Pathology User Handbook 2012 - Hampshire Hospitals NHS ...

Hampshire Hospitals NHS Foundation Trust Revision: 6 Q‐Pulse Filename: UH‐GEN‐HANDBK 

The Royal Hampshire County Hospital 

Author: Co‐ordinator David Beacher Authorised by: Dr. N. Hutchison 

PATHOLOGY DEPARTMENT Date of issue: April 2012 Page 1 of 115 


PATHOLOGY USER HANDBOOK 

Author 

: Pathology Collaboration 

Authorised By 

: Dr. N. Hutchinson (Clinical Director) 

Date of Next Revision : APRIL 2013 

DO NOT USE AFTER : JUNE 2013 

This document is designed for on‐line viewing. Printed copies although permitted, are deemed 

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Table of Contents 

Preface .............................................................................................................................. 13 

INTRODUCTION ................................................................................................................. 14 

Contact Details .................................................................................................................. 16 

Outpatient Phlebotomy times ............................................................................................ 17 

Air tube stations ................................................................................................................ 18 

Quality Assurance .............................................................................................................. 18 

Turnaround Times .............................................................................................................. 18 

Pathology IT Links .............................................................................................................. 19 

Pathology Supplies ............................................................................................................. 19 

Screening Programmes and other non‐NHS work ................................................................. 19 

Labelling of specimens/sample ........................................................................................... 20 

Request forms ................................................................................................................... 23 

Specimen Collection/Sample Requirements ......................................................................... 24 

Requests for additional tests .............................................................................................. 25 

Date and time of samples ................................................................................................... 25 

Availability of Results ......................................................................................................... 25 

Point of Care Testing (POCT) ............................................................................................... 29 

POCT contact details ....................................................................................................... 29 

Clinical Advice and Interpretation ....................................................................................... 30 

DEPARTMENTAL SPECIFIC INFORMATION ............................................................................ 31 

HAEMATOLOGY & BLOOD TRANSFUSION ............................................................................ 31 

Help lines ....................................................................................................................... 31 

Useful clinical information ‐ Common causes of spurious results ......................................... 32 

Patient Referrals ............................................................................................................. 34 

Thrombophilia clinic ........................................................................................................ 34 

Fertility Investigations ..................................................................................................... 35 

BIOCHEMISTRY & IMMUNOLOGY ........................................................................................ 36 

Help lines ....................................................................................................................... 36 

Paediatric Sample Requirements ...................................................................................... 36 


CELLULAR PATHOLOGY ....................................................................................................... 39 

Help lines ....................................................................................................................... 39 

Availability of Results ...................................................................................................... 40 

Urgent Requests ............................................................................................................. 40 

Mortuary ....................................................................................................................... 43 

Viewings ........................................................................................................................ 46 

MICROBIOLOGY ................................................................................................................. 47 

Help Lines ...................................................................................................................... 48 

Specimen Collection/Sample Requirements ...................................................................... 48 


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Availability of Results ...................................................................................................... 50 

Appendix A ‐ FNA PREPARATION ......................................................................................... 51 

Appendix B ‐ ROUTINE REFERRAL LABORATORIES: ............................................................... 54 

Appendix C ‐ TELEPHONED RESULTS SHEET .......................................................................... 58 

Appendix D ‐ TEST INDEX .................................................................................................... 59 

BACTERIOLOGY .................................................................................................................. 59 

Aspirates and fluids from normally sterile sites .................................................................. 59 

Blood cultures ................................................................................................................ 59 

Bronchial washings ......................................................................................................... 59 

Broncho‐alveolar lavage .................................................................................................. 59 

Cerebrospinal fluid (CSF) .................................................................................................. 59 

Cervical swab ................................................................................................................. 59 

Chlamydia ...................................................................................................................... 60 

Contact lens and lens fluid ............................................................................................... 60 

Culture for bacterial infections ......................................................................................... 60 

Ear swab ........................................................................................................................ 60 

Eye swab ........................................................................................................................ 60 

Faeces ........................................................................................................................... 61 

Hair ............................................................................................................................... 61 

Nail ................................................................................................................................ 63 

Nasal swab ..................................................................................................................... 63 

Nasopharyngeal aspirate ................................................................................................. 63 

Pleural fluid .................................................................................................................... 63 

Pneumococcal antigen (urine). ......................................................................................... 63 

Pus ................................................................................................................................ 63 

RSV ................................................................................................................................ 63 

Schistosoma parasites ..................................................................................................... 63 

Sellotape slide ................................................................................................................ 63 

Seminal fluid for culture .................................................................................................. 63 

Sputum .......................................................................................................................... 64 

Threadworm .................................................................................................................. 64 

Throat swab ................................................................................................................... 64 

Tissue and biopsies ......................................................................................................... 64 

Tuberculosis ................................................................................................................... 64 

Urethral swab ................................................................................................................. 64 

Urine ............................................................................................................................. 65 

Viral ............................................................................................................................... 65 

Wound and ulcer swabs .................................................................................................. 65 

SEROLOGY ......................................................................................................................... 66 

Adenovirus antibody ....................................................................................................... 66 

Amoebic IFAT ................................................................................................................. 66 

Antenatal screen (Rubella IgG, HIV, Hepatitis B surface antigen, Syphilis) ............................. 66 

Antistaphylolysin ............................................................................................................ 66 

Antistreptolysin O (ASO) .................................................................................................. 66 


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Aspergillus precipitins ..................................................................................................... 66 

Avian precipitins ............................................................................................................. 66 

Bartonella antibodies ...................................................................................................... 66 

Bilharzia antibodies ......................................................................................................... 66 

Bordetella pertussis antibodies ........................................................................................ 66 

Borrelia burgdorferi antibodies ........................................................................................ 66 

Brucella antibodies ......................................................................................................... 67 

Campylobacter Antibodies ............................................................................................... 67 

Candida Serology ............................................................................................................ 67 

Cat scratch disease .......................................................................................................... 67 

Chlamydia psittaci ........................................................................................................... 67 

Cysticercosis Immunoblot ................................................................................................ 67 

Cytomegalovirus antigen ................................................................................................. 67 

Cytomegalovirus IgM ...................................................................................................... 67 

Cytomegalovirus IgG ....................................................................................................... 67 

Cytomegalovirus PCR ...................................................................................................... 67 

CMV avidity .................................................................................................................... 67 

Dengue antibody ............................................................................................................ 68 

EBV PCR ......................................................................................................................... 68 

Enterovirus IgM (includes antibodies to Coxsackie A and B and Echovirus infections) ............ 68 

Epstein Barr virus antibodies ............................................................................................ 68 

Farmers Lung .................................................................................................................. 68 

Filarial antibodies ............................................................................................................ 68 

Haemophilus B antibody .................................................................................................. 68 

Helicobacter pylori antibodies .......................................................................................... 68 

Hepatitis A IgM ............................................................................................................... 68 

Hepatitis A Total Antibody ............................................................................................... 68 

Hepatitis B surface antigen .............................................................................................. 68 

Hepatitis B antibodies ..................................................................................................... 69 

Hepatitis B core ............................................................................................................. 69 

Hepatitis B markers ......................................................................................................... 69 

Hepatitis B viral load ....................................................................................................... 69 

Hepatitis C antibody ........................................................................................................ 69 

Hepatitis C viral load ....................................................................................................... 69 

Hepatitis C RNA .............................................................................................................. 69 

Hepatitis E Antibody ........................................................................................................ 69 

Hydatid ELISA ................................................................................................................. 69 

HIV 1 and 2 antibodies .................................................................................................... 69 

HIV viral load .................................................................................................................. 69 

HSV I and II Antibodies .................................................................................................... 69 

Influenza A antibodies ..................................................................................................... 70 

Influenza B antibodies ..................................................................................................... 70 

Legionella antibodies ...................................................................................................... 70 

Leishmania antibodies ..................................................................................................... 70 

Leptospira antibodies ...................................................................................................... 70 


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Malaria .......................................................................................................................... 70 

Measles antibodies ......................................................................................................... 70 

Meningococcal PCR ......................................................................................................... 70 

Mumps antibodies .......................................................................................................... 70 

Mycoplasma antibodies ................................................................................................... 70 

Parvovirus B19 IgM ......................................................................................................... 70 

Q fever (Coxiella burnetii) antibodies ................................................................................ 71 

RSV antibodies ................................................................................................................ 71 

Rubella IgG ..................................................................................................................... 71 

Rubella IgM .................................................................................................................... 71 

Schistosome antibodies ................................................................................................... 71 

Strongyloides serology .................................................................................................... 71 

Syphilis serology ............................................................................................................. 71 

ToRCH screen (Toxoplasma, Rubella IgM and IgG, CMV IgM, Herpes) ................................... 71 

Toxoplasma antibodies .................................................................................................... 71 

Tropical screen ............................................................................................................... 71 

Vancomicin Level ............................................................................................................ 71 

Varicella zoster antibodies ............................................................................................... 72 

Viral respiratory antibody screen ...................................................................................... 72 

Yersinia antibodies .......................................................................................................... 72 

HAEMATOLOGY/BT ............................................................................................................ 73 

Antenatal screen ............................................................................................................. 73 

(Group and antibody screen) ............................................................................................ 73 

Antibodies (specific identification) .................................................................................... 73 

Anti Xa assay .................................................................................................................. 73 

Antithrombin – part of Thrombophilia screen. Consultant referral only. ............................... 73 

Bleeding time ................................................................................................................. 73 

Blood Group and save serum ........................................................................................... 73 

Chromosomes ................................................................................................................ 73 

Coagulation screen ......................................................................................................... 73 

(PT & aPTT) .................................................................................................................... 73 

Cold Agglutinins .............................................................................................................. 74 

Cord Coombes Test ......................................................................................................... 74 

Direct Antiglobulin Test ................................................................................................... 74 

(Coombes Test) ............................................................................................................... 74 

D‐Dimer ......................................................................................................................... 74 

Donath Landsteiner (PCH) ................................................................................................ 74 

ESR ................................................................................................................................ 74 

Factor assays .................................................................................................................. 74 

and Inhibitor status ......................................................................................................... 74 

FBC (Full Blood Count) ..................................................................................................... 74 

[includes blood film if required] ....................................................................................... 74 

Factor V Leiden/ ............................................................................................................. 75 

Prothrombin Mutation part of Thrombophilia screen. Consultant referral only ..................... 75 

Fibrinogen level .............................................................................................................. 75 


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G6PD ............................................................................................................................. 75 

Glandular Fever screen .................................................................................................... 75 

Group and save serum ..................................................................................................... 75 

Haemoglobinopathy screen ............................................................................................. 75 

HLA B27 ......................................................................................................................... 75 

Haptoglobin assay ........................................................................................................... 76 

HbA1c ............................................................................................................................ 76 

Hams test (PNH) ............................................................................................................. 76 

Iron & Transferrin ‐ see Biochemistry ............................................................................... 76 

Kleihauer test ................................................................................................................. 76 

Lupus inhibitor ............................................................................................................... 76 

Malaria film .................................................................................................................... 76 

PK (Pyruvate kinase – red cell enzyme) ............................................................................. 77 

Plasma Viscosity ............................................................................................................. 77 

Platelet function tests ..................................................................................................... 77 

Pregnancy test – regular .................................................................................................. 77 

Pregnancy test ‐ sensitive ............................................................................................... 77 

Activated Protein C Resistance ......................................................................................... 77 

Protein C ........................................................................................................................ 77 

Protein S ........................................................................................................................ 77 

aPTT .............................................................................................................................. 78 

PT .................................................................................................................................. 78 

Red cell osmotic fragility .................................................................................................. 78 

Red cell survival studies ................................................................................................... 78 

Reticulocyte count .......................................................................................................... 78 

Sickle test ....................................................................................................................... 78 

Sperm count ................................................................................................................... 78 

Thrombophilia screen: ..................................................................................................... 78 

von Willebrand’s screen .................................................................................................. 79 

Anti Neutrophil antibodies ............................................................................................... 80 

Anti Platelet antibodies ................................................................................................... 80 

BCR‐ABL transcripts......................................................................................................... 80 

Clozapine/Norcloazipine assay ......................................................................................... 80 

DNA analysis .................................................................................................................. 80 

Erythropoietin assay ....................................................................................................... 80 

HIV screen ...................................................................................................................... 80 

HLA typing ...................................................................................................................... 81 

Neutrophil Function tests ................................................................................................ 81 

Orotic acid ..................................................................................................................... 81 

Red Cell Membrane studies ............................................................................................. 81 

White cell markers .......................................................................................................... 81 

IMMUNOLOGY .................................................................................................................. 82 

β2 Glycoprotein 1 abs...................................................................................................... 83 

Cardiolipin abs. (IgG & IgM) ............................................................................................. 83 

Cardiac muscle abs. ......................................................................................................... 83 


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B2‐ Glycoprotein 1 abs .................................................................................................... 83 

Centromere abs. ............................................................................................................. 83 

Cyclic citrullinated peptide abs. ........................................................................................ 83 

dsDNA abs. ..................................................................................................................... 84 

ENAs –Extractable nuclear antigen abs. ............................................................................. 84 

Endomysial abs (IgA & IgG) .............................................................................................. 84 

GAD Antibody ................................................................................................................. 84 

Gastric Parietal cell Antibodies ......................................................................................... 84 

Glomerular Basement Membrane abs. .............................................................................. 84 

Gm‐1 Ganglioside abs ...................................................................................................... 84 

Hep‐2 ANA pattern ......................................................................................................... 84 

Histone Antibody ............................................................................................................ 84 

Hu antibodies ................................................................................................................. 84 

IgA Autoantibodies ......................................................................................................... 85 

Intrinsic factor abs. ......................................................................................................... 85 

Islet cell abs. ................................................................................................................... 85 

Jo‐1 antibody .................................................................................................................. 85 

La antibody .................................................................................................................... 85 

Liver‐Kidney Microsomal Abs ........................................................................................... 85 

Mitochondrial M2 Abs ..................................................................................................... 85 

Mitochondrial Antibodies ................................................................................................ 85 

MuSK (Muscle specific kinase) abs. ................................................................................... 85 

Myelin associated glycoprotein abs (MAG) ........................................................................ 85 

Myeloperoxidase Antibodies ............................................................................................ 85 

Myositis antibodies ......................................................................................................... 86 

Neuronal Antibodies (includes Hu, Yo, Ri, CRMP/CV2, Ma1 Ma2 & Amphiphysin) ................. 86 

Ovarian Antibodies ......................................................................................................... 86 

Pemphigoid Antibody ...................................................................................................... 86 

Phospholipid antibodies (See Cardiolipin abs.) ................................................................. 86 

Pm – Scl abs ................................................................................................................... 86 

PR3 Antibodies ............................................................................................................... 86 

Rheumatoid Factor (RF) ................................................................................................... 86 

RNP antibodies ............................................................................................................... 86 

Ro antibody .................................................................................................................... 86 

Scl‐70 Antibody .............................................................................................................. 87 

Sm antibody ................................................................................................................... 87 

Smooth Muscle Antibody ................................................................................................. 87 

Thyroid peroxidase ELISA ................................................................................................. 87 

Tissue Transglutaminase IgA ............................................................................................ 87 

TSH receptor Antibodies .................................................................................................. 87 

Voltage gated calcium channel abs ................................................................................... 87 

Voltage gated potassium channel abs ............................................................................... 87 

IgE (Total) ....................................................................................................................... 88 

Specific IgE (RAST) – ........................................................................................................ 88 

FOODS ........................................................................................................................... 88 


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ANIMALS ........................................................................................................................ 89 

OTHERS .......................................................................................................................... 89 

BIOCHEMISTRY .................................................................................................................. 91 

ACE (Angiotensin converting enzyme) ............................................................................... 91 

ACTH ............................................................................................................................. 91 

Alpha‐Fetoprotein (AFP) .................................................................................................. 91 

Albumin (in profile) ......................................................................................................... 91 

Alcohol (Ethanol) ............................................................................................................ 91 

Alpha 1 antitrypsin .......................................................................................................... 91 

Alkaline Phosphatase (in profiles) ..................................................................................... 91 

Alkaline Phosphatase isoenzymes ..................................................................................... 91 

Alanine Aminotransferase (ALT) in LFT profile .................................................................... 91 

Amino acids .................................................................................................................... 92 

Amiodarone ................................................................................................................... 92 

Ammonia ....................................................................................................................... 92 

Amylase ......................................................................................................................... 92 

Androstenedione ............................................................................................................ 92 

Aspartate Aminotransferase (AST) .................................................................................... 92 

B2 Microglobulin ............................................................................................................ 92 

B12 ................................................................................................................................ 92 

Bicarbonate (HCO3) ........................................................................................................ 92 

Bile acids ........................................................................................................................ 92 

Bilirubin (in profile) ......................................................................................................... 92 

Bilirubin – neonatal ......................................................................................................... 93 

BONE PROFILE: ............................................................................................................... 93 

Alkaline phosphatase ...................................................................................................... 93 

Calcium .......................................................................................................................... 93 

Phosphate ...................................................................................................................... 93 

Albumin ......................................................................................................................... 93 

CA125 ............................................................................................................................ 93 

CA15.3 ........................................................................................................................... 93 

CA19.9 ........................................................................................................................... 93 

Cadmium ....................................................................................................................... 93 

Caeruloplasmin ............................................................................................................... 93 

Carbamazepine (Tegretol) ................................................................................................ 94 

Calcium (in profile) .......................................................................................................... 94 

