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Department of Clinical Biochemistry & Immunology North Glasgow

User Handbook

Document: CLIN003

Revision: 18

of 41 Last printed 30/06/2014 11:14:00

North Glasgow Clinical Biochemistry Service

Glasgow Royal Infirmary

Gartnavel General Hospital Western Infirmary Glasgow

Stobhill Hospital

http://www.nhsggc.org.uk

Approved by: Maurizio Panarelli

IN THE EVENT OF PROBLEMS OR UNFORESEEN EVENTS – CONTACT THE LEAD CLINICIAN


User Handbook

Document: CLIN003

Revision: 18

of 41 Last printed 30/06/2014 11:14:00

CONTENTS

GENERAL INFORMATION........................................................................................ 3 Point-of-care testing............................................................................................. 4

Blood gas analysers ....................................................................................................................... 4 Glucose meters .............................................................................................................................. 4

ESSENTIAL SITE-SPECIFIC INFORMATION........................................................... 5 GLASGOW ROYAL INFIRMARY (GRI)................................................................. 5

Emergency requests and out-of hours service x24487.................................................................. 6 WESTERN INFIRMARY (WIG) & GARTNAVEL GENERAL HOSPITAL (GGH) .. 7

Emergency requests and out-of hours service x52476.................................................................. 7 PRINCESS ROYAL MATERNITY HOSPITAL ....................................................... 9

Emergency requests and out-of hours service x24487.................................................................. 9 SPECIMEN COLLECTION AND HANDLING ...................................................... 10

1. REQUEST FORM & PATIENT IDENTITY.......................................................................... 10 2. SPECIMEN LABELLING .................................................................................................... 10 3. PATIENT PREPARATION.................................................................................................. 11 4. SPECIMEN COLLECTION ................................................................................................. 11 5. SAMPLE IDENTIFICATION ............................................................................................... 11 6. SPECIMEN PACKAGING .................................................................................................. 12 7. STORAGE PRIOR TO TRANSPORT TO LABORATORY ................................................ 12 8. SAFETY AND DANGEROUS SPECIMENS ...................................................................... 12 9. DISPOSAL OF PHLEBOTOMY EQUIPMENT ................................................................... 13 10. DEALING WITH SPILLAGES AND BREAKAGES ........................................................... 13 11. COLLECTION OF SPECIMENS FROM NEONATES........................................................ 13

DATA PROTECTION............................................................................................... 14 REFERENCE RANGES & TURNAROUND TIMES.................................................. 15

TURN AROUND TIME DEFINITION............................................................................................ 24 TUBE TYPES ............................................................................................................................... 24

Maternal third trimester: reference ranges for guidance ............................... 25 PREMATURE NEONATES .................................................................................. 26 HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS............. 28 HORMONES OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS .............. 30 HORMONES OF THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS ............ 31 OTHER HORMONES AND BONE MARKERS .................................................... 33 COMMONLY PERFORMED DYNAMIC TESTS .................................................. 33 TRACE ELEMENTS............................................................................................. 34 MICRONUTRIENT SCREEN................................................................................ 35 PORPHYRINS ...................................................................................................... 36 REQUEST INTERVENTION................................................................................. 37

REFERRAL LABORATORIES ................................................................................ 38 USEFUL TELEPHONE NUMBERS......................................................................... 40 THINGS TO DO TO KEEP THE SERVICE EFFICIENT .......................................... 41


User Handbook

Document: CLIN003

Revision: 18

of 41 Last printed 30/06/2014 11:14:00

GENERAL INFORMATION

The Clinical Biochemistry service is provided by the laboratories at the Glasgow Royal Infirmary, Gartnavel General Hospital and the Western Infirmary. There is a small satellite laboratory at Stobhill ACH, which handles emergency samples only. We provide an analytical and interpretative service. Please telephone us to discuss any problems or issues you may have. Our efficiency depends to a large extent on your cooperation. Your compliance with a few simple rules concerning safety, specimen identification and transport of specimens to the laboratory, all outlined in this handbook, will greatly help us deliver an efficient service.

Clinical advice

Phone the Duty Biochemist for advice on test range, procedures and interpretation. Contact the Duty Biochemist out with working hours through the hospital switchboard.

Results

Both authorised and non-authorised reports are available electronically. Results awaiting authorisation and comments are shown on the screen in high intensity to alert the clinician that they have not been authorised and do not have interpretative comments.

Telephone requests for results

Please note that we need to establish the caller’s identity before giving the results over the telephone. We cannot give results to patients or their relatives. We can only provide results to medical practitioners or their authorised deputies.

Add-On Requests to Existing Specimens

Requests for add-ons may be made up to 48 hours after receipt by emailing northglasgow.biochem@ggc,scot.nhs.uk

Please use a secure (nhs.net) email to request add-on tests. These will be processed as soon as is possible. Urgent processing of add-ons is not guaranteed. If an additional test is required urgently it may be necessary to send a fresh sample.

Website http://www.nhsggc.org.uk/biochemistry


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Point-of-care testing Blood gas analysers The Biochemistry Department provides full support for blood gas analysers in North Glasgow Hospitals.

Glucose meters A number of wards have their own glucose meters.

The Biochemistry Department provides:

• A full training and assessment programme

• A programme of quality control and maintenance to the wards

• Replacement meters

• Help and advice when problems arise

For further information contact the Duty Biochemist.

Research

Please contact the head of service to discuss biochemistry participation in research projects.


