NHS GENERAL Title: Clinical Chemistry laboratory handbook QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman Created Date: 12 th October 2018 Disposal date: 12 th October 2048 Page 1 of 65 NORTHUMBRIA HEALTHCARE FOUNDATION NHS TRUST Medical Laboratory No. 9585 Department of Clinical Chemistry CLINICAL CHEMISTRY LABORATORY HANDBOOK This SOP supersedes all previous versions REFERENCE & VERSION No. LH-CCH-GEN-G-001 Version 19 REPLACES DOCUMENT No. LH-CCH-GEN-G-001 Version 18 LOCATION OF COPIES 1. Q Pulse 2. Northumbria Healthcare NHS Trust Intranet 3. Northumbria Healthcare NHS Trust Internet Last Updated on behalf of Pathology Services: July 2018
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NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 1 of 65
NORTHUMBRIA HEALTHCARE FOUNDATION
NHS TRUST
Medical Laboratory No. 9585
Department of Clinical Chemistry
CLINICAL CHEMISTRY LABORATORY HANDBOOK
This SOP supersedes all previous versions
REFERENCE & VERSION No. LH-CCH-GEN-G-001 Version 19
REPLACES DOCUMENT No. LH-CCH-GEN-G-001 Version 18
LOCATION OF COPIES
1. Q Pulse
2. Northumbria Healthcare NHS Trust Intranet
3. Northumbria Healthcare NHS Trust Internet
Last Updated on behalf of Pathology Services: July 2018
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 2 of 65
Clinical Chemistry Department
Overview The Clinical Chemistry Department is part of the Pathology Service at Northumbria Healthcare NHS Foundation Trust. Analytical Laboratory services are provided at three Trust locations; The Northumbria Specialist emergency care Hospital, North Tyneside and Wansbeck Hospitals. The department also refers specialised tests by arrangement to relevant reference centres. Our aim is to provide an accessible and comprehensive diagnostic support service to both hospital and primary care clinicians. The Clinical Chemistry department is committed to providing a quality service and as such is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189 standards. This is the national accreditation body for the UK ensuring laboratories meet the required national standard for Medical laboratories necessary for quality and competence. The department was awarded UKAS accreditation on the 27th April 2018. As part of the on-going requirement to maintain compliance with ISO 15189 standards UKAS will undertake annual surveillance visits with a full inspection every 4 years. Not all tests in the laboratory repertoire fall under the scope of accreditation therefore it is recommended that the UKAS website is checked for an up to date list of all tests covered. https://www.ukas.com/wp-content/uploads/schedule_uploads/00007/9585%20Medical%20Multiple.pdf In addition to analytical services, the Department provides an electronic result reporting service to General Practices, in accordance with National Pathology Messaging Guidelines.
When the department or referral laboratory changes a test or procedures it may result in that test having to be taken out of scope until UKAS have undertaken an assessment of the test. (Although a test is out of scope, please be assured that the test has been verified to ISO15189 standards). In the event that this does occur the laboratory will highlight that the test is not currently within scope and therefore not accredited by indicating this on the report where possible or highlighted within this manual in the test repertoire section.
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 3 of 65
PROTECTION OF PERSONAL INFORMATION Northumbria health care Foundation Trust takes the security of personal information very seriously. Everyone working for the NHS has a legal duty to keep information about patients confidential. Patients’ health information is protected through a number of measures; all Trust staff are required to: a. Record patient information accurately and consistently b. Keep patient information private c. Keep patient information physically secure d. Disclose and use information with appropriate care Any breaches of security or incidents relating to Information Governance are investigated, actioned and reported via the Trust’s Governance Structure. In order to support our staff in ensuring personal information is kept securely the Trust have a number of policies which set out the requirements staff must fulfil when accessing or sharing personal information. Furthermore, all staff receive Information Governance Training which includes topics such as information security, confidentiality and data protection.
The Clinical Biochemistry department work to all Trust policies regarding the protection of personal information. These policies are available on the trust intranet under Data Governance and Information Governance. These policies can be viewed via the trusts intranet at the following link.
Compliments, Concerns and Complaints Clinical Chemistry aims to provide a high quality of service to patients and users. We realise that there may be times when we do not always get things right. On these occasions we welcome your feedback as this helps us to improve the services we provide. If you have any problems with any aspect of the Clinical Chemistry Services, please tell us by contacting a member of senior Pathology staff team (refer to contacts list on page 5 and 6). The trust has a Complaints Policy and Procedure for raising Concerns Policy (RMP14). Concerns and complaints can be raised verbally or in writing with the Pathology Quality manager, departmental manager or via the Patients Services/PALS. The department encourages users to raise any concerns to ensure the continued provsion of the highest quality service possible. We endeavour to resolve any issues raised as quickly as possible. The contact details for patient services and PALS is shown below;
Patient Advice & Liaison Service (PALS) Freepost RLTC-SCHH-EGXJ North of Tyne PALS The Old Stables Grey’s Yard Morpeth Northumberland NE61 1QD Tel: 0800 032 0202 Text: 01670 511 098 Email: [email protected]
Clinical Advice Dr Stewart Pattman, Dr Nigel Brown (Toxicology), Dr Roy Talbot and Elizabeth Robinson are available to provide advice on appropriate investigations and interpretation of results. Out of normal working hours the on call biochemist may be contacted via the hospital switchboard for advice over urgent matters. The quality of the service is continuously monitored by internal quality control procedures and participation in National External Quality Assessment Schemes for the range of analytes provided. In additional the department regularly participates in clinical audit.