Complement C3, C4 ........................................................................................................ 94 

C1 esterase inhibitor ....................................................................................................... 94 

Carbon Monoxide ........................................................................................................... 94 

CEA ............................................................................................................................... 94 

Cholesterol ..................................................................................................................... 94 

Cholinesterase (phenotype) ............................................................................................. 94 

Chloride ......................................................................................................................... 94 

CK (Creatine Kinase) ........................................................................................................ 95 

Cobalt ............................................................................................................................ 95 


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Copper ........................................................................................................................... 95 

Cortisol .......................................................................................................................... 95 

CRP (C‐reactive protein) .................................................................................................. 95 

Creatinine ...................................................................................................................... 95 

Creatinine Clearance ....................................................................................................... 95 

Cyclosporin .................................................................................................................... 96 

Digoxin .......................................................................................................................... 96 

eGFR .............................................................................................................................. 96 

ELECTROLYTE PROFILE: .................................................................................................... 96 

Urea .............................................................................................................................. 96 

Sodium .......................................................................................................................... 96 

Potassium ...................................................................................................................... 96 

Creatinine ...................................................................................................................... 96 

Ferritin ........................................................................................................................... 97 

Folate ............................................................................................................................ 97 

FSH – see hormone profiles ............................................................................................. 97 

Blood Gases ................................................................................................................... 97 

Gamma GT ..................................................................................................................... 97 

Gentamicin assay – once daily dose .................................................................................. 97 

Glucose .......................................................................................................................... 97 

Growth Hormone(HGH) ................................................................................................... 97 

HCG ............................................................................................................................... 98 

HDL cholesterol .............................................................................................................. 98 

HEPATIC PROFILES – See LFTs ........................................................................................... 98 

5HIAA ............................................................................................................................ 98 

HORMONE PROFILES: ...................................................................................................... 98 

Infertility: ....................................................................................................................... 98 

Menopause: ................................................................................................................... 98 

PCO ............................................................................................................................... 98 

IMMUNOGLOBULINS: ...................................................................................................... 99 

IgG ................................................................................................................................ 99 

IgA ................................................................................................................................. 99 

IgM ................................................................................................................................ 99 

IgE ................................................................................................................................. 99 

Immunofixation .............................................................................................................. 99 

Insulin ............................................................................................................................ 99 

IGF 1 (Insulin‐like growth factor 1) .................................................................................... 99 

Iron ............................................................................................................................... 99 

Lactate ......................................................................................................................... 100 

LDH ............................................................................................................................. 100 

LDL Cholesterol ............................................................................................................. 100 

Lead ............................................................................................................................ 100 

LIVER PROFILE: ............................................................................................................. 100 

Liver Function Tests (LFT) ............................................................................................... 100 

Bilirubin ....................................................................................................................... 100 


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Alkaline phosphatase .................................................................................................... 100 

ALT .............................................................................................................................. 100 

Albumin ....................................................................................................................... 100 

Total Protein ................................................................................................................ 100 

LH – see Hormone profile .............................................................................................. 101 

LIPID PROFILE: (Fasting) ................................................................................................. 101 

Cholesterol ................................................................................................................... 101 

Triglyceride (fasting) ...................................................................................................... 101 

HDL on all cholesterols (random or fasting) ..................................................................... 101 

Lithium ........................................................................................................................ 101 

Magnesium .................................................................................................................. 101 

Mercury ....................................................................................................................... 101 

Oestradiol .................................................................................................................... 101 

Osmolality .................................................................................................................... 101 

P3NP ........................................................................................................................... 101 

Paracetamol ................................................................................................................. 101 

Phenobarbitone ............................................................................................................ 102 

Phenytoin .................................................................................................................... 102 

Phosphate .................................................................................................................... 102 

Potassium – see electrolyte profile ................................................................................. 102 

Progesterone ................................................................................................................ 102 

Prolactin ...................................................................................................................... 102 

Prostate Specific Antigen (PSA) ...................................................................................... 102 

Protein, Total (in profile)................................................................................................ 102 

Protein electrophoresis ................................................................................................. 102 

PTH ............................................................................................................................. 102 

RAST ............................................................................................................................ 103 

Salicylate ...................................................................................................................... 103 

Selenium ...................................................................................................................... 103 

Sex Hormone Binding Globulin ....................................................................................... 103 

(SHBG) ......................................................................................................................... 103 

Sodium – see electrolyte profile ..................................................................................... 103 

Thyroid Function Tests: ................................................................................................. 104 

INITIAL FT4 AND TSH ..................................................................................................... 104 

FT4 .............................................................................................................................. 104 

TSH .............................................................................................................................. 104 

Transferrin ................................................................................................................... 104 

Theophylline ................................................................................................................ 104 

Thyroglobulin ............................................................................................................... 104 

Triglyceride (in lipid profile) ........................................................................................... 104 

Troponin I .................................................................................................................... 104 

Tryptase ....................................................................................................................... 105 

Urea – see electrolyte profile ......................................................................................... 105 

Uric acid ....................................................................................................................... 105 

Valproate ..................................................................................................................... 105 


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Vitamin A ..................................................................................................................... 105 

Vitamin D ..................................................................................................................... 105 

Vitamin E ..................................................................................................................... 105 

Zinc ............................................................................................................................. 105 

URINE TESTS: ................................................................................................................ 106 

Albumin/Creatinine Ratio (microalbuminuria) ................................................................. 106 

Amino acids .................................................................................................................. 106 

Amylase ....................................................................................................................... 106 

Bence Jones Protein screen ............................................................................................ 106 

Bile Pigments ................................................................................................................ 106 

Calcium ........................................................................................................................ 106 

CATECHOLAMINES: ....................................................................................................... 107 

Adrenalin ..................................................................................................................... 107 

Dopamine .................................................................................................................... 107 

Metadrenalin ............................................................................................................... 107 

Noradrenalin ................................................................................................................ 107 

Normetadrenalin .......................................................................................................... 107 

Cortisol ........................................................................................................................ 107 

Creatinine .................................................................................................................... 107 

Creatinine Clearance – blood sample required at the same time........................................ 107 

Deoxypyridinoline ......................................................................................................... 108 

(x‐links) ........................................................................................................................ 108 

Electrolytes and Urea: ................................................................................................... 108 

Sodium ........................................................................................................................ 108 

Potassium .................................................................................................................... 108 

Urea ............................................................................................................................ 108 

HMMA = VMA = see Catecholamines .............................................................................. 108 

5HIAA .......................................................................................................................... 108 

Magnesium .................................................................................................................. 108 

Mucopolysaccharide ..................................................................................................... 108 

Osmolality .................................................................................................................... 109 

Oxalate ........................................................................................................................ 109 

Phosphate .................................................................................................................... 109 

PORPHYRINS: ............................................................................................................... 109 

Porphobilinogen ........................................................................................................... 109 

Porphyrin ..................................................................................................................... 109 

PCR (Random) protein/creatinine ration ......................................................................... 109 

Protein (24 Hr) .............................................................................................................. 109 

Uric acid ....................................................................................................................... 109 

OTHER SAMPLES: .......................................................................................................... 110 

C.S.F.: .......................................................................................................................... 110 

Protein ......................................................................................................................... 110 

Lactate ......................................................................................................................... 110 

CSF Glucose ................................................................................................................. 110 

CSF/serum IgG albumin ratio and Oligoclonal bands. ........................................................ 110 


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CSF Xanthachromia ....................................................................................................... 110 

FAECES: ....................................................................................................................... 110 

Occult blood ................................................................................................................. 110 

Faecal Elastase ............................................................................................................. 111 

Faecal Porphyrins .......................................................................................................... 111 

Sweat tests ................................................................................................................... 111 

CALCULI – Quantative analysis ....................................................................................... 111 

FLUIDS: ........................................................................................................................ 111 

Pleural fluid:‐ ................................................................................................................ 111 

Other fluids:‐ ................................................................................................................ 111 

Paediatric Sample Requirements – Biochemistry ................................................................ 112 

Blood samples .............................................................................................................. 112 

Urine samples ............................................................................................................... 114 

Faecal Samples ............................................................................................................. 114 

CSF Samples ................................................................................................................. 114 

Appendix E ‐ Site map ...................................................................................................... 115 


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Preface 

This guide has been prepared to inform the users of The Royal Hampshire County 

Hospital Pathology Laboratory of which services are available and how to obtain 

the services required. 

It is appreciated that with the ever increasing range of tests available it is difficult 

for the user to know which request form, specimen container, type of specimen 

and particular protocol is needed to obtain the specific investigation and result they 

require. Hopefully, this guide will address these difficulties. In addition to this type 

of information, the guide also contains lists of relevant telephone numbers to 

facilitate easy access to appropriate Consultant and other senior staff for advice as 

well as departmental numbers for result enquiries. 

Any laboratory is, to a large extent, only as good as the user allows it to be. It is 

important that all request forms and specimen containers are labelled properly 

with the relevant demographic and clinical details. Care must also be taken to 

follow any necessary protocol where a result could otherwise be adversely 

affected. If any doubt exists, it is advisable to contact the appropriate Consultant 

or department who will be pleased to provide the necessary information. Finally, 

any views that users may have about how this guide could be improved would be 

welcomed for incorporation into future editions. Please give these, preferably in 

writing to David Beacher, Quality Manager (mailto:David.Beacher@HHFT.NHS.UK). 

Sixth edition April 2012 

Dr N. Hutchinson 

on behalf of the Pathology Department 


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INTRODUCTION 

The Winchester Clinical Pathology Service is based at the Royal Hampshire County 

Hospital, Romsey Road, Winchester and is part of the Hampshire Hospitals NHS 

Foundation Trust. It is located at the rear of the main hospital buildings (see map 

p115) and is clearly signposted throughout the hospital. The department is divided 

into four main areas, Biochemistry (including Immunology), Haematology (including 

Blood Transfusion), Cellular Pathology, (including Histopathology, Cytopathology 

and Mortuary) and Microbiology. 

To ensure safety, all visitors should introduce themselves at Pathology reception 

and wait until they are met by the person they wish to see. It is advisable to make 

appointments in advance, to ensure staff availability. 

Hours of Business 

Haematology – 

Routine service Mon – Fri 08.45 – 17.15 

Saturday 08.45 – 12.00 Hospital service ONLY 

Out of hours service Mon – Fri 17.15 – 08.45 

Sat 12.00 – Mon 08.45 and bank holidays 

Contact via switchboard (01962) 863535 

Phlebotomy ‐ 

Phlebotomy outpatients Mon – Fri 07.30 – 16.45 

Phlebotomy service to RHCH Wards Mon – Fri 08.00 – 12.00 

Afternoon service for Urgent request ONLY Mon – Fri 14.00 – 1600 

Contact Phlebotomy supervisor for further information on Ext 4456. 

Saturday service for inpatients ONLY 08.00 – 11.00 (Max 75 requests) 

Sunday service for inpatients ONLY 08.00 – 11.00 (Max 50 requests) 

Andover War Memorial outpatient Phlebotomy service 

Mon – Fri 07.30 – 16.45 

Andover phlebotomy service to wards 

Mon – Fri 10.00 – 10.30 (Max 5 requests) 


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Biochemistry – 


Saturday 08.45 – 12.00 Hospital service ONLY 

Out of hours service Mon – Fri 17.15 – 08.45 

Sat 12.00 – Mon 08.45 


Microbiology – 


Saturday 09.00 – 12.00 

On call service Mon – Fri 17.30 – 0.900 

Saturday 12.00 – Mon 09.00 


Cellular Pathology – 

Routine service 08.30 – 17.00 

No on‐call service is available 

Mortuary – 


On call service at all other times including weekends 



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Contact Details 

1.All result enquiries for Haematology and Biochemistry: 

i) 01962 824287/8 

ii) or ext 4287/8 

2. Blood Transfusion enquiries ext 4449 or 01962 824449 

3. Cytology enquiries ext 4704 or 01962 824704 

4.Histology enquiries ext 4381 or 01962 824381 

5.Mortuary enquiries ext 4413 or 01962 824413 

6. Microbiology enquiries ext 4461 or 01962 824461 

7.Serology enquiries ext 4706 or 01962 824706 

8.Infection Control enquiries ext 5170 or 01962 825170 

9.Anticoagulant enquiries ext 5624 or 01962 825624 

10.Phlebotomy enquiries ext 4456 or 01962 824456 

11 Point of Care coordinator ext 4697 or 01962 824697 

12 Fertility bookings ext 4289 or 01962 824289 

13 Immunology ext 4458 or 01962 824458 

Service Director: Dr Nicki Hutchinson 01256 313310 

Services Manager: Lorraine Amos 01962 824384 

Quality Manager: David Beacher 01962 824463 

Computer Manager: Doug Cousins 01962 824452 

Administrator: Linda Trangmar 01962 824289 

Fax: 01962 853449 

Office Supervisor: Samantha Macdonald 01962 825934 

Pathology Supplies: Chris Irons bleep 191 01962 824469 

pathology.supplies@hhft.nhs.uk Fax: 01962 825774 


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Dealing with specimens 

The Departments endeavour to deal with all specimens received in the most timely 

and accurate way possible. On‐site phlebotomy staff take blood specimens for outpatients 

in the Pathology OP department. 

Receipt of specimens 

During working hours all specimens should be delivered to Pathology reception. 

Out of normal opening hours blood cultures must be placed in the incubator in 

specimen reception to which porters have access, and other samples into the 

chilled cabinet. There is access to the chilled cabinet from outside reception via a 

specimen “letter box”, as it is fixed into the wall. 

Community units: A daily transport run is made to all of these for the collection of 

specimens Mon ‐ Fri. 

GP surgeries: A daily transport run is made to all surgeries Mon – Fri. 

For urgent specimens outside of core hours – Please telephone the lab to inform 

us of all urgent specimens/requests. A 24hour/7 day week service operates in 

Haematology and Biochemistry. All samples will be processed on receipt. 

However, for urgent transfusion requests it is essential to contact the Biomedical 

Scientist in the laboratory. For urgent Microbiology samples please contact the 

BMS on call. 

Outpatient Phlebotomy times 

Samples will be taken whenever the laboratory is open during the week (07.30‐ 

16.45), but Monday to Friday 11.00 ‐ 16.00 represents the optimum times for 

outpatients (and particularly for children over 4 years old ) to attend. Patients 

attending for phlebotomy between 13.00 ‐ 14.00hrs may have a short wait due to 

lunch time staffing levels. Patients for fasting blood samples can report at 07.30am 

onwards when every effort will be made to take the sample as soon as possible. 


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Air tube stations 

There is a compressed air tube transport system which is primarily for pathology 

samples. There are stations in A&E, EMAU, ICU, NNU, Labour ward and the 

Treatment Centre. 

DO NOT SEND Histopathology specimens in Formalin through the air tube system. 

Quality Assurance 

All departments aim to give the very highest quality of service with the minimum of 

delay. To ensure this, all departments participate in recognised External Quality 

Assurance Schemes. There are also extensive internal quality control checks. The 

laboratory’s methods and procedures aim to conform to CPA standards and regular 

audits of turnaround times and user satisfaction surveys are carried out. 

Any problems regarding the quality of the service should be brought to the 

attention of the Head of Department concerned. 

Research and Development 

It is the Department's policy to encourage appropriate research and development 

and to promote personal, professional development. Many of the medical and 

scientific staff take an active part in medical education and research. 

Turnaround Times 

Most tests are performed the same day, but some are batched and performed once 

or twice a week. A full table of representative turnaround times is in the Test Index. 

Turnaround times are routinely monitored as part of the Laboratories Continual 

Quality Improvement Programme. 

Reports 

Standard format reports are computer generated several times a day. Surgeries 

that are linked to the NHS Net and have EDI links have the results automatically 

sent to them, EXCEPT Histology reports. Hard copies are still sent for 

Histology/cytology and for other departments if electronic transfer is not possible. 

The reference/normal or therapeutic ranges are quoted on the report form for 

most assays. These are current ranges and may supersede other listed ranges. 


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Pathology IT Links 

Pathology has IT links to all wards for the data transfer of results. Results for 

electronically requested tests are sent electronically to the wards after 

authorisation by the department's senior staff. 

Encrypted data links to GP practices for the transfer of results are via the Keystone 

system. Biochemistry, Haematology and Microbiology results are sent 

electronically to all GP practices. Practices with the ability to accept these 

messages and the data transfer allow the pathology results to be incorporated 

directly into the patients’ records, after authorisation by the GP. 

All blood transfusions at RHCH are controlled by an electronic blood tracking 

system. This must be used to both maximise patient safety and to ensure that the 

hospital complies with the requirements of the Blood Safety and Quality 

Regulations. 

For further details contact the Pathology Computer Manager on ext 4452 or the 

Trust IM&T Department on ext 5245. 

Pathology Supplies 

At the RHCH a ward top‐up system is operated by supplies. Additional stock may be 

ordered and collected directly from pathology stores during core hours. 

Outside RHCH orders can be made by fax, email or writing. These are dispatched as 

promptly as possible. However, please allow three working days for delivery. 

Urgent orders may be dispatched the same day within working hours. Service 

users are advised not to horde supplies as stock is date‐coded and issued on a 

rotational basis. For further information please contact Chris Irons, Pathology 

Supplies on 01962 824469. 

PLEASE NOTE: from April 2007 charges will apply for all stock supplied. 

