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Part of the Biochemistry autoanalyser section


 


 Telephone Extensions

 Consultant Chemical Pathologist  Dr S. Ramachandran  Click to view photo  47246
 Consultant Clinical Scientist (Biochemistry)  Dr David Kennedy   Click to view photo  47254 
 Consultant Clinical Scientist (Immunology)  Mr Mike Smith  Click to view photo  43184
 Head Biomedical Scientist  Phil Hurley  Click to view photo  49247
 Medical Secretary  Katherine Taylor     Click to view photo  47246
 Laboratory  General enquiries    47317
 Laboratory  Customer Service Direct Line    0121-424 7317
 Laboratory  General enquires (GP's only)  47317 or 0121-424 7317 
 43235

 (Clinical queries)
 Customer Service Representative  Gerry Ranahan    47279

24 Hour Service

The Department operates a 24 hr service, 7 days a week. To ensure that immediate attention is given to emergency requests, doctors must phone the laboratory to ensure that staff are aware of the priority. It is the responsibility of the requesting doctor to ensure the sample is sent to the Department.

For out of hours clinical advice, please contact switchboard and ask for the Duty Consultant Biochemist on-call. Consultant advice for immunology is also available via switchboard.

Accreditation

The Laboratory has full accreditation with Clinical Pathology Accreditation Ltd (CPA). The last assessment was February 2007 and the department was assessed against CPA standards incorporating ISO 15189:2003.

 

Adverse Drug Reactions

Samples should be sent to the Biochemistry Department as soon as possible.
The protocol to be followed for patient's suspected of having suffered an adverse drug reaction is as follows:
Location of packs
"Adverse Reaction Packs" are available on Theatres and ITU or from Biochemistry.
Blood
1. First sample ideally within 1 hour of reaction;  5 ml EDTA blood.
2. Further blood sample 3 hours after reaction;  5 ml EDTA blood.
3. Further blood sample 24 hours after reaction;  5 ml EDTA blood.
Laboratory analysis
Blood :  plasma tryptase assays.
Clinical History
Full details of the reaction itself, all drugs administered, nature of the surgical procedure, and relevant PMH and full patient identification are essential and must accompany blood/urine samples
Help
Please telephone Biochemistry Department on 47254 if any help or advice is required.
Results
These will be sent to the requesting Clinician and an Anaesthetist where appropriate. 

 

Alcohol

Blood alcohol levels can be carried out on samples preserved with fluoride/oxalate which is the same sample as blood sugar estimations (grey top). If requesting glucose together with alcohol level, please send two grey top samples. A common marker for liver damage has been the liver enzyme -Glutamyl-transferase. However, a new biochemical marker of alcohol consumption is Carbohydrate-deficient Transferrin. For this test 5 ml of blood is required in a plain (red top) tube. Patients who have been drinking over 25 units of alcohol per week should give a positive result for this test. Full details available on request.

 

Authorisation of Reports

Reports are validated by Senior Laboratory Staff from the Birmingham Heartlands site and significantly abnormal or unusual results scrutinised by a Clinical Scientist. There are written procedures for the reporting of abnormal results. This service is provided by staff from all sites on a rota basis.

 

Blood Gas

Blood gas samples cannot be analysed in the laboratory. Instruments are sited in ITU, EAU, SCBU, Labour Ward and A&E. Training in the use of these instruments must be given by Biochemistry staff before these analysers are used. Please contact Biochemistry on ext 47317 or bleep 8418 to arrange training to use gas machine and obtain passwords.

Untrained and unauthorised staff must NOT use this equipment.
Please refer to the Trust's 'Point of Care Testing' guidelines available on the intranet under "M" for Medical Devices Management.

 

Breath Tests

The Laboratory routinely offers the following 'Breath Tests':
1. 13Carbon-Urea Test - see Helicobacter pylori investigation.
2. Hydrogen Breath Test.
Hydrogen Breath Tests :
Lactose Tolerance Test

Patients can present with a variety of GI symptoms due to absolute or relative lactase deficiency. Lactose is a ubiquitous part of the diet and therefore patients can still have symptoms even if they have eliminated milk from their diet. The test is safe, and takes approximately 2.5 hours to perform. The test is based on the principle that if the patient has appropriate amounts of lactase in the GI Tract then Lactose will be split into Glucose and Galactose and absorbed into the blood stream. However, if insufficient Lactase is present, bacterial action will metabolise the Lactose anaerobically to produce hydrogen. The hydrogen is taken in the blood stream to the lungs and expired. The levels of hydrogen measured are of the order of 1 to 50 parts per million. A simple sampling device is used to collect the breath hydrogen samples. This test is very well tolerated by patients.

