a guide to the haematology laboratory services wirral

A GUIDE
TO THE
HAEMATOLOGY
LABORATORY
SERVICES
WIRRAL UNIVERSITY TEACHING HOSPITALS
An accredited laboratory, under the
Clinical Pathology Accreditation (CPA) scheme
August 2011 Version 1.0
J. McCreadie
CONTROLLED DOCUMENT – DO NOT PHOTOCOPY
Wirral Hospital NHS Trust – Directorate of Laboratory Medicine – Department of Microbiology
Document printed on 10/08/2011 MM-POL-002 Version 2…. Page 1 of 24
The history of this document including the author, authoriser(s) and revision date can be found on Q-Pulse. Any copy made from the electronic version shall be considered an
uncontrolled copy. Individuals with uncontrolled copies are responsible for ensuring the use of the current version.

CONTENTS
1 General Information ...........................................................................................3
Introduction................................................................................................................3
Opening hours and contact numbers .......................................................................4
BMS Out Of Hours Service for urgent tests .............................................................5
2 Clinical advice.................................................................................................6
3 Key contacts and their telephone numbers / extensions ...............................7
4 Haematology - Principal Services.....................................................................8
5 Requirements for request forms (PCIS, WROCS and Handwritten forms).10
CERNER REQUESTING .......................................................................................11
6 Labelling requirements for specimens...........................................................11
7 Sample Availability...........................................................................................11
8 Standard procedures for the safe collection of specimens..........................13
9 Blood Collection Chart for HaematologySGATHER EQUIPMENT................14
10 Transport of clinical specimens to the Laboratory .......................................15
Specimens collected from Arrowe Park Hospital ...................................................15
Specimens collected from GP Practices ................................................................15
Packaging and transport ........................................................................................15
11 Haematology tests and Turnaround Times....................................................16
12. Key factors which affect the performance and or result of a haematology
Test...................................................................................................................20
13 HAEMATOLOGY REFERENCE RANGES........................................................21
2 – 7 Years................................................................................................................24
8 – 14 Years..............................................................................................................24
Coagulation............................................................................................................25
14 Haematology Referral Laboratories................................................................27
Appendix 1 Location of Haematology Laboratory at Arrowe Park Hospital
Page

1 General Information
Introduction
Welcome to the Haematology Department User Manual of Wirral University Teaching
Hospital NHS Foundation Trust (WUTH). The Haematology Department provides a
wide range of consultative, analytical, teaching and developmental services. The
department provides its services from 2 sites. The main department is located at
Arrowe Park Hospital with a satellite essential services laboratory located at
Clatterbridge Centre for Oncology which is located on the Clatterbridge site.
This user manual is designed to give an overview of services available in the
Department including the availability of clinical advice as well as the scope and
limitations of the service. It is intended as a quick reference guide for all users, both
within WUTH and primary and other secondary care health providers who use the
service. Results of laboratory tests are made available to patients through their
Clinicians or General Practitioners. The Haematology Department is accredited by
Clinical Pathology Accreditation (UK) Ltd. In addition, the Transfusion service is
regulated by Medicines and Healthcare Regulatory Authority (MHRA). The service
undergoes continuous review through quality assurance and audit activities
A controlled electronic copy of this manual is available to all clinical areas and
general practitioners within WUTH catchment area via the WUTH website:
http://www.whnt.nhs.uk
Information regarding laboratory tests can be obtained by accessing laboratory tests
on line:
Lab tests on line:
http://www.labtestsonline.org.uk/
Or by contacting the department directly:
0151 678 5111 ext 2093
Address for all correspondence:
Arrowe Park Hospital
Arrowe Park Road
Upton
Wirral
CH49 5PE
Hospital telephone number 0151 678 5111
Web address : http://www.whnt.nhs.uk