Screening Programmes and other non‐NHS work 

The Department is involved in health screening programmes and is happy to 

provide quotations for individually tailored schemes and private work. Please 

contact the Pathology Services Manager on 01962 824384. 

The department is also involved in several non‐NHS schemes and performs 

pathology testing that includes: 


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Private hospitals 

Education courses 

Health screening 

Quality Control 

Pregnancy testing DVLA 

Blood collection 

Please use the vacutainer system to collect blood samples rather than using a 

needle and syringe. Artefactual results may be obtained when using a syringe and 

then decanting the blood into Vacutainers, it is much more expensive and less safe. 

To ensure that requests are dealt with effectively, it is essential to comply with the 

following guidelines. Specimens should be placed in the appropriate containers 

which must be securely fastened. Fill blood tubes in the correct order e.g. fill gel 

tubes and plain tubes before EDTA tubes to avoid EDTA interfering with 

Biochemistry assays; Always inoculate blood culture bottles first. 

The vacutainer system has many advantages: 

Mixing of the correct volume of blood and anticoagulant is instantaneous. 

Wide selection of bottles available with different volumes and anticoagulants. 

Syringes are not required and the volume of blood needed does not have to be calculated in advance. 

Closed sampling is safer on the wards and in the laboratory. 

Adaptors for use with butterflies are available for 

'Difficult veins' 

patients who can not keep still 

situations where continued venous access is required 

Note the preferred order of tube use is ... 

Citrate samples LIGHT BLUE 

ESR samples BLACK 

Plain 

RED 

Plain Gel Samples YELLOW/GOLD 

Heparinised samples GREEN 

EDTA samples PINK/LAVENDER/LILAC/PURPLE 

Oxalate samples GREY 

Trace metals NAVY BLUE 

If you are not familiar with the system, or wish to have instruction, our phlebotomists will be happy to 

help you. 

Labelling of specimens/sample 

Specimens must be identifiable. Unlabelled samples will not be processed and it is 

the requesting clinician’s responsibility to ensure that samples are labelled 

correctly. The minimum information required on the specimen label is: 


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• Patient’s full name (initials are not acceptable) and date of birth 

• Date and time of collection 

Addressograph labels MUST NOT BE USED on blood samples. 

Acceptable use of printed labels 

(similar size to original label and placed directly over the original label so as not to 

obscure the sample) 

Samples will be rejected if the printed label used is too big, this causes equipment 

failure due to jamming of the system, or if the labels are placed in position so that 

the sample is obscured from view. 

Rejected samples 

(The label is too big and obscures the sample on the green top tube and the labels 

have been placed in a position which obscures the sample from view on the gold 

top tubes) 

Antenatal samples MUST be labelled with at least THREE identification points and 

include: 


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Patient’s full name 

Date of birth 

NHS and/or Hospital number 

Also required on the sample is the Collector's signature, date and time of collection 

Samples for blood transfusion and/or blood grouping must have at least THREE 

identification points and include: 

Patient’s full name 

Date of birth 

NHS and/or Hospital number* 

*Patient’s Full Address (This may be substituted for NHS/Hospital number 

ONLY) 

Post code only is not acceptable 

Also required on the sample is Collector's signature, date and time of 

collection 

Addressograph labels MUST NOT BE USED 

Specimens MUST be labelled by hand 

The container should be sealed in the bag attached to the combined pathology 

request form, or placed into one of the clear plastic 2 part bags supplied, with the 

printed request form in the attached compartment. Specimens should be 

transported to the laboratory as rapidly as possible after collection to ensure that 

no significant deterioration occurs before processing. For all specimens 

transported from the community by road these must be packaged in accordance 

with Packing Instruction PI650 available from the Department for Transport or from 

the Pathology Quality and Health & Safety Manager. This minimum requirement is 

as follows: 

Primary leak proof container (specimen tube etc.) 

Absorbent material 

Secondary leak proof container (Specimen request/bag or Ziplock bag) 

Rigid outer container (Transport tin or equivalent) 

(The outer container MUST be marked with the UN3373 Biological Substance, 

category B Diamond as per PI650) 


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Further information on labelling can be found in the Specimen and Request form 

Labelling Policy (CP094) available under the Our services section of the Trust web 

page within the Pathology/Pathology User Handbook section or on the internal 

Intranet via the document search engine using the CP094 code. 

High Risk specimens 

High‐risk groups can include patients suffering from, or thought to be suffering 

from, Hepatitis, HIV, TB, E coli 0157 and other notifiable diseases. Intra‐venous drug 

users and patients who’ve had recent foreign travel with unexplained high pyrexia 

should also be treated as high risk. 

Request forms and samples MUST be labelled with "Danger of Infection" labels, 

placed in a Bio‐hazard bag and transported to the laboratory with care. 

To protect all healthcare workers, requests for investigations on high risk samples 

should be the minimum required for diagnosis and good patient management. 

Great care must be taken when obtaining specimens, and equipment such as 

needles and blades must be immediately disposed of safely, in approved sharps 

boxes. Should a spillage of blood, fluids or tissue occur, this should be made safe 

and disposed of appropriately. 

Request forms 

A completed request form must accompany each specimen sent to the laboratory. 

Please ensure that the patient details are correct, fully completed and the 

requesting clinician and destination are clearly indicated. Any further details, such 

as copies required for other clinicians can also be included. Clear and careful 

details on the request form will avoid the misdirection of reports. 

The following legible information is required on the request form: 

• Patient's full name (initials are not acceptable) 

• Date of birth and sex of patient 

• NHS number and, if known, hospital number 

• Patient’s address including the postcode 

• Patient’s contact telephone number** 

• The requesting clinician with location and address for report 

• Relevant clinical information and any drug therapy 

• The tests being requested 


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• Type of specimen and anatomical site if appropriate with the date and time it 

was collected 

• Indication if HIGH RISK status “Danger of Infection” label 

**Abnormal results for GP patients can only be telephoned to the out of hours’ 

service if a contact number is supplied for the patient. 

Additional information may be required for some investigations ie “special 

haematology, thrombophilia and ante natal screening”. Please see separate 

departmental sections. 

‘Unknown’ patients e.g. those admitted unconscious, unaccompanied and without 

documentation, should have their specimens identified with the casualty number. 

See the Trust Policy for Unconscious Patients. 

Regrettably, specimens will be discarded if they are inadequately labelled, if the 

patient’s identification is in doubt, or if they have leaked and/or been 

contaminated. 

Forms for blood transfusion and/or blood grouping must have at least FOUR 

identification points and include: 

Patient’s full name (initials are not acceptable) 

Date of birth 

NHS and/or Hospital number 

Patient’s Address including post code 

Also required is Collector's signature, date and time of collection 

Specimen Collection/Sample Requirements 

It is important to use the correct specimen container and/or tube and take the 

sample at the appropriate time. If you have any doubts, please contact the 

department who will be happy to advise. Further information can be found in the 

departmental specific sections or in the test index at the rear of the handbook. 

Sample Storage 

Ideally all samples should be received on the day of collection. If delay is 

anticipated, store the sample at 4ºC (in the fridge overnight) to minimise the 

effects on the condition of the specimen, except Blood Cultures which must be 


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placed in the incubator in specimen reception, and fixed cellular pathology 

specimens which should be kept at room temperature. 

Some Biochemistry samples require special conditions, such as freezing, or 

centrifugation/separation of plasma, which requires immediate attention. This may 

mean the patient has to attend the RHCH to be bled. 

Requests for additional tests 

Biochemistry cannot accept requests for additional tests on samples which are 

greater than 3 days old. 

Immunology, requests for additional tests will be accepted up to 1 month post 

sample collection. 

Haematology cannot accept requests for additional tests on samples which are 

greater than 24 hours old. 

Histopathology cannot accept requests for additional test on samples which are 

greater than 1 month old. 

Microbiology will discuss additional test on an individual basis please contact the 

laboratory. 

Date and time of samples 

The 24‐hour time clock on samples is preferred and is especially important for 

blood glucose, Digoxin and other drug assays, as therapeutic drug monitoring may 

require dose related timing. The date the specimen was taken is essential for the 

laboratory to assess whether there has been a delay in receipt of the sample. 

Hormone profiles in women may also require the day in the menstrual cycle (if 

appropriate), for interpretation. 

Availability of Results 

Many tests are performed the same day, but some take several days and are 

performed in batches. Special investigations may be sent to other centres and 

these results can take two weeks, sometimes longer. 

Urgent results may be available within the hour, following prior discussion with the 

laboratory. Results for routine haematology and biochemistry tests are available 

via the Pathology computer within 4 – 8 hours. 

Grossly abnormal results will be telephoned. 


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The out of hours’ range of tests 

Haematology 

Full blood count 

ESR 

Coagulation screen 

INR (with Fibrinogen) 

Glandular Fever screen 

Group & Save Serum 

Cross‐match and issue of blood products 

Blood film 

Malarial screen 

Sickle test 

PTT 

Sensitive Pregnancy test 

Direct Antiglobulin test 

Biochemistry 

Albumin 

Electrolytes 

Amylase 

Glucose 

Bilirubin ‐ Total and conjugated LFT 

Blood Gases 

Magnesium 

Calcium 

Osmolality 

Chloride 

Paracetamol 

CK (Total only) 

Phosphate 

Creatinine 

Salicylate 

CRP 

Uric Acid 

CSF – Protein, Glucose & Xanthochromia 

Total Protein 

Ammonia ) 

Carboxyhaemoglobin ) Discuss with duty Biomedical scientist 

Lactate ) before requesting 

Troponin ) 

Microbiology 

Urine Microscopy 

Pus/pus swabs 

CSF 

Serology tests following needle‐stick 

injury 

Joint/Pleural fluid 


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Grossly Abnormal Results 

(On a first occasion), these are telephoned to the requesting clinician/surgery. 

Abnormal results from GP patients will be telephoned to the out‐of‐hours service if 

a current patient telephone number is supplied. This applies to results outside of 

the following limits: 

Haematology 

Hb 

< 8.0 g/dl or >18.0g/dl 

WBC 30 x10 9 /l 

Neutrophils 40mm/hr (Temporal Arteritis) 

INR 

>1.5, or >5.0 for warfarinised patients 

PTT ratio >1.5, or >4.0 for heparinised patients 

Fibrinogen < 1.0 g/l 

D‐dimers >250 for out‐patients, and >1000 for in‐patients 

Positive Malarial screens 

Positive Sickle Tests 


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Biochemistry 

As above, to results outside of the following limits: 

ANALYTE BELOW ABOVE 

SODIUM 120 150 

POTASSIUM 2.5 6.5 

UREA 

30.0 (>10 if 200 if 300 

AST 

>615 (GP ONLY) 

ALT 

>675 male and >510 Female (GP ONLY) 

CK 

>5000 unless ? MI 

TRIGLYCERIDE 

>20 (GP ONLY) 

LITHIUM 1.5 

DIGOXIN 2.5 

PHENYTOIN 25 

GENTAMICIN 7 

CARBAMAZEPINE 25 

THEOPHYLLINE 25 

PHENOBARBITONE 70 

CSF GLUCOSE 2.2 

CSF PROTEIN 1000 

TROPONIN 

>0.04 (GP ONLY) 


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Point of Care Testing (POCT) 

POCT refers to any investigation performed on a body fluid/tissue in a clinical 

setting, where the result is available without reference to the laboratory and may 

directly affect patient management. Examples include blood gas analysers, blood 

glucose meters, urine stix tests, urine pregnancy tests, bilirubinometers, Hb meters, 

coagulation meters, etc. 

Pathology undertakes the quality management of all POCT within the Trust, via the 

POCT Management Group and the services of the Pathology POCT coordinator. We 

can provide help and advice on the implementation of a variety of Pathology pointof‐care 

testing systems, including blood gas analysers and hand held blood glucose 

meters. Please contact our POCT Coordinator, or the Pathology Services Manager 

for further information. 

All POCT testing is subject to strict governance and must be performed to the same 

quality standards as all testing undertaken within the Clinical Pathology 

Accreditation UK (CPA UK) accredited central RHCH laboratories 

All operators of POCT equipment must adhere to the Trust POCT Policy (CP093), 

which can be located on the Trust Intranet and should also be consulted prior to 

procurement of any new POCT equipment. All requests for additional POCT 

equipment must be supported by an appropriate business case identifying the 

clinical need and performance criteria required for the proposed service. The 

process of procurement should be conducted in accordance with the Trust’s 

Supplies Department protocols and tenders will be reviewed by the POCT 

Management Group, for consideration and if appropriate, subsequent ratification. 

POCT contact details 

POCT Coordinator: Paul Litherland: 01962 824697 

POCT pregnancy tests: Michelle Judd: 01962 824460 

POCT coagulation enquiries: Simon Bowen 01962 824460 

POCT Clinical advice and interpretation of results: initially contact the Central 

Laboratory from 0845 – 1715hrs; for out of hours, please contact appropriate 

clinical laboratory lead, via switchboard 


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Clinical Advice and Interpretation 

For Clinical Advice or Interpretation of results please contact the following: 

Haematology/Blood Transfusion 

Dr John Van de Pette 01962 825901 

Dr Jennifer Arnold 01962 824700 

Cellular Pathology 

Dr Raid Al‐Talib / 

Dr Adnan Al‐Badri / 

Dr Balvinder Shoker / 

Dr Hayley Burnley 01962 824701 

Biochemistry 

Dr Heather Barbour 01962 824455 

Dr Teresa Teal 01962 825799 

Microbiology 

Dr Matthew Dryden / 

Dr Roberta Parnaby / 

Dr. Kordo Saeed 01962 824451 

Immunology 

Dr David Sinclair, Portsmouth Hospital 02392 286812 

Myk Saas 01962 824458 

For URGENT clinical advice outside normal working hours please contact 

switchboard on 01962 863535 and ask for the on‐call consultant for the 

department required. 

Please note that URGENT out of hours Microbiology advice is also provided by 

consultants based at Basingstoke and North Hampshire NHS Foundation Trust on 

a cross cover basis via switchboard. 

Immunology out of hours advice please contact Portsmouth Hospital switchboard 

and ask for Dr. Sinclair 


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DEPARTMENTAL SPECIFIC INFORMATION 

HAEMATOLOGY & BLOOD TRANSFUSION 

Includes: 

Haematology 

Anti coagulation service 

Andrology 

Blood Transfusion 

Phlebotomy service 

The department provides a comprehensive clinical and laboratory service covering 

general diagnostic haematology, haemostasis and transfusion. 

Consultant Haematologists 

Dr John Van de Pette 01962 825663 

Dr Jennifer Arnold 01962 824453 

Dr. S. Webb, Department Manager 01962 824736 

Dr. Webb secretary 01962 824700 

Section Heads 

Haematology – Simon Bowen 01962 824781 

Transfusion ‐ John Travers 01962 824449 

Specialist Practitioner, Transfusion – Jenny Bodkin 01962 824129 

(Bleep 494) 

Phlebotomy Supervisor – Connie Hopper 01962 824456 

Phlebotomy Supervisor at Andover WMH – 

Ruth Stott 01264 835221 

Anticoagulant Co‐ordinator ‐ Tracy May 01962 825624 

Help lines 

1. Patient results and enquiries 01962 824287/4288 

2. Haematology enquiries ext 4287/4288 

3. Blood Transfusion enquiries ext 4449 

4. Specimen reception ext 4735 

5. Urgent requests during core hours ext 4735 

6. Out of hours via hospital switchboard 01962 863535 

7. Consultant’s secretaries: Dr Van de Pette’s ext 5901 

Dr Arnold’s ext 4700 

Fax: 01962 853449 


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Useful clinical information ‐ Common causes of spurious results 

Please ensure that you follow instructions when collecting and storing samples. 

Inappropriate sample collection, storage and transport can interfere with a number 

of results. Some examples are given in the table below: 

Problem Common causes Effect 

Incorrect tube 

fill/mixing 

Storage 

Haemolysis 

Poor technique/ difficult 

patient 

Haematology samples in a 

fridge 

Expelling blood through a 

needle into the tube 

Vigorous shaking 

Extremes of temperature 

Lack of centrifugation 

Fibrin Clots. Incorrect coagulation results. 

Erroneous FBC↓, WBC, platelets, 

if RT. ↓coagulation factor assays. 

Erroneous coagulation results. 

Unable to perform D Dimer test 

Unable to perform Group and save 

Inappropriate 

collection site 

Sample taken from drip arm Diluted FBC results. ↑coagulation /PTT 

results when taken from heparin line. 

Incorrect container No fluoride oxalate 

or anticoagulant 

E.D.T.A. contamination 

Unable to perform coagulation test or ESR. 

Heparin – causes WBC clumping. 

Li sample collected into Li 

Heparin 


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HAEMATOLOGY 

The routine haematology section provides emergency and routine analysis using 

automated analysers. Further investigations are undertaken following abnormal 

results and screening for atypical diseases e.g. blood films, malaria parasite 

identification. Specialist areas have been developed to carry out more complex 

investigations. 

An automated analytical area is established for the rapid processing of all high 

volume work, including blood counts and testing associated with coagulation 

studies. 

The coagulation and haemostasis section of the department is primarily involved 

with the investigation of various coagulopathies. These include bleeding and 

thrombotic problems, both acquired and hereditary. D‐Dimer testing is performed 

for early detection of thrombosis. Various conditions such as haemophilia and von 

Willebrand’s disease are diagnosed and monitored by this section. 

BLOOD TRANSFUSION 

A comprehensive clinical service for the provision of blood and appropriate blood 

products is offered 24 hours a day. All blood and blood products are issued from 

the blood bank following any necessary pre‐transfusion compatibility testing. 

