Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
guide to clinical biochemistry and immunology
Typology: Lecture notes
1 / 72
This page cannot be seen from the preview
Don't miss anything!
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 1 of 72 Date of last review: July 2021 Revision: 20.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 2 of 72 Date of last review: July 2021 Revision: 20.
Efficient and appropriate use of the laboratory service is central to the modern practice of medicine. The aim of this user guide is to provide clear guidance on how and when to use our service, which analyses are available and which sample type should be used. Clinical Biochemistry has laboratories on the three acute Trust sites in East Kent and provides a continuous service to hospitals and local general practitioners. Our specialist immunology service is located at the William Harvey Hospital, Ashford. Clinical Biochemistry (including immunology) is accredited by UKAS to ISO 15189 (laboratory reference 8636). We process more than 9 million individual biochemistry and immunology tests each year. Analyses are performed using the latest technology by qualified, HCPC registered scientific staff assisted by trained support staff. All processes are rigorously quality controlled and the laboratory participates in external quality assessment programmes and accreditation schemes. Authorised personnel periodically review the examinations provided by the laboratory to ensure that they are clinically appropriate for the requests received. Clearly, a concise user guide cannot give comprehensive coverage of all aspects of the service we offer. Contact names and telephone numbers of key senior members of staff are given - please contact us whenever you have a query over which investigation is most appropriate, what collection conditions might affect your result and how you should interpret that result. Clinical advice is always available from HCPC registered clinical scientists and is an essential part of the service we offer: effective liaison with us improves our service to you. We have made every effort to ensure that the information in this user guide is correct at the time of publication. However, information will obviously change as new technologies become available and the service evolves to meet the needs of our users. We welcome any comments or suggestions you would like to make, positive or negative, so that these can be incorporated into future editions. Dr Sally Stock PhD FRCPath Consultant Clinical Scientist & Head of Service for Clinical Biochemistry and Immunology
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 4 of 72 Date of last review: July 2021 Revision: 20.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 5 of 72 Date of last review: July 2021
The figure below demonstrates the wide geographical spread of East Kent’s Pathology services as things stand. FIGURE 1 – SPREAD OF MAIN NHS TRUST SITES CLINICAL BIOCHEMISTRY (INCLUDING IMMUNOLOGY) LABORATORY LOCATIONS WHH laboratory is located on the ground floor in the green zone at the rear of the hospital. Note that phlebotomy facilities at WHH are located near the main entrance, not in Pathology. K&CH laboratory is located in the corridor between Outpatients and Clarke Ward. Phlebotomy services are adjacent to the laboratory. QEQMH laboratory is located in the St Peter’s Road wing on the ground floor. Phlebotomy services are adjacent to the laboratory.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 7 of 72 Date of last review: July 2021 Revision: 20. Royal Victoria Hospital, Folkestone AREA DAYS TIMES Outpatients Monday – Friday 08.30-16. Outpatients Saturdays 09.00-12. All patients are seen via an appointment system, appointments are booked via the patient portal on the EKHUFT website. Buckland Hospital, Dover AREA DAYS TIMES Outpatients Monday – Friday 08.00-15. All patients seen via an appointment system. Appointments are booked via the patient portal on the EKHUFT website. Appointments required for Glucose Tolerance Tests (GTT) only. Booking number 01304 222552
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 8 of 72 Date of last review: July 2021 Revision: 20.
K&CH Main Laboratory Results (please try computer terminals first)
QEQMH Main Laboratory Results (please try computer terminals first)
Duty Biochemist (clinical enquires) ekhuft.biochemistryekhuft@ nhs.net
01233 616287 (direct line) Immunology laboratory WHH Main Laboratory 723 6716 Senior personnel Dr Sally Stock Consultant Clinical Scientist and Head of Service
01233 616025 (direct) Dr Edmund Lamb Consultant Clinical Scientist and Clinical Director of Pathology
Dr Joanna Sheldon Visiting Consultant Clinical Scientist (Immunology)
Miss Elizabeth Hall Principal Clinical Scientist 722 2868 Dr Helen Holt Principal Clinical Scientist and Quality Lead
Dr Danni Fan Principal Clinical Scientist 723 6165
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 10 of 72 Date of last review: July 2021 Revision: 20.
