiotic assays.
9.21 Useful Links
Contact numbers
Institution
National Virus Reference Laboratory
(NVRL)
Telephone
01-7161323
01-7161354
Web Address
www.nvrl.ie
Claymon laboratories
01-2958545
www.claymon.com
Irish Meningococcal & Meningitis
Reference Laboratory (IMMRL)
01-8784432
Microbiology Laboratory, AMNCH
Main microbiology laboratory, AMNCH
01-4143941
01-4143942
www.amnch.ie
St. James’s Hospital
01-4143000
www.stjames.ie
46
9.22 Turnaround times for Microbiology samples
Test
Sample
Sample Volume
C/S Abscess swab
C/S Abscess fluid
C/S Arterial/
Central line/tip
C/S Ascitic fluid
C/S BAL
C/S Blood culture
Abscess swab
Abscess fluid
Arterial line/tip
Transport swab
Total sample
4 cm approx. of tip
Ascitic fluid
BAL
Blood
5- 10 mls
Total sample
5-10 ml per bottle
C/S Bile fluid
Bile fluid
5- 10 ml
C/S
Cerebrospinal fluid 3 samples
Cerebrospinal fluid
Special
Instructions
4°C immediately
4°C immediately
Turnaround
Time
48-96 hrs
48-96 hrs
24-48 hrs
4°C immediately
48-96 hrs
48-96 hrs
24 hrs- 21 days
Incubate
immediately or
leave at RT°C
4°C immediately
Process immediately,
do not send in PTS.
C/S/ Cervical swab
C/S Ear swab
C/S Endocervical
swab
C/S Eye swab
C/S Faeces
Cervical swab
Transport swab
Ear swab
Transport swab
Endocervical swab Transport swab
48-96 hrs
24-48 hrs
culture
1 hr microscopy
48-96 hrs
48-96 hrs
48-96 hrs
Eye swab
Faeces
48-96 hrs
48-96 hrs
C/S Fluid aspirate
C/S HVS
C/S Joint aspirate
C/S Mouth swab
C/S Nasal swab
C/S Penile swab
C/S Peritoneal fluid
C/S Pleural fluid
C/S Pus/ Pus swab
C/S Skin swab
C/S Sputum
C/S Throat swab
C/S Urethral swab
C/S Ulcer swab
C/S Urine
C/S Vulval swab
C/S Wound swab
M.R.S.A screen
Fluid aspirate
HVS
Joint aspirate
Mouth swab
Nasal swab
Semen analysis
Peritoneal fluid
Pleural fluid
Pus/ Pus swab
Skin swab
Sputum
Throat swab
Urethral swab
Ulcer swab
Urine MSU,CSU
Vulval swab
Wound swab
Nasal & groin
swabs
Semen
BAL: Bronchoalveolar Lavage
HVS: High vaginal swab
Transport swab
1/3 of a universal
container.
5 – 10 ml
Transport swab
5-10 ml
Transport swab
Transport swab
Transport swab
5 – 10 ml
5 – 10 ml
Transport swab
Transport swab
1 ml non-salivary
Transport swab
Transport swab
Transport swab
10 ml
Transport swab
Transport swab
Transport swabs
Complete sample
C/S : Culture and Sensitivity
MSU: Mid stream urine
47
4°C immediately
4°C immediately
4°C immediately
4°C immediately
4°C immediately
Sample must be
received within 1 hour
of being produced.
Incubated at 37°C
immediately
48-96 hrs
48-96 hrs
48-96 hrs
24-48 hrs
24-48 hrs
48-96 hrs
48-96 hrs
48-96 hrs
48-96 hrs
48-96 hrs
24-48 hrs
24-48 hrs
48-96 hrs
48-96 hrs
24-48 hrs
48-96 hrs
48-96 hrs
48-96 hrs
Same day for
microscopy.
Morphology
referred 10 days
approx.
CSU: Cathether sample urine
10. HISTOPATHOLOGY DEPARTMENT (AMNCH)
All Histology /Cytology specimens received in NGH are sent to and processed in the Histopathology
Department at AMNCH.
All Histology specimens taken must therefore meet the AMNCH Specimen Acceptance Criteria as
outlined below.
Sample Acceptance Criteria for Histology Specimens
Completing the Request Form
The following information must be documented in a LEGIBLE manner on all sheets of the request
form.
Items marked with an * are minimum identifiers and failure to provide the minimum data
required will delay processing of the sample.
1.
*Patient’s Hospital Number (If request is on a registered patient)
2.
*Patient’s Full Surname and Full Forename.
3.
*Patient’s Date of Birth
4.
*Specimen Type
5.
Clinical Details
6.
Patient’s Full Current Address
7.
Patient’s Location (Hospital Ward)
8.
Consultant/Clinician name
9.