Opening hours and contact numbers
OPENING HOURS AND CONTACT NUMBERS
SECTION CORE HOURS CONTACT NUMBER
Specimen Reception
Mon – Fri 9am – 9pm
Sat & Sun 9am - 5am
0151 678 5111 ext 2104
DDI 0151 604 7093
Phlebotomy
Haematology (APH)
Haematology (CCO)
Molecular Genetics
Warfarin Monitoring
(WACS)
Flow Cytometry
Transfusion
Mon – Thurs 8.30am – 5.30pm
Fri 8.30 – 5pm
Sat & Sun 7.30am -11.30am
(ward service only)
Mon-Fri 9am – 5.30pm
(except bank holidays)
Mon-Fri 9am – 5.30pm
(except bank holidays)
Mon-Fri 9am – 5.30pm
(except bank holidays)
Mon-Fri 9am – 5.30pm
(except bank holidays)
Mon-Fri 9am – 5.30pm
(except bank holidays)
Mon-Fri 9am – 5.30pm
(except bank holidays)
For appointments:
0151 678 5111 ext 2518
DDI 0151 604 7382
0151 678 5111 ext 2093
0151 334 4000 ext 4519
0151 678 5111 ext 2101
0151 678 5111 ext 2536
DDI 0151 604 7393
FAX 0151 604 0370
0151 678 5111 ext 2101
0151 678 5111 ext 2100
FAX 0151 604 0034
Transfusion Practitioner
Team
Mon-Fri 9am – 5.30pm
(except bank holidays)
0151 678 5111 ext
Bleep 2209

BMS Out Of Hours Service for urgent tests
An out of hours service is available at Arrowe Park site outside of core hours.
The service is accessed via the hospital bleep.
All requests made during out of hours should be requested on HIS with an urgent
priority. If a request form is used, the form should be marked URGENT and a contact
telephone number where the result can be telephoned to must be provided.
Bleep 2093
Monday to Friday 17:30 to 09:00 following
day
Saturday / Sunday / 09:00 to 09:00 following
Bank Holiday
day
There is at least 1 BMS is on duty throughout the out of hours period. All out of hours
tests received during this period will be prioritized and processed. However, the BMS
must be contacted if:
• Request is for blood or blood products/components
• Request is very urgent
• Request for malarial parasite screening
• Urgent ESR
• Pre-operative sickle screen
• Non- non core test requested
Haematology out of hours test list
For any other tests the on call consultant haematologist must be contacted
Transfusion
Haematology
Group & Antibody Screen
Blood and blood product issue
Group and Coombs
Transfusion Reaction Investigation
Kleihaur
FBC
Coagulation Screen
INR
APTT
D-Dimer
Malaria Screen
ESR if:
Suspected Temporal Arthritis
Polymyalgia rheumatica
Differential diagnosis of hip pain in children
Sickle screen – Patients going for emergency theatre
Only.

2 Clinical advice
Clinical advice is available at all times.
To contact a consultant haematologist during core hours, 9am – 5.30pm Monday –
Friday, contact the Consultant Haematologists’ secretary. The individual telephone
numbers are contained in section 3, Key contacts and their telephone numbers.
To Contact the Consultant Haematologist during non core hours, telephone Arrowe
Park switchboard, telephone number 0151 678 5111 and ask to speak to the
Haematologist on call.

3 Key contacts and their telephone numbers / extensions
Members of staff are available on extension numbers during normal working hours
via the Arrowe Park Hospital Switchboard, telephone number 0151 678 5111
LOCATION / ROLE STAFF MEMBER INTERNAL EXTENSION
Haematology / Coagulation Elaine Lupton 2093 or 2834
Warfarin Monitoring:
Dosing
Clinic queries
Keith Skinner
Helen Woodward
2536
2536
Molecular Genetics John Welbourn 2641
Flow Cytometry Paula Peppin 2101
Transfusion David Goodridge 2100
Lead Transfusion
Practitioner
David Goodridge 2209
Bleep 2209
Service Manager Julie McCreadie 2847
Consultant Haematologist
Secretary
Consultant Haematologist
Secretary
Consultant Haematologist
Secretary
Dr N Butt
Pauline Sweeney-Jones
Dr D Galvani
Anne Whitehead
Dr R Dasgupta
Hazel Edwards
2821
DDI 0151 604 7105
2105
2089
DDI 0151 604 7122
2658
8069
DDI
8456
Pathology
Clinical Director
Pathology
Deputy ADO
Dr M Lipton 2982
Margaret Shaughnessy 2095
Phlebotomy Manager Jan Colligan 2032
Specimen Reception
Team Leader
Dianne McLavery 2102