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ESSENTIAL SITE-SPECIFIC INFORMATION

GLASGOW ROYAL INFIRMARY (GRI)

EMERGENCY REQUESTS: EXT 24487

Address Department of Clinical Biochemistry, Macewen Building, Glasgow Royal Infirmary, GLASGOW G4 0SF

Fax 0141 552 3324

Contacts External Internal

Duty Biochemist .................................................0141 211 4003/4 ....24003/4 option 3

General Enquiries ..............................................0141 211 4003/4 .............. 24003/4

Duty Endocrine Biochemist ................................0141 211 4362 ................. 24362

Specimen Reception ..........................................0141 211 4047 ................. 24047

Lead Clinician.................................................... Dr Maurizio Panarelli ........ 20830

Consultant Clinical Scientist (Endocrinology) .... Dr Karen Smith ................. 24424

Consultant Clinical Biochemist………………… . Dr Janet Horner ................ 24631

Consultant Clinical Scientist (Core & STEMRL) Dr Dinesh Talwar………… 24490

Laboratory Manager ..........................................Mrs Christine Brownlie ....25534

Quality Manager ................................................Mrs Linda Mackinnon ....... 24339

Location of the laboratory and hours of work

The laboratory is in the Macewen Building, at Alexandra Parade (adjacent to Accident & Emergency Department). It provides routine service Monday – Friday between 9am and 5pm and on Saturday between 9am and 12pm. An emergency service operates at all times.

Reporting Office/interpretative advice

Call the Duty Biochemist on ext 24004 from any of the hospitals (211 4004 if telephoning from outside during working hours, and via the switchboard out-of hours).

Specimen transport

A pneumatic tube system serves the Accident & Emergency Department, the ITU, Ward 65, Theatres in the Queen Elizabeth Building, Theatre Suite, Oncology, and


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Jubilee Building, all floors of the Princess Royal Maternity Hospital, Wards 4-11 and Wards 28-33. The pneumatic tube system may be used for blood samples. The pneumatic tube system should not be used for:

� High risk samples e.g. TB, Anthrax, VHF � Sharps � Samples for Blood Gas Analysis � Pathology samples � Heavy material (>kg) � Large liquids >30ml such as urine or pleural washes � Leaking samples

Contamination results in tube shut down for all users until disinfection process is complete.

Otherwise samples are collected by porters. The ward collection times are as follows:

Weekdays (am) ........8.00am, 9.00am, 10.25am, 11.20am

Weekdays (pm) ........1.00pm, 2.20pm, 3.30pm

Saturdays and Public Holidays..8.00am, 9.00am, 10.30am

Sundays ....................................8.45am, 9.45am

The emergency blood porter must be paged to arrange transport of urgent specimens.

� For the main hospital page 1616 � For the Queen Elizabeth Building page 1509.

Emergency requests and out-of hours service x24487

The 24/7 emergency laboratory is at GRI, Macewen Building ground floor.

Results of tests requested as an emergency are normally available 60 minutes after the arrival of the specimen.

Note that all requests for emergency analysis must be arranged with the laboratory (x24487) to alert staff to the arrival of an urgent sample. Also, the request form must specify emergency request. Affix an emergency/urgent sticker to the request form – not the specimen bag. If this is not done the sample will be processed as routine and this may take longer.

Availability of results The results of all tests are available via ward or clinic terminals in real time (therefore phoning laboratory for results does not save time). Hard copy reports follow daily. The laboratory will telephone grossly abnormal results.


User Handbook

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WESTERN INFIRMARY (WIG) & GARTNAVEL GENERAL HOSPITAL (GGH) Address Department of Clinical Biochemistry Gartnavel General Hospital 1053 Great Western Road GLASGOW G12 0YN

Fax ............. 0141 211 3452

Contacts

Duty Biochemist ......................................................... 24003/4 option 3

General Enquiries ...................................................... 24003/4

Duty Endocrine Biochemist ........................................ 4362

Specimen Reception .................................................. 53347

WIG Laboratory.......................................................... 52476

Professor M H Dominiczak, Consultant Biochemist .. 52788; pager 07659132346

Lab Manager .............................................................. 52652

Location of laboratories and hours of work

The main laboratory is at GGH (in the Laboratory Block of the GGH Complex). This laboratory also provides an emergency service Mon-Fri between 8.45 am and 5 pm.

Emergency requests and out-of hours service x52476 The 24/7 emergency laboratory is at the WIG in the G Block, on the ground level.

Results of tests requested as an emergency are normally available 60 minutes after the arrival of the specimen.

Note that all requests for emergency analysis must be arranged with the laboratory (x52476 at WIG) to alert staff to the arrival of an urgent sample. Also, the request form must specify emergency request. If this is not done the sample will be processed as routine and this might take longer.

Reporting Office/ Interpretative Advice

Call the Duty Biochemist on x24003/4 from any of the hospitals (or 211 4003/4 if phoning from outside) or page through the hospital switchboard outside working hours.


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Transport of specimens within hospitals and between WIG and GGH

GGH has a pneumatic tube system which serves each floor of the main building, the outpatient clinics and the Brownlee Centre. The Beatson Oncology Centre has a dedicated pneumatic tube transport system.

These operate during normal working hours. They may be used for blood samples. The pneumatic tube system should not be used for:

• urine samples,

• samples which would be difficult to repeat (e.g. CSF),

• high risk samples

Outside normal working hours use the portering services.