Serological problems associated with red cell specific antibodies and ante‐natal 

investigations are carried out in the blood bank using the latest available 

technology. An automated blood grouping facility is used for routine requests. 

The department employs a Transfusion Practitioner who works with all staff 

involved in the transfusion pathway to ensure best transfusion practice. 

COAGULATION THERAPY 

An anticoagulant management service is offered for referred outpatients. This is 

run as a community service by the co‐ordinator based at RHCH, with consultant 

advice as necessary. 


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A completed referral for all new patients MUST be faxed to 01962 825941. In line 

with national guidelines, patients will not be admitted onto the anticoagulant clinic 

without an appropriate referral form. 

Patient Referrals 

The consultant haematologist deals with general haematology, thrombophilia and 

oncology referrals. Referrals may be made by letter, fax, email or, if urgent, by 

telephone via the consultant’s secretary. 

Dr Van de Pette’s secretary: ext 5901 

Fax: 01962 853449 

Dr. Jennifer Arnold’s secretary ‐ Shirley Docherty ext 4700 

Fax: 01962 853449 

Dr S Webb (Thrombophila referrals) ext 4700 

Haematology Clinics 

Monday a.m. at AWMH 

Tuesday a.m. at RHCH 

Tuesday p.m. at RHCH X2 

Wednesday a.m. at RHCH 

Thursday a.m. at RHCH 

Thursday p.m. at RHCH 

Friday 

p.m. at AWMH 

The haematology consultants are happy to discuss individual cases, or aspects 

pertaining to any disease or pathological condition, with hospital clinicians and 

general practitioners. 

Thrombophilia clinic 

Thursday a.m. in out patients department 

Further Patient Management 

Inpatient day care facilities are available on the Discharge and Admissions Lounge 

at RHCH for patients undergoing intensive treatments. Counsellors and support 


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nurses are available to patients for psychological support, and palliative care is 

available through a specialist palliative care team. 

Fertility Investigations 

Referrals for Fertility Investigations must be made on a Referral for Semen Analysis 

form. The patient must be given a sterile 30ml container, and the Patient 

Information Sheet. Appointments may be made, by the patient once they have 

been given a completed referral form, patient information sheet, and specimen 

container, on Tuesday and Wednesday mornings by telephoning 01962 824289. 


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BIOCHEMISTRY & IMMUNOLOGY 

The Biochemistry department provides a comprehensive, high quality analytical 

service for the Trust and for its external users. It has high levels of automation to 

cope with the largest workload within the Pathology Department. 

The laboratory has a good record of development and clinical audit in clinical 

Biochemistry and supporting clinical teams. The Clinical Biochemists are happy to 

discuss individual cases, or aspects pertaining to any disease or pathological 

condition, with hospital clinicians and general practitioners. 

The Biochemistry department is divided into two main areas: The automated 

laboratory, which has a high throughput and provides emergency analyses using 

automated random access analysers, and the non‐automated area, which includes 

paraprotein identification and therapeutic drug monitoring . In addition, the 

department provides a sub‐regional service for cholinesterase phenotyping and a 

specialist renal calculi service. 

Help lines 

1. Patient results and enquiries 01962 824287/4288 

2. Biochemistry enquiries ext 4287/4288 

3. Specimen reception ext 4735 

4. Urgent requests during core hours ext 4735 

5. Out of hours ‐ via the hospital switchboard 01962 863535 

Paediatric Sample Requirements 

For Paediatric sample requirements see table on p112 ‐ p114. For further 

information regarding minimum volumes, please contact the Biochemistry 

laboratory. For tests that are referred to other laboratories (see main test list) 

please contact the Biochemistry laboratory. 

Dr Martyn Knapp, Consultant Biochemist 01962824458 

Dr Heather Barbour, Consultant Biochemist 01962 824455 

Dr Teresa Teal, Consultant Biochemist 01962 825799 

Colin Dickens, Department Manager 01962 824467 


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Please ensure that you follow instructions when collecting and storing samples. Inappropriate 

sample collection, storage and transport can interfere with a number of results. Some examples 

are given in the table below: 


Inappropriate collection site Sample taken from drip arm 

Increased drip analyte 

e.g. K , Glucose 

Dilution effect low results 

Prior use of Ametop analgesic gel Increased Na. 

Incorrect container or 

anticoagulant 

No fluoride oxalate 

E.D.T.A. contamination 

Decreased glucose 

Decreased Ca and Alk P 

Increased K 

Li sample collected into Li Heparin Increased Li 

Incorrect tube fill/mixing 

Delay in separation of 

serum/plasma 

Labile analytes 

overnight storage 

delay in transit 

Not immediately separated and 

frozen 

ALL analytes may be 

compromised 

Increased K, PO4, LDH 

Decreased ACTH, Insulin, C 

Peptide and Gastrin 

Storage Biochemistry samples in a fridge Increased K 

Haemolysis 

Expelling blood through a needle 

into the tube 

Vigorous shaking 

Extremes of temperature 

Increased K, PO4, ALT, LDH, 

Mg, Iron 


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Immunology 

The Immunology section of Biochemistry was created in 2009 and offers a 

comprehensive range of Autoimmune, Allergy and Immunochemistry analyses. 

Most tests are performed on site at Winchester however more specialised tests, 

including Cellular Immunology, are referred to other accredited Immunology 

laboratories. 

Our service is fully CPA accredited, with specialist clinical advice being provided by 

from Queen Alexandra Hospital, Portsmouth. The laboratory participates in all 

appropriate national quality assurance schemes and aims to maintain standards in 

all aspects of its service. 

Following our merger with North Hampshire Hospitals Trust in 2012 we anticipate 

being able to enlarge our local range of tests further, thus improving the service we 

offer. Staff are happy to discuss individual cases, or aspects pertaining to any 

disease or pathological condition, to help determine the most appropriate 

analytical approach. Clinical advice is available from our Consultant Immunologist. 

For comprehensive information about our service please refer to the separate 

‘Immunology Service Guide’ 

Help lines 

1. Patient results 01962 824287/4288 

2. Immunology enquiries / interpretation ext 4458 

3. Urgent Immunology requests during core hours ext 4458 

4. Out of hours ‐ via biochemistry / hospital switchboard 01962 863535 

Dr David Sinclair, Consultant Biochemist/ Immunologist 

Queen Alexandra Hospital, Portsmouth 02392 286812 

Dr. Martyn Knapp, Consultant Biochemist 01962 824455 

Myk Saas, Immunology Section Manager 01962 824458 


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CELLULAR PATHOLOGY 

Includes: 

Histopathology 

Cytopathology 

Mortuary 

The Cellular Pathology department provides services in general Histopathology, 

Cytopathology and includes the Mortuary service. 

Consultant Histopathologists 

Dr Raid Al‐Talib 01962 824399 

Dr Adnan Al‐Badri 01962 824454 

Dr Balvinder Shoker 01962 824379 

Dr Hayley Burnley 01962 824465 

Jayne Buckley, Department Manager 01962 824636 

Department Heads 

Histology ‐ Mrs Jayne Buckley 01962 824636 

Cytology ‐ Mr Craig Roberts 01962 824468 

Mortuary ‐ Mr David Blades 01962 825417 

Help lines 

1. Histology enquiries ext 4381 or 01962 824381 

2. Cytology enquiries ext 4704 or 01962 824704 

3. Post‐Mortem enquiries ext 4701 

4. Mortuary enquiries 01962 825417 

contactable out‐of‐hours via switchboard 01962 863535 

5. Bereavement Officer 01962 824648 

6. Coroner’s Officer 02380 857447 


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The time taken for a result to be available varies depending upon the type, size and 

complexity of the specimen. Any case in which the Histopathologist considers the 

findings to be of clinical urgency is telephoned to the clinician immediately. 

Most results are available via the Pathology computer as follows: 

• Urgent ‐ within 24 ‐ 36 hours 

• Histopathology ‐ simple cases, 2 ‐ 4 working days ‐ 

complex cases, up to 10 days 

• Non‐cervical cytology ‐ within 2‐3 days 

• Cervical cytology ‐ 98% of results received by woman within 2 weeks of the test 

being taken 

Urgent Requests 

Please mark the request form URGENT, with a contact name and a 

telephone/bleep number for the result. Results for very urgent small biopsies may 

be available within 24 hours or less after prior discussion with the laboratory (ext 

4381), or one of the Consultant Histopathologists. 

Urgent results of fine needle aspirate (FNA) Cytology and same day results for 

other Cytology specimens are available by special arrangement with the laboratory 

(ext 4468). 

Histopathology 

A comprehensive general Histopathology service is provided for a wide range of 

samples from hospital and primary care sources. Increasing numbers of biopsies 

and fine needle aspirates (FNA) are processed. The immunohistochemistry section 

uses the latest technology to detect cell markers e.g. specific breast markers. 

Specimens for histopathology should be fixed as soon as possible after removal in 

10% neutral buffered formalin obtainable from Pharmacy. Where possible the 

volume of fixative should be at least 10 times the volume of the specimen. For 

large specimens where this is not possible, at least make sure that the specimen is 


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totally immersed in formalin. Please ensure that the specimen pot (not the lid) is 

correctly labelled. 

FRESH and URGENT specimens must be marked as such and transported 

immediately to the Histopathology laboratory on level 3 in the main Pathology 

building. A "Danger of Infection" label must be applied to specimens known to be 

an infection hazard. 

The following histology specimens may be sent fresh (unfixed): 

Skin Biopsies for immuno‐fluorescence 

These should be sent fresh or in Michel’s medium (obtainable from the laboratory, 

ext 4381). Fresh specimens must be labelled (as above) and sent immediately to 

Histopathology. 

Special Diagnostic Biopsies 

Contact the pathologist when the selection of tissue requires special consideration 

and fixation, or the biopsy is of special interest or difficulty. 

Frozen Sections 

Frozen sections should be booked by telephoning the laboratory (4381), preferably 

with 24 hours notice. The laboratory should be notified again when the specimen is 

on its way. Samples MUST be received by 4pm. 

Cytopathology 

The Cytopathology section carries out cervical screening Hampshire Health 

Authority and some areas of the Wiltshire Health Authority. The laboratory has a 

computerised fail‐safe mechanism to ensure follow‐up of women with abnormal 

smears, and direct electronic linkage with Hampshire FHSA to facilitate 3 – 5 year 

recall. 

Non‐cervical Cytology includes a wide range of fine needle aspiration, endoscopic 

brushings and other exfoliative Cytology specimens received from clinical divisions 

and General Practitioners. The Cytopathology section supports the Breast Clinics at 

RHCH, offering cytological diagnosis of screen detected breast lesions obtained 

from stereotactic and ultrasound localised lesions, as well as palpable ones. 


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Liquid Based Cytology Cervical Samples (LBC) 

All sample takers MUST BE trained in using “Surepath” LBC Technique. 

Samples will only be accepted for processing if the forms are completed including 

NHS Number, Cervix visualised and 360˚ sweep x 5. 

All samples should be placed in a specimen bag containing absorbent pads and 

then placed in a pink LBC specimen transport bag before sending using the 

dedicated hospital transport. Please send the specimens (in the pink bags) on the 

next available transport ‐ even if there is only one specimen. Supplies of LBC vials 

and transport bags/absorbent pads are available from Pathology Supplies. 

Fine Needle Aspirates (FNA) 

Assistance is available (subject to staff availability) at RHCH for fine needle 

aspirates to prepare the slides. Contact the BMS3 in the cytology laboratory (ext 

4468). (see appendix A for FNA preparation instructions) 

Urine Cytology 

A full voiding, preferably not an early morning specimen, should be sent without 

delay in a sterile bottle (again obtainable from pathology supplies, ext 4469). The 

request form should state the time and date of collection and whether it was a 

catheter or post‐cystoscopy specimen. Please do not use the red topped 

microbiology universal container as this contains boric acid and is not suitable for 

cytology specimens. 

Cyst Fluid, Serous Fluids and Washings, Cerebrospinal Fluids (CSF) 

Fluid should be collected into a sterile bottle and sent without delay. Do not use 

powdered gloves when collecting synovial fluid, as this may contaminate the 

specimen. 

Sputum 

An early morning specimen should be collected into a sterile container. Ideally the test 

should be carried out on three consecutive days and each specimen sent as soon as it is 

taken. 


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Mortuary 

The Mortuary receives bodies from the community and the hospital and acts as the 

public mortuary, providing a service to H M Coroner for mid‐Hampshire and a 

forensic post mortem service Hampshire‐wide. Post mortems are undertaken for 

the coroner and requesting clinicians, subject to the appropriate consent. 

Viewing facilities are available for relatives after prior arrangement with mortuary 

staff. Released bodies are collected regularly by undertakers. An out‐of‐hours 

service is available for sudden deaths in the community. 

Deceased patients from the wards 

All deceased patients transferred to the mortuary from the wards must have 

identification bracelets attached to their wrist and ankle. The information on the 

bracelets should include the full name, hospital number and the date of birth. 

The deceased must be transported to the mortuary in a body bag (with the Death 

Notice on the outside of the bag, and any valuables noted). Any infection risk must 

also be marked on the outside of the bag and the mortuary staff informed (ext 

5417) before the patient leaves the ward. 

This procedure is to be followed if a patient dies within the hospital (patients who 

have been admitted). If a patient dies outside of the hospital, even if in an 

ambulance outside of A&E, this is classed as a community death. 

Community deaths 

The mortuary staff provide a 24‐hour on‐call service for deaths in the community. 

The on‐call technician can be contacted via the hospital switchboard: 01962 

863535. 

Post Mortems 

Hospital post mortem 

If the cause of death is not known the case must be reported to the Coroner’s 

Officer 02380 857447. 


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If the cause of death is known but a post mortem examination is required for 

medical interest purposes, the Death Certificate must be issued to relatives/person 

in qualifying relationship before approaching them about consent for hospital PM. 

Consent forms are available from the bereavement officer. Verbal consent is not 

acceptable. 

Written consent for a post mortem must be obtained from the next of kin/person 

in qualifying relationship (highest ranking) by a senior member of the medical staff 

(not the bereavement officer or the house officer) and all family members must 

agree to the post mortem. If any family member objects, the post mortem cannot 

take place. 

If the cause of death is known and there is no next of kin/person in a qualifying 

relationship then a Post Mortem MUST not be conducted. 

Checklist for obtaining consent for a post mortem 

• Issue the death certificate 

• Speak to the highest ranking person in a qualifying relationship to obtain 

consent for post mortem 

• Inform the mortuary that a hospital request port mortem is required 

• Complete a clinical summary for the pathologist who will be carrying out the 

examination 

• Send the patient’s case notes, the clinical summary and the completed consent 

form to the mortuary via a porter 

When speaking to relatives it is important to explain clearly the procedure involved 

during the post mortem examination. Relatives should be reassured that the post 

mortem does not: 

• Cause any disfigurement which would be distressing for the family should they 

wish to view the body after post mortem examination 

• Delay the funeral 

To avoid any delays to funeral arrangements and so that relatives can inform 

funeral directors, telephone the mortuary to obtain a date for post mortem. 


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Should you require any further information, please contact the mortuary staff on 

extension 5417, or via the hospital switchboard out of hours (01962 863535). 

Checklist for reporting deaths to H M Coroner 

If a death is to be reported to H.M. Coroner the following procedure should be 

followed: 

From Monday to Friday during working hours telephone the Coroner’s Officer on 

02380 857447 or the Coroners Secretary on 02380 857038. Inform the Coroner’s 

Officer also of any infection risk. 

Outside of normal working hours telephone the police control room on 0845 045 

45 45 who will take the details. Please give details of the death including a factual 

account of the clinical sequence and the parts played by the medical practitioner 

and other healthcare workers. 

Any death which falls under the following criteria MUST be reported to the 

Coroner’s Office. A death certificate must not be issued. This will be issued by 

H.M. Coroner. 

• When death is known to be connected with crime or suspected crime, 

suspicious circumstances or suicide. 

• When the medical practitioner cannot certify death because he/she has not 

attended the deceased in his/her last illness. 

• When the medical practitioner did attend the deceased in his/her last illness but 

did not see the deceased after death, or within 14 days before death. 

• When the cause of death is uncertain or sudden, i.e. no last illness or unnatural. 

An unexpected death occurring in A&E or any other Trust department must be 

reported. 

• When the death occurs during an operation or before the recovery from the 

effects of anaesthetic. 

• When the death occurs after an operation necessitated by injury (whether by 

accident or otherwise). 

• When the deceased has a fracture or injury. 

• When a contributory cause of death is: 

Alcohol poisoning ‐ chronic or acute 


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Accidents or injuries 

Violence 

Drugs 

Unexplained death of a young person 

Industrial disease or pathological condition arising out of the deceased’s 

employment 

Poisoning from any cause ‐ occupational, food, accidental and abortion 

• When the deceased is: 

A foster child 

A reputed stillborn child where there is suspicion that it was alive at birth 

A service disability pensioner 

A mental defective in an institution, certified house or under guardianship 

In legal custody ‐ prison, borstal or detention centre 

Viewings 

Viewings during the hours of 9:00am and 3:30pm should be arranged via the 

bereavement officer on extension 4648. Out of these hours Monday to Friday 

4:00pm to 9:00pm and Saturday, Sunday and Bank Holidays 8:00am to 9:00pm all 

viewings should be arranged with the duty on‐call mortuary technician, before 

giving a time for the relatives to attend. 