Glucose Hydrogen Breath Test

Patient suspected of having bacterial overgrowth in the small intestine are tested by the measurement of breath hydrogen. Glucose is used as a fermentable substrate by pathologically high levels of small bowel bacteria. The hydrogen  released by the fermentation is rapidly absorbed and expired in the breath. An increase in breath hydrogen >12 parts per million above the fasting level is indicative of bacterial overgrowth. This takes approximately 3 hours to perform.

 

Clinical Enquiries

Daytime : Ext. 43235 or bleep 2506
A duty biochemist is available for enquiries about sample reports, interpretation of results, arranging follow-up tests, dynamic function tests, reference ranges and any problems with any aspect of the Biochemistry service.

Out-of-Hours
Please contact switchboard and ask for the Duty Consultant Biochemist on-call. Dr Ramachandran and Dr Kennedy can also be contacted via switchboard. Immunology advice is also available via switchboard.

 

Coronary Heart Disease (CHD) Risk Assessment

The Department of Biochemistry can now calculate the forthcoming Risk Score of a CHD event for any patient given the following information::

 

CHD Risk Request
Does NOT apply to patients with ischaemic heart disease, peripheral Vascular disease, genetic hyperlipidaemia or on lipid lowering drugs.
Age...........(30-74 yrs only)            Sex :  M     F
Systolic BP.................mmHg    Mean of last 2 readings
Smoker    :    YES       NO               No = Not for at least 12 months
Diabetes  :    YES       NO
LVH           :    YES       NO      Don't Know

 

If a blood sample is submitted to the laboratory, we would carry out the test for cholesterol and HDL and together this information can be used to calculate a 'risk score' of a CHD event over the next ten year period.
Special labels for request forms are available from the department (ext 47246).

 

Cytogenetics

Samples are sent directly to the Regional Cytogenetics Laboratory, Birmingham Womens Hospital.  Tel : 0121 627 2710. These requests are not processed by pathology at Good Hope Hospital. Please ensure that a cytogenetics request form is completed and sent with the samples. Please contact Biochemistry specimen reception for a Cytogenetic form.
Blood for Chromosome Analysis
5-10ml. in lithium heparin additive tubes. (Green Cap)
Blood for DNA testing
10-20ml. in EDTA additive tubes. (Purple Cap)
Amniotic Fluid
10-20ml in a sterile universal container. Transport packs are available from the Laboratory (Cytogenetics Laboratory, Birmingham Womens' Hospital)
Please pre-book samples with the Cytogenetics Laboratory
Skin and other Tissues
Place in sterile container with transport medium, sterile saline or PBS.
Do NOT place in formalin.
Chronic Villus
Place in a sterile container with CVS transport media which is available from the laboratory.
Please pre-book samples with the Cytogenetics Laboratory
Bone Marrow
Place in a sterile universal container with bone marrow transport media, containing heparin. Transport media is available from the laboratory.
Any samples that are to be kept overnight before delivery to the laboratory should be stored at 4 degrees centigrade.
If you have any queries regarding taking samples, using the correct container or transportation to the laboratory, do not hesitate to contact the Cytogenetics department at Birmingham Maternity Hospital on 0121 627 2710
Please use the Regional Cytogenetics Request Forms (blue form)
Sample collection protocols are available from the Cytogenetics Laboratory.

Please send heart, blood, skin or gonads to:
         The Regional Cytogenetics Laboratory
         Birmingham Womens Hospital
         Tel: 0121 627 2710  Fax: 0121-627-2618
A driver from Good Hope Hospital delivers daily to the above address and leaves Pathology Reception at 1.00pm.
Clinical advice and counselling is available from:
         Clinical Genetics
         Birmingham Women's Hospital
         Tel: 0121-627-2630

 

 

 

Function Tests

The following protocols for common function tests are available :
       Arginine & Clonidine Provocation Test for Growth Hormone Deficiency
       Creatinine Clearance
         Urea Breath test for investigation of Helicobacter pylori infection
       CRH Test
       Dexamethasone Suppression Test (low dose, High dose and overnight)
       Glucose Tolerance Test (for suspected diabetes or acromegaly)
       GnRH Test
       Mixed meal tolerance test
       Synacthen Stimulation Test (short).
       Water deprivation test
Biomedical Scientist performing thyroid function tests
All Function Tests are carried out in the Function Test Room in the Treatment Center (room B22) at a Friday morning clinic. 