Routine samples from the WIG are collected by the porters and transported to the GGH laboratory by van shuttle. This may take over two hours. Samples registered by the laboratory by 1400 hours are likely to be processed that day.

Availability of results The results of all tests are available via ward or clinic terminals in real time (therefore phoning laboratory for results does not save time). Hard copy reports follow daily. The laboratory will telephone grossly abnormal results.

Nutrition Team Contact Prof M H Dominiczak (x52788).

Specialist Toxicology The following assays are performed by Southern General Hospital

• Immunosuppressants • Antifungal drugs • Drugs of abuse • Methanol • Ethylene glycol

Results for the above are available at the Southern General Hospital by telephoning the Reporting Office on 0141 354 9060 or 89060 (Option 4).


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PRINCESS ROYAL MATERNITY HOSPITAL

Contacts Duty Biochemist .................................................24003/4 option 3

For Metabolic advice, contact Dr Peter Galloway, Consultant Clinical Biochemist (x89034 or on radiopage via switchboard at Southern General Hospital).

Emergency requests and out-of hours service x24487 The 24/7 emergency laboratory is at GRI, Macewen Building ground floor. Routine Service

All specimens except those for blood gases and metabolic analysis are sent to the Biochemistry Laboratory at GRI. Please refer to Pages 17-24 or telephone the Duty Biochemist (ext 24003/4 option 3) for advice about specialist sample handling e.g. anticoagulant, temperature etc.

Metabolic analysis When metabolic analysis including lactate and ammonia are required, please send the sample to the Royal Hospital for Sick Children (RHSC), Yorkhill, Glasgow. During working hours telephone Ext 80339 (option 1) and out-of-hours ask switchboard to Page the BMS. Between 1630 and 0900 hours the sample must be sent by taxi to the main Porter’s Desk at the entrance to RHSC. The package should be marked URGENT and addressed to:

Department of Biochemistry c/o Main Reception Royal Hospital for Sick Children Yorkhill GLASGOW G3 8SJ

Specimen transport to the laboratory There is a portering collection for specimens to the Department of Biochemistry. This starts at Level 6 of the Princess Royal Maternity Hospital and works down to cover the nurse’s stations of all wards and clinics. The collections start at 8.50am, 10am, 11am, 12-noon, 1pm, 2pm, 3pm and 4pm from Monday to Friday. Saturday collections start at 9am and 11am. On Sunday, page the Emergency Porter (Page 2206) to deliver specimens.

Pages 25-27 list the routine repertoire and these also give ranges for guidance. These are not and cannot be definitive reference ranges. This applies particularly to premature neonates (Pages 26 and 27).

Reporting Results of tests requested as an emergency are normally available from ward terminals 60 minutes after the arrival of the specimen.

Hard copy reports follow daily. The laboratory will telephone grossly abnormal results.


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SPECIMEN COLLECTION AND HANDLING

Sample containers of any type should be obtained through normal supply routes for consumables. The Biochemistry Department does not supply containers or packing materials except by special arrangement.

Specimens will not be sent to external laboratories on behalf of ward staff unless specifically arranged.

Please follow these simple rules to help us provide a service of quality to our patients.

1. REQUEST FORM & PATIENT IDENTITY

• Ensure the request form is completed correctly (Surname, Forename, DOB, CHI No, Hospital No., date & time of specimen collection & brief clinical details.

• The name and full address to which the report should be sent (Consultant, GP Surgery, Hospital Ward, Clinic etc) must be included on the request form.

• The laboratory will not process samples that do not have clear patient identification. Handwriting must be legible.

• Clinical information included on the form permits laboratory staff to assess the validity of results and may prevent unnecessary repeat analyses. Supporting information may be required for correct interpretation. For example, therapeutic drug monitoring requests require information about dosage, time since last dose, and a complete list of prescribed drugs.

• Confirm the identity of the patient prior to sampling.

2. SPECIMEN LABELLING

Normally, the minimum for adequate identification includes the patient’s forename and surname, plus date-of-birth, CHI number or hospital number.

• A pre-printed label is preferred: please affix it to both top and bottom copies of the form (if applicable).

• When emergency tests are required for unidentified patients the requesting clinician should indicate ‘unknown male/female’ in place of name and surname, and must indicate the exact time of sample withdrawal. The Casualty number, where available, is helpful.

• The laboratory cannot process specimens that are not clearly identified.


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3. PATIENT PREPARATION

• The patient should be resting for at least 5 minutes before withdrawal of blood.

• Venous blood samples should be taken with minimal stasis.

• Hyperventilation by the patient during arterial blood gas sampling may affect results.

• Many analyses require that the specimen be collected under specified conditions, e.g. fasting. In some cases, the requirements are quite stringent, e.g. for the measurement of plasma renin/aldosterone. In all cases, you should make sure that the appropriate requirements are met. If in doubt, please contact the Duty Biochemist.

4. SPECIMEN COLLECTION

• Ensure that the correct sample container is used for the requested tests.

• For venous blood use vacuum blood collection tubes.

• Collect fluid samples (ascitic, drain etc) into vacutainers – the laboratory can provide details of aspiration devices

• You must use an appropriate container for each test.

• If more than one tube is collected from a patient, the potassium EDTA tube should be filled last to avoid errors in potassium and calcium measurement.

• Anticoagulant tubes should be inverted several times to ensure adequate mixing.

• When taking arterial blood gas samples expel liquid heparin from arterial blood gas syringes. The heparin should fill only the dead-space of the syringe. Air bubbles should be expelled before the syringe is sealed.