4 Haematology - Principal Services
Clinical and Diagnostic Service
The department offers a wide range of consultative, analytical, teaching and
developmental services.
The principal diagnostic laboratory is based at Arrowe Park Hospital. In addition
there is a small essential services satellite laboratory on the Clatterbridge site within
the Clatterbridge Centre for Oncology building. Access to consultative and principal
diagnostic services are available on a 24 hour basis. Advice on the selection of
appropriate diagnostic specimens, their collection and transport is also available.
Results of particular clinical significance are phoned through to the surgery, ward
or relevant medical staff, irrespective of whether the original request is marked as
urgent or routine.
Consultative Services
Consultant haematologists are available for advice regarding clinical or laboratory
issues during office hours and provide an emergency only service out of hours via
the switchboard at Arrowe Park Hospital.
Significantly abnormal results are reviewed by a consultant haematologist and results
communicated to clinical staff to ensure rapid access for haematological opinion.
In addition, Arrowe Park Hospital has a 7-day consultant-led clinical haematology unit
for effectively managing both in- and out-patient haemato-oncology patients.
Consultant Haematologists also deliver general haematology clinics and
anticoagulant clinics in an out-patient setting.
As well as general haematology interests, the Consultant Haematologists also take a
pro-active lead in the specialist areas of transfusion, anticoagulation, thalassaemia
and haemoglobinopathy investigations and cancer.
Analytical Services
In addition to routine haematology, coagulation and transfusion laboratory services,
the department also delivers a range of haematological molecular genetic and flow
cytometry tests. The department is fully-automated to ensure it delivers a timely
service to support patient care. In addition to its routine service, it provides an out of
hour’s service delivering rapid turnaround of out of hours tests for primary and
secondary care.
All test results validated by a full programme of both internal and external quality
assurance procedures.

Teaching
The department is an IBMS approved training laboratory for pre-registration
Biomedical Scientists and specialist training in Haematology with Hospital
Transfusion Practice.
It supports the training of undergraduate and postgraduate medical students and
undergraduate BMS students and has developed close links with the local
universities. It is also actively involved in providing work experience for year 12 and
13 pupils from local schools. All training in the department is supported by the
departmental training co-coordinator.
Audit
To ensure a process of continuous improvement, the department has an internal
monthly audit schedule which examines all areas of department performance. The
department also participates in national audits in order to bench mark its
performance and ensure best practice compliance. The audit programme is
supported by the departmental quality lead.
Research and Development
The department has an active research and development programme in several
areas, especially molecular genetics and flow cytometry.
The clinical haematology unit is actively involved in clinical trials and is supported in
this role by a specialist haematology research nurse.
The Transfusion Practitioner Team supports transfusion development and patient
safety issues.
All medical and technical staff participate in CPD. Technical staff are required to
maintain a professional portfolio.
Our readily accessible clinical and laboratory staff are glad to answer any questions
and offer advice.

Document control
All documents used in Haematology are managed electronically using Q-Pulse
software (Q-Pulse Version 5 Gael Quality Limited).
Documents are embedded within the system and backed up on WHIS Servers to
protect their integrity.
There are policies, procedures and templates specific to Haematology as well as
shared directorate documents.
The department and Directorate of Laboratory Medicine are obliged to follow Trust
policy and procedures. To avoid duplication some of these policy and procedure
documents are used in place of departmental ones.
Trust policies and procedures are located on the intranet.
5 Requirements for request forms (PCIS, WROCS and
Handwritten forms)
Requests communicated to the laboratory are as follows
PCIS forms generated at ward level
WROCS forms generated by the GP practises
Hand written ‘Red forms’
Individual GP request forms
All verbal requests to the laboratory must be accompanied by one of the above request
forms for the test to proceed.
HOSPITAL WARDS AND DEPARTMENTS
All requests for haematology tests should be made electronically on the Hospital
Information System (HIS). Once a request has been made the appropriate request
documentation will be generated. This will be either a request form (PCIS request) or
a sample label (CERNER request).
In the event of HIS downtime, downtime request forms provided by WHIS must be
used. The essential information required, as detailed in the table below, MUST be
completed.
GENERAL PRACTITIONERS
All requests for haematology tests should be made electronically on Wirral Remote
Order Communications System (WROCS). In the event of WROCS downtime, paper
request forms either provided by or approved by the laboratory MUST be completed.
A request form must accompany all specimens sent to the laboratory using WROCS or
PCIS patient ordering systems. It should clearly state the following information for
unequivocal identification of the patient and specimen:

• Patient name (in full – no abbreviations)
• Ward, Clinic, or GP name and number/ address
• NHS number
• Date of Birth (rather than age, if possible)
• Sex
• Type of specimen
Date and time specimen taken
The ONLY exception where a request form is NOT requires is a request for an INR
for anticoagulant monitoring via WACS. In this event, the patients’ OAT book (Oral
Anticoagulant Therapy ‘yellow book’) serves as the request form.
It is ESSENTIAL that the laboratory knows the date on which a specimen is taken as
processing delayed specimens can yield unhelpful or frankly misleading results. In
addition if a request for malarial parasite screening is made, all relevant clinical details,
prophylaxis treatment and history of foreign travel is required.
CERNER REQUESTING
CERNER is a hospital paperless system that will not generate a request form EXCEPT
for transfusion requests. All CERNER requests should have a status collected in
CERNER. The specimens should be sent with the printed label on the specimen. All of
the above details are necessary to include when making a CERNER request.
6 Labelling requirements for specimens
• The specimen must be labelled with the patient details as on the request form.
• The specimen must be labelled with the date of collection.
• Please note that unlabelled, inadequately labelled or mislabelled specimens cannot
be processed and will be discarded.
The criterion for sample acceptance is described in Wirral University Teaching
Hospital NHS Foundation Trusts Standard for Labelling of Laboratory Specimens
Policy, policy reference number 044. The criterion for blood transfusion sample
acceptance is also detailed in Blood Transfusion Policy, policy reference number
019. This is strictly adhered to in the interest of patient safety
If the laboratory cannot unequivocally identify the sample and match it to a form,
then it will be discarded.
The laboratory will inform senders by means of an electronic or printed report when a
specimen has been discarded for the above reasons.
7 Sample Availability

In certain circumstances it may be possible to add tests to samples that the
laboratory has already received.
The table below indicates how long samples are kept in the laboratory before
disposal.
Requests for extra tests must be received within the sample storage period and must
be accompanied by a request form. Please telephone the laboratory before
requesting extra tests to ensure the sample is available and still viable.
Sample
FBC
Coagulation
Molecular Genetics
Blood Transfusion
Flow Cytometry
Minimum sample retention time post
analysis and Storage condition
48 hours @ room temperature
24 hours @ room temperature
whole blood sample:1 month @ 2-8°c
DNA: 10 years @ 2-8°c
7days @ 2-8°c
Peripheral blood 7 days @ room temperature
Bone marrow 5 weeks @ 2-8°c

8 Standard procedures for the safe collection of
specimens
These procedures concern all clinical staff, who are qualified and have been deemed
competent to collect diagnostic specimens from patients.
N.B. Staff must always follow aseptic techniques when handling blood, body fluids, excretions, or
secretions, even when these have not been specified as infectious.
Objectives
All staff must be aware of the potential physical and infectious hazards, associated
with these procedures, and should therefore collect specimens:
1 being mindful of personal safety, without injury or exposure of themselves and
2 of collective safety, without exposing colleagues who are involved with the
handling, transport and laboratory investigations of specimens, to physical or
infectious hazards.
Staff collecting specimens must take care to prevent contaminating themselves,
their environment, the external surfaces of the specimen containers, or the
accompanying test request forms. If gross contamination of the hands with
blood, faeces or other biological fluids is anticipated, then gloves should be
worn. Hands should always be washed after taking specimens. If splashing into
the eyes or on to mucous membranes is anticipated goggles should be worn.
3 In addition, specimens should be collected aseptically, without allowing
contamination by extraneous and, therefore, irrelevant micro-organisms.
Contaminated specimens can adversely affect the validity of many laboratory
results. For example, the microbiological investigation of contaminated blood or
other materials from sites, which are normally sterile, can commit patients to
unwarranted courses of expensive and potentially toxic treatment.
Before you start
1 Ensure that the lighting conditions are adequate.
2 Select the correct specimen container(s) (see Quick Guide in Section 10),
appropriate for the type of specimen, and keep the container close to the site
from which the specimen is to be obtained.
3 Complete, legibly and fully, all sections of the label on the specimen container
and, check the details on the computer generated request form from WROCS is
correct or, where used, the colour-coded test request forms.
4 If you suspect, or are aware of, an infection with a Hazard Group 3 pathogen
(examples of relatively common Hazard Group 3 pathogens are Hepatitis B
virus, Human Immunodeficiency virus and Mycobacterium tuberculosis), this
must be mentioned in the clinical details sent with the specimen.
5 If you suspect, or are aware of, an infection with a Hazard Group 4 pathogen
(Viral haemorrhagic fevers, eg Ebola and Lassa) do not attempt to collect any
specimen. Inform the Infection Control Doctor at once on extension 4512.