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 5 of 65
*International Carriage of Dangerous Goods by Road (ADR)
Flow of responsibilities
Step 1. The requesting clinician ensures
The correct patient
At the correct time
Requesting the ap-propriate analysis
Documents the patients cir-cumstances appropriate to the
analysis e.g Fasting
Step 2. The phlebotomist, nurse or clinician collecting the specimen checks and ensures ( for example us-ing the patient wrist band double checked against the request form and specimen label)
The correct patient and correct time
The analysis
requested
The correct specimen
taken
Correct and complete labelling
Safe handling and
waste disposal
Step 3. The ward, theatre, department or surgery ensures
Safe handling & infection control
Secure and appropri-ate storage
Timely onward transfer by the most appro-priate means depending on urgency
Step 4. The person undertaking the logistics stage (Transport, Courier)
Reasonable scheduling for transit
Safe handling
Secure and appropriate carriage, to health and
safety regulations
Meeting ADR * regulations on transport
of dangerous goods 2009
Timely transfer to laboratory
Step 5. The laboratory checks and ensures
The correct patient
The correct Specimen received
The correct result / advice given
Step 6 . The responsible clinician checks and ensures
Receipt of the result /advice
The correct patient
The correct therapeutic action
The validity of the patient record
Correct result released / returned
to requestor
Patient consent
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 6 of 65
Useful Telephone numbers
Specimen reception:
Hexham 01434 655942 Internal ext 35942
Wansbeck 01670 529743 Internal ext 33743
North Tyneside 0191 293 2764 Internal ext 32764
The Northumbria 0191 607 2244 Internal ext 72244/ 72245/72246
(Including all GP enquires) The Northumbria 01916072237 Internal Ext 72237 /72238
SENIOR STAFF
Consultant Chemical Pathologist / Head of Department Dr. Stewart Pattman. BSc. MBChB (Edinburgh), MCRP, FRCPath Telephone NTGH 0191 2932546 (EXT 32376) Mobile 07785728264 [email protected]
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 8 of 65
LABORATORY OPENING HOURS
The Northumbria specialist emergency care Hospital The department is open 24/7 for the receipt and handling of specimens. North Tyneside Open for the receipt and handling of specimens from 08:30 to 18:00 for Inpatient and until 22:00 for GP work, Monday to Friday. During these periods we assay most of the routinely available tests every day. Outside these hours i.e. between 18:00 and 08:30, Monday to Friday and all day at weekends Point of care equipment is available for the analysis of tests that are deemed too urgent to transfer to the Northumbria site for processing. Wansbeck The laboratory is open for receipt of samples between the hours of 08:30 and 18:00 Monday to Friday for receipt and processing work. Outside these of hours i.e. between 18:00 and 08:30, Monday to Friday and, all day at weekends Point of care equipment is available for the analysis of tests that are deemed too urgent to transfer to the Northumbria site for processing. Hexham The laboratory is open for receipt of samples between the hours of 08:30 and 17:00 Monday to Friday. A range of urgent requests are available via point of care equipment on this site, otherwise samples are transferred off site for analysis.
REQUEST FORMS AND SPECIMEN CONTAINERS Wherever possible we would ask that you give full clinical and drug therapy details – this helps us process your request accurately and efficiently as well as allowing us to add additional tests to facilitate patient management .The information helps us to deal with abnormal results which may need urgent transmission e.g. out-of-hours. Full information is given on the specimen requirements for the common Biochemistry assays on the Vacutainer Tube Guide distributed to each ward and practice. The Sunquest ICE ordering system is in use with in Northumbria Trust. This system will provide information on specimen tubes required based on the tests requested, on the generated request form.
BLOOD AND BODY FLUID SPILLAGES PROCEDURE Staff dealing with spillages must have received training in this procedure and must protect themselves by wearing gloves and a plastic apron. The effective management of blood and body fluid spillage is a crucial factor in the successful control of infection. Exposure to any such fluid presents a risk to the health of all persons involved. However, these risks are easily minimised by following the principles of standard precautions, in addition to maintaining a routine approach to simple cleaning and
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 9 of 65
disinfection procedures. It is of course essential that all blood and body fluid spillages are cleaned and disinfected as soon as is practicable. Refer to the procedures in your location for dealing with spillages and breakages or seek advice from a senior member of staff in your area. If necessary contact the Laboratory for advice on any aspect of dealing with spillages and breakages of pathology specimens. The Clinical Chemistry department uses the Clinell spill wipes for dealing with spillages of blood and body fluids. For directions on use see the reverse of the packet.