• Some analyses require that the samples be collected into special containers and/or separated and deep-frozen within minutes of collection. Details of the appropriate collection containers for all samples - blood, urine, CSF, and faeces – can be found in this handbook.

• Where there is any doubt about sample preparation, storage, or transport please contact the Duty Biochemist.

5. SAMPLE IDENTIFICATION

The minimum for adequate identification includes the baby’s first name and surname, plus date of birth, hospital number or CHI number and, ideally, address. It is preferred that details are printed. Identification of the


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Ward/Clinic is essential for telephoning results. The laboratory will not process unlabelled specimens.

6. SPECIMEN PACKAGING

• In order to minimise the risk of interchange of samples and cross contamination a specimen bag can contain specimens from one patient only.

• Always ensure the sample container is securely capped.

7. STORAGE PRIOR TO TRANSPORT TO LABORATORY

• Do not expose the specimens to extremes of temperature prior to transport

• Samples should be transferred to the laboratory with minimal delay to maintain sample integrity. Delays in centrifugation can affect the values obtained for certain analyses (e.g. potassium).

8. SAFETY AND DANGEROUS SPECIMENS

• The Department cannot analyse, or accept for storage, disposal or onward transmission, any specimen from a patient suffering an illness associated with, or suspected of being caused by, a Category 4 pathogen.

• Please note that the laboratory will not process a leaking specimen or one that arrives with a needle attached.

• Potentially dangerous specimens must be labelled as such using a “Danger of Infection” sticker. Samples from patients with Category 3 pathogens, or suspected of having them, must be labelled with “Danger of Infection” stickers on the bag, form and sample tubes The specimen must be double bagged and the clinical details include suspected pathogen. The pneumatic tube system should not be used for such high risk samples.

• In practice, dangerous specimens are specimens that carry the risk of transmitting hepatitis B virus, HIV and other Category 3 pathogens.

• The Committee on Control of Infection should be contacted where there is any uncertainty. Such specimens include those from confirmed or suspected cases of the disease, known carriers (e.g. those known to be antibody or antigen positive), as well as patients from an at-risk group (e.g. IV drug abusers).

• ‘Danger of Infection’ stickers should be put on the bag, form and container, and the bag then sealed. For large specimens such as 24-hour urine


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specimens, specimen containers should be enclosed in individual clear plastic bags which must be tied at the neck.

• The request form should be placed in a plastic envelope which is then securely tied or taped to the neck of the sack. The request form should state the suspected/confirmed infection.

• Certain 24-hour urine collections require a container with acid – avoid direct contact with the acid.

9. DISPOSAL OF PHLEBOTOMY EQUIPMENT

Please refer to your local health and safety procedures for the safe disposal of all materials used during specimen collection

10. DEALING WITH SPILLAGES AND BREAKAGES

• Please refer to your local health and safety procedures for dealing with spillages and breakages.

11. COLLECTION OF SPECIMENS FROM NEONATES

• Specimens from the Neonatal Unit are mainly capillary specimens taken from heel stabs. Care should be taken to ensure that the specimen is taken from the outer aspect of the heel, that there is no contamination, that undue force is not exerted and that the blood is free-flowing and is collected quickly. The appropriate containers are given on Pages 26 and 27 Even with the best blood collection technique, samples may still show haemolysis and results cannot then be given for certain analytes, e.g. potassium, conjugated bilirubin.

• The volume of blood required for routine analyses (e.g., U&E, LFT, Bone, CRP, bilirubin, triglycerides) depends on the number of tests/test profiles being requested. In general we require 0.25 ml blood for 1 test(s)/test profile(s), 0.5ml for 2 and 0.75ml for 3 or more. However, this is dependent on the haematocrit and more blood will be required if the haematocrit is high. The blood volumes required for more specialised tests are given on Pages 27 & 28.

• Blood can be taken from an arterial line if the umbilical artery has been catheterised. It is important not to use a line which is used for infusion, since this can lead to contamination of specimens and to increased risk of infection.

• Blood gases are analysed by medical staff in the laboratory at the ward.


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DATA PROTECTION

The Data Protection Act 1998 is based upon eight enforceable principles of good practice:

1. Personal data shall be obtained and processed fairly and lawfully.

2. Personal data shall be held only for specified and lawful purposes and shall not be further processed in any manner incompatible with those purposes.

3. Personal data shall be adequate, relevant, and not excessive in the relation to the required purposes.

4. Personal data shall be accurate and, where necessary, kept up-to-date.

5. Personal data shall not be retained longer than is necessary.

6. An individual shall be entitled to have access to his or her data and where appropriate, have it corrected or erased.

7. Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of the data.

8. Personal data shall not be transferred outside EU countries unless an adequate level of data protection exists.

Organisations are obliged to comply with these principles. Failure to comply can result in an enforcement notice being issued by the Registrar.


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REFERENCE RANGES & TURNAROUND TIMES

Please contact the Duty Biochemist for more detailed information on reference ranges (e.g. sex- or age- related reference limits).

Analyte Type of sample

Container (volume, ml)

Reference range Comments Turnaround time

Adrenocorticotrophin (ACTH)

B Purple top* (1) < 20 mU/L *See page 28 for full sampling requirements.

7 days

Alanine aminotransferase (ALT) ++

B Yellow top (2) < 50 U/L Same day if rec’d before 12 mid-day.