Patients are sent a location map when arrangements are made for Function Tests

If a Protocol is required, or any information or advice about the tests, please contact Dr David Kennedy on ext 47254.

Guidance on Completion of Request Forms

Request forms must be completed LEGIBLY. Before sending a request, please check that the patient demographic label matches exactly with that on the form. Please provide:

1. Unique Patient Identification Number (Hospital Number or NHS Number for GP requests).

2. Patient's name - surname and forename(s) or anonymous coded identifier.

3. Patient's date of birth or age.

4. Patient's consultant or GP.

5. Location for report - ward, department or GP surgery.

6. Type of specimen, eg blood, urine, CSF etc.

7. Date and time of sample.

8. Investigation(s) requested.

9. Relevant clinical details - including any special information or precautions relevant to specimen handling including.

  • Significant diagnoses.
  • If patient is on relevant medications e.g thyroxine or carbamazole for TFTs, steroids for cortisol requests etc.
  • LMP when relevant.
  • Therapeutic drugs - time of last dose and dosage.
  • Relevant previous medical history.

10. Requesting doctor's name in block capitals/signature and Bleep No./Ext.

Also refer to Pathology sample and request form acceptance policy

 

 

Helicobacter pylori Investigation

Diagnosis
This test is for patients being investigated to either diagnose or confirm eradication of the H.pylori infection. The 13Carbon Urea test is safe as it uses a non-radioactive label, is well tolerated by patients, and the procedure can be completed within 30 minutes. Each patient is provided with a "Patient Information Leaflet" giving straight-forward information about the test, at the same time as the appointment letter is sent out. A copy of this leaflet is available, on request.

 

Point of care testing (POCT)/Near patient testing (NPT)

HbA1c analyser being prepared for a near patient testing session Any POCT/NPT equipment must be approved by the POCT committee. Please see trust POCT policy (on the trust intranet under "M" for medical devices management) or contact Dr David Kennedy (POCT committee chair) for any queries regarding POCT. The Laboratory provides support for the operation of POCT pathology testing facilities, applying guidance laid down by the Department of Health. Where appropriate, training to use the equipment can be provided (47317)
Trust Policy for POCT is available from Dr David Kennedy (Biochemistry Department) or via the trust intranet site.

 

Prostate Specific Antigen (PSA)

As a result of an extensive audit carried out with the co-operation of many General Practitioners and the Department of Urology, a protocol has been prepared for the investigation of patients presenting with symptoms of Prostatic Disease in General Practice. Interpretative comments and age related reference ranges have been provided after consultation with the consultant urologists.

Requesting Additional Tests

The following describes the procedures to be followed for adding tests on to samples already sent to the laboratory. 
The time limits for adding on the most common tests are shown below, any other tests should be referred to the Duty Clinical Scientist (Ext 43235)

Time Limits for Adding Tests (after collection)
Tests Max. Time after collection
U+E (with potassium) 2 hours
U+E (without potassium) 12 hours
Plasma Glucose (Grey Top Tube) 72 hours
Serum Glucose (Yellow/Red Top Tube) 2 hours
Serum PTH (Yellow/Red Top Tube) 4 hours
Plasma PTH (Purple Top Tube)  12 hours
Phosphate  12 hours
Bicarbonate  12 hours
AST/LDH/Iron  12 hours
Lipid profile (+ or – HDL)  72 hours
LFT  72 hours
All other tests  72 hours

 

Inpatients - All requests for add on tests on inpatients must be on the appropriate pink form. If this form is not available then the normal request form can be used and must state clearly that it is an add on test. If the form is not signed then the test will not be added on and the Clinician will be informed. If the test is required urgently, the requesting Clinician should phone the appropriate lab that performs the test. 