When you have finished
All waste generated from obtaining a specimen should be disposed of according to
Local Waste Disposal Protocols.
9 Blood Collection Chart for HaematologySGATHER EQUIPMENT.
PARE EQTEP 3: SKIN PREPARATION.
VACUETTE ® SELECTION CHART
Rec Cap Tube Tests Special Re-order
Filling Colour Type Instructions Part
Order
Number
1st
Clotting
Accelerator
B12, folate, ferritin, Paul Bunnell,
haptoglobins, anticardiolipin
Aantibodies
KFK059
1st
Clotting
Accelerator
INR, clotting screen, APTT,D-
Dimer, Lupus Anticoagulant,
Thrombophilia screen (part of),
Von Willebrands screen, factor
assays, anti Xa
Blood must
be collected
to the
volume
specified
on the tube
KFK22
5
1st
Clotting
Accelerator
Separation
Gel
FBC, ESR, Paul Bunnell,
malarial screen, plasma
viscosity, sickle screen,
thalassaemia screen, klieihaur,
thrombophilia screen (part of),
molecular genetics
Mix 6 times.
Separate
sample
KFK22
4
1st
Clotting
Accelerator
Separation
Gel
Group and save / Crossmatch
KFK26
5
Samples for blood transfusion MUST be hand written
Thrombophilia screening requires 3 blue bottles, 1 lavender
bottle and 1 pink bottle
If the test you are requesting is not on this list please contact the

10 Transport of clinical specimens to the Laboratory
Specimens collected from Arrowe Park Hospital
Monday to Friday
From 9.00 am until 2.00 p.m. daily there is an hourly
collection of pathology specimens from wards by the portering
staff,
After 2.00 p.m., bleep porters on bleep 2074 to pick up
specimens Alternatively, samples maybe sent to the
laboratory via the air tube system (pod) which has stations in
various locations around the Arrowe Park site.
Weekends and Bank holidays There are no scheduled collections for pathology
samples on weekends or bank holiday. To arrange sample
collection by a porter, bleep 2074. Alternatively samples
maybe sent to the laboratory via the air tube system.
Specimens collected from GP Practices
MCS Courier Services provide collection of specimens from General Practice for
Laboratory Medicine Monday to Friday only.
Packaging and transport
Before the specimens are collected by Porters, Couriers, Volunteers, Nursing and
Support staff ensure that specimens and request forms are placed correctly into the
mini-grip plastic bags. Specimens should be placed in the pocket of the plastic bag
and grip seal sealed. The request form should be slid into the sleeve of the plastic
bag. The specimen should then be placed in the large Pathology specimen bag for
collection. If there is to be a delay in transporting the sample to the laboratory,
advice from the laboratory regarding appropriate storage should be sought.
Specimens that are to be transported by taxi should be placed in a specimen tin or
sealed in an large envelope.
N.B.
The plastic transport bags, if properly sealed, are designed to contain accidental specimen
leakage from the container. Spontaneous specimen discharge, due to defective materials, is
rare. Most incidents of specimen leakage are due to the fact that neither the container nor the
integral bag strips have been closed properly. If both container and transport bag are closed
correctly, the practice of 'double-bagging', even when an infection with a Hazard Group 3
pathogen is suspected, does not confer any additional safety advantage and is, therefore,
unnecessary
The containers supplied, comply with standards BS 4851 and BS 5213 for leakage and
spontaneous discharge. Leaked containers frequently result in irreplaceable loss of specimens
and, equally as important, staff to unwarranted hazards of infection.
Members of the public who come across specimen tins containing specimens should
follow the instructions printed on the tin.