Albumin ++ Albumin Albumin/creatinine ratio (ACR) Albumin excretion rate (AER)

B U U

Yellow top (2) EMU (20) EMU (5) 24 h Plain UC

35 to 50 g/L < 20mg/L < 2.5 mg/mmol < 3.5mg/mmol

< 20 µg/minute

Male Female

1 day Up to 4 days “ “ “ “ “

Aldosterone B Yellow top (1.5)

100 to 400 pmol/L 100 to 800 pmol/L

Adult (supine). Adult (upright). Age-related ranges are available – Please contact Duty Endocrine Biochemist

10 days

Alkaline phosphatase (Alk phos) ++ Alk phos isoenzymes

B B

Yellow top (2) Red top (2)

30 to 130 U/L Qualitative test

Results high in children and pregnancy, and raised in the elderly. Age and sex related ranges available. Only measured if ALP > 250 U/L.

Daily. Same day if rec’d before 12 mid-day. 14 days

α1-Antitrypsin B Yellow top (2) 1.1 to 2.1 g/L Phenotyping available by arrangement.

Same day if rec’d before 12 mid-day.

α-Fetoprotein (AFP) B Yellow top (2) < 6 kU/L As tumour marker only. Send pregnancy AFP to Medical Genetics, RHSC, Yorkhill.

1 day

Aluminium B U RO Water

Heparin* (5) Plain Universal Container (20) Plain Universal Container (20)

< 0.5 µmol/L <1.0 µmol/24 h

< 10 µg/L

10 days

Amikacin B Yellow top See prescribing protocols

Trough: pre-dose Peak: 1 hour post- dose

4 hours

Ammonia B Green top 20 to 44 µmol/L Spin ASAP. Send immediately on ice to Yorkhill Biochemistry Department.

Sent away

Amylase ++

“ Amylase/creatinine clearance ratio

B U U

Yellow top (2) Plain UC (10) Plain UC (10)

< 100 U/L 30 to 600 U/L 1 to 5%

Daily. Same day if rec’d before 12 mid-day.

Androstenedione

B Yellow top (1) -

See page 28 for sampling requirements.

7 days

Angiotensin converting enzyme (ACE)

B Yellow/red top (2) < 88 U/L Same day if rec’d before 12 mid-day.

Anti-Mullerian Hormone (AMH)

B Yellow top (2) Contact Laboratory Please contact the laboratory. 14 days


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Anti-thyroid peroxidase antibody (Anti-TPOAb)

B Yellow top (2) < 6 IU/L 1 day

Apolipoprotein A-1 B Red/purple top (2) 1.0 to 2.2 g/L 1 week

Apolipoprotein B B Red/purple top (2) 0.6 to 1.3 g/L 1 week

Arsenic U Hair

Plain UC * (20) Sealable bag.

< 30 nmol/mmol creatinine <0.5 µg/g

Consult 0141 211 5178 to arrange.

10 days

Ascorbic acid B Green top (2) 15 to 90 µmol/L If delivery to laboratory is out with 4 hrs contact 0141 211 5178 for sample handling instructions.

10 days

Aspartate aminotransferase (AST) ++

B Yellow top (2) < 40 U/L Same day if rec’d before 12 mid-day.

β2-Microglobulin B Yellow top (2) 1.2 to 2.4 mg/L 5 days

Bence Jones protein U EMU/Plain UC Qualitative test Use serum electrophoresis as first line test.

10 days

Bicarbonate B Yellow top (2) 22 to 29 mmol/L Daily. Same day if rec’d before 12MD.

Bilirubin (Total) ++ Bilrubin (Direct) (Conjugated)

B B

Yellow top (2) < 20 µmol/L <15% total

Only measured if total bilirubin > 45

µmol/L.

Daily. Same day if rec’d before 12MD.

Blood gases (arterial) ++

B Syringe H+: 36 -43 nmol/L PCO2:4.6-6.0kPa PO2:10.5-13.5kPa

10 min

CA125 B Yellow/red top (2)

< 35 kU/L < 25 kU/L

Adult pre-menopausal female. Post-menopausal. Elevated in patients with ascites or pleural effusions.

1 day

Cadmium B U

EDTA (5) 24 h/Plain UC (20)

< 30 nmol/L < 50 nmol/L < 1 nmol/mmol creatinine

Non-smokers Smokers

10 days 10 days

Caeruloplasmin B Yellow/dark blue top (2)

0.16 - 0.47 g/L 0.02 - 0.15 g/L 0.06 - 0.36 g/L 0.13 - 0.47 g/L 0.16 - 0.47 g/L

Adults 0 to 3 months 4 - 6 months 1 - 13 years 10 - 13 years


Calcitonin B Green top* (5) < 15 ng/L *See page 33 for collection requirements.

10 days

Calcium ++ “

B U

Yellow top (2) 24 h/Plain UC

2.20-2.60mmol/L 2.5-7.5 mmol/24 h Ca/Creat ratio 0.04-0. 7

Adjusted = Ca + (0.017 x (43 -albumin)).


Carbamazepine ++ B *Yellow top (2) 4.0 to 12.0 mg/L *Pre dose sample preferred. Conversion Factor (molar into mass units)

µmol/L x 0.24 = mg/L.

1 day

Carcinoembryonic antigen (CEA)

B Yellow top (2) < 5 µg/L 1 day

Carboxyhaemoglobin ++

B Syringe < 5% of total haemoglobin

1 hour


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Carotenoids B Green/red top (2) - See Vitamin A, page 24 10 days

Catecholamines adrenaline noradrenaline dopamine

U 24 h/acid < 230 nmol/24 h < 900 nmol/24 h < 3300 nmol/24 h

Give full drug history. Avoid Paracetamol-containing medication for at least 48 h prior to starting urine collection.