GP patients - Requests for additional tests from GP’s can be made by telephone. The lab staff taking the telephone call will note the name of the person making the request and the name of the requesting GP.

 

Sample requirements

See the sample requirements page for sample details on adult blood tests, paediatric blood tests, faecal tests, urine tests.
Also see the Pathology 'Sample Rejection Policy'.

 

Specialised Tests

The Laboratory makes appropriate use of Regional and Supra-Regional Laboratories for over 100 specialised investigations such as:
Aldosterone ACTH  Vitamin A Insulin   Gut Hormone Profile         Renin   Etc.
Please contact the Laboratory for any information about Specialised Tests, as there are usually special requirements for sample handling. Our Policy is to issue the actual report from the Specialist Laboratory. We also log all results returned on to our computer system, for future reference by users. There are very many different types of reporting stationery used by different laboratories and the attachment of our usual report form has proved useful in helping the report reach its appropriate place in the patient's notes.

If you wish to know the referral laboratory for a particular test please contact Biochemistry department.

Also see the Reference Laboratory referral page


Samples : Policy for Rejection

Samples will be rejected for analysis if:
1. The sample has been collected inappropriately.
2. The sample is grossly haemolysed.
3. The sample is grossly lipaemic.
4. The sample has leaked from the container and, therefore, does not conform with Health & Safety Regulations.
5. The sample is unlabelled or incorrectly labeled.
Our policy is to advise the requestor either by telephone, or by letter as soon as possible, and to follow this up with written confirmation. The Laboratory will do everything it can for the test to be satisfactorily completed.

Also refer to the Pathology sample and request form rejection policy

 

Storage of Records

Paper copies of laboratory test results are maintained for a minimum period of two years. Both Internal and External Quality Control data is held for a minimum period of two years. The department complies with the recommendations in the RCPath/IBMS guideline "The retention and storage of pathological records and archives (3rd edition 2005)".

 

Tests for investigation of spiked drink cases

Any request related to 'spiked drink' or 'drug facilitated sexual assault (DFSA)' are processed in a standardised way.

There is a list of drugs proposed by DFSA working group which are included in all DFSA cases requiring toxicological analysis of biological fluid.

These drugs/compounds have been proposed due to their potential effects and their previous detection in DFSA cases. The list is regularly updated to maintain the relevance of the drugs included.

These samples are analysed at the Regional Toxicology Laboratory, Brimingham.
Sample requirements
5ml blood (lithium heparin and/or fluoride/oxalate tube)
10 ml urine (plain universal)

Test Reporting Information : Urgent/Routine Tests

Urgent results should be available within 1 hour of receipt of the specimen.
Routine hospital results should be available within 4 hours of receipt of the specimen.
All other  results should be available within 24 hours of the receipt of the specimen.
 Tests available 24 hours a day -
 Sodium  Potassium  Urea  Creatinine
 Calcium  Magnesium  Lithium  Phosphate
 Chloride  Osmolality *  Glucose  Amylase
 Urate  Salicylate  Paracetamol  CRP
 B12  Albumin  Total Protein  Bilirubin (Total and Fractionated)
 ALP  ALT  AST  GGT
 Cholesterol  Triglyceride  Lactate Troponin T
 Digoxin  Phenytoin  Theophylline  Carbamazepine
 CSF Protein  CSF Glucose  TSH  FT4
 FT3  HCG*  Bile Acids*  
* Routine Osmolality results should be available by the next working day
*Only urgent HCG for the early detection of pregnancy are available 24 hours a day 
*Only urgent Bile Acids are available 24 hours a day

Tests Reported within one Working Day

For the following routine tests, results will normally be available by the next working day:-

 Ferritin  Osmolality  LH/FSH  Progesterone
 Prolactin  Cortisol  HbA1c  Testosterone
  Folate      

Tests Reported within one Week
For routine tests not listed in the above tables, results will normally be available within seven working days.

 

 

Thyroid Strategy

The laboratory protocol for thyroid function tests is available on request. Most recent versions of the lab request form have tick boxes for thyroid function tests to distinguish between treated and non-treated patients. Please put a tick in the appropriate box. FT4 and/or FT3 will only be measured if the TSH is abnormal or if clinical details state patient is on T3 (Liothyronine) or hypopituitarism is suspected.