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.
Specimen Ordering on ICE/Electronic Requesting Guidance for Use There are comprehensive manuals built into ICE, available to all users.
Contact Names for ICE For pathology Trust wide: Please email [email protected] or phone the Application Management | Computer Services Tel: 0191 203 1327 Or Contact Computer services help desk on ext 31311
REPORT TURNAROUND TIME The majority of the commonly requested non-urgent tests will have results available within 4 hours. See individual test details for further information.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 10 of 65
ADD ON TESTS Additional tests on blood samples will only be performed on receipt of an add-on test request form which can be created using the ‘Biochemistry Add On’ test option in ICE. The request form can then be sent to the department. Retrieval of samples already in the laboratory to add on additional requests may take some time, particularly if the sample is still being processed for the tests originally requested. They can therefore not be processed as urgent tests. If the further tests are urgent, please send a new request. Samples are stored for 5 to 7 days after analysis. The decision to perform add on tests will depend on the delay in receiving the request and the stability of the analyte concerned. You will be advised if the sample is too old or unsuitable for the test you are requesting. If there is insufficient sample remaining for your additional request, this will be reported in the same way that a result would be (by paper report and electronically) – the person taking your call will not know at the time that there is insufficient sample.
URGENT AND PLEASE PHONE RESULTS URGENT requests MUST be accompanied by a telephoned request from the clinician indicating the degree of urgency and the form marked as Urgent, unless there are agreed alternative arrangements in place e.g. Red Pouches in A/E
Assays available under the Urgent System are: Blood Alcohol Ammonia Amylase Blood Gases and Carboxy Hb BHCG Calcium/Albumin Carbamazepine Creatine Kinase Digoxin Glucose Lactate Lithium Liver function tests Magnesium Osmolality Paracetamol Salicylate Theophylline Troponin T Urate U/E, Bicarbonate and Chloride
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 11 of 65
CSF Glucose Protein Xanthochromia (Spectophotometry) Lactate
Urine Albumin/Creatinine ratio Osmolality Porphyrin screen Protein/Creatinine ratio (pregnancy) U/E
Test profiles
1. U & E A routine U&E consists of Na, K, Urea and Creatinine. Chloride and Bicarbonate are added to urgent requests or if specifically requested. 2. Liver Function Tests. This routinely consists of Bilirubin, Alkaline Phosphatase, ALT, Total Protein, Albumin and calculated Globulins. AST and GGT are available on request. Conjugated bilirubin is available if specifically requested but will only be done if the total bilirubin is raised. An abnormal globulin level together with appropriate clinical details may in addition be subjected to a paraprotein screen if not previously done. 3. Thyroid Function Tests. A cascade system is used where TSH is measured initially. If raised then Free Thyroxine (fT4) is also measured. If the TSH is low then fT4 and fT3 are also measured. If hypopituitarism is suspected than fT4 should be specifically requested. Please indicate on the request form if the patient is on thyroid replacement, on therapy for hyperthyroidism or has been treated for thyroid cancer.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 12 of 65
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
Inappropriate collection site
Sample taken from drip arm
Increased drip analyte e.g. K , Glucose, albumin and total protein Dilution effect low results
Prior use of Ametop anal-gesic gel
Increased Na.
Incorrect container or anticoagulant
No fluoride oxalate
Decreased glucose
NA+ Fluoride / K+ Oxalate contamination
Increased NA and K. Decreased CA and en-zymes including LDH , ALP and Amylase.
K+ E.D.T.A. contamination Decreased Ca and Alk P Increased K
Li sample collected into Li Heparin
Increased Li
Sodium citrate contamina-tion
Increased serum sodium and normal osmolality
Incorrect tube fill/mixing ALL analytes may be compromised
Delay in separation of serum/plasma
overnight storage delay in transit
Increased K, PO4, LDH Decreased bicarbonate
Labile analytes Not immediately separated and frozen
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
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 13 of 65
Specimen and request form minimum requirements. Samples should be sent to the laboratory fully labelled in a safe manner. Samples should be in a separate transport bag with the completed request form attached. Samples can only be accepted for routine processing if there is no leakage, correct labelling, accompanying request form and appropriate container used. Rejection of samples will depend on: - Ability to obtain a repeat sample e.g. Lumbar puncture for CSF analysis. The health risk to staff Ability to correctly identify the patient To ensure samples and form can be uniquely linked to a patient and historical data, the minimum labelling for the form and sample is as follows: -
Specimen Labelling Requirements To comply with Trust Policies and the Safer Practice Notice NPSA/2009/SPN002, the NHS number must be given on all correspondence etc.
All specimens must be labelled with; First Name and Surname Date of birth NHS or Trust number and should have the following included Date and time of specimen taken Location
All request forms must give; NHS number Full patient name Trust Number (for hospital patients only) Date of birth and include with the following information Location of request Identity of the person collecting the primary sample. Date and time of specimen taken Requesting Doctor/Practitioner and Consultant/GP All appropriate Clinical Information relevant to tests requested
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 14 of 65
To assist with handling of abnormal results out of hours, all GP request forms should give the patient’s address and a contact telephone number.