Out‐of‐hours viewing is discouraged, however, where the needs of the family make 

this situation unavoidable, arrangements can be made with the on‐call technician 

who can be contacted via the hospital switchboard. 


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MICROBIOLOGY 

Includes: 

Microbiology 

Serology, Virology and Infection Control 

Consultants 

Dr Matthew Dryden, Consultant Microbiologist 01962 824451 

Dr Roberta Parnaby, Consultant Microbiologist 01962 824334 

Dr Kordo Saeed, Consultant Microbiologist 01962 825927 

Michael Grover, Department Manager 01962 824705 

Caeron Bacon, Operation Manager 01962 824807 

Infection Control 

Sue Dailly, Infection Control Nurse Bleep 177 01962 824483 

Sheryl Lucero, Infection Control Nurse Bleep 194 01962 824383 

Karen Davis‐Blues, Infection Control Nurse 01962 824383 

Communicable Diseases 

From 1 st July 2006 the HPA took responsibility for the public health aspects of 

communicable disease. Contact the Hampshire & Isle of Wight Health Protection 

Unit, Unit 8, Fulcrum 2, Solent Way Whiteley, PO15 7FN, telephone 0845 055 2022, 

fax 0845 504 044 0448, out of hour contact 0844 967 0082. 

Email:‐ hiowhpu@hpa.org.uk for public health issues and any contact tracing 

relating to: 

Gastrointestinal pathogens 

Hepatitis Bs Ag +ve 

Hepatitis C + 

Meningococci 

TB 

Pertussis 

Diphtheria 

Hib 

Hep A IgM 

Scabies 

Chickenpox contacts 

Supply of mumps salivary testing kits 

Immunisation queries 


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Outbreaks 

School health issues 

Nursing home infections 

Enquiries from the prison, colleges and universities 

Requests for advice from Test Valley and Winchester EHOs 

Avian/pandemic flu/SARS enquiries 

Statutory notification forms 

Advice on infection control to GPs and practice nurses 

Help Lines 

1. Patient results and enquiries 01962 824461 or ext 4461 

2. Serology enquiries 01962 824706 or ext 4706 

3. Infection control enquiries 01962 825170 or ext 5170 

4. Department Secretary 01962 824451 or ext 4451 

5. Clinical Advice 01962 824451/824334 or ext 4451 or 4334 

6. Out of hours: 

Technical and Clinical advice via switchboard 01962 863535 

7. Infectious Disease outpatient appointments 01962 824451 

Specimen Collection/Sample Requirements 

Best results are obtained when an appropriate, well taken specimen, in the correct 

container, is delivered to the laboratory promptly with the relevant clinical 

information on the request form. Further information regarding the collection of 

specimens can be found in the test index. 

Microbiology samples MUST be accompanied by a request form stating the 

following information: 

• Clinical details including travel history 

• Any antimicrobial therapy, Date of onset and duration of illness 

• The anatomical site of any wound 

• Useful epidemiological information e.g. In cases of diarrhoea, occupation of 

adults, nursery or school of children, any occupational or recreational risks 

• 

Leaking samples will not normally be processed 


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Please ensure that you follow instructions when collecting and storing samples. 

Inappropriate sample collection, storage and transport can interfere with a number 

of results. Some examples are given in the table below: 

Bacteriology 


Delay in transport/ incorrect 

post collection 

Samples not refrigerated Overgrowth off growing 

bacteria 

storage 

Incorrect container Charcoal swab for 

Overgrowth of bacteria 

virus/chlamydia 

Virus/chlamydia swab for Bacteria killed by media 

Unsterile container 

Leaking samples 

Lack of appropriate clinical 

details 

bacteria 

Household jars medicine 

containers 

Non laboratory approved 

container 

No reference to foreign travel. 

No reference to pregnancy. 

No reference to antibiotic 

allergies. 

No reference to 

past/current/intended 

antibiotics 

ingredients 

Contamination or bacteria 

killed by previous contents. 

These containers are also 

unsafe due to potential 

breakages/leakage in 

transport 

Health hazard to all surgery, 

transport and pathology staff 

Appropriate tests not 

performed. 

In complete/misleading 

results and comments 

Serology 


Haemolysis 

Expelling blood through Inaccuracy in many tests. 

needle into the tube 

Inappropriate collection site Sample collected from same 

site as antibiotic 

Highly inaccurate antibiotic 

levels. 

administration 

Incorrect container 

Unable to perform tests 


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Please refer to the test index for individual turnaround times. 

• Urgent microscopy results 

• Rapid antigen detection tests 

• Some urgent blood tests with prior arrangement 

• Routine investigations 

• Non routine investigations 

• Referral tests 

2 hours 

4 hours 

Same day 

2‐3 days 

3‐7 days 

10 ‐ 14days 

Results of urgent clinical or public health significance will be telephoned to the 

requesting clinician. These include: 

• Positive blood cultures 

• Microscopy of non routine cerebrospinal fluids 

• Detection of AFB 

• Significant isolates from faeces samples 

• Isolates of Group A streptococci 

• Isolates of Group B streptococci from neonates, pre and post delivery HVS 

• MRSA on initial isolation 

• Significant Gram stain from pus and fluids 

• Positive identification of sexually transmitted diseases (culture or serology) 

• Positive Hepatitis and Lyme serology 

• Non‐immune Varicella zoster serology in pregnancy 


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Appendix A ‐ FNA PREPARATION 

1.0 FNA Preparation 

1.0.1 Assemble the needle and syringe. Remove the tops from the washings bottles. Lay out the 

slides. Palpate the lump and define its boundaries. 

1.0.2 Clean the skin then immobilise between thumb and forefinger. 

1.0.3 Enter the lesion with the needle point, gently exert negative pressure through the syringe. 

1.0.4 Maintain negative pressure and gently withdraw the needle tip to the edge of the lesion, 

then re‐insert at a slightly different angle. Repeat this twice at different angles. 

1.0.5 Release the pressure on the syringe barrel and withdraw the needle. 

It is essential to release the pressure or cellular material will be lost into the barrel as 

the needle is withdrawn. 


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PREPARING THE ASPIRATE 

1.0.6 Immediately after the aspiration, remove the needle and fill the syringe with air (DO NOT 

RESHEATH THE NEEDLE). 

1.0.7 Replace the needle and squirt one drop of material towards the top end of labelled glass 

slide. 

1.0.8 Make 2 slides as required or as material aspirated allows. 

1.0.9 Wash the needle and syringe in the solution provided. 

Place a second slide over the droplet and allow the material to start to spread. 

Quickly and smoothly draw the slides apart. 

It is imperative that cells are not simply squashed and rotated between slides as this will result 

in distortion and possibly render the slides uninterpretable. 

1.0.10 Waft the slides in the air to Rapidly air dry the material 

A hair drier (on warm, not hot) is beneficial. 

1.0.11 Place wet fix slide in 95% alcohol or spray fix 


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IF technical assistance is given. 

1.0.12 Ensure that ALL slides and washings are clearly marked with patients’ details. Please give 

as much clinical information as possible, including the patients age and aspiration site. 

1.0.13 Place slides into a transport box and send to the laboratory together with the washings. 

REQUIRED NUMBER OF SLIDES 

Breast FNA – 2‐4 air dried slides + wash 

Other FNA (e.g. Lymph Node or EUS) – 2 air dried slides + 2 wet fix slides + wash. 

Wet fix slides should be prepared onto charged glass slides to prevent loss of cellular 

material. 

FAILURE TO ASPIRATE CELLS 

This is the most common complaint. It may be due to:‐ 

A hard fibrous tumour that does not yield cells easily. 

Operator inexperience. Ensure the needle is rotated and moved back and forth during aspiration. 

MECHANICALLY DAMAGED CELLS 

In the spreading of the smears it is easy to damage fragile malignant cells, rupturing cell walls and 

rendering them unidentifiable. Do not squash and rotate the material between the slides – 

simply allow the aspirate to spread between the slides then swiftly and smoothly pull them apart 

horizontally. 

SMEARS TOO THICK TO VISUALIZE CELLULAR DETAIL 

The smears must be thin and even, otherwise patchy staining and poor cellular detail will make 

interpretation difficult if not impossible. Gentle heat (hair drier) is ideal for drying smears 

quickly. 

INSUFFICIENT MATERIAL TO PREPARE DRIED SLIDES 

In this case, just wash the needle out in the fixative to provide a washing. 


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Appendix B ‐ ROUTINE REFERRAL LABORATORIES: 

Depts: Chemical Pathology, Trace Metals Unit, Immunology Dept., 

Endocrine Unit., Dept. of Molecular Pathology, Histopathology, HPA 

Laboratory 

Southampton General Hospital 

Tremona Road 

Southampton 

SO16 6YD 

___________________________________________________________________ 

Medical Toxicology Unit 

New Cross Hospital 

Avonley Road 

London 

SE14 5ER 

___________________________________________________________________ 

Depts: Chemical Pathology, Microbiology 

Basingstoke & North Hampshire Hospital 

Aldermaston Road 

Basingstoke 

Hampshire 

__________________________________________________ 

Biochemistry (Michael Darmady Laboratory), 

Queen Alexandra Hospital 

Cosham 

Portsmouth 


The SAS Protein Reference Unit and Immunology 

St Georges Hospital 

PO box 10295 

London 

SW17 0NH 

SAS Reception 

Pathology Centre, area G 

Hammersmith Hospital 

Du Cane Road 

London 

W12 0HS 


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Depts: SPRU & Department of Immunology, Histopathology 

Northern General Hospital 

Herries Road 

Sheffield 

S5 7AU 

International Blood Group Reference Laboratory 

Southmead Road 

Bristol 

BS10 5ND 

Platelet Immunology Dept. 

National Blood Service 

Oxford Centre 

John Radcliffe Hospital 

Headington 

Oxford 

OX3 9DU 

Wessex Regional Genetics Laboratory 

Salisbury Healthcare NHS Trust 

Salisbury 

SP2 8BJ 

Oxford Haemophilia Centre 

Churchill Hospital 

Old Road 

Headington 

Oxford 

OX3 7LJ 

CPMS Laboratory 

55 Wimpole Street 

London 

W1G 7DF 


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Bristol RCI 

500 North Bristol Park 

Northway 

Filton 

Bristol 

BS34 7QH 

Department of Haematology 

University Hospital of Wales 

Heath Park 

Cardiff 

CF14 4XW 

Haematology Department 

Jenner Wing 

St. Georges Hospital Medical School 

Tooting 

Cranmer Terrance 

London 

SW17 0RE 

Malaria Reference Laboratory 

London School of Hygiene and Tropical Medicine 

Keppel (Gower) Street 

London 

WC1E 7HT 

Guy’s Purine Research Laboratory 

5 th Floor 

Thomas Guy House 

Guy’s Hospital 

London 

SE1 9RT 

Department of Immunology 

West Block A Floor 

Queens Medical Centre 

Nottingham 

NG7 2UH 


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West Middlesex Laboratories 

Clinical Trials Service 

_______________________________________________________________ 

PathLore Pathology Services 

Medical Solutions PLC 

1 Orchard Place 

Nottingham Business Park 

Nottingham 

NG8 6PX 

St. John’s Institute of Dermatology 

St. Thomas’ Hospital 

Lambeth Palace Road 

London 

SE1 7EH 

The National Centre for Reference & Specialist Microbiology 

Specialist & Reference Microbiology Division 

61 Colindale Avenue 

London 

NW9 5HT 

Microbiology 

Queen Alexandra Hospital 

Cosham 

Portsmouth 


________________________________________________________________ 

Princess Ann Hospital 

Coxford road 

Southampton 


SO16 5YA 

_______________________________________________________________ 


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Appendix C ‐ TELEPHONED RESULTS SHEET 

Patients name .............................................DOB................. 

NHS/Hospital No: .........................Consultant/GP………………………………….. 

Date.........................Time............................ 

Signed/Received by.............................................Ward………………………… 

HAEMATOLOGY BIOCHEMISTRY MICROBIOLOGY 

Haemoglobin g/dl Sodium mmol/l Specimen: 

White cell count x10 9/ l Potassium mmol/l MICROSCOPY: 

Platelet count x10 9 /l Urea mol/l White cells 

ESR mm/hr Creatinine mmol/l Red cells 

Neutrophils x10 9 /l Alk Phos iu/l Epithelial cells 

Lymphocytes x10 9 /l Tot Protein g/l Casts 

Monocytes x10 9 /l Albumin g/l Organisms: 

Eosinophils x10 9 /l Globulin g/l 

Basophils x10 9 /l Bilirubin umol/l CULTURE: (Organism isolated) 

Glandular Fever ALT (SGPT) iu/l 1. 

MCV fl Calcium mmol/l 2. 

Haematocrit Ratio Cholesterol mmol/l 3. 

Reticulocytes x10 9 /l Triglyceride mmol/l ANTIBIOTIC Sensitivity: (Tick) 

Sickle test Glucose mmol/l For organism(s) above 1 2 3 

COAGULATION: TSH miu/l Penicillin 

INR Uric Acid mmol/l Erythromycin 

PTT secs CK iu/l Flucloxacillin 

Fibrinogen g/l Amylase mmol/l Amoxycillin 

D‐Dimer LDH iu/l Augmentin 

Warfarin dose BLOOD GASES: Nitrofurantoin 

Next appointment pH Trimethroprim 

TRANSFUSION: pCO2 KPA 

Group pO2 KPA 

Rhesus Base excess mmol/l Other tests: 

DCT Act Bicarb mmol/l 

Kleihauer Std Bicarb mmol/l Gentamicin ug/l 

Other tests 


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Appendix D ‐ TEST INDEX 

BACTERIOLOGY 

TEST SAMPLE & COLLECTION INSTRUCTIONS COMMON 

INDICATIONS 

Aspirates and fluids 

from normally sterile 

sites 

Blood cultures 

Bronchial washings 

Broncho‐alveolar 

lavage 

Cerebrospinal fluid 

(CSF) 

Cervical swab 

TURNAROUND 

(working days) 

25ml sterile universal container (white top). 3 

Venous blood is collected aseptically into blood culture bottles. Take before 

antimicrobials are given if possible. Clean site and bungs of bottle(s) with 

chlorohexadine in alcohol wipes and allow to dry before collection. 

Adult: approx. 5‐10ml blood into each bottle. 

Child: approx. 0.5‐ 4.0ml blood into one paediatric bottle. 

Septicaemia, 

pneumonia, 

endocarditis, 

meningitis. 

60ml sterile container or 25ml sterile universal container (white top). 3 

60ml sterile container or 25ml sterile universal container (white top). 3 

For cell count, gram staining and culture send 2‐3ml of CSF in each of four 

25ml sterile universal containers (white top). If meningitis is suspected 

contact the laboratory and send the specimens immediately. Send specimens 

1 and 3 to micro and 2 and 4 to biochemistry for glucose and protein 

including SAH examination. 

Endocervical swabs are required for gonococcal or chlamydial investigations. 

For gonorrhoea use a bacterial swab in charcoal transport medium and 

transport to the laboratory immediately. Urethral, rectal and throat swabs 

may also be collected. For the investigation of Chlamydia use a Chlamydia 

swab in Chlamydia transport medium (yellow top). 

Meningitis, 

subarachnoid 

haemorrhage (SAH), 

encephalitis. 

Pelvic inflammatory 

disease, vaginal 

discharge, suspected 

STD. 

Preliminary 

report: 2 

Microscopy: 0.5 

Culture: 3 

3 


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INDICATIONS 

Males: >20ml urine sample in a 25ml sterile universal container. The patient Pelvic inflammatory 

Chlamydia 

should not have passed urine in the hour prior to collection. 

disease, urethritis. 

Females: urethral/endocervical swabs in chlamydia transport medium 

(yellow top) or urine in a 25ml sterile universal container. 

Contact lens and lens 

fluid 

Culture for bacterial 

infections 

Ear swab 

Eye swab 

TURNAROUND 


5 

Referred 

Eyes: swab from conjuntiva in chlamydia transport medium (yellow top) 

Specimen 5 

25ml sterile universal container (white top) or lens case. Referred 

specimen 

10 ‐ 14 

Pus is the ideal sample for a biopsy of the infected tissue. Send in a 25ml 

5 

sterile universal container (white top). 

A bacterial swab in charcoal transport medium. 

Ear infection, otitis 

media, otitis 

externa. 

3 

Routine culture: a bacterial swab in charcoal transport medium. Conjunctivitis 3 


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INDICATIONS 

For bacteriology, parasitology and virology: 

Diarrhoea, gastroenteritis 

Faeces 

with the wooden spatula provided transfer a grape sized portion or 

and 

equivalent volume of fluid into a 60ml sterile container. Community patient outbreaks. 

routine tests include: salmonella, shigella, campylobacter and E. coli O157. 

Tests for other pathogens will be added depending upon the clinical details, 

travel history and seasonal occurrence. 

C. difficile will be routinely tested from patients over the age of 65 with liquid 

stools. For those under 65, unless C.difficile is specifically requested or clinical 

details suggest testing is appropriate (eg on antibiotics), the test will not be 

performed. 

For patients admitted to hospital, routine tests include: salmonella, shigella, 

campylobacter and E. coli 

O157. Tests for other pathogens will be added depending upon the clinical 

details, travel history and seasonal occurrence. 

C. difficile will be routinely tested from patients over the age of 2 years with 

liquid stools. 