Legible Signature of requesting Doctor
10. Contact or Bleep Number of requesting Doctor
11. Priority Status of Request (Urgent or Routine)
12. Details of any sample associated Infection Risk
Labelling the Sample Container
The following information must be documented in a LEGIBLE manner on all sheets of the request
form.
Items marked with an * are minimum identifiers and failure to provide the minimum data
required will delay processing of the sample.
1.
*Patients’ Full Surname
2.
*Patients’ Full Forename
3.
*Hospital number
4.
*Date of birth
5.
*Specimen Type
48
11. PATHOLOGY REFERRED TESTS
The following tests are referred to other centres, Monday to Friday only. (*T-Time = Turnaround Time)
Test Name
Sample Type
Location of Test
Acetylcholine
Antibodies
Serum
Claymon
Acid Fast Bacilli (AFB)
See Zn/TB
AMNCH
Activated Protein C
Resistance (APCR)
Special Requirements
*T-Time
4 days
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia
Contact NVRL for sample
requirements
____
Adenovirus
Serum / Faeces
sample
NVRL
Adrenaline
(Epinephrine)
EDTA
Claymon
9 days
Adrenaline (Urine)
24 hr Urine
(Acid Washed)
Claymon
10 days
Adrenocorticotrophic
Hormone (ACTH)
Special tube
available form lab.
(EDTA + Aprotinine)
Claymon
Sample frozen less than 30 minutes 6 days
Aldolase
Serum
Claymon
3 days
Aldosterone (Serum)
Serum
Claymon
1st sample: patient lying overnight 4 days
2nd sample: patient standing for at
least 1 hour
Aldosterone (Urine)
24hr Urine (Plain)
Claymon
3 days
Alpha 1 Anti-Trypsin
Serum
Claymon
3 days
Alpha Feta Protein
(AFP)
Serum
AMNCH
Alpha gliadin antibodies
(AGA)
Serum
Claymon
Amikacin
Serum
AMNCH
Aminophylline
Lithium Heparin
AMNCH
Amiodarone
Serum
Claymon
Spin and Freeze
9 days
Amphetamine
MSU
Beaumont
Part of drug urine screen
2 days
49
Spin and Separate
5 days
3 days
6 days
Be in Lab by 09.30 trough &
peak samples together
1 day
2 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Amylase (Urine)
24hr Urine (Plain)
Claymon
3 days
Androstenedione
Serum
Claymon
15 days
Angiotensin Converting
Enzyme (ACE)
Serum
Claymon
3 days
Angiotensin II
EDTA
Claymon
Spin and freeze <30minutes
AMNCH
Part of thrombophilia screen.
Refer to Thrombophilia Screen
Anti-Cardiolipin
Antibodies
16 days
____
Anti Citrullinated Peptide
(CCP) Antibodies
Serum
Claymon
3 days
Anti double stranded
(ds) DNA Antibodies
Serum
Claymon
4 days
Anti endomysium
antibodies
Serum
Claymon
4 days
Anti-GAD Antibodies
Serum
Claymon
3 days
Anti- Gliadin Antibodies
Serum
Claymon
4 days
Anti glomerular
basement membranes
Serum
Claymon
6 days
Anti-Hep. B core
Serum
NVRL
7-10 days
Anti Hepatitus B (Titre)
Serum
NVRL
7-10 days
Anti Heparin Platelet
Factor 4 Complex
antibodies
Citrated Plasma
Claymon
Spin and freeze <30minutes
8 days
Anti-HLA antibodies
1 serum
NBC
Label sample with name,
D.O.B and date sample taken
2 days
Anti-Insulin Antibodies
Serum or EDTA
Claymon
Spin and Freeze within 1 hour
7 days
Anti- Intrinsic Factor
Antibodies
Serum
Claymon
11 days
Anti LKM Antibodies
Serum
Claymon
1 day
Anti-Microsomal
Antibodies
Serum
Claymon
11 days
50
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Anti- Mitrochrondial
Antibodies
Serum
Claymon
Anti Nuclear Antibodies
(ANA)
Serum
Claymon
Anti Neutrophilic
cytoplasmic antibodies
(ANCA)
Serum
Claymon
6 days
Anti-Parietal Cell
Antibodies
Serum
Claymon
9 days
Anti-Phospholipid
Screen
1 Serum
AMNCH
Anti Platelet
Alloantibodies
Serum
NBC
5 days
Anti Platelet Antibodies
Serum
NBC
5 days
Anti Signal Profile
Antibodies (SRP)
Serum
Claymon
5 days
Anti single strand (ss)
DNA Antibodies
Serum
Claymon
14 days
Anti Smooth Muscle
Antibodies (ASMA)
Serum
Claymon
6 days
Anti Streptolysin O titre