As with all phlebotomy/sample collection processes it is essential that correct positive patient ID is performed and that all samples are labelled with the correct patient information. When placing printed sample labels on the containers, it is essential they are placed in the correct position and orientation and on the correct sample for the tests required. If the labels are not applied correctly, the analysers are not able to read the barcodes. This may cause delay in issuing results.
Note how the label is perfectly centred and straight, clearly printed and aligned on the tube with the coloured lid on the left.
This label has been wrapped around the tube sideways. The analysers are unable to see/read the entire barcode. Try to ensure the label is placed on the tube as straight as possible. Crooked, crumpled or torn labels will need reprinting.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 11 of 72 Date of last review: July 2021 Revision: 20. All Sunrise labels have the correct container information printed on them which relates to the tests requested/collected. The above tests were routine blood chemistry tests that should have been put in a yellow (gold) topped tube. All Sunrise labels have the correct container information printed on them which relates to the tests requested/collected. The above tests were CSF tests that should have been put into a plain bottle and not grey topped. All labels will fit onto adult blood tubes so there is no need to let them wrap over the bottom of the sample container. This is an example of why we are asking for request forms for paediatric samples – our labels are too large for paediatric sample containers. If you require more than 1 tube for tests then either Sunrise will print the correct number of labels or you should reprint labels but please ensure that you reprint the correct NOTE: THE BARCODE MUST BE CLEAR AND IN SHARP DEFINITION. IF THE LABEL IS SMUDGED, PLEASE CLEAN THE PRINTER WITH AN ALCOHOL WIPE AND REPRINT THE LABEL.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 13 of 72 Date of last review: July 2021 Revision: 20.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 14 of 72 Date of last review: July 2021 Revision: 20.
Random urines should be collected into a 60 mL white-top (or silver-top) universal container. Do not use the red-top (Boricon) microbiology pots. Patient information leaflets describing the collection procedure are available (see section 21) 24 h urine containers are issued by the laboratory. The Pathology reception staff are responsible for ensuring that the correct container and collection details are issued, either directly to the patient or to the ward or clinic staff. Urine containers for trace metal (e.g. copper) analysis are acid-washed. Patient information leaflets describing the collection procedure are available (see section 21). CSF SAMPLES A plain universal or 2 mL sterile tube must be used for total protein or oligoclonal bands and a fluoride oxalate sample for glucose. When investigating suspected meningitis, the CSF glucose request must be accompanied by a plasma glucose request/sample. When investigating suspected multiple sclerosis, the request for CSF oligoclonal bands must be accompanied by a clotted (red or gel separator tube) blood sample. CSF specimens contaminated with blood will not be analysed. For xanthochromia testing see section 21. FAECAL SAMPLES Faecal specimens for measurement of porphyrins, calprotectin and elastase must be collected into sterile faeces pots. Specimens for porphyrins MUST be protected from light. Patient information leaflets describing the collection procedure are available (see section 21). STORING SAMPLES The storage of whole blood specimens in a refrigerator at 4oC prior to sending to the laboratory is not suitable for the vast majority of analytes. Notably serum potassium, phosphate and magnesium will be falsely elevated due to leakage from the red blood cells and the bicarbonate may be falsely decreased. Do not store specimens in the freezer! Do not stand specimens on radiators or other very hot places! If in doubt, contact the laboratory. Some samples must be brought to the laboratory immediately (e.g. ammonia, lactate, ACTH, gut hormones, renin, aldosterone, and plasma metanephrines). Samples for these tests cannot be collected in primary care (see section 10). Please contact the duty biochemist if you wish to discuss sample requirements, or make the laboratory aware that an unstable sample is being sent. If samples are not delivered to the laboratory within 4 hours after collection, they must be centrifuged (2000 g for 10 minutes) at source (within 8 hours of collection) and stored at 2 – 8 degrees before transportation, to preserve sample integrity and to ensure that they are not rejected upon arrival at EKHUFT. The laboratory must be informed that this procedure is in place, and it must be agreed in writing. UNSUITABLE SAMPLES Under certain circumstances results of some tests will not be reported due to the receipt of a compromised sample (e.g. many analytes will not be reported on haemolysed or lipaemic samples). This is done to ensure that the results you receive are clinically meaningful and accurate: please do not ask laboratory staff to release results in these situations.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 16 of 72 Date of last review: July 2021 Revision: 20.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 17 of 72 Date of last review: July 2021 Revision: 20.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 19 of 72 Date of last review: July 2021 Revision: 20.