TURNAROUND 


3 

Hair 

Clostridium difficile toxin detection is only performed on liquid samples. 

Follow up testing is rarely required. 

Refer to mycology. 


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INDICATIONS 

TURNAROUND 


High vaginal swab Collect a swab into charcoal transport medium for candida, trichomonas Vaginal discharge, 3 

(HVS) 

vaginalis, bacterial vaginosis and bacterial pathogens. For PID and 

gonorrhoea investigations send a cervical swab (see above). 

SROM. 

Intrauterine device Send in a 60ml sterile container. 5 

(IUCD) 

IV line tips 

Aseptically place the terminal 5‐10cm of the tip into a 25ml sterile universal Line infection, 3 

container. 

septicaemia. 

Joint fluid 

For microscopy, crystals and culture. Send in a 25ml sterile universal Arthritis, infection, 3 

container (white top). 

gout. 

Legionella culture Sputum from deep expectoration and not saliva is required. Saliva will not Atypical pneumonia. 5 

(sputum) 

be processed. Collect into a 60ml sterile container. 

Mouth swab A bacterial swab in charcoal transport medium. Oral candidiasis. 3 

MRSA screening swabs A bacterial swab in charcoal transport medium. 

For hospital patients refer to the Hospital MRSA Policy. For community 

patients, screening is only normally required for known positive patients prior 

to elective surgery. Other cases: refer to the Community Infection Control 

Policy. 

2 

Mycology 

For skin, hair and nail clippings use Dermapaks or black card. 

Skin: Scrape skin with a blunt scalpel from the active edge of the lesion. 

Nail: Cut small pieces of the nail using clippers. 

Hair: Forceps may be needed to remove body hairs. Infected hair stumps are 

easily removed by scraping with a scalpel. 

A bacterial swab in charcoal transport medium is used for Candida infections. 

Dermatophyte 

infections. 

Microsocopy: 5 

Culture: 28 

Azole assay: 12 

Azole sensitivities: 

12 

Candida ID: 12 

Yeast sensitivities: 

12 


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INDICATIONS 

Refer to mycology. 

Nail 

Nasal swab 

Nasopharyngeal 

aspirate 

Pleural fluid 

Pneumococcal antigen 

(urine). 

Pus 

RSV 

Schistosoma parasites 

Sellotape slide 

Seminal fluid for 

culture 

A bacterial swab in charcoal transport medium. 

Specific organism 

screen, eg MRSA, 

Staph aureus. 

3 

Traps containing a specimen should be sealed using a loop of tubing. 3 


25ml sterile universal container (white top). 

By prior arrangement with the laboratory. 

Atypical pneumonia. 0.5 

TURNAROUND 


Transfer into a sterile universal container. Only use a bacterial swab in Infected site 3 (culture for 

charcoal transport medium when pus cannot be obtained. 

anaerobes 5 days) 

Sputum or nasopharyngeal aspirate into a 60ml sterile container. 0.5 

Recommended method: Collect the last few drops of urine from each 

micturition over a 24 hour period in a plain 25ml sterile universal container. 

Acceptable alternative: Collect a random specimen ideally between 12.00 

and 15.00 hours after light exercise (e.g. 20 rapid knee bends) to maximise 

the release of eggs. 

Refer to Threadworm. 

Bilharzia 1 



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INDICATIONS 

Sputum samples are best collected in the morning. It is important that the Chest infection, 

Sputum 

specimens submitted for examination are true sputum and not saliva, or pneumonia. 

contaminated with food. Sputum from deep expectoration is required. 

Saliva will not be processed. Collect into a 60ml sterile container. 

Threadworm 

Throat swab 

Tissue and biopsies 

Tuberculosis 

Urethral swab 

Collect the sample in the morning before the patient has washed. Press the 

sellotape onto the peri‐anal skin firmly. Remove and stick the sellotape flat 

onto a clean microscope slide (sticky side down). Place this in a slide box. 

For bacterial investigation send a bacterial swab in charcoal transport 

medium. 

For virology investigations send a viral swab in virus transport medium. 

Sterile container. If the sample is small add sterile saline to prevent it drying 

out. 

The best samples are early morning sputum, pus or tissue in a 60ml sterile 

container. 

Only collect urine when renal tuberculosis is suspected; collect the complete 

early morning specimen in 250ml containers on three consecutive days. 

For the investigation of gonorrhoea use a bacterial swab in charcoal transport 

medium and transport to the laboratory immediately. 

For the investigation of Chlamydia use a Chlamydia swab in Chlamydia 

transport medium (yellow top). 

Threadworm 

infection, anal 

irritation/itching. 

TURNAROUND 


3 

1 

Pharyngitis 2 

Infected site 5 

Night sweats, low 

grade fever. 

Renal TB. 

Microscopy: 1 

Culture: up to 40 

days 

3 


Uncontrolled






INDICATIONS 

MSU, CSU, supra pubic aspirate, ileal conduit specimens are all collected into UTI, haematuria, 

Urine 

red top 20ml sterile universal containers containing the preservative boric fever, inflammatory 

acid (red top). 

response. 

To collect an MSU allow the first part of the urine to be voided. Collect the 

mid‐part of the sample then void the remainder of the specimen. 

CSU’s are only appropriate when clinical indication of fever, rigors or supra 

pubic pain are present. 

TURNAROUND 


2 

Viral 

Wound and ulcer 

swabs 

For urine Chlamydia see Chlamydia test above. 

Viral swab in virus transport medium (green top) (NOTE: medium must be 

red, not yellow). PCR tests are now used. Each test is specific for each virus. 

Please state clinical details and/or virus suspected. 

A bacterial swab in charcoal transport medium. Collect as much material 

from the infected site as possible avoiding contamination from surrounding 

areas. 

Ulcer swabs are only appropriate when signs of severe clinical infections are 

present. 

Infection at local 

site. 

Referred 

specimen 7 

3 

(culture for 

anaerobes 5 days) 


Uncontrolled





SEROLOGY 

TEST 

Adenovirus antibody 

Amoebic IFAT 

Antenatal screen (Rubella IgG, 

HIV, Hepatitis B surface 

antigen, Syphilis) 

Antistaphylolysin 

Antistreptolysin O (ASO) 

Aspergillus precipitins 

Avian precipitins 

Bartonella antibodies 

Bilharzia antibodies 

Bordetella pertussis antibodies 

Borrelia burgdorferi antibodies 

SAMPLE & COLLECTION 

INFORMATION 

Refer to viral antibody screen 

REFERENCE 

RANGE 

UNITS 

COMMON 

INDICATORS 

TURNAROUND TIMES 

(WORKING DAYS) 

Gold top gel tube and a faeces 

Referred specimen 14 

sample required also 

Gold top gel tube 5 

Referred samples 8 

Gold top gel tube Staphylococcal 

disease 


Gold top gel tube





TEST 

Brucella antibodies 

Campylobacter Antibodies 

Candida Serology 

Cat scratch disease 

Chlamydia psittaci 

Cysticercosis Immunoblot 

Cytomegalovirus antigen 

Cytomegalovirus IgM 

Cytomegalovirus IgG 

Cytomegalovirus PCR 

CMV avidity 


INFORMATION 

REFERENCE 

RANGE 

UNITS COMMON 

INDICATORS 



Gold top gel tube Brucellosis Referred specimen 14 

Gold top gel tube Referred specimen 14 


Refer to Bartonella antibodies 



Urine in a 25ml sterile universal container or 


respiratory secretions 



Lavender top EDTA tube Referred specimen 14 



Uncontrolled





TEST 

Dengue antibody 

EBV PCR 

Enterovirus IgM (includes 

antibodies to Coxsackie A and B 

and Echovirus infections) 

Epstein Barr virus antibodies 

Farmers Lung 

Filarial antibodies 

Haemophilus B antibody 

Helicobacter pylori antibodies 

Hepatitis A IgM 

Hepatitis A Total Antibody 

Hepatitis B surface antigen 


INFORMATION 

REFERENCE 

RANGE 

UNITS COMMON 

INDICATORS 










Gold top gel tube Dyspesia 10 

Gastric Ulcer 


Gold top gel tube Post vaccination Referred specimen 10 

Gold top gel tube 10 (1if urgent specimen) 


Uncontrolled





TEST 

Hepatitis B antibodies 

Hepatitis B core 

Hepatitis B markers 

Hepatitis B viral load 

Hepatitis C antibody 

Hepatitis C viral load 

Hepatitis C RNA 

Hepatitis E Antibody 

Hydatid ELISA 

HIV 1 and 2 antibodies 

HIV viral load 

HSV I and II Antibodies 


INFORMATION 

REFERENCE 

RANGE 

UNITS COMMON 

INDICATORS 



Gold top gel tube. 

Immunity 10 

10 weeks post vaccination 





Gold top gel tube within 4 hours, by prior 


arrangement with the laboratory. 




Gold top gel tube 10 (1 if urgent specimen) 

Lavender top EDTA tube within 


2 hours, by prior arrangement 

with the laboratory 



Uncontrolled





TEST 

Influenza A antibodies 

Influenza B antibodies 

Legionella antibodies 

Leishmania antibodies 

Leptospira antibodies 

Malaria 

Measles antibodies 

Meningococcal PCR 

Mumps antibodies 

Mycoplasma antibodies 

Parvovirus B19 IgM 


INFORMATION 



REFERENCE 

RANGE 

This test is no longer available. Please discuss with the 

Consultant Microbiologist. 

UNITS 

COMMON 

INDICATORS 

Atypical 

pneumonia 

TURNAROUND TIMES (WORKING 

DAYS) 



Lavender top EDTA to 

haematology for Film and call 

Microbiologist for advice. 

Antibodies rarely required. 

Gold top gel tube Ring CCDC if 

suspected 

Lavender top EDTA tube. By prior 

arrangement with the laboratory. 

Meningococcal 

disease 

Ring CCDC. 

Gold top gel tube Ring CCDC if 

suspected. 




Refer to viral antibody screen Referred specimen 14 

Gold top gel tube Suspected 

infection in 

pregnancy 



Uncontrolled





TEST 

Q fever (Coxiella burnetii) 

antibodies 

RSV antibodies 

Rubella IgG 

Rubella IgM 

Schistosome antibodies 

Strongyloides serology 

Syphilis serology 

ToRCH screen (Toxoplasma, 

Rubella IgM and IgG, CMV IgM, 

Herpes) 

Toxoplasma antibodies 

Tropical screen 

Vancomicin Level 


INFORMATION 

REFERENCE 

RANGE 

UNITS 

COMMON 

INDICATORS 

Refer to viral antibody screen Pneumonococcal 

urinary Ag 




Refer to viral antibody screen Referred specimen 14 

Gold top gel tube Immunity 7 


Date of onset essential. 

Infection. If 

suspected ring 

CCDC 


Gold top gel tube Bilharzia Referred specimen 14 


Gold top gel tube Infection 10 

(Confirmation Referred 

Specimen 20) 


Gold top gel tube Infection 2 (10 if referred specimen) 

Gold top gel tube – Discuss with 

Referred specimen 10‐14 

Microbiologist 


Telephoned report 1 


Uncontrolled





TEST 


INFORMATION 

REFERENCE 

RANGE 

UNITS 

COMMON 

INDICATORS 



Varicella zoster antibodies 

Viral respiratory antibody screen 

Yersinia antibodies 

Gold top gel tube Immunity 2 (10 if referred specimen) 

Gold top gel tube, collected 

between day 1‐3 (acute) and 

day 10‐21 (convalescent). The 

acute specimen will be stored 

until the convalescent is 

received. (Adenovirus, 

Chlamydia psittaci, CMV, 

C.burnetii, Influenza A and B, 

RSV, Mycoplasma). The range 

of investigations performed will 

depend on clinical details; 

accurate and full information 

will ensure the relevant tests 

are performed. 

>1:160 in 

single sera or a 

4 fold rise in 

titre 

Titre Referred specimen 14 

Gold top gel tube 160 Titre Referred specimen 10‐14 


Uncontrolled





HAEMATOLOGY/BT 

TEST 

Antenatal screen 


INSTRUCTIONS 

REFERENCE 

RANGE 

UNITS COMMON INDICATIONS TURNAROUND 

TIME 


Pink top 6ml Transfusion tube 1 

(Group and antibody screen) 

Antibodies (specific 

identification) 

Anti Xa assay 

Antithrombin – part of 

Thrombophilia screen. 

Consultant referral only. 

Bleeding time 

Blood Group and save serum 

Pink top 6ml Transfusion tube 

Light Blue citrate tube 

– Contact Consultant 

Light Blue citrate tube 80% ‐ 120% 28 

Appointment required – please ring 

Consultant 

Pink top 6ml Transfusion tube 1 

Chromosomes 

Refer – please speak to laboratory 

(samples received Monday to Thursday only; to reach the Department by 4.00 pm the same day the sample is 

collected, as it is sent to the Regional Centre in Salisbury) 

INR 1.0 – 1.2 Ratio Bleeding; bruising 

Coagulation screen Light Blue top citrate tube 

Pre operation 

PTT 35.0 – 37.5 Seconds 

(PT & aPTT) 

30 

0.5 


Uncontrolled





TEST 

Cold Agglutinins 

Cord Coombes Test 

Direct Antiglobulin Test 

(Coombes Test) 

D‐Dimer 

Donath Landsteiner (PCH) 

ESR 

Factor assays 


INSTRUCTIONS 

Pink top 6ml Transfusion tube (keep 

sample at 37 o C) 

REFERENCE RANGE UNITS COMMON INDICATIONS TURNAROUND 

TIME 


< 1/64 Cold agglutinin disease; 

2 

Reynaud’s 

Lavender 3ml EDTA tube 0.5 

Lavender 3ml EDTA tube Haemolysis – antibody mediated 0.5 

Light Blue citrate tube





TEST 

Factor V Leiden/ 

Prothrombin Mutation part 

of Thrombophilia screen. 

Consultant referral only 


INSTRUCTIONS 

2 x Lavender 3ml EDTA & 4 x Light 

Blue citrate tubes – Contact 

Consultant as part of thrombophilia 

screen only. 


TIME 


Referred specimen 

20 

Fibrinogen level 

Light Blue citrate tube 2.0 – 4.0 g/L DIC; Liver disease 0.5 

G6PD 

Glandular Fever screen 

Group and save serum 

Lavender top 3ml EDTA tube – 

Contact Consultant 

4.6 – 13.5 u/g Hb Jaundice; Haemolysis post 

infection 

Lavender top 3ml EDTA tube Infectious mononucleosis; EBV 

May be positive in lymphoma & 

others 

0.5 

Pink top Transfusion tube 2 

4 

Haemoglobinopathy screen Lavender top 3ml EDTA tube Haemoglobinopathy 3 

1 x large 6ml Purple top EDTA tube 

Ankylosing spondylitis Referral specimen 14 

HLA B27 

or 2 x 3ml Lavender topped EDTA 

tubes 

(HLA B27 samples received Monday to Thursday only; to reach RHCH Haematology Dept. by 12 noon the 

same day the sample is collected, as it is sent to the Regional Centre in Tooting (London)). 


Uncontrolled





TEST 

Haptoglobin assay 

HbA1c 

Hams test (PNH) 

INR (International 

normalised ratio) – Warfarin 

Monitoring 


INSTRUCTIONS 


TIME 


Gold top gel tube 0.7 – 3.8 g/L Haemolysis marker 4 

Lavender topped EDTA 

tube 

Lavender top 3ml EDTA tube, Discuss 

with Haematology Consultant 

Light Blue citrate Tube 

Non‐diabetic: 

4.6 – 6.3 

26.8‐45.4 

Both units reported in 

parallel. 

% 

mmol/l/mol) 

Glycaemic control in 

diabetes 

Negative Diagnosis of Paroxsymal 

Noctunal Haemoglobinuria 

1.0 – 1.2; Therapeutic 

2.0 – 4.0 

Ratio Warfarin control 0.5 

2 

2 

Iron & Transferrin ‐ see 

Biochemistry 

Kleihauer test 

Lupus inhibitor 

Malaria film 

Pink top 6ml Transfusion tube 

or lavender top EDTA tube 

2 x Light Blue citrate tubes 

– Discuss with lab. 

Lavender top EDTA tube to 

Haematology for Film. 

Call Microbiologist 

for advice/antibodies. 

Trans‐placental bleed 0.5 

14 

0.5 


Uncontrolled





TEST 

PK (Pyruvate kinase – red 

cell enzyme) 


INSTRUCTIONS 

Lavender top EDTA tube – Contact 

Consultant 


TIME 


Pyruvate kinase deficiency Referral specimen 14 

PK (Referral specimen – please speak to laboratory. Samples received Monday – Wednesday only; to reach department by 3:00 pm the same day the 

sample is collected, as it is sent to Pathology at Kings’s College Hospital) 

Lavender top EDTA tube 1.50 – 1.72 mPa/s Macroglobulinaemia; Myeloma 2 

Plasma Viscosity 

Platelet function tests 

Pregnancy test – regular 

Pregnancy test ‐ sensitive 

Activated Protein C 

Resistance 

Protein C 

Protein S 

Special tubes and by appointment only; please contact the Consultant 

25ml Universal container 

( Sample 6 weeks after LMP – 

Monday to Friday) 

>200 iu/L HCG 0.5 


>50 iu/L HCG 0.5 

(Sample 7 days after implantation – 

Clinical emergencies and 

Fee paying patients – Monday to 

Friday a.m.) 