11 Haematology tests and Turnaround Times
All turn around times are stated in working days
Turnaround time is defined as time from receipt in laboratory to result
released
Working days – Monday – Friday 9am – 5.30pm
Test / investigation Container and comments Turnaround
Times
FBC
Adult - 4 ml LAVENDER EDTA
Paediatric – 1.3ml EDTA
Routine 4 hrs
Urgent 2hrs
ESR 4 ml LAVENDER EDTA Routine 4 hrs
Urgent 1hr
Reticulocytes 4 ml LAVENDER EDTA Routine 4 hrs
Urgent 2hrs
Blood film 4 ml LAVENDER EDTA 48 hrs
Malarial parasite screen 4 ml LAVENDER EDTA initial report within
2 hrs
Plasma viscosity 4 ml LAVENDER EDTA 2 working days
Paul Bunnell 4 ml LAVENDER EDTA 4 hrs
INR 3.5ml BLUE Trisodium citrate Routine 4 hrs
Urgent 2hrs
APTT 3.5ml BLUE Trisodium citrate Routine 4 hrs
Urgent 2hrs
Clotting screen
3.5ml BLUE Trisodium citrate
Routine 4 hrs
Urgent 2hrs
D-Dimer 3.5ml BLUE Trisodium citrate Routine 4 hrs
Urgent 2hrs
Thrombophilia screen
3.5ml BLUE Trisodium citrate
5 working days
4 ml LAVENDER EDTA
4 ml OCHRE

Test / investigation Container and comments Turnaround
Times
Von Willebrands screen 3.5ml BLUE Trisodium citrate 5 working days
treatment plan
2hrs
Lupus anticoagulant 3.5ml BLUE Trisodium citrate 5 working days
Factor assays 3.5ml BLUE Trisodium citrate 5 working days
treatment plan
2hrs
Cell markers
4 ml LAVENDER EDTA
7 days
This test requires a separate container
verbal result for
urgent samples
2hrs
Bone Marrow
Trephine and aspirate
4 ml LAVENDER EDTA 10 working days
Human Leukocyte Antigen (HLA)
4 ml LAVENDER EDTA
10 working days
This test requires a separate container
CD4 4 ml LAVENDER EDTA 5 working days
Thalassaemia screen
4 ml LAVENDER EDTA
This test requires a separate container
3 working days
Sickle screen 4 ml LAVENDER EDTA Routine 3 working
days
Urgent 2 hours
Confirmation of abnormal Hb /
thalassaemia
P2010A gene
HFE gene
JAK mutation
4 ml LAVENDER EDTA
This test requires a separate container
4 ml LAVENDER EDTA
This test requires a separate container
4 ml LAVENDER EDTA
This test requires a separate container
4 ml LAVENDER EDTA
This test requires a separate container
4 weeks
90% of all
samples within 2
weeks
90% of all
samples within 2
weeks
90% of all
samples within 2

Test / investigation Container and comments Turnaround
Times
weeks
9:22 screen 4 ml LAVENDER EDTA
This test requires a separate container
90% of all
samples within 4
weeks
BCR-Abl
FVLeiden
4 ml LAVENDER EDTA
This test requires a separate container
4 ml LAVENDER EDTA
This test requires a separate container
90% of all
samples within 4
weeks
90% of all
samples within 2
weeks
B12 4 ml LAVENDER EDTA 4 hrs
Folate 4 ml OCHRE 4 hrs
Ferriritn 4 ml OCHRE 4 hrs
Haptoglobins 4 ml OCHRE 4 hrs
Erythropoeitin
Anti Xa
4 ml OCHRE
This test requires a separate container
3.5ml BLUE Trisodium citrate
This test requires a separate container
7 working days
5 working days
HIT screen
3.5ml BLUE Trisodium citrate
This test requires a separate container
5 working days
G6PD 4 ml LAVENDER EDTA 4 working days
Group and save 6ml PINK EDTA Routine 4 hrs
Urgent 1hr
Direct Coombs test 6ml PINK EDTA 4 hours
Group and Coombs test Cord blood – 6ml PINK EDTA Routine 4 hrs

Test / investigation Container and comments Turnaround
Times
Capillary sample – 1.3ml EDTA
Urgent 1hr
Kleihaur 4 ml LAVENDER EDTA 48 hrs
Transfusion reaction investigation
Haem-oncology Cytogenetics
HLA B27
6ml PINK EDTA
4 ml LAVENDER EDTA
Urine sample
Bone marrow transport media
available from laboratory
4 ml LAVENDER EDTA
This test requires a separate container
4 hours
Routine 3 weeks
Urgent 10 days
90% of all
samples within 2
weeks
Specimens should be transported and processed as soon as possible.