n/a (^) Carbamazepine (mg/L) 25 (^50) Ciclosporin (g/L)** 250 n/a CK (U/L) 5000 50 (unless post-dex.) 200 (if post-synacthen) Cortisol (nmol/L) n/a n/a Creatinine (umol/L) 350 (200 if less than 16 years old and adults with no previous result or no result in the previous year) n/a (^) CRP 200 (GP only) n/a Digoxin (g/L) 2.5 (GP B see note) n/a Ethanol (mg/L) 4000 n/a (^) Gentamicin (mg/L) 2.
Document Number: BIO NO 038 Author: Dr S. Stock Approved by: Dr H Holt Page 20 of 72 Date of last review: July 2021 Revision: 20. 2.0 (^) Glucose (CSF) (mmol/L) n/a 2.5 Glucose (mmol/L) 15.0 (in children <16 y) 25.0 (adult not known to be DM) 30.0 (adult known to be DM) n/a Lithium (mmol/L) 1.5 (GP B see note) 0.40 (^) Magnesium (mmol/L) 4. 260 (unexplained) Osmolality (serum)(mOsm/Kg H 2 O) 305 (unexplained) n/a (^) Paracetamol (mg/L) 30 n/a Phenobarbital (mg/L) 70 (adults), 40 (paediatrics) n/a Phenytoin (mg/L) 25 (GP B see note) 0.30 Phosphate (mmol/L) n/a 2.5 Potassium (mmol/L) 6.0 (only if AKI) 6.5 (all except neonates and pre-dialysis) 7.0 (all) n/a Salicylate (mg/L) 300 (^2) Sirolimus (g/L)** 10 130 (paediatric only) 120 (unexpected inpatient results/all out-patients & GP's) Sodium (mmol/L) 150 (unexpected^ inpatient^ results/all^ out- patients & GP's) n/a Sweat chloride All positive tests (^3) Tacrolimus (FK506) (g/L)**
n/a Theophylline (mg/L) 25 (GP B see note) n/a Thyroid stimulating hormone 100 (GP only) 50 (when unexpected, GP only) n/a Thyroxine (T4, free) 50 (when unexpected, GP only) n/a Tobramycin (mg/mL) 2. n/a Triglycerides 20.0 (when unexpected, GP only) n/a Vancomycin (mg/L) 25.0 (pre dose) 80 .0 (post dose) n/a (^) MPO, PR3, GBM antibodies New positives n/a Paraproteins New cases at discretion of clinical scientist *It is not necessary to telephone AKI scores for patients on dialysis. AKI (or other) critical alerts relating to radiology patients awaiting or following contrast injection for CT must be telephoned to the duty radiologist (via the X-ray viewing extension 722-2829 between 08:00 and 17:00 Monday to Friday, or via switchboard between 17:00 and 20:00 Monday to Friday and between 08:00 to 20:00 at weekends and on public holidays). Outside of these hours such results must be telephoned to the on call medical registrar. **Telephone all critical immunosuppressant results to the renal transplant office (extn. 722-6443) in addition to the requesting location if not a renal ward/renal unit. Note GP B: if primary care and out of surgery hours then telephone the GP the next day unless the next day is a Saturday, Sunday or Public Holiday in which case telephone the out of hours service Note: tests in cells with blue shading do not need to be telephoned to A&E (Emergency Department, ED), unless the laboratory has been informed that the PTL is out of operation.