If the NHS number is not available, the reason should be written on the request form and specimens will be analysed as usual if otherwise compliant with above policy. If the patient identification details need to be handwritten, then allowance will be made for the difficulties of writing the details on a specimen, but those on the request form must be clear and legible.
Otherwise, unlabelled or inadequately labelled specimens will not be processed except in exceptional circumstances after discussion with the appropriate Consultant Pathologist. All requests/specimens failing the above criteria will be subject to IR1 reporting.
If you require any further advice please contact either Dr Stewart Pattman, Consultant Chemical Pathologist (0191 2932546 or ext 32376)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 15 of 65
TELEPHONING OF RESULTS
The results telephoned are shown in table 1. The values used are based on guidance from the Royal College of Pathologists.
Table 1 Northumbria Healthcare Clinical Chemistry
Lab telephone criteria
Analyte Lower limit Upper limit Comments
Sodium <125 >155 * unless consistent with previously reported results
Potassium <3.0 >5.5
Urea >30
* unless consistent with previously reported results
Creatinine >200 * unless consistent with previously reported results
CO2 <12
Amylase >300
Calcium <1.8 >2.8
Phosphate <0.5
Urate >700*
Glucose <3.0 >25
Magnesium <0.5 >2.0
Lactate >3.9
Ketone >3.0
CK >1000
Carbamazepine >15
Digoxin >2.5
Lithium >1.0
Phenobarbitone >50
Phenytoin >20
Theophylline >25
Valproate >150
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 16 of 65
Triglyceride >20
AST or ALT >600
CRP >200 GPs only
Troponin >14 GPs only
Paracetamol All detected
Salicylate All detected
CSF Xanthachro-mia
All detected
Bile Acid >14
*only in patients not know to have gout
Telephoned Results *somewhat wider limits are applied to some analytes for
results of GP samples analysed outside surgery hours, where it will be necessary to contact the GP deputising service. Abnormal results will be telephoned to the GP surgery the next morning. (Refer to table 2)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 17 of 65
Table 2 Northumbria Healthcare Clinical Chemistry
Critical list for telephoning to GPs out of hours
Analyte Lower limit Upper Limit
Sodium <120 >155*
Potassium <2.5 >6.0
Urea >30* (>10 if <16yrs)
Creatinine >300* (>200 if <16 yrs)
Calcium <1.8 >3.5
Urate 700*
Glucose <2.5 >25
Magnesium <0.4
Ketone >3.0
Phosphate <0.3
Carbamazepine >25
Digoxin >2.5
Theophylline >25
Phenytoin >25
Lithium >1.0
Phenobarb >70
AST or ALT >600
Valproate >150
CK >5000
Amylase >300
Troponin T >14
* unless consistent with previously reported results.
All results where paracetamol, salicylate or CSF xanthachromia are detected are also telephoned.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 18 of 65
Tumour Markers – indications for measurement Marker Organ General
Screening Diagnosis Prognostic
Indicator Monitoring Treatment Other causes of raised levels
No No Yes Yes Chronic liver disease, Inflammatory bowel disease, other malignancies
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 19 of 65
Toxicology and Drugs of Abuse service Northumbria Healthcare has a specialist toxicology section which is able to provide a wide range of analyses. Drugs of abuse. Screening is provided on a routine basis and is available on random urine in a white capped universal. The classes of drugs included in the routine screen are Amphetamines, Benzodiazepines, Cannabinoids, Cocaine, EDDP (Methadone metabolite), and Opiates. Individual samples required for clinical purposes should be submitted to the lab as for any other request. If you wish to use the service on a regular basis from outside Northumbria Trust (e.g. as part of a Drug Action Team initiative or for occupational purposes) please contact Nigel Brown at Wansbeck Hospital 01670 592714 (ext 33714) to discuss. Turnaround times are generally within 48 hours.
Suspected poisoning. Toxicological investigations are available for a range of possible compounds which may have been ingested deliberately or accidentally. In the case of ethylene glycol or methanol a blood sample should be collected into a fluoride oxalate tube (as for blood glucose) and contact the lab to discuss. Where the potential substance is uncertain (e.g drink spiking) a random urine (in a white capped universal) collected at presentation is the best initial sample although a blood sample collected at the same time may also be helpful. If presentation is more than 18 hours after the alleged spiking incident, contact Nigel Brown (Wansbeck ext 33714) as soon as possible to discuss sample requirements. Investigations out of hours are only available after discussion; contact the On Call Consultant Clinical Chemist via the switchboard. The toxicology section also undertakes investigations in cases referred to the Coroner but these will be arranged by the Coroners Officer or by the Police.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 20 of 65
Alphabetic listing of Clinical Chemistry Tests Listed below are tests done in clinical chemistry or sent away to other clinical chemistry laboratories.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Return to Clinical Chemistry Index
*Where the assay laboratory is indicated as other than Northumbria, queries about sample collection, results, interpretation or any other
issues should be via the Northumbria Trust laboratories and not direct to the referral lab.