(ASOT)
Serum
Claymon
6 days
Antithrombin (AT)
6 days
If >160 anti ENA and anti NA
antibodies will be carried out
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen
6 days
____
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen
____
Further investigation of thyroid
function will only be done if
clinically indicated
2 days
Further investigation of thyroid
function will only be done if
clinically indicated
6 days
Anti-thyroidperoxidase
antibodies (TPO)
Lithium Heparin
AMNCH
Anti-Trypsin Antibodies
Serum
Claymon
Anti-TSH Receptor
Antibodies (TRAB)
Serum
Claymon
Aspergillus Serology
Serum
Claymon
7-10
days
Atypical Pneumonia
Serum
NVRL
7- 10
days
51
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
7-10 days
Atypical Viral Screen
Serum
NVRL
Auto-immune Screen
Serum
Claymon
Barbiturates (Blood)
Serum
Beaumont
Part of Blood Toxicology Screen
2 days
Barbiturates (Urine)
MSU
Beaumont
Part of Urine Toxicology Screen
2 days
Bence Jone Protein
Random Urine
20mls and Serum
AMNCH
Early morning urine sample
preferable. Serum specimen also
required
5 days
Benzodiazepines (Blood)
Serum
Beaumont
Part of Blood Toxicology Screen
2 days
Benzodiazepines (Urine)
MSU
Beaumont
Part of Urine Toxicology Screen
2 days
Beta (2) HCG as a
Serum
AMNCH
Li Heparin
AMNCH
1 day
Beta (2) glycoprotein
Serum
Claymon
8 days
Beta (2) microglobulin
Serum
Claymon
Spin and separate on receipt in lab 3 days
Tumour Marker
Beta (2) HCG for
Pregnancy Testing
(Serum)
Bone Biomarkers
Note: Can also be measured in
1 day
Urine, CSF and Fluids.
Ensure sample received matches
the specific request
Contact
Biochemistry Lab
NGH
Bone Marrow Aspirate Minimum of 4 bone
marrow slides and 1
EDTA sample taken
at same time
as aspirate
Metabolic Lab
SVH
Contact Senior Scientist,
Biochemistry Department, NGH
prior to taking specimens.
Variable
AMNCH
Notify Naas laboratory.
To lab by 09.30
15 days
RPMI medium available from
haematology. If left overnight
store at 4°C
1-6
weeks
Notify Naas laboratory.
To lab by 09.30
10 days
Bone Marrow
Cytogenetics
Bone Marrow in
RPMI
Bone Marrow Trephine
Biopsy
In Formaliin
AMNCH
Borrelia burgdorferi
(Lyme disease)
Serum
NVRL
52
7-10
days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Brucella serology
Serum
Claymon
B12
Serum
Claymon
C282Y Mutation
(Haemochromatosis)
Refer to
Haemochromatosis
Crumlin
National Centre for
Medical Genetics,
Ca 15.3
Serum
AMNCH
Spin and separate
3 days
CA 19.9
Serum
AMNCH
Spin and separate
3 days
CA 125
Serum
AMNCH
Spin and separate
3 days
Calcium (Ionised)
SST Tube available
from lab
AMNCH
To lab immediately. Allow to
coagulate without opening tube,
centrifuge and freeze without
decanting. Freeze in original
unopened tube
3 days
Calcitonin
Serum
Claymon
Calicivirus
Serum
NVRL
Cannabis (Urine)
MSU
Beaumont
Carbamazepine
Lithium Heparin
AMNCH
Cathecholamines
(plasma)
Lithium Heparin
Claymon
2ml Frozen within 30 minutes
12 days
Cathecholamines
(urine)
24hr urine acid
washed
Claymon
Special requirements. Conact
Biochemistry beforerequesting
5 days
CD4 Count
1 Fresh EDTA
SJH
Clinical details essential. To Naas
Lab Reception by 09.30 Mon-Fri.
3 days
Carcinoembryonic
Antigen (CEA)
Serum
AMNCH
Spin and separte on receipt in Lab. 3 days
Ceruloplasmin
Serum
Claymon
3 days
Chlamydia
Urine,
Chlamydia swab
C1 inhibitor
(Functional)
Lithium
Heparin/Serum
7-10 days
Exclude haemolysed samples
5 days
3 month
Patient should be fasting overnight. 5 days
Spin and freeze sample <4hours
7-10 days
Part of Urine Toxicology Screen
2 days
2 days
National Virus
Females: Endocervical swab and/or 7-10 days
Reference Laboratory first catch for PCR. Males:First catch
urine / urethral swab for PCR.