10 days

Carbohydrate-deficient transferrin (CDT)

S Yellow top <1.7% Approx 14 days

Chloride ++ “

B U

Yellow top (2) 24 h/Plain UC

95 to 108 mmol/L 150 - 250 mmol/24h


Cholesterol (β-Quant ultracentrifugation- total Cholesterol, VLDL, LDL, HDL)

B Purple/red/ yellow top (7)

10 days

Cholesterol (Total) LDL(calculated) HDL

B

Yellow top (2)

< 5.0 mmol/L desirable in ‘at-risk’ individuals. <3.0 mmol/L desirable in ‘at risk’ individuals. >1.0 mmol/L desirable in ‘at risk’ individuals. Calculated LDL = Chol – HDL-C - 0.46 x trig


Chromium B U

Purple top (7) Random/plain UC (10)

< 40 nmol/L < 6.0 nmol/mmol creatinine

MHRA action limit: 135nmol/L (7 µg/L)

10 days

Cobalt B U

Purple top (7) Random/plain UC (10)

< 50 nmol/L < 1.6 nmol/mmol creatinine

MHRA action limit: 120nmol/L (7 µg/L)

10 days

Copper B

U Liver

Heparin/plain (5)

24 h/Plain UC (20) Plain UC

10 - 22 µmol/L

11 - 25 µmol/L

27 - 49 µmol/L

1.5 - 7.0 µmol/L

4.0 - 17.0 µmol/L

8.0 20.5 µmol/L

12.5 22.0 µmol/L

< 0.6 µmol/24 h 8 - 40 µg/g dry weight

(male) (female) (pregnancy)

(0-3 months)

(4-6 months)

(7-12 months)

(1-13 years)

4 days

4 days 6 days

Cortisol “ Cortisol/Creatinine ratio

B U

Yellow top* (2) 24 h/plain UC (10) or EMU/*Plain UC (10)

240 - 600 nmol/L 50 - 290 nmol//L < 250 nmol/24 h

< 25 µmol/mol creatinine

7 to 9 am 9pm-12am *See page 29 for full details. *See page 29 for full details.

1 day 7 days

C-Reactive protein (CRP) ++

B Yellow top (2) < 10 mg/L Daily. Same day If rec’d before 12 pm

Creatine kinase (CK) ++ B Yellow top (2) F 25-200 U/L M 40-320 U/L


Creatinine ++ “ Creatinine clearance (CL Monday to Friday

B U U+ B

Yellow top (2) 24 h/Plain UC 24 h/Plain UC + Yellow top (2)

40 - 130 µmol/L 9.0 - 18.0 mmol/24 h 80 - 140 mL/min

Age and sex related ranges available. Varies with age, and sex. Requires



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only) serum creatinine on a sample taken during the urine collection period.

Cryoglobulin Cryofibrinogen

B B

Red top (2) Purple top (2)

Normally absent Normally absent

Arrange with Duty Biochemist for warm flask.

10 days 10 days

CSF glucose ++

CSF Grey top (1) > 70% of plasma glucose

Compare with simultaneous plasma glucose.

1 hour

CSF xanthochromia CSF Plain UC (1) Qualitative test Send sample to laboratory without delay. Record exact time of sampling on request form. Arrange with local laboratory.

Sent Away

CSF protein ++ CSF Plain UC (2) < 0.45 g/L Contamination with blood renders this test invalid.

1 hour

Dehydroepiandrosterone sulphate (DHAS)

B Yellow top* (1) 2.5 - 16 µmol/L

2 - 12.5 µmol/L

Male (16-50 yrs) Female (16-50 yrs)

7 days

Digoxin ++ B Yellow top (2) 0.5 to 2.0 µg/L *Collect at least 6h post-dose Conversion Factor (molar into mass

units) nmol/L x 0.78 = µg/L.

1 day

Drugs of abuse screen ++

U Random/plain UC (20)

Qualitative test Screen for amphetamines, metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, phencyclidine and tricyclic antidepressants

Available out-of-hours as an emergency.

Ethanol B Grey Top (2) Reported in mg/dL Conversion Factor molar into mass units mmol/L x 4.6 = mg/dL. mass to molar units mg/dL x 0.22 = mmol/L. Interpretation: refer to Duty Biochemist via Switchboard.

1 day (available out of hours)

Calprotectin Faeces (F)

Plain UC/ Random (1-5 g)

0-50 µg/g of stool <10 Not detected. ?IBS. 10-50 Within reference range. ?IBS. 51-100 Suggests possible GI inflammation. 101-200 Suggests probable GI inflammation. >200 Consistent with Active GI inflammation.

7 days

Faecal osmotic gap F Plain UC/ Random (10g)

< 75 mosmol/kg > 75 mosmol/kg

Secretory diarrhoea Osmotic diarrhoea

7 days

Faecal pH F Plain UC/ Random (10g)

< 6.5 bile acid diarrhoea is unlikely > 5.6 carbohydrate induced diarrhoea unlikely

Send to laboratory ASAP, within 2 hours.

7 days

Fasting lipid profile B Yellow top (5) See individual components

Total cholesterol, triglycerides, HDL-cholesterol. Fasting sample.