**Target turnaround times given are for routine samples and for time from receipt in lab to completion of technical validation. For tests
done within Northumbria Trust the time to results may often be shorter. If a faster turnaround time is required for a particular patient, please contact the Northumbria lab by telephone. The target turnaround time for emergency analyses is 1 hour.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 21 of 65
Test Specimen (see be-
low)
Assay La-
boratory*
Target Turna-
round time** Notes
A
Acetyl choline receptor an-tibodies
Immunology, Birmingham
1 to 2 weeks
Acylcarnitine Guthrie or EDTA pas-
ma Newcastle 1 to 2 weeks Guthrie dried blood spot preferred.
Adrenocorticotrophic
hormone (ACTH)
EDTA Newcastle 1 to 2 weeks Transport to lab on ice immediately
Adenosine deaminase 1ml Pleural Fluid London 1 to 2 weeks All queries or requests must be brought to the attention of the Duty Biochemist Freeze or send immediately
Antidiuretic Hormone
(arginine – vasopressin)
(ADH)
Note that this test is no longer performed as of 2016 and Copeptin is used as an alternative. Please contact duty biochemist to discuss if required.
AKI (acute kidney alerts) These are automatically reported on U+E samples where the creatinine change compared to previous values triggers either a stage 1,2 or 3 comment to be added to the U+E result.
Alanine Aminotransferase
(ALT) SST Northumbria 4 hours Part of LFT profile
Albumin SST Northumbria 4 hours Part of LFT and Bone profiles
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 22 of 65
Albumin/Creatinine Ratio ACR (Urine)
EMU or random urine (white cap universal)
Northumbria 12 hours EMU preferred
Alcohol (blood) Fluoride Oxalate or SST
Northumbria 4 hours
Alcohol (urine) Random Urine (white cap universal)
Northumbria 24 hours
Aldosterone EDTA Newcastle 1 to 2 weeks Transport to lab within 30 mins – not on ice if Renin also requested. If possible, withdraw agents that markedly affect ARR for at least 4 weeks (e.g. spiro-nolactone, amiloride, K-wasting diuretics).
Alkaline Phosphatase SST Northumbria 4 hours Part of LFT profile
Alkaline Phosphatase Iso-enzymes
SST Newcastle 2 to 3 weeks Only sent if Total Alk Phos is significantly raised relative to gamma GT. Smaller (<2x) rises in Alk Phosp may not permit accurate reporting of Iso-enzymes.
1-Anti Trypsin & Pi Typ-ing
SST Sheffield 1 to 2 weeks A1AT quantitation is performed initially and followed by Pi typing if appropriate
Alpha feto protein SST Northumbria 24 hours When used as a tumour marker (Maternal screening samples dealt with by Northern Genetics, Newcastle)
17-Alpha Hydroxyproges-terone
SST Newcastle 1 to 2 weeks
Aluminium Newcastle 3 to 4 weeks Contact lab for tube and collection kit
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 23 of 65
AMH (Anti Mullerian Hor-mone)
SST but Lithium Hep Newcastle
1- 2 Weeks Special Requirement: Sample must be separated within 24 hours of collection. If sample is not to be analysed/posted to lab immediately, store at -20°C prior to dis-patch. Patients should be under the care of an NHS fertility service
Amino Acids (urine or se-rum)
Random Urine (white capped universal) or
SST
Newcastle 2 to 3 weeks Urine or blood specimens must be sent to the lab without delay
Ammonia EDTA or Lithium Hep (adult)
Li Hep capillary (neo-nate or child)
Northumbria 4 hours Send on ice, phone lab. A second, unused, sample container should also be sent to the lab to act as a blank
Amylase (serum) SST Northumbria 4 hours
Amylase (urine) Random Urine (white capped universal)
Northumbria 12 hours Send serum sample as well
Androstenedione SST Newcastle 1 to 2 weeks
Angiotensin converting enzyme (ACE)
SST Newcastle 1 to 2 weeks
Apolipoprotein A1 and B Serum or EDTA plasma Newcastle 1-2 weeks
Apolipoprotein E genotyp-ing
EDTA Cardiff 4 weeks
Arsenic EDTA Urine (Random or 24hr)
Birmingham
1-2Weeks
Aspartate aminotransfer-ase (AST)
SST Northumbria 24 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 24 of 65
B
Bence Jones Protein EMU or Random Urine (white capped universal)
Northumbria 4 days EMU preferred
Beta-HCG SST Northumbria 12 hours For use as tumour marker and in specific pregnancy situations (e.g. ?ectopic preg-nancy) Not for use as general pregnancy test.