2 x Light Blue citrate tubes 28 

2 x Light Blue citrate tubes 70 – 120% 28 

2 x Light Blue citrate tubes 60 – 140% 28 

Above 3 x tests performed as part of a thrombophilia screen only, please contact the Consultant Haematologist. 


Uncontrolled





TEST 

aPTT 

(Partial thromboplastin time) 

PT 

(Prothrombin time) 


INSTRUCTIONS 

REFERENCE 

RANGE 

Light Blue citrate tube 25.0 – 37.5 

Therapeutic 

40 – 70 secs Ratio 

1.5 – 2.5 

Light Blue citrate tube 

Normal range 

12.0 – 15.0 


TIME 


seconds Bruising, bleeding, pre op screen 0.5 

seconds Bruising, bleeding, pre op screen 0.5 

Red cell osmotic fragility 

Red cell survival studies 

Reticulocyte count 

Sickle test 

Sperm count 

Post vasectomy: 

Lavender top EDTA tube 

or green Lithium Heparin tube – 

Contact Consultant first 

Special tubes and by appointment 

only; please contact the Consultant 

0.40 – 0.45 % 

haemolysis 

Lavender top EDTA tube 0.5 – 2.5% 10 9 /L Red cell production; Aplasia; 

Bleeding haemolysis 


30ml white top container 

Should reach the department within 2 hours of collection, Monday to Friday (excluding Bank holidays) 

0.5 

Infertility Semen analysis: 

Thrombophilia screen: 

Infertility work on Tuesday and Wednesday mornings, and by appointment only. Give the patient a 

completed Referral for Semen Analysis form, the Patient Information Sheet, and sterile 30ml specimen 

container. Patient must telephone 01962 824289 to book appointment. 

4 x Light blue citrate and 3 x Lavender EDTA tubes Thrombophilia 28 

(Antithrombin, Protein C, Protein S, APCR, INR, PTT, FVIII, D‐Dimer, FV Leiden and Thrombin time) – By appointment with Consultant Haematologist only. 


Uncontrolled





TEST 

Vitamin B12 and Folate 


INSTRUCTIONS 

(see B12/Folate under 

Biochemistry) 

REFERENCE 

RANGE 


TIME(working days) 

Vitamin B12 and Folate 

von Willebrand’s screen 

3 x Light Blue citrate tubes – 

Contact Consultant 

50 – 150 von Willebrand’s disease 28 


Uncontrolled





TEST 


INSTRUCTIONS 

REFERENCE 

RANGE 



SEND AWAY TESTS (Not listed in main table above) 

2 x Gold gel tubes 21 

Anti Neutrophil antibodies 

Anti Neutrophil antibodies (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day the 

sample is collected, as it is sent to National Blood Service (Bristol) 

2 x Gold gel tubes + 2 x large Purple 

21 

Anti Platelet antibodies EDTA 

Anti Platelet antibodies (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day the 

sample is collected, as it is sent to National Blood Service (Bristol) 

1 x large Purple EDTA tube 20 

BCR‐ABL transcripts 

BCR‐ABL (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day the sample is 

collected, as it is sent to Southampton General Hospital) 

1 x lavendar EDTA tube 

7 

Clozapine/Norcloazipine assay Complete Clozapine request form 

Clozapine/Norcloazipine assay (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day 

the sample is collected, as it is sent to Kings College Hospital) 


DNA analysis 

DNA analysis (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day the sample is 

collected, as it is sent to the regional centre in Salisbury) 

1 x Gold gel tube 7 

Erythropoietin assay 

Erythropoietin assay (Referral specimen. Samples received Monday – Thursday only; to reach department before 12:00 pm the same day the sample is collected as it is 

sent to University College Hospital (Wales)) 


HIV screen 

HIV screen (Referral specimen. Samples received Monday – Friday, on day the sample is collected, as it is sent to Southampton General Hospital) 


Uncontrolled





TEST 


INSTRUCTIONS 

SEND AWAY TESTS (Not listed in main table above) 

1 x large Purple EDTA tube 

HLA typing 

4 points of Patient ID required 

REFERENCE 

RANGE 



HLA typing (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department before 12:00 pm the same day the sample is 

collected, as it is sent to National Blood Service (Tooting)) 


Neutrophil Function tests 

Neutophil function tests (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department before 12:00 pm the same day 

the sample is collected, as it is sent to Southampton General Hospital) 

20ml plain urine 14 

Orotic acid 

Orotic acid (Referral specimen – please speak to laboratory. Samples received Monday – Thursday only; to reach department by 3:00 pm the same day the sample is 

collected, as it is sent to Southampton General Hospital) 

2 x large Purple EDTA tubes 14 

Red Cell Membrane studies 

(Collect sample before Transfusion. Referral specimen – please speak to Consultant. Samples received Monday – Thursday only; to reach department 

before 12:00 pm the same day the sample is collected as it is sent to the International Blood Group Reference Laboratory (Bristol)) 

1 x large Purple EDTA tubes 7 

White cell markers 

(Referral specimen. Samples received Monday – Friday; to reach department before 12:00 pm the same day the sample is collected, as it is sent to Southampton General 

Hospital 

21 


Uncontrolled





IMMUNOLOGY 

Autoantibody Panel 

Rheumatic disease 

Includes Antinuclear Antibody 

Screen & Rheumatoid Factor 

Anti Phospholipid 


screen and Anti‐ Cardiolipin 

Antibodies 

Vasculitis 


Screen, Rheumatoid Factor & 

Complement C3,C4 

Liver disease 

Includes Antinuclear, Smooth 

muscle, Mitochondrial & Liver‐ 

Kidney Microsomal antibodies 

Renal disease 


Screen, ANCA & Complement 

C3,C4 

Sample type & 

collection 

instructions 

Gold top gel tube 





Reference Range Units Common Indicators Testing Frequency 

& Turnaround Time 

(TAT) 

See individual tests 

below for details 









Twice weekly 

(TAT up to 14 days if ANA 

Screen Positive) 

Weekly 



Twice weekly 



Weekly 



Weekly 




Uncontrolled





Autoantibody Test 

Antinuclear Antibody screen 

Sample type & 

collection 

instructions 




(TAT) 






dsDNA abs. 

ENAs –Extractable nuclear 

antigen abs. 

( See specific tests below) 

Endomysial abs (IgA & IgG) 

GAD Antibody 

Gastric Parietal cell Antibodies 

Glomerular Basement 

Membrane abs. 

Gm‐1 Ganglioside abs 

Hep‐2 ANA pattern 

Histone Antibody 

Hu antibodies 

Sample type & collecReference Range Units Common Indicators Testing Frequency 

instructions 


(TAT) 






IgA Autoantibodies 

Intrinsic factor abs. 

Islet cell abs. 

Jo‐1 antibody 

La antibody 

Liver‐Kidney Microsomal Abs 

Mitochondrial M2 Abs 

Mitochondrial Antibodies 

MuSK (Muscle specific kinase) 

abs. 

Myelin associated glycoprotein 

abs (MAG) 

Myeloperoxidase Antibodies 

Sample type & 

collection 

instructions 




No separate sample 

required, in ‘ENAs’ 










(TAT) 

IgA deficiency follow up 

Referral – 14 days 

Negative Pernicious anaemia Referral – 14 days 

Negative Type 1 Diabetes mellitus Referral – 14 days 

Negative Polymyositis, dermatomyositis Referral – 14 days 

Negative Sjögren’s, SLE Referral – 14 days 

Negative Autoimmune Hepatitis type 2 Weekly 

Negative Primary biliary cirrhosis Referral – 14 days 

(Done if routine ab. tests 

unclear.) 

Negative Primary biliary cirrhosis Weekly 

Negative 

Negative 

Myasthenia gravis ( e.g. in cases 

where Acetylcholine receptor abs. 

are negative.) 

MAG IgM neuropathy, 

Chronic sensory neuropathies 

Gold top gel tube 0‐5 u/mL Monitoring p‐ANCA positive 

vasculitis 





Uncontrolled






Sample type & 

collection 

instructions 



(TAT) 

Myositis antibodies 

(includes – Ku, Mi‐2, PmScl‐ 

100, PmScl‐75, Jo‐1, SRP, EJ, OJ, 

PL‐7, PL‐12, Ro‐52) 


Specialist investigation of myositis 

and overlap syndromes 


Neuronal Antibodies (includes 

Hu, Yo, Ri, CRMP/CV2, Ma1 

Ma2 & Amphiphysin) 

Ovarian Antibodies 

Pemphigoid Antibody 

Gold top gel tube 0 ‐ 200 Various neuropathies Referral – 14 days 

Negative Premature ovarian failure Referral – 14 days 


Negative Bullous skin diseases Referral – 14 days 


Phospholipid antibodies (See 

Cardiolipin abs.) 

Pm – Scl abs 

Gold top gel tube Anti‐phospholipid syndrome Weekly 



PR3 Antibodies Gold top gel tube 0‐5 

Rheumatoid Factor (RF) Gold top gel tube






Scl‐70 Antibody 

Sm antibody 

Smooth Muscle Antibody 

Thyroid peroxidase ELISA 

Tissue Transglutaminase IgA 

TSH receptor Antibodies 

Voltage gated calcium channel 

abs 

Voltage gated potassium 

channel abs 

Sample type & 

collection 

instructions 













(TAT) 

Negative Scleroderma Referral – 14 days 

Negative Subset of SLE Referral – 14 days 

Negative Autoimmune hepatitis (CAH) Weekly 

0‐70 Iu/mL Grave’s Disease, Hashimoto’s Thyroidit Weekly 

0‐4 IU/mL Coeliac disease Twice weekly 

Negative 

Thyroid disorders/pregnancy. Risk of p Referral – 14 days 

partum or 

neonatal thyroid dysfunction. 

0‐100 pM Lambert –Eaton syndrome Referral – 30 days 

0 ‐ 100 pM Acquired neuromyotonia 

Limbic encephalitis‐like syndromes 



Uncontrolled





Allergy Test 

IgE (Total) 

Sample type & 

collection 

instructions 




(TAT) 

3 months





Allergy Test 

ENVIROMENTAL 

Mix gx3 – Grasses 

Mix tx8 – Trees 

Mix wx3 – Weeds 

Mix mx1 – Moulds 

Sample type & 

collection 

instructions 



(TAT) 

Twice weekly 

Gold top gel tube





Immunodeficiency Test Sample type & 

collection 

instructions 



(TAT) 

Please discuss all cases of suspected Immunodeficiency with the Consultant before taking samples. 

Immunoglobulins IgG, IgA, IgM Gold top gel tube Adult ranges 

IgG 7.51 – 15.60 

IgA 0.82 – 4.53 

IgM 0.46 – 3.04 

IgG subclasses Gold top gel tube Age dependant. 

Gender differences in 

Adults. 

Functional Immunoglobulins ‐ Gold top gel tube 

Abs to Pneumococcal antigens 

HIB, tetanus 

Complement C3 and C4 Gold top gel tube C3 : 0.75 – 1.65 

C4 : 0.14 – 0.54 

Complement CH50 

Complement AP50 


Sample must reach lab 

within 1hr of collection 


Sample must reach lab 

within 1hr of collection 

g/L 

g/L 

g/L 

Immunodeficiency; 

Lymphoproliferative disorders 

Autoimmune pancreatitis (IgG4) 

Not a 1st line test for 

Immunodeficiency. Request 

Functional Immunoglobulins instead 

Immunodeficiency investigations & 

Vaccine responses 

Daily 



SLE; Hereditary angioedema Daily 

Vasculitis; Renal disease, Cryoglobulina 


23 ‐ 46 U/mL Complement deficiency / recurrent 

Neisserial infections. 

66% ‐ 125% Suspected complement deficiency / 

recurrent meningitis Rare alternative 

pathway complement deficiencies 

with normal CH50 (e.g. Properdin) 


Individual complement 

components 

Cellular immunology – 

Totals and Function 

As advised by 

laboratory 

As advised by 

laboratory 

Tertiary testing in cases of suspected 

complement dysfunction or 

deficiency 




Uncontrolled





BIOCHEMISTRY 

TEST 

SERUM TESTS: 

ACE (Angiotensin converting 

enzyme) 

ACTH 

Alpha‐Fetoprotein (AFP) 

Albumin (in profile) 

Alcohol (Ethanol) 

Alpha 1 antitrypsin 

Alkaline Phosphatase (in 

profiles) 

Alkaline Phosphatase 

isoenzymes 

Alanine Aminotransferase 

(ALT) in LFT profile 


INSTRUCTIONS 

REFERENCE RANGE UNITS COMMON INDICATORS Turnaround 

Time (Working days) 

Gold top gel tube 30 ‐100 IU/L Sarcoid 14.0 

Lavender top EDTA, 

Referral test. Must get to 

lab within 30 minutes. 

Please contact 

Biochemistry for details. 

Age dependent ng /L Pituitary & Adrenal 

Function 

Gold top gel tube Less than 10 ku/L Hepatoma, Teratoma 2.0 

Gold top gel tube 35 – 48 g/L Nutritional status, hepatic 0.5 

function 

Grey top fluoride/oxalate 

mg/100ml Available only for clinical 2.0 

tube 

purposes 

Gold top gel tube 0.88 – 1.74 g/L Alpha 1 antitrypsin 7.0 

Deficiency 


Adult: 42 ‐128 Age U/L Liver and bone disease 0.5 

related ranges 

reported 

Referral test. Please 

Differentiation of 14.0 

contact Biochemistry 

increased ALP 

for details 

Gold top gel tube Male: up to 45 IU/L Liver cell damage 0.5 

Female: up to 34 

14.0 


Uncontrolled





TEST 

Amino acids 

Amiodarone 

Ammonia 

Amylase 

Androstenedione 

Aspartate Aminotransferase 

(AST) 

B2 Microglobulin 

B12 

Bicarbonate (HCO3) 

Bile acids 

Bilirubin (in profile) 


INSTRUCTIONS 



for details. 

Gold top gel tube; 

sample before next dose 

Please 


for details. 


Time 

(Working days) 

Metabolic disease 14.0 

Therapeutic 

0.6 – 2.5 

mg/L Therapeutic dose 

Monitoring 

9 – 35 µmol/L Acute hepatic failure; 

Urea cycle defects 

Gold top gel tube 36 ‐128 IU/L Acute pancreatitis 0.5 


Age and sex nmol/L Congenital adrenal 

14 

dependent 

hyperplasia, PCO, hirsuitism 

Gold top gel tube





TEST 

Bilirubin – neonatal 

BONE PROFILE: 

Alkaline phosphatase 

Calcium 

Phosphate 

Albumin 

CA125 

CA15.3 

CA19.9 

Cadmium 

Caeruloplasmin 


INSTRUCTIONS 

Special tube 


Time 


Total: dependant µmol/L Neonatal jaundice 0.5 

on gestational age 

at birth. Direct:





TEST 

Carbamazepine (Tegretol) 

Calcium (in profile) 

Complement C3, C4 

C1 esterase inhibitor 

Carbon Monoxide 

CEA 

Cholesterol 

Cholinesterase (phenotype) 

Chloride 


INSTRUCTIONS 

Gold top gel tube; 

sample before dose 


Time 


Therapeutic 4 – 12 mg/L Therapeutic drug 

1.0 

Monitoring 

Gold top gel tube 2.15 – 2.60 mmol/L Bone disease 0.5 

Gold top gel tube C3 : 0.75 – 1.65 

C4 : 0.14 – 0.54 

g/L 

SLE; Hereditary 

angioedema 

Vasculitis; Renal disease 

Gold top gel tube 0.11 – 0.36 g/L Hereditary acquired angioedem14.0 

Lavender topped tube 

Please 

contact Biochemistry for 

details. 

Non‐smokers 0.5 – 

1.5, Smokers 4‐5 

Heavy Smokers 

8‐9 

% CO saturat 

of Hb 

7.0 

CO exposure 0.5 

Gold top gel tube Below 5 µg/L Tumour marker: 

colorectal, lung, breast 

and pancreas. 

Gold top gel tube Aim for





TEST 

CK (Creatine Kinase) 

Cobalt 


INSTRUCTIONS 



Time 


0.5 

Males up to 171 FemIU/L 

up to 145 

MI; Skeletal muscle 

Disease 

Blue top heparinised tube 14.0 

Copper 

Blue top heparinised tube 12 – 26 µmol/L Nutritional status, 

Wilsons disease 

14.0 

Cortisol 

CRP (C‐reactive protein) 

Creatinine 

Creatinine Clearance 

Cryoglobulin 

Gold top gel tube 9 a.m. 240 – 618 

Midnight ‐





TEST 

Cyclosporin 

Digoxin 

eGFR 


INSTRUCTIONS 

Lavender top EDTA tube. 

Sample before dose 

(Trough) 


(6 to 8 hrs post dose) 


Time 


ng/L 

14.0 

Depends on the 

clinical use. 

Affects the immune 

Response in grafts,RA 

and psoriasis. 