Claymon
53
10 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
C1 Inhibitor (Total level)
Serum
Claymon
6 days
Creutzfeld-Jakob
Disease (CJD)
CSF
Neuropathology Lab,
Beaumont Hospital
Variable
Clobazam
Serum
Claymon
Spin and Freeze
7 days
Clonazepam
Serum
Claymon
Spin and Freeze
21 days
Clozaril
EDTA
Claymon
Clozapine
EDTA
Claymon
4 days
CMV (Cytomegalovirus)
Serum
NVRL
7-10 days
Coagulation correction
tests
6 trisodium citrate
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Coagulation Factor
assays (excluding FVIII
and FIX)
6 trisodium citrate
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Coagulation factor
inhibitor assay
2 trisodium citrate
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Cocaine (Urine)
MSU
Beaumont
Part of Urine Toxicology Screen
2 days
Coeliac Screen
Serum
Claymon
4 days
Cold agglutinins
Serum
Claymon
Sample must be kept at 37-C prior to 6 days
separation. Must be separated before
transporting to Claymon.
Complement
( C3 and C4)
Serum
Claymon
Complement component
required needs to be specified
on request form.
6 days
Conjugated Bilirubin
Lithium Heparin
AMNCH
Speak to Senior in Biochemistry
prior to ordering test.
2 days
Copper
Serum or Plasma
Claymon
Coronavirus
Serum
NVRL
Cortisol (Blood)
Lithium Heparin
AMNCH
54
Glass Free Tube, No Rubber Cap, 6 days
No Vacutainer. Avoid contact with
rubber, metal, glass and silica
7-10 days
Times must be specified on
samples
2 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Cortisol(Urine)
24hr Urine (Plain)
Claymon
Cotinine (Urine)
MSU
Claymon
Coxsackie
Serum
NVRL
Coxiella burnetti
(Q Fever)
Serum
NVRL
Acute sample & 2nd sample
10-14 days later
C-peptide
Serum
Claymon
Spin and Freeze on receipt in lab
Cryoglobulins
Serum
Claymon
4 ml Serum. Draw blood into 37 12 days
degree prewarmed tube.Transport
tube at ambient temperature
Cryptosporidium
Faeces
Cherry Orchard
Cyclosporin
2 EDTA
Claymon
Cystine(Urine)
24hr Urine(Plain)
Claymon
Cystic Fibrosis
(Genetic Testing)
1 EDTA
National Centre for
Medical Genetics,
Crumlin
Clinical details essential
Cytology
Urine, Sputa,Fluids,
Bronchial washings
AMNCH
Separate sample required
DHEA
Serum
Claymon
Diazepam
2 Serum
Claymon
Digoxin
Lithium Heparin
AMNCH
Drug Screen (Blood)
Serum
Beaumont
Drug Screen (Urine)
MSU
Beaumont
E.coli 0157
Faeces
Cherry Orchard
Electrophoresis
(Haemoglobin)
SJH
55
2 days
7-10 days
7-10 days
7-10 days
7 days
7-10 days
3 days
Spin and Freeze
6 days
2 days
Profile consists of Barbiturate,
Benzodiazepine, Tricyclics
And
*Paracematol, *Saliclyates,
*Alcohol (*Performed in Naas)
2 days
Profile consists of Barbiturate,
2 days
Benzodiazepine, Cocaine, Opiates,
Propoxyphene, Phenothiazines,
Cannabis, Amphetamine,
Methadone, L.S.D. and Alcohol
For contact tracing and outbreaks
7-10 days
Refer to Haemoglobinopathy Screen ____
Test Name
Sample Type
Location of Test
Special Requirements
Clinical details essential
*T-Time
Electrophoresis (Serum)
Serum
AMNCH
7 days
Electrophoresis (Urine)
MSU
AMNCH
Endomysial Nuclear
Antibodies (ENA)
Serum
Claymon
ENA Profile of 8 Tests, only
performed if ANA is abnormal
Enterovirus
Serum/Throat
swab/Faeces
NVRL
Contact NVRL for sample
requirements
Epanutin
Lithium Heparin
AMNCH
Enteropathogenic
E. coli (EPEC)
Faeces/ Slope
of organism
Cherry Orchard
Epilim
Lithium Heparin
AMNCH
2 days
Epstein Barr Virus
(EBV)
Serum
NVRL
7-10 days
Erythropoietin
Serum
Claymon
Early morning sample essential
5 days
Extrinsic Factors
4 Trisodium citrate
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
FactorAssays
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Factor V Leiden
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen.
Variable
7 days
Endomysial Antibodies
7-10 days
2 days
For confirmation of suspect isolates. 7-10 days
Factor VIII
3 Trisodium Citrate
AMNCH
To Naas Lab ASAP.
To Naas lab by 09:30
6-8
weeks
Factor IX
3 Trisodium Citrate
AMNCH
To Naas Lab ASAP.
To Naas lab by 09:30
6-8
weeks
Faecal Elastase
Faeces
Biochemistry Dept.