1 day

Follicle stimulating hormone (FSH)

B Yellow top (2) Sex, age and cycle related

See page 31 for full reference ranges.

2 days

Gamma glutamyl transferase (GGT) ++

B Yellow top (2) < 70 U/L < 40 U/L

Male Induced by many drugs. Female


Gastrin B Green top* (2) < 120 ng/L *See page 35 for full collection requirements.

20 days

Gentamicin B Yellow top* (2) See prescribing protocols

Trough: pre-dose Peak: 1 hour post- dose.

4 hours

Globulins ++ B Yellow top (2) 23 to 38 g/L Calculated value (total protein - albumin).

1 day.


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Glucose ++ “ ++

B CSF

Grey top (2) Grey top (0.5)

3.5 to 5.5 mmol/L > 70% of plasma glucose

Fasting. Compare with simultaneous plasma glucose.


Glutathione Peroxidase B Heparin/EDTA (2) 15-50 IU/g Hb 20 days

Growth hormone

B Yellow top (2) < 0.4 µg/L excludes acromegaly

Fasting; avoid stress. 7 days

Gut hormone screen B Green top* (7) - *Fasting patient. Contact laboratory for Trasylol/ heparin tubes and precautions. Gastrin, pancreatic polypeptide, glucagon, neurotensin, VIP, chromogranin A, chromogranin B measured.

4 weeks

Haemoglobin A1c (HbA1c)

B Purple (2) <42mmol/molHb > 48 mmol/molHb

Good glycaemic control Poor control

Haptoglobin B Yellow (2) 0.3 to 2.0 g/L Same day if rec’d before 12 mid-day.

Human chorionic gonadotrophin (HCG)

B Yellow top (2) < 5 U/L Varies with gestational age

When used as tumour marker. When used in obstetrics.

1 day

Hydrogen ion B Syringe (1) 36 to 43 nmol/L 10 min

5-Hydroxy indole acetic acid (HIAA)

U 24 h/acid < 50 µmol/24 h Elevated by dietary walnuts, bananas, tomatoes, avocado, kiwi fruit, pineapple, plantain, plums, pecan nuts. Avoid for 3-4 days prior to starting urine collection.

10 days

17-Hydroxy progesterone

B Blood spot

Yellow top* (0.5 to 2.0)

< 12 wks of age <40 nmol/L >12 wks of age <13 nmol/L

Adults and normal infants (>4 days). *See page 28 for full details.

7 days. Same day by arrangement

Immunoglobulins B Yellow top (2) 6 to 16 g/L* 0.8 to 4.0 g/L* 0.4 to 2.4 g/L*

IgG IgA IgM *Age-related reference range available. Paraproteins quantitated and typed.

1 day 7 days

Insulin-like growth factor (IGF1)

B Yellow top (2) Adults (20 to 60 years). Varies with age. See page 33 for reference ranges.

7 days

Insulin Amended insulin/Glucose ratio

B B

Green top(2)*

< 13 mU/L < 5.0

*See page 33 for full collection details. Collect glucose sample at same time. .

7 days

Insulin C-peptide Green top(1)* 0.36 to 1.12 nmol/L *See page 33 for full collection details

7 days

Iron ++ Transferrin saturation ++ Iron Iron

B U Liver

Yellow top (2) Plain Universal Container (20) Plain Universal

10 to 30 µmol/L

<1.0 µmol/24 h 0.17 - 1.40 mg/g dry

Consider haemochromatosis if: >60% (M) or >50% (F)

Hepatic Iron Index 0 - 2.0 µmol

4 days 6 days 10 days


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Container weight iron/gram liver/year

Lactate ++ B Grey top (2) 0.5 to 2.2 mmol/L By arrangement only. Send to WIG for analysis.

Lactate dehydrogenase (LDH) ++

B Fluid

Yellow top (2) Red top (5)

80 to 240 U/L > 120 U/L

Pleural fluid/serum LDH > 0.6: consistent with exudate

Lead B U

Purple top (5)* Plain Universal Container (20)

< 0.5 µmol/L < 4.5 nmol/mmol creatinine

Legal limit: 2.9 µmol/L Telephone 0141 211 5178 if rapid turnaround is required. Legal limit: 60 nmol/mmol creatinine

5 days 10 days

Lipoprotein A (Lp(a)) B Red/purple top (2) < 30 mg/dL Increased coronary risk over 30mg/dL.

1 week

Lithium ++ B Yellow top* (2) 0.4 to 1.0 mmol/L *Other ranges acceptable depending on clinical circumstances.

1 day

Luteinising hormone (LH)

B Yellow/red top (2) *Sex, age and cycle related

*See page 31 for full reference ranges.

2 days

Macroprolactin B Yellow top (2) 7 days

Magnesium ++ “ “

B U F

Yellow top (2)l 24 h/Plain UC Random/plain UC (5)

0.7 - 1.0 mmol/L 2.0 - 11.0 mmol/24 h < 100 mmol/kg

Excludes magnesium-induced diarrhoea.Sample should be received in lab within six hours after collection. Refrigerate and send on ice ASAP.

Same day if rec’d before 12 mid-day. 5 days 5 days

Manganese B Heparin/EDTA* (5) 70 to 280 nmol/L 6 days

Mercury B U Hair

Heparin/EDTA (5) Plain Universal Container (20) Plain Universal Container (20)

<30 nmol/L <5 nmol/mmol creatinine <2 µg/g

Telephone 0141 211 5178 if rapid turnaround is required. Contact 0141 211 5178 to arrange.