1.0‐2.6 nmol/L Therapeutic drug 

Monitoring 

Gold top gel tube Adult ( >16yrs) mls/min Chronic kidney disease (CKD) 1.0 

1.0 

Stage 1 Normal 

function >90 

Stage 2 mild 

impairment 60 – 89 

Stage 3 moderate 

impairment 30 – 59 

ELECTROLYTE PROFILE: 

Urea 

Sodium 

Potassium 

Creatinine 

Gold top gel tube 0.5 

2.9 – 7.1 mmol/L 

136 – 144 mmol/L 

3.6 – 5.1 mmol/L 

Male 80 – 115 

Female 53 ‐97 

mmol/L 


Uncontrolled





TEST 

Ferritin 

Folate 

FSH – see hormone profiles 

Blood Gases 

Gamma GT 

Gentamicin assay – once 

daily dose 

Glucose 

Growth Hormone(HGH) 

GTT (Glucose Tolerance 

Test) 


INSTRUCTIONS 

Gold top gel tube Male 23.9 – 336.2 


Time 


ng/ml Assessment of Iron stores 1.0 

Female 11.0 – 306.8 

1.0 

malabsorption 

Depends on cycle, IU/L Pituitary – gonadal 

3.0 

Age and sex 

Axis 

Depends on cycle, IU/L Acid base status < 1 hour 

Age and sex 

Gold top gel tube >3 ng/ml Macrocytic anaemia, 


Heparinised arterial 

sample 

(rush to lab – on ice) 

Gold top gel tube Male 11 – 49 

Female 7 – 32 

IU/L Cholestasis, alcohol abuse 1.0 


mg/L 1.0 

Take a random sample the 

morning after the dose. 

Record the time of the dose 

and the time the sample was 

taken. 

Grey topped fluoride Fasting 4.0 – 6.0 mmol/L Diabetes diagnosis 

0.5 

oxalate tube. 

and monitoring. 

Referral test. Please Fasting with/without ug/L Pituitary function, 

contact Biochemistry a GTT 

Acromegaly 

for details. 

Non‐diabetic (75g dose): 

Appointment required 

Fasting below 6.0 

2 hour below 7.8 

mmol/L 0.5 


Uncontrolled





TEST 

HCG 

HDL cholesterol 

HEPATIC PROFILES – See 

LFTs 

5HIAA 

HORMONE PROFILES: 

(Appropriate for clinical 

details) 

Infertility: 

Menopause: 

PCO 


INSTRUCTIONS 


Time 


0.5 

germ cell tumours 

Gold top gel tube Below 5.0 IU/L Pregnancy and 

Gold top gel tube Male > 0.8 mmol/L Lipid profiling, CHD risk 1.0 

See URINE list 

Gold top gel tube 2.0 – 14.0 

Plain blood sample on day 21 of a 28 day cycle 

Plain blood sample on day 1 – 3 of cycle 

Plain blood sample on day 5 – 8 of cycle 

0.5 


Uncontrolled





TEST 

IMMUNOGLOBULINS: 

IgG 

IgA 

IgM 

IgE 

Immunofixation 

Insulin 

IGF 1 (Insulin‐like growth 

factor 1) 

Iron 


INSTRUCTIONS 


Time 


7.0 

Gold top gel tube Immunodeficiency; 

Lymphoproliferative 

disorders 

Adult 7.51 – 15.60 g/L 

Adult 0.82 – 4.53 g/L 

Adult 0.46 – 3.04 g/L 

Adult





TEST 

Lactate 

LDH 

LDL Cholesterol 

Lead 

LIVER PROFILE: 

Liver Function Tests (LFT) 

Bilirubin 

Alkaline phosphatase 

ALT 

Albumin 

Total Protein 


INSTRUCTIONS 


Time 


0.5 – 2.2 mmol/L Metabolic acidosis, inborn 0.5 

errors 

Grey topped 

fluoride/oxalate tube 

Gold top gel tube Up to 500 IU/L Haematological abnormality 

Liver disease, some tumors 

Gold top gel tube 2.0 – 5.0 mmol/L Lipid profile 1.0 

Blue top heparinised tube 

Children and 

unexposed adults 

below 1.3 

µmol/L 

Environmental and 

Occupational exposure 


Below 20 µmol/L 

42 – 128 (Adult) IU/L 

Male





TEST 

LH – see Hormone profile 

LIPID PROFILE: (Fasting) 

Cholesterol 

Triglyceride (fasting) 

HDL on all cholesterols 

(random or fasting) 

Lithium 

Magnesium 

Mercury 

Oestradiol 

Osmolality 

P3NP 

Paracetamol 


INSTRUCTIONS 



Time 


Depends on age, IU/L Pituitary –gonadal axis 2.0 

sex and cycle 


Aim for 1.0 

mmol/L 


(12 hours post dose) 

Timed therapeutic 

0.4 – 1.0 

mmol/L Therapeutic drug monitoring 1.0 

Gold top gel tube 0.74 – 1.03 mmol/L Electrolyte and calcium 0.5 

Status 


Evironmental and 

14.0 

Contact Biochem. For details 

occupational exposure 


Depends on age, pmol/L Ovarian function 3.0 

cycle, etc 

Gold top gel tube Adult 285 – 295 mosmol/Kg SIADH (with urine 

1.0 

osmolality and NA) 

Gold top gel tube 1.7 – 4.2 µg/L Hepatic fibrosis, 

14.0 

myelofibrosis 

Gold top gel tube Therapeutic 10‐25 mg/L Overdose 0.5 


Uncontrolled





TEST 

Phenobarbitone 

Phenytoin 

Phosphate 

Potassium – see electrolyte 

profile 

Progesterone 

Prolactin 

Prostate Specific Antigen 

(PSA) 

Protein, Total (in profile) 

Protein electrophoresis 

PTH 


INSTRUCTIONS 


Time 


14.0 

Gold top gel tube Therapeutic 15‐40 mg/L Therapeutic drug 

monitoring; overdose 

Gold top gel tube Therapeutic 10‐20 mg/L Therapeutic drug 

monitoring; overdose 

Gold top gel tube Adults 0.78‐1.53 mmol/L Bone & renal function 0.5 

Gold top gel tube Depends on cycle nmol/L Ovulatory function 3.0 



Males : 55 – 276 FemamIU/L 

58 – 561 

Age related µg/L 

reference range 

Pituitary function, tumour 

marker 

Tumour marker: Prostate 

cancer 

Gold top gel tube 61 – 79 g/L 0.5 

Gold top gel tube Paraprotein studies 7.0 


Please contact Biochemistry 

for details (requires rapid 

freezing) 

0.5 – 6.4 pmol/L Parathyroid tumour: 

Hypercalcaemic states 

1.0 

3.0 

1.0 

14.0 


Uncontrolled





TEST 

RAST 

Salicylate 

Selenium 


INSTRUCTIONS 

Gold top gel tube (please 

state which allergens you 

require) 


Time 


Specific allergies 14.0 

Gold top gel tube Therapeutic





TEST 

Thyroid Function Tests: 


INSTRUCTIONS 


Time 


INITIAL FT4 AND TSH 

FT4 

TSH 

Transferrin 

Theophylline 

Thyroglobulin 

Triglyceride (in lipid profile) 

Troponin I 

Gold top gel tube 7.5‐21.1 pmol/L Thyroid function 1.0 

Gold top gel tube 0.345 – 5.60 mIU/L Thyroid function 1.0 

Gold top gel tube Male 1.8 – 3.3 

Female 1.9 – 2.8 

g/L Iron saturation studies 1.0 


Adults 8.0 – 20.0 mg/L Therapeutic drug monitoring 1.0 

Samples: 30mins post IV 

dose, 2hrs post oral rapid relea 

4hrs post oral slow release 

Gold top gel tube Normal 1.7 – 35 µg/L Thyroid cancer 14.0 

Post thyroid 

ablation < 1 

Below 2.0 (fasting) mmol/L 1.0 


>12 hours and < 1 week 

post event 

< 0.04 – no MI 

0.04 – 0.5 ACS 

> 0.5 MI 

ng/ml To exclude ACS and MI 0.5 


Uncontrolled





TEST 

Tryptase 

Urea – see electrolyte profile 


INSTRUCTIONS 


Take sample within 30 mins 

of reaction then 3 and 24 hrs 

post reaction 


Time 


28 

2 ‐ 14 ng/ml Severe allergic reaction 

Uric acid 

Valproate 

Vitamin A 

Vitamin D 

Vitamin E 

Zinc 


Gold top gel tube, sample 

before next dose, (trough) 



details 

Male: 0.29 – 0.52 Fem 

0.16‐0.48 

mmol/L Gout; tumour lysis; pre‐eclamp 1.0 

50 – 100 mg/L Therapeutic drug 

Monitoring 

2.1 – 4.6 µg/L Nutritional status; Cystic 

fibrosis review 

Gold top gel tube 72‐374 nmol/L Nutritional status 

Calcium metabolism 

Referral test. Please 11.6 – 37.1 µg/L Nutritional status; Cystic 


fibrosis review. 

details 

Blue top heparinised tube 9 – 22 µmol/L Nutritional deficiency 14.0 

1.0 

14.0 

14.0 

14.0 


Uncontrolled





TEST 


INSTRUCTIONS 


Time 


URINE TESTS: 

Albumin/Creatinine Ratio 

(microalbuminuria) 

Amino acids 

Amylase 

Bence Jones Protein screen 

(if present, immunofixation) 

Bile Pigments 

Calcium 

25ml Universal container 0 – 3 mg/mmol Diabetic nephropathy 1.0 



details 

Metabolic disease 14 

25ml Universal container 1 – 17 U/hour IU/L Acute Pancreatitis 1.0 

24 – 408 U24/hours 

25ml Universal container Myeloma 7.0 

25ml Universal container Fresh Detection of Bilirubin/Urobilino 4.0 

24hr Urine Adult 2.5 – 7.5 mmol/24h Disorders of Calcium metabolis 

stone 

Formers 

1.0 


Uncontrolled





TEST 

CATECHOLAMINES: 

Adrenalin 

Dopamine 

Metadrenalin 

Noradrenalin 

Normetadrenalin 

Cortisol 

Creatinine 

Creatinine Clearance – 

blood sample required at 

the same time. 


INSTRUCTIONS 


Time 


14.0 

adrenal medullary carcinoma 

< 0.1 umol/24h 

24hr Urine with preservative Phaeochromocytoma, 

0.49 ‐2.85 umol/24h 

< 1.49 umol/24h 

0.07 – 0.48 umol/24h 

< 3.0 umol/24h 

24hr Urine Adult 160 – 470 nmol/24h Pituitary Cushing’s/ 

14.0 

adrenal hyperplasia 

24hr Urine Adult 10 – 15 mmol/24h 1.0 

24hr Urine Adult – above 140 L/24h 1.0 


Uncontrolled





TEST 

Deoxypyridinoline 

(x‐links) 

Electrolytes and Urea: 

Sodium 


INSTRUCTIONS 


Time 


25ml Universal container 3.0 – 7.4 nmol/L Metabolic bone disease 20.0 

24hr Urine 0.5 

120 – 250 mmol/24h 

25 – 100 mmol/24h 

200 – 500 mmol/24h 

Potassium 

Urea 

HMMA = VMA = see 

Catecholamines 

5HIAA 

Magnesium 

Mucopolysaccharide 

Myoglobulin 

24hr Urine with preservative 5 – 35 µmol/24h Carcinoid tumours 14.0 

24hr Urine Adult 3.3 – 5.0 mmol/24h 1.0 

25ml Universal container 2‐3 years: below 28 Mucopolysaccharidosis 14.0 


FRESH URINE 

Trauma & rhabdomyolysis 1.0 


Uncontrolled





TEST 

Osmolality 

Oxalate 

Phosphate 

PORPHYRINS: 

Porphobilinogen 

Porphyrin 

PCR (Random) 

protein/creatinine ration 

Protein (24 Hr) 

Uric acid 


INSTRUCTIONS 


Time 


1.0 

25ml Universal container mosmol/Kg SIADH, renal 

concentrating function, 

water deprivation test (supervi 

in hospital) 

24hr Urine with preservative P Male 80 – 490 

Female 40 – 320 

µmol/24h Hyperoxaluric stone 

forming 

14.0 

24hr Urine with preservative 15 – 50 mmol/24hr Renal calculi 1.0 


FRESH URINE 





TEST 

OTHER SAMPLES: 


INSTRUCTIONS 


Time 


C.S.F.: 

Protein 

Lactate 

CSF Glucose 


Young adults: 

250 – 500; 

higher in neonates, 

lower in children, 

rises in elderly 

mg/L 

Inflammatory conditions 

of the meninges 

Grey top fluoride tube. Inherited metabolic disease 0.5 

Grey top fluoride tube. 

Blood sample also required. 

2.2 – 3.9 

mmol/L Bacterial Meningitis 0.5 

Depends on plasma glu 

0.5 

CSF/serum IgG albumin 

ratio and Oligoclonal bands. 

Referral test. 

Blood sample and CSF 

14.0 

CSF Xanthachromia 

4 th sample after LP 

preferred. 

Send to lab by porter 

nba





TEST 

Faecal Elastase 

Faecal Porphyrins 

Sweat tests 

CALCULI – Quantative 

analysis 


INSTRUCTIONS 


Time 


200 normal 

Insufficiency 

Porphyria screening 7.0 

60ml plain universal 

container 

60ml container – 

fresh sample 

Referral test. Contact Biochem 

for details 

Renal stones Differential Diagnosis of 

Stone formation – 

Metabolic disorders 

Cystic Fibrosis 1.0 

14.0 

FLUIDS: 

Pleural fluid:‐ 

Total protein 

Albumin 

Glucose 

pH 

LDH 

Other fluids:‐ 

Amylase 

Urea 



g/l 

g/l 

mmol/L 

IU/L 

IU/L 

mmol/L 

2.0 

Transudate/exudate 

Transudate/exudate 

TB or lupus pleuritis 

Empyema, malignant or rheum 

effusion 

paragonimiasis 

Pancreatic origin 

Urinary tract origin 

2.0 


Uncontrolled





Paediatric Sample Requirements – Biochemistry 

Blood samples 

Test Sample requirements Tube Top Minimum blood 

(ml)* 

17OHP Lithium‐heparin – ideally take between 08:00 ‐ 09:00am under ACTH control 0.5 

ACTH EDTA tube‐ rush to lab (with cortisol sample, taken at 9am) 1 

Alpha‐1‐antitrypsin Lithium‐heparin 0.5 

Alpha‐1‐antitrypisin phenotyping Plain serum tube/gel tube 0.5 

Alpha‐fetoprotein (AFP) Lithium‐heparin 0.5 

Amino acids Lithium‐heparin 0.5 

Ammonia EDTA tube‐ phone lab before taking, rush to lab once taken. 0.5 

Auto immune dsDNA Lithium‐heparin 0.5 

Bile acid Lithium‐heparin 0.5 

Biotinidase Lithium‐heparin‐ rush to lab 0.5 

Caeruloplasmin Lithium‐heparin 0.5 

Carnitines Blood on spot cards‐ ideally patient should be fasting for 10‐12 hours. ‐ 

Cortisol Lithium‐heparin(taken at 9 am) 0.5 

Copper Lithium‐heparin 0.5 

C‐peptide Plain serum tube‐ rush to lab 0.5 

GAL1PUT Lithium‐heparin 1.0‐2.0 

Glucose Fluoride‐Oxalate tube 0.5 

Immunoglobulins Lithium‐heparin 0.5 


Uncontrolled





Test Sample requirements Tube Top Minimum blood 

(ml)* 

Hormone profile Lithium‐heparin 1 

Insulin Plain serum tube‐rush to lab 0.5 

Lactate Fluoride‐ Oxalate tube 0.5 

Long chain fatty acids Lithium‐heparin‐ rush to lab 2 

Lysosomal enzymes Lithium‐heparin 2x6mL ‐ rush to lab 8 

Selenium Plain serum tube 0.5 

Thyroid Function Lithium‐heparin 0.6 

Thyroid peroxidase antibody (TPO) Lithium‐heparin 0.5 

Tissue transglutaminase abs Lithium‐heparin 0.5 

Transferrin isoforms Lithium‐heparin rush to lab 0.5 

Urea and electrolytes (U+Es) & LFTs Lithium‐heparin 0.6 

Uric acid (UA) Lithium‐heparin 0.5 

Vitamin A Plain serum tube/ gel tube‐ must be fasting. Protect from light, rush to lab 0.5 

Vitamin D Plain serum tube/gel tube‐ rush to lab 0.5 

Vitamin E Plain serum tube/gel tube‐ must be fasting Rush to lab 0.5 


Uncontrolled





Urine samples 

Test 

Aminoadipic acid 

Amino acids 

Catecholamines 

Drugs of abuse screen 

Guanidinoacetate 

Mucopolysaccharides 

Protein + albumin/creatinine ratio 

Organic acids 

Steroid hormone profile 

Sugars 

Sulphite 

Sample requirements 

Collect in a plain universal‐ rush to lab 


Ideally 24hr urine collected in an acidified 

container. If not possible send 20 mL random 

urine sample. (White top) 

Collect in a plain universal 

Collect in a plain universal‐rush to lab 


Collect in a plain universal 


Ideally 24hour collection in a plain container. If 

not possible send 20 mL random urine sample. 

(White top) 


Fresh urine required in plain universal, dipstick 

test performed at Southampton. 

Faecal Samples 

Faecal elastase 

Reducing sugars 

CSF Samples 

Test 

Sample Requirements 



Amino acids (glycine) 

Lactate 

Oligoclonal bands 

Test 

Sample Requirements 


Fluoride ‐ Oxalate tube; phone lab before taking, 

rush to lab once taken. 



Uncontrolled





If you have any queries regarding sample requirements please ring ext.4458/4697 or Consultant Biochemist 4455. 

Appendix E ‐ Site map 


Uncontrolled

Pathology User Handbook 2012 - Hampshire Hospitals NHS ...

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