Wythenshave Hosp,
Southmoore Road,
Manchester M23 9LT
0044 161 998 7070
Sample must be well formed. Runny
samples not acceptable. Preferable
that sample is frozen
Farmers Lung
Serum
Claymon
Felbamate
Serum
Claymon
Ferritin glycosylated
Serum
Claymon
56
7-10 days
Spin and Freeze
7 days
Performed if serum ferritin > 100 ug/L 15 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Please supply current
FBC and Hb level
10 days
Ferritin Red Cell
Lithium Heparin
Claymon
Ferritin Serum
Serum
Claymon
6 days
Foetal Haemoglobin
(Kleihauer Test)
5ml EDTA Whole
blood
Claymon
9 days
Folate Red Cell
1 Serum + 1 EDTA
Claymon
6 days
Folate Serum
Serum
Claymon
Do not send plasma
6 days
Fragile X
4-5 mls EDTA
National Centre
for Medical Genetics,
Crumlin
Turnaround time dependent
on category
Variable
Free Androgen Index
Serum
Claymon
9 days
FSH
Lithium Heparin
AMNCH
2 days
Free T3 (FT3)
Lithium Heparin
AMNCH
Fungal culture and
microscopy
Skin scrapings, hair,
nail clippings
Claymon
14-21
days
G6PDH
Lithium Heparin or
EDTA
Claymon
5 days
Gabapentin
Serum
Claymon
Spin and Freeze
9 days
Gastrin
Serum
Claymon
Spin and Freeze Immediately
8 days
Gentamicin
Serum
Naas Mon-Fri,
AMNCH Weekends
Be in Lab by 09.30 trough & peak
samples together
1 day
Gonadotrophins
(FSH/LH)
Lithium Heparin
AMNCH
Growth Hormone
Serum
Lithium Heparin
Claymon
H63D
Refer to
Haemachromatosis
Crumlin
Haematinic screen
2 serum and
1 EDTA
Claymon
57
Further investigation of
thyroid function will only be done
if clinically indicated
2 days
2 days
Spin and Freeze
8 days
3
months
Serum B12, Serum folate,
Serum ferritin and Red cell
folate performed
14 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Haemochromatosis
Diagnostic testing
2 EDTA
National Centre for
Medical Genetics,
Crumlin
Contact haematology lab prior to
sampling. Special request form
required. Essential to have raised
fasting transferrin saturation and
elevated ferritin results prior to
testing
3
months
Haemochromatosis
Carrier Status
2 EDTA
National Centre for
Medical Genetics,
Crumlin
Essential to have details of
family member who is a
carrier or affected.
3
months
Haemoglobinopathy
screen
2 EDTA and 1
serum
St James Hospital
Haemolytic Screen
(Retic, DCT, LFT, LDH,
Haptoglobin, *Urinary
Haemosiderin and
Blood Film)
2 EDTA, 1 Serum,
1 Li Heparin, 24 hr
Urine (Plain)
Naas and *SJH
Haemophilia Screen
6 Coag
NCHCD
Haemosiderin (Urine)
24 hr Urine
(Plain)
SJH
Homocysteine
(Plasma)
Serum
Claymon
Homocysteine
(Urine)
24 hr Urine
(Acid Washed)
Claymon
7 days
HCG as a Tumour
Marker
Serum
AMNCH
Spin and separate on receipt in lab 3 days
HCG for Pregnancy
Testing
Li Heparin or Serum
AMNCH
1 day
Heliobacter Serology
Serum
Claymon
7-10 days
Hepatitis A-E
Serum
NVRL
7-10 days
Serum
NVRL
7-10 days
Serum
NVRL
7-10 days
Hepatitis B Surface
Antigen (HbsAg)
Hepatitis C Antibodies
58
7 days
Naas Haem – Retic, BF and Hapto 3 days
Naas Transfusion – DCT
Naas Bio- LFT, LDH
SJH – Urinary Haemosiderin
Check with NCHCD
about requirements
Variable
HPLC
Chemiluminescence
5 days
1 day
Test Name
Sample Type
Hepatitis C PCR
Location of Test
Special Requirements
*T-Time
NVRL
7-10 days
Hepatitis Screen
(Hepatitis B and C)
Serum
NVRL
7-10 days
Herpes simplex
Serum
NVRL
7-10 days
Heparin induced
2 trisodium citrate
thrombocytopenia Screen
and a vial of
(H.I.T)
heparin used
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Human immunodeficiency
virus (HIV)
Serum
NVRL
Special consent required
7-10 days
HIV Viral Load
2 x 2mls EDTA
NVRL
Frozen <1 hour
Variable
HIV 1/11 Serology
Screening EIA
Serum
NVRL
Variable
HIV 1/11 Serology
Confirmation
immunoblotting
Serum
NVRL
Variable
HLA B-27
1 large EDTA
(5 -10 mls)
NBC
10 days
HLA DQ2+8
1 large EDTA
(5 -10 mls)
NBC
10 days
Homocysteine
1 ml Heparin Plasma
or 1 ml Serum
Claymon
Spin & freeze sample
within 30 minutes
6 days
Huntingtons Disease
1 EDTA
Crumlin
Letter from Neurologist essential
Variable
5 Hydroxyindoleacetic
Acid (5 HIAA)
24 hr Urine
(Acid Washed)
Claymon
8 days
Hypercoagulation
Screen
Refer to
Thrombophilia
Screen
NCHCD
____
Hypocoagulation screen 7 trisodium citrate
Immunoglobulin/T Cell
Receptor(TCR)
rearrangements
Li Heparin,
1 EDTA,
Bone Marrow
in RPMI, Slides x 2
NCHCD
SJH
59
In consultation with AMNCH
Haematology Team only
Variable
In consultation with AMNCH
15 days
Haematology Team only. Bone
Marrow slides, immunophenotyping
report and parrafin embedded
sections to accompany request.