12. Key factors which affect the performance and or result
of a haematology Test
The technical competency, bias and experience of the staff performing the
test.
The patient sample, how it is taken, stored and transported to the laboratory
Delayed sample delivery to the laboratory
Clotted or partially clotted sample for a test which requires whole blood or
plasma
Sample collected into an incorrect container
Dilution of the sample if the sample is taken from a drip arm
Expelling the sample through a needle into the sample container or over
vigorous mixing resulting in haemolysis
Sample taken after a fatty meal or from a patient receiving intra-lipid resulting
in a lipaemic sample

13 HAEMATOLOGY REFERENCE RANGES
TEST
FBC
Adult
Reference
Range
Units
Remarks
WCC 3.5 – 11.0 x 10 9 /L Male/Female
RCC 4.25 – 5.55
3.80 – 4.85
Haemoglobin 13.0 – 16.6
11.2 – 14.8
RDW 11.7 – 13.7
11.4 – 14.6
Haematocrit 0.385 – 0.490
0.340 – 0.450
MCV 80 – 100
80 – 100
MCH 28.1 – 32.1
26.2 – 33.8
MCHC 32.2 – 35.4
31.3 – 34.9
x 10 12 /L
g/dl
ratio
fl
pg
g/dl
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
# Neutrophil 1.8 – 8.0 x 10 9 /L Male/Female
# Lymphocyte 0.6 – 4.4 x 10 9 /L Male/Female
# Monoytes 0 – 0.9 x 10 9 /L Male/Female
# Eosinophils 0 – 0.6 x 10 9 /L Male/Female
0 – 0.6
# Basophils 0 – 0.4 x 10 9 /L Male/Female
Platelets 150 – 400 x 10 9 /L Male/Female

TEST
Adult
Reference
Range
ESR 1 – 15
1 – 20
Units
mm/h
Plasma Viscosity 1.50 – 1.72 mPas
Reticulocytes 0.2 – 2.0%
Remarks
Male
Female
Note - Increases with age
Blood Film
(associated with
FBC)
Interpretative cytology report.
Relevant clinical data must be
provided when requested.
Paul Bunnell N/A Screening test for Glandular
Fever
Malarial Parasites N/A Laboratory must be contacted,
area of travel, prophylaxis and
symptoms must be provided.

Paediatric haematology reference ranges
Source: Alder Hey Children’s Hospital
Neonate:
Parameter Units 1 Day 3 Days 2 Weeks 1 Month 2 Months
WCC x 10 9 /L 9.0 – 18.4 9.0 – 18.4 5.0 – 18.0 5.0 – 18.0 5.0 – 18.0
RCC x 10 12 /L 3.80 – 6.50 3.80 – 6.50 3.2 – 6.4 2.80 – 5.30 2.60 – 4.30
Hb g/dl 14.0 – 22.0 14.0 – 22.0 12.5 – 20.5 10.0 – 17.0 9.0 – 13.5
Hct Ratio 0.450 – 0.670 0.450 – 0.670 0.39 – 0.63 0.310 – 0.550 0.280 – 0.420
MCV Fl 98 – 130 94 – 130 86 – 120 85 – 120 77 – 115
MCH Pg 31.0 – 39.0 30.0 – 37.0 28.0 – 37.0 27.0 – 36.0 26.0 – 34.0
MCHC g/dl 30.0 – 36.0 30.0 – 36.0 28.0 – 36.5 29.0 – 36.5 29.0 – 36.5
Neutrophil x 10 9 /L 4.8 – 17.2 2.0 – 9.4 1.7 – 6.0 1.0 – 9.0 1.0 – 9.0
Lymphocyte x 10 9 /L 2.0 – 7.3 2.0 – 7.3 2.8 – 9.1 3.0 – 13.5 3.0 – 13.5
Monocyte x 10 9 /L 0.1 – 1.9 0.1 – 1.9 0.1 – 1.7 0.1 – 1.7 0.1 – 1.7
Eosinophil x 10 9 /L 0 – 0.9 0 – 0.8 0 – 0.8 0 – 0.8 0 – 0.8
Basophil x 10 9 /L 0 – 0.2 0 – 0.2 0 – 0.2 0 – 0.2 0 – 0.2
Platelets x 10 9 /L 150 – 400 150 – 400 150 - 400 150 – 400 150 – 400