Bicarbonate SST Northumbria 4 hours Cannot be added to a sample which has already been analysed for other tests
Bile Acids SST Northumbria 24 hours Results will be telephoned within 1 working days if >14
Bilirubin SST Northumbria 4 hours Part of LFT Profile
Blood Gases Arterial blood in syringe Northumbria Immediately Send directly to lab (not in air tube). Avoid air bubbles. Remove needle
Calcitonin SST or Lithium Hep (See also Gut hormone entry)
Newcastle 1 to 2 weeks Send on ice to lab as soon as possible, phone lab
Calcium (total) SST Northumbria 4 hours
Calcium (ionised) Separate SST Northumbria 4 Hours Full tube
Carbamazepine SST Northumbria 24 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 25 of 65
Carboxyhaemoglobin Lithium heparin or Sie-mens Rapidlyte Blood Gas sample (Lithium Heparin)
Northumbria 12 hours In cases of suspected exposure, sample must be taken as soon as possible as breathing air or oxygen can quickly reduce COHb in circulation
Carcinoembryonic Antigen (CEA)
SST Northumbria 24 hours GI tumour marker
Carnitine EDTA or Guthrie card Newcastle 2 to 3 weeks
(Catecholamines ) No longer routinely avail-able
See Metadrenaline
Chloride SST Northumbria 4 hours
Cholesterol SST Northumbria 4 hours
Cholinesterase EDTA Bristol 2 to 3 weeks To check for suxamethonium apnoea
Chromium (Urine) Chromium (Blood)
Random urine EDTA (Trace elements 368381)
Newcastle
1 to 2 weeks If industrial screen, collect after last shift of week
Chromogranin A EDTA Belfast 2 to 3 weeks On ice, part of Gut Hormones
Cobalt (blood) EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
Complement (C3 and C4) SST Northumbria 48 hours
Copeptin SST Newcastle 4-6 weeks Copeptin values are of most benefit when taken under an osmotic stimulus.
Copper (Plasma EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
Copper (Urine) 24h Urine Newcastle 1 to 2 weeks
Cortisol SST Northumbria 24 hours
Cortisol (Urine) 24h Urine Newcastle 1 to 2 weeks
C-Peptide SST Newcastle 1 to 2 weeks On ice, contact lab
Creatine Kinase (CK) SST Northumbria 4 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 26 of 65
Creatinine SST Northumbria 4 hours Part of U/E Profile
C-Reactive Protein (CRP) SST Northumbria 4 hours
Cryoglobulins Plain @ 37oC
Northumbria 72 hours Contact lab for details of specimen collection Cryoglobulin testing is not covered by the current scope of UKAS accreditation.
CSF Glucose Fluoride Oxalate Northumbria 4 hours
CSF Lactate Fluoride Oxalate Northumbria 4 hours
CSF Protein Universal Northumbria 4 hours
CSF Bilirubin See Protocol Northumbria 8 hours Special collection protocol & kit available from lab
CSF Oligoclonal bands CSF Serum
Newcastle 1-2 weeks Send serum of approximately the same date.
Ciclosporin EDTA Newcastle 1 to 2 weeks Trough level preferred. Arrange in advance if weekend analysis required
Cystine (Urine) 24h Urine Newcastle 2 to 3 weeks Random urine acceptable in children
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 27 of 65
Fluid Tests (i.e TP, U/E etc) White capped Universal Northumbria 4 hours Indicate what type of fluid on request form. Discussion with Duty Biochemist may be required for some fluid tests. Fluid testing other than Blood, CSF and Urine are not covered by the current scope of UKAS accreditation
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 28 of 65
5HIAA (Urine) (5- hydroxyindole acetic acid)
Overnight or 24h urine Newcastle 1 to 2 weeks Obtain urine bottle containing preservative (sand & acid) from laboratory.
Intake of food with a high content of serotonin (avocados, bananas, plums, walnuts, pineapple, aubergine,
tomatoes/tomato products, kiwifruit, dates, grapefruit, nuts, cantaloupe/honeydew melon) within 48 hours of the urine collection could result in falsely elevated 5-HIAA excretion.Drugs that can increase 5-HIAA secretion include paracetamol, caffeine, diazepam (Valium), nicotine, some cough medicines (containing ephedrine or glyceryl guaiacolate, and phenobarbital. Drugs that can decrease 5-HIAA include aspirin, ethyl alcohol, imipramine, levodopa, MAO inhibitors, heparin, isoniazid, methyldopa, and tricyclic antidepressants.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 29 of 65
HMMA (urine) HVA
Random urine Newcastle 1 to 2 weeks Reference ranges exist for children up to 16 years. can be elevated in the presence of neuroblastoma Administration of L-dopa may falsely in-crease vanillylmandelic acid (VMA) results. Patients receiving L-dopa should stop taking it for 24 hours before and during the collection. All patients receiving L-dopa should be identified to the laboratory when VMA and homovanillic acid tests are ordered. Administration of L-dopa may falsely increase vanillylmandelic acid (VMA) results. Pa-tients receiving L-dopa should stop taking it for 24 hours before and during the collection. All patients receiving L-dopa should be identified to the laboratory when VMA and homovanillic acid tests are ordered.
I
Ionised calcium SST Northumbria 4 hours Full tube required.