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Immunoglobins:
IgA, IgG, IgM
Serum
AMNCH
6 days
Immunoglobins:
IgE
Serum
Claymon
7 days
Immunophenotyping
Peripheral blood
Refer to
Haematology Staff
EDTA + 1
unstained blood film
AMNCH
Refer to Haematology Staff
15 days
Only patients with a persistent
lymphocytosis (>4.2 x 10 9/L) are
accepted. In all other cases contact
the Haematology Team, AMNCH.
Immunophenotyping
Bone Marrow aspirate
BMA in RPMI
+ 4 unstained
BM slides
AMNCH
Relevant clinical history essential. 15 days
Transport on same day as collection.
To Naas lab by 09.30
Influenza
Serum/ Throat swab
NVRL
Viral throat swab required
7-10 days
Iron Profile/Studies
Serum
Claymon
Profile consists of : Iron, Latent
Capacity UIBC, TIBC,
Transferrin Saturation
4 days
Insulin
EDTA
Claymon
Insulin Like Growth
Factor
Serum
Claymon
Intrinsic Factor
Antibodies
Serum
Claymon
Intrinsic Factor Screen
6 trisodium citrate
NCHCD
In consultation with AMNCH
Haematology Team only
JAK2 Mutation
5 EDTA Samples
CMD
DNA based test.
Keppra Levels
Serum
Claymon
Spin and freeze
Lamictal
Serum
Claymon
Spin and freeze
Lamotrigine
See Lamictal
LAP Score
1 Lithium Heparin
and 2 blood films
from Li Heparin
sample
AMNCH
Essential to contact Naas
haematology lab before ordering.
Send to lab before 09:30
3 days
Lead
Lithium
Claymon
Do not Centrifuge
4 days
3 days
Fasting, Spin and Freeze within 21 days
four hours. Patients age and clinical
details essential.
Variable
3 days
5 days
60
Test Name
Legionella Serology
Sample Type
Location of Test
Special Requirements
*T-Time
Serum and random
urine
Claymon
7-10
days
Leptospira Serology
(Weils’s disease)
Serum
NVRL
7-10
days
Lipoprotein A
Serum
Claymon
Liver Antibodies
Serum
Claymon
LH
Lithium Heparin
AMNCH
Long Chain Fatty Acids
(LCFA)
Lithium Heparin
Claymon
Lorazepam
Serum
Claymon
Spin and Freeze
L.S.D.
MSU
Beaumont
Part of Urine Toxicology Screen
Lupus Anticoagulant
3 Trisodium Citrate
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen.
OK to order on its own if:
1. Repeated Miscarriages
2. Investigation of Low Platelets
No need to check with AMNCH if
for 1 or 2 above
Lupus Screen
3 Serum and
3 Trisodium Citrates
Claymon
3 days
2 days
7 days
6-8 wks
Profile consists of:
β2 glycoprotein, Anticardiolipin
antibody, ANA, Anti dsDNA,
Anti Sm(Smith) antibodies,
Lupus anticoagulant (LA).
Sample for LA➾Remove plasma,
spin and freeze
7-10 days
Lyme Disease
Serum
NVRL
Lymphocyte Subsets
1 Fresh EDTA
SJH
Measles
Serum
NVRL
Meningococcal PCR
CSF, EDTA
Irish Meningitis
Reference Lab.
Temple St.
Methadone
MSU
Beaumont
Part of Urine Toxicology Screen
2 days
Methyltetrahydrofolate
reductase (MTHFR)
2 EDTA
Claymon
Enclose consent form
15 days
61
Clinical details essential.