Paediatric haematology reference ranges
Source: Alder Hey Children’s Hospital
Child:
Parameter Units 6 Months 1 Year 2 Years 2 – 7 Years 8 – 14 Years
WCC x 10 9 /L 5.0 – 17.0 5.0 – 17.0 5.0 – 17.0 6.3 – 16.2 4.9 – 13.7
RCC x 10 12 /L 3.6 – 5.0 4.3 – 5.3 4.0 – 5.0 4.00 – 5.00 4.00 – 5.20
Hb g/dl 10.0 – 14.3 10.0 – 14.1 10.0 – 14.8 10.0 – 14.8 11.5 – 15.8
Hct Ratio 0.300 – 0.430 0.300 – 0.410 0.310 – 0.430 0.310 – 0.430 0.34 – 0.470
MCV Fl 72 – 95 73 – 92 73 – 90 74 – 88 76 – 92
MCH Pg 25.0 – 33.0 24.0 – 32.0 23.0 – 32.0 25.0 – 32.0 25.0 – 33.0
MCHC g/dl 30.0 – 36.0 30.0 – 36.0 30.0 – 36.0 31.0 – 36.0 31.0 – 36.0
Neutrophil x 10 9 /L 1.0 – 8.5 1.5 – 8.5 1.5 – 8.5 1.6 – 9.0 1.4 – 7.5
Lymphocyte x 10 9 /L 4.0 – 13.5 4.0 – 10.5 3.0 – 9.5 2.2 – 9.8 1.9 – 7.6
Monocyte x 10 9 /L 0.1 – 1.3 0.1 – 1.3 0.1 – 1.3 0.1 – 1.3 0.1 – 1.3
Eosinophil x 10 9 /L 0 – 0.8 0 – 0.8 0 – 0.8 0 – 0.8 0 – 0.75
Basophil x 10 9 /L 0 – 0.2 0 – 0.2 0 – 0.2 0 – 0.2 0 – 0.2
Platelets x 10 9 /L 150 - 400 150 – 400 150 – 400 150 – 400 150 – 400

Coagulation
Test Adult Reference Range Remarks
INR 0.9 – 1.2
APTT
Fibrinogen
Clotting Screen
23 – 39 secs
1.5 – 4.5 g/L
Comprises: INR, APTT and fibrinogen
D-Dimer < 200 ng/ml Performed for query DVT and PE
only
Protein C 70 – 150% Affected by oral anticoagulant,
pregnancy and current thrombotic
events
Protein S 60 – 140% Affected by oral anticoagulant,
pregnancy and current thrombotic
events
Antithrombin III 85 – 120% Invalid for heparin treatment
Von Willebrand
screen
Lupus
Anticoagulant
Thrombophilia
Screen
Factor II 60 – 160%
Factor V 70 – 150%
Factor VII 60 – 160%
Factor VIII 50 – 150%
Factor VIII Rag 50 – 200%
Factor IX 55 – 150%
Factor X 60 – 120%
Factor XI 55 – 150%
Factor XII 56 – 140%
VIIIRICoF 50 – 150%
Serum B12
Serum Folate
Interpretative report.
0.9 – 1.2 Ratio Interpretative report.
223 – 1132 ng/L
2.8 – 18.6 ug/L
Interpretative report.

Test Adult Reference Range Remarks
Serum Ferritin 30 – 284 ug/L Male
“ 6 – 81 ug/L Female under 46 years
“ 14 – 186 ug/L Female over 45 years
Thalassaemia
Screen
Hb F 0 – 0.8%
Hb A2 1.9 – 3.4%
Haptoglobins
0.7 – 3.8 g/L
Interpretative report provided with
each request
Factor V Leiden
Prothrombin
20210A
HFE Genotyping
Interpretative report provided with
each request
Interpretative report provided with
each request
Interpretative report provided with
each request
JAK2 V617F
Interpretative report provided with
each request
CD4 0.75 – 2.28 x 10 9 /L Interpretative report provided with
each request
Cell marker
studies
Interpretative report provided with
each request

14 Haematology Referral Laboratories
NHS Blood and Transplant – Bristol, Liverpool, Sheffield, Manchester
Christies Hospital – Manchester
Liverpool School of Tropical Medicine
Royal Liverpool University Hospital Trust
Leeds General Infirmary
Hb Variant Reference Laboratory – Manchester

Appendix 1 Location of Laboratory
Laboratory Medicine
Haematology