Immunoglobulins G,A,M SST Northumbria 48 hours If not checked previously, will usually also have a paraprotein screen performed
IgE SST Northumbria 1 week
Insulin SST and Fluoride Oxa-late
Newcastle 2 to 3 weeks Transport Insulin sample to lab immediate-ly on ice. Send fluoride oxalate tube and request glucose at the same time Contact lab for sample collection protocol
Intermediary Metabolites PCA Newcastle 2 to 3 weeks Special tube and collection details available from laboratory
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 30 of 65
Iron SST Northumbria 4 hours Only requested without transferrin for iron overdose cases
L
Lactate Fluoride Oxalate Northumbria 4 hours Send to lab immediately
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 31 of 65
Metadrenalines (urine) Overnight or 24 hr urine Newcastle 1 to 2 weeks Obtain urine bottle containing preservative (sand & acid) from laboratory.
Many drugs are now known to increase catecholamine and metabolite concentrations, including tricyclic
antidepressant's, selective serotonin reuptake inhibitors, serotonin and nora-drenaline reuptake inhibitors, α- and β- adrenergic receptor blockers, calcium channel blockers, monoamine oxidase inhibitors, Levo(L)-Dopa, methyldopa and several stimulant/sympathomimetic drugs. Ideally patients should discontinue all medications that may affect plasma and urinary catecholamine or metanephrine concentrations prior to sampling. In practice, it is not always possible to discontinue medication before testing and it might be better to repeat testing only when initial tests are elevated.
Metanephrines (plasma) EDTA Newcastle 1 to 2 weeks Transport to lab immediately on ice. Only usually requested once urine screen has identified possible problem. See notes above under urine metadrenalines for details on potential drug interferences.
Mercury (Urine) Random or 24 hr urine Birmingham 1 to 2 weeks Sample of choice for chronic exposure to vapour or inorganic salts. Analysis of urine or blood has not proved useful in people concerned about dental amalgams
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 32 of 65
Mercury (Blood) EDTA or Lithium Hep Birmingham 1 to 2 weeks Sample of choice for exposure to organic mercury compounds or acute exposure to vapour or inorganic salts
Microalbumin See Albumin / creatinine ratio
N
NT-proBNP SST Northumbria 4 days
O
Oestradiol SST Northumbria 24 hours
Osmolality SST Northumbria 4 hours
Osmolality (urine) Random (white capped universal)
Northumbria 4 hours A fresh sample is best. A sample for serum osmolality should be sent to the lab at the same time
P
Paracetamol SST Northumbria 4 hours In overdose situations, sample 4 hours after ingestion
Paraprotein Screen SST Northumbria 3 days (See Bence Jones Protein for urine paraprotein screen)
Porphyrin Profile Blood, Urine and Faeces Cardiff 1 to 2 weeks For investigation of full spectrum of porphyrias. Wrap all samples in foil, black plastic or paper bag to protect from light
Porphyrin Screen (for acute porphyrias during possible attack only)
Random Urine Newcastle 7 days Send directly to lab. Protect from light
Potassium SST Northumbria 4 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 33 of 65
Progesterone SST Northumbria 24 hours
Prolactin SST Northumbria 24 hours Samples with raised levels will be checked for the presence of macroprolactin and this will delay the turnaround time
Prostate Specific Antigen (PSA)
SST Northumbria 24 hours
Protein/creatinine ratio (PCR)
EMU or random urine (white capped universal)
Northumbria 24 hours
R
Renin EDTA Newcastle 1 to 2 weeks Send to lab immediately (NOT on ice). Provide details as to current antihypertensive therapy. If possible, withdraw agents that markedly affect ARR for at least 4 weeks (e.g. spi-ronolactone, amiloride, K-wasting diuret-ics).
Rheumatoid Factor SST Northumbria 24 Hours
S
Salicylate SST Northumbria 4 hours
Selenium EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
SHBG SST Northumbria 24 Hours
Sodium SST Northumbria 4 hours
T
TSH (Thyroid Profile) SST Northumbria 12 hours Free T4 and FreeT3 will be added as cascade tests as appropriate
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 34 of 65
Tacrolimus (FK506)or Siro-limus
EDTA Newcastle 1 to 2 weeks
Testosterone SST Northumbria 24 hours
Theophylline SST Northumbria 24 hours
Troponin T SST Northumbria 2 hours Haemolysed samples are unsuitable for analysis.
Total protein SST Northumbria 4 hours Part of LFT profile
TPMT EDTA (needs to be full) Birmingham 1 to 2 weeks Used prior to azathioprine therapy
Contact lab for appropriate 24 hour collection bottle
Urinary c peptide. Urine 20ml Boric acid
Universal
Exeter Clin-ical Chem-istry lab
1 week Routinely requestable by Endocrinology specialists. Otherwise will require discussion with duty biochemist.
V
Valproate SST Northumbria 24 hours Monitoring not recommended in epilepsy therapy. Measurement may be useful in some cases of bipolar disorder.