To Naas Lab Reception by 09.30
3 days
7-10 days
Use Meningococcal Ref. Lab forms 1 day
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Mumps
Serum
NVRL
7-10 days
Mycobacteria
(Zn, AFB, TB)
See ZN TB
AMNCH
Variable
Mycoplasma
Serum
NVRL
7-10 days
Myeloma Screen
(includes Bence Jones
Protein)
1 Serum and
random early
morning urine
AMNCH
7 days
Myoglobin (Urine)
24hr Urine (Plain)
Claymon
3 days
Nitrazepam
Serum
Claymon
Norovirus
(Winter vomiting)
Faeces
National Virus
Reference Laboratory
Oestradiol
Lithium Heparin
AMNCH
Oligoclonal bands
CSF and Serum
Immunology Lab,
SJH
CSF and serum must be sent
together
Opiates (Urine)
MSU
Beaumont
Part of Urine Toxicology Screen
Beaumont
Profile: HIV, Hep B, Hep C, CMV,
Toxoplasmosis, HTLV 182,
TPHA, EBV
Organ Donor
Virology
Osmolality (Serum)
Serum
AMNCH
Osmolality (Urine)
MSU and Lithium
Heparin
AMNCH
Osmotic Fragility
4 EDTA
Claymon
Osmotic Fragility
(ordered by Dr. O'Connell)
2 Lithium Heparin
(As fresh as possible)
AMNCH
Oxylates (Urine)
24 hr Urine
(Acid Washed)
Claymon
Parainfluenzae
Serum
NVRL
Parathyroid Hormone
Parvovirus
Spin and Freeze
7 days
Separate sample required for C/S. 7-10
days
2 days
7-10
days
2 days
2 days
Lithium Heparin sample required
2 days
7 days
If ordered by Dr O'Connell only.
2 Li Hep samples from normal
controls required also.
Mon-Thurs only
3 days
7-10 days
Contact the laboratory
Serum
NVRL
62
7-10 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Phenobarbitone
Lithium Heparin
AMNCH
Phenothiazine (Urine)
MSU
Beaumont
Phenytoin
Lithium Heparin
AMNCH
Philadelphia
Chromosome
5 EDTA
CMD
Send by taxi immediately.
Variable
NCHCD
Only with consultation with
Haematology Team, AMNCH
Variable
Platelet Function Test
Plasma Viscosity
EDTA
2 days
Part of drug Toxicology Screen
2 days
2 days
SJH
2 days
Plasminogen activator 1ml citrated plasma
inhibitor type 1 (PAI-1)
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Plasminogen Activity
1ml citrated plasma
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Pleural Fluid Differential
Pleural Fluid
Claymon
Pneumococcal
Antigen
MSU
Claymon
Porphyrins
24 hr Urine
(Plain)
SJH
Post Mortem
(Bloods)
Celbridge
Post Mortem
(Tissue Samples)
AMNCH
7-10 days
Contact Biochemistry before
7 days
requesting. Special requirements.
Primidone
Serum
Claymon
Spin and Freeze
Procollagen III
Serum
Claymon
Spin and Freeze
Progesterone or
Day 21 Progesterone
Lithium Heparin
AMNCH
17OH Progesterone
Serum
Claymon
Prolactin
Lithium Heparin
AMNCH
Protein C (PC)
Refer to
Thrombophilia
screen
AMNCH
63
2 days
2 days
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen
––––
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Protein S (PS)
Refer to
Thrombophilia
screen
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen
––––
Prothrombin Variant
Refer to
Thrombophilia
screen
AMNCH
Part of Thrombophilia Screen.
Refer to Thrombophilia Screen
____
PTH
Serum
AMNCH
Spin and Freeze < 30 mins
3 days
Propoxyphene (Urine)
MSU
Beaumont
Part of Urine Toxicology Screen
2 days
RAST + IgE Allergens
(airbourne or food)
Serum
Claymon
7 days
Renin
EDTA
Claymon
1st sample: taken after patient lying 4 days
down for 3 hours. 2nd sample: after
patient standing for 1 hour.
Separated and frozen < 4 hours
Rheumatoid Factor
(RF)
Serum
Claymon
4 days
Rhinovirus
Respiratory samples
NVRL
Contact NVRL for sample types
7-10 days
Rotavirus
Faeces
NVRL
Sent on patients < 3 years old
7-10 days
NVRL
Contact NVRL for sample types
7-10 days
Respiratory Syncitial Respiratory samples
Virus (RSV)
Rubella
Serum
NVRL
7-10 days
Salmonella Typing
Slope of organism
Cherry Orchard
7-10 days
Schilling Test
24 hour urine
SJH
Must be prearranged with
Nutritional Lab, SJH
1 month
Scleroderma Screen
Serum
Claymon
Part of auto immune screen
____
Shigella Typing
Slope of organism
Cherry Orchard
7-10 days
Semen Morphology
Fixed slides
Mater
(Endocrinology)
1-2
weeks
Sex Hormone Binding
Globulin (SHBG)
Serum
Claymon
8 days
SLE Screen
Refer to Lupus
Screen
____
64
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Smears
Smear sample
AMNCH
Smears
Smear sample
Claymon
£30 cheque to accompany form
5 days
Synactin
3 Li Heparin
AMNCH
Base sample, Pre and
Post Samples
3 days
Syphillis Serology/
Treponema Pallidum
Serum
NVRL
Tacro Levels
EDTA
St. Vincents
Tegratol
Lithium Heparin
AMNCH
Teicoplanin
Serum
AMNCH
Testosterone (M +F)
Lithium Heparin
AMNCH
3 days
Total Testosterone:Free Lithium Heparin
Testosterone Ratio
Claymon
3 days
7-10
days
2 days
Samples in Lab by 09.30
Trough & Peak
Thalassaemia screen
2 EDTA, 1 serum
SJH
Theophylline
Lithium Heparin
AMNCH
2 days
Thyroid Peroxidase
Antibodies
Lithium Heparin
AMNCH
2 days
Tiagabine
Serum
Claymon
Spin and Freeze
12 days
Tissue plasminogen
activator
1 ml citrated
NCHCD
In consultation with AMNCH
Haematology Team only
Variable
Serum
Claymon
12 days
AMNCH
Essential to contact Naas
8 weeks
haematology lab prior to sampling.