Vitamin A and E SST, Lithium Hep or EDTA Rotherham 1 to 2 weeks Protect from light
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 35 of 65
Vitamins B1, B2 and B6 EDTA or Lithium Heparin Glasgow 1 to 2 weeks Samples must arrive in the lab during the morning, Monday to Wednesday to allow for sample processing and transport. Handled by Haematology
Vitamin C 5ml Lithium Heparin de-livered immediately to lab .Requires further storage
in preservative prior to dispatch.
Rotherham
1 to 2 weeks
Discuss with duty Biochemist. Requires advance notice of testing to obtain appropriate tubes with preservative.
Vitamin D SST Northumbria Daily Sample must arrive at lab on same day
Z
Zinc (Plasma) EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks Haemolysed samples are unsuitable
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 36 of 65
Specimen Types
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 37 of 65
Specimen Types EDTA K3 Purple topped vacutainer EDTA K2 (Trace metal) Royal Blue topped vacutainer Fluoride Oxalate Grey topped vacutainer Lithium Heparin Green topped vacutainer Plain Red topped vacutainer SST Gold topped vacutainer (Serum Separator tube)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 38 of 65
REFERRED TESTS
Address Accreditation Tests referred
Regional Regulatory Peptide La-boratory, 2nd Floor, Kelvin Building Royal Victoria Hospital Belfast BT12 6BA
CPA No. 1338
(at 03/07/18)
Calcitonin gene related peptide
Carcinoid Screen Blood
Chromogranin A
Gastrin,
Gastrin releasing peptide
Glucagon
Gut Hormones
Neurokinin A
Pancreastatin
Pancreatic Polypeptide
Dept of Clinical Biochemistry Queen Elizabeth Hospital Birmingham
Mindelson way West midlands Birmingham B15 2WB
UKAS No. 8910
(at 03/07/18)
Alpha Sub Unit
Clinical Chemistry Birmingham Children's Hospital Laboratory Medicine Block Children’s Hospital Whittall Street Birmingham B4 6NL
Cadmium Lamotrigine Blood Lead Blood Mercury Nickel Zinc Protoporphyrin Random Urine Arsenic Random Urine Cadmium Random Urine Copper Random Urine Cu/Chr/Ars Random Urine Mercury Random Urine Trace Elements 24h Urine Copper 24h Urine Cu/Chrom/Ars 24h Urine Mercury
(Purine Lab) Medical Biochemistry & Immunol-ogy University Hospital of Wales Heath Park Cardiff CF14 4XW www.cardiff-porphyria.org, e-mail [email protected]
UKAS No. 8989
(at 03/07/18)
Apo E Genotype Apo E Phenotyping Homocysteine (as CHD risk factor) Porphyrin Profile (Cardiff) Urine Porphyrine (Quant)
S Gamma Glutamyl transferase GT U/L 0 Up to 3m 0 - 200
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 50 of 65
3m - 6m 0 - 150
>6m M <70
F <45 >120 +/- 25
S Lactate Dehydrogen-ase LD U/L 0 < 270 >600
+/- 200
Routine Serum
P Glucose (fasting) GLU mmol/L 1 3.0 - 6.0 Non fast
<3.0 : > 10
S Osmolality OSM mmol/kg 0 275 - 295 05/07/2010
S Amylase AMY U/L 0 <100 <10 : > 300 +/- 50
S Troponin T TNTHS ng/L ≤14
TnTHS on paired sam-ples both ≤14or 1 sam-ple >12 hrs after chest pain is nega-tive An increase of 100% in TnThs (initial TnThs <30) between paired sam-ples is posi-tive An increase of
01/02/2011
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 51 of 65
<100% (initial TnThs <30) between paired sam-ples is equiv-ocal A TnThs >30 corresponds to a TnT>0.01ug/L and should be managed as previously
S Iron FE umol/L 0 Over 3y 9 - 28 <5 : > 40 +/- 5
S Transferrin TRFG g/L 1 >1m 2.0 -3.6 +/-10
S Transferrin Saturation TRFS
(PSAT) % 0 <16y 15 - 50 <15 : >50
M 16 - 55y 20 - 55 <15 : >60
F 16 - 55y 15 - 50 <15 : >55
All >55y 20-55 <15 : >60
S Cholesterol CHOL mmol/L 1
See local guidelines for interpretation +/- 1.0
S Triglycerides (fasting) TRIG mmol/L 1 <1.7
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v19 Author: D Dodds Authorised by: S Pattman
Created Date: 12th October 2018 Disposal date: 12
th October 2048 Page 52 of 65
S HDL Cholesterol HDL mmol/L 1 Male >1.0 +/-0.3
Female >1.2
S Total/HDL Cholesterol ratio 1
See local guidelines for interpretation
S LDL Cholesterol LDL mmol/L 1
See local guidelines for interpretation
S Urate URATE umol/L 0 Up to 1y 100 - 500 >500
> 1y M 200-430
>1y F 140-360 >700 +/- 30
S Creatine Kinase (To-tal) CK U/L 0 Up to 1m < 900