Special request form required.
Reliable results if 6 weeks post event
or 6 weeks post cessation of warfarin.
No CCU or A/E patients tested.
Tissue
transglutaminase (TTG)
Thrombophilia Screen
1 Serum, 1 EDTA,
6 Trisodium Citrates
Send FBC and unstained film
1 day
Topamax
Serum
Claymon
Tricyclics (Blood)
Serum
Beaumont
Part of Blood Toxicology Screen
TSH Receptor
Antiboides (TRAB)
Serum
Claymon
Further investigation of thyroid function
will only be done if clinically indicated
65
1 week
2 days
Test Name
Total Iron Binding
Capacity (TIBC)
Sample Type
1Serum or
Heparinised sample
Location of Test
.
Special Requirements
Claymon
*T-Time
6 days
Transcobalmin
Serum
Claymon
Do not send plasma
1 month
Transferrin Saturation
Serum
Claymon
Fasting sample
6 days
Transferrin soluble receptors
Serum
Claymon
8 days
Thyroid Peroxidase
antibodies (TPO)
Lithium Heparin
AMNCH
Dependent on TFT results from Naas 2 days
Thyroglobulin
Serum
Claymon
Full clinical details including any
teatment for thyroid function must
be supplied
4 days
Tobramycin
Serum
AMNCH
Be in Lab by 09.30
trough & peak samples together
1 day
Toxicology Screen
(Blood)
Beaumount
Refer to Drug Screen (Blood)
1 day
Toxicology Screen
(Urine)
Beaumount
Refer to Drug Screen (Urine)
2 days
Toxoplasma gondii
Serum
NVRL
7-10
days
Treponema Pallidum
(Treponema pallidum
haemagglutination
assay, TPHA)
Serum
NVRL
7-10
days
Tuberculosis (TB)
See ZN
AMNCH
Unconjugated Bilirubin
Lithium Heparin
Rotunda
Urate (Urine)
24 hr Urine
(Plain)
Claymon
Weils Disease
NVRL
Valporate
Lithium Heparin
AMNCH
Vancomycin
Serum
Naas Mon-Fri,
AMNCH weekends
Vanillymandelic Acid
(VMA)
24hr Urine
(Acid Washed)
Claymon
66
Variable
Speak to Senior in Biochemistry,
prior to ordering test.
1 day
7 days
See Leptospira
2 days
Samples in Lab by 09.30
Trough & Peak
1 day
5 days
Test Name
Sample Type
Location of Test
Special Requirements
*T-Time
Varicella Zoster (VSV)
Serum
NVRL
Vasculitic Screen
Serum
Claymon
VDRL
(Venereal disease
research laboratory,
Syphillis)
Serum
NVRL
7-10
days
Viral PCR
CSF and EDTA
NVRL
7-10 days
Vitamin B12
Serum
Claymon
3 days
Claymon
4 days
Vitamin C
Vitamin D
Serum
Vitamin K
Viral studies
Virus transport swab
(available in lab)
Von Willebrand Screen 6 trisodium citrate
Claymon
7-10 days
Spin and Freeze within 1 hr
4 days
Claymon
6 days
NVRL
7-10
days
NCHCD
In consultation with AMNCH
Variable
Haematology Team only.
6 coag to arrive to lab before 15:00
Zinc
Serum
Claymon
Zn/TB
Urine
AMNCH
Zn/TB
Sputum
AMNCH
Zn/TB
Bronchial washings
AMNCH
Variable
Zn/TB
Pleural fliud
AMNCH
Variable
67
4 days
Only performed when clinically Variable
indicated
Only performed when clinically
indicated
Variable
Disclaimer:
Correct at time of going to press.
Always take note of reference ranges and comments on individual reports.
Science - constantly changing/different kits/different centres for referral.