10 days 10 days

Methaemoglobin B Green top/syringe (1)

<1.5% Send ASAP; protect from light. 1 hour

Methotrexate B Red top (2) See Protocols Toxic levels: >10

µmol/L at 24 hrs

>0.5 µmol/L at

48 hrs, >0.1 µmol/L at 72 hrs

LLD: 0.1 µmol/L.

Interpretation related to time since start of dose. If the patient has had prep of mass monoclonal A/B or had carboxypeptidase G2 as a rescue therapy the specimen should not be tested by this assay

Available as an emergency by arrang

t.

Microalbumin Albumin/creatinine ratio (ACR) Albumin excretion rate

U U U

EMU/plain UC (5) EMU/plain UC(5) 24 h/plain UC (5)

< 20 mg/L <2.5 mg/mmol creat <3.5 mg/mmol creat

AER <20 µg/min

Male Female

2 days

Micronutrient screen B 1 x Heparin tube(5) + 1 x EDTA tube(5)

See under individual analytes

Includes copper, zinc, selenium, manganese and vitamins A, B1, B2, B6, C and E. Screens for Scottish customers also include vitamin D

10 days

Nickel U Plain Universal container (1)

Reference range < 10 nmol/mmol creatinine

14 days

Oestradiol (E2) B Yellow top (2) *Sex and cycle related

*See Page 31 for full details of ref ranges.

2 days

Osmolality ++ “ ++

B U

Yellow top (2) Random/plain UC (5)

275 to 295 mmol/Kg Variable

Fresh specimen required.



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Oxalate “

U 24 h/acid 0.08-0.49 mmol/24 h 0.04-0.34 mmol/24 h

Male Female Children: reference ranges for oxalate/creatinine ratio are available

14 days

Paracetamol ++ B Yellow top (2) Refer to BNF diagram. Treatment levels –100 mg @ 4 h 50 mg @ 8 h 25 mg @ 12 h

Collect at least 4 hours post-dose. Relate to time after dose to assess hepatotoxicity. See chart (available from Biochemistry and in the BNF) for interpretation. Conversion Factor (molar into mass units) mmol/L x 151 = mg/L.

1 hour

Parathyroid hormone (PTH)

B Purple top* (2) 1.6 to 7.5 pmol/L Sample stable for up to 8 hrs in EDTA.

1 day

PCO2 (arterial) ++ B Syringe (1) 4.6 to 6.0 kPa Send on ice, within 30 minutes.. 10 min

pH ++ “

U F

Plain UC Plain UC (5 g)

>5.9

Contact laboratory. Excludes carbohydrate malabsorption.

10 min

Phenobarbitone ++ B Yellow top (2) Neonates: 15.0-30.0 mg/L Adults: 15.0-40.0 mg/L

*Collect pre-dose (not critical). Conversion Factor (molar into mass

units) µmol/l x 0.23 = mg/L

1 day

Phenytoin ++

B

Yellow top (2)

Neonates: 6.0-15.0 mg/L Adults: 10.0-20.0 mg/L

*Pre-dose sample preferred. Conversion Factors (molar into mass

units) µmol/L x 0.25 = mg/L.

1 day

Phosphate ++

B U

Yellow top (2)l 24 h/plain UC

0.8 to 1.5 mmol/L 13 - 39 mmol/24 h

Varies with diet.

Daily. Same day if rec’d before 12 pm. Urine: Mon-Fri.

PO2 (arterial) ++ B Syringe (1) 10.5 to 13.5 kPa Send on ice, within 30 minutes. 10 min

Porphobilinogen U Plain UC (20) < 10 µmol/L Protect from light - See page 36 10 days

Porphyrin screen

B U F

Purple/yellow top (5) Plain UC (20) Plain UC (10 g)

Qualitative test < 300 nmol/L 10-200 nmol/g dry weight

Protect from light. } Protect from light. } See page 36 Protect from light. }

2-6 weeks 10 days 10 days

Potassium ++ “ “

B U U

Yellow top (2) 24 h/plain UC Random/plain UC

3.5 to 5.3 mmol/L 25 to 125 mmol/L Varies with diet

Invalid in old/ haemolysed samples. Interpret with serum concentration.


Pregnancy test ++ U EMU/plain UC (20) Qualitative result Sensitivity: 25 U/l HCG. Test becomes positive approximately 7-10 days after conception.

3 days

Prostate-specific antigen (PSA)

B Yellow top (2) Age 50 -59 y

PSA <3.0 µg/L Age 60-69 y

PSA <4.0 µg/L Age > 70 y

PSA <5.0 µg/L

1 day

Progesterone B Yellow/red top (2) > 20 nmol/L* Confirms ovulation if taken in mid-luteal phase.

1 day

Prolactin B Yellow top (2) Male < 400 mU/L Female < 630 mU/L

Avoid stress. Macroprolactin screen carried out if prolactin >700 mU/L on second occasion.

1 day


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Protein ++ “ “ “

B U CSF Fluid

Yellow top (2) 24 h/plain UC Plain UC (2) Red top (2)

60 to 80 g/L < 150 mg//24 hour < 0.45 g/L < 30 g/L

Avoid venous stasis. Contamination with blood renders this test invalid. Pleural fluid/serum protein > 0.5: consistent with exudates.

2 days 1 hour

Protein electrophoresis B Yellow top (2) - Paraprotein quantitation and typing. 7 days 14 days if immuno-fixation required.

Renin concentration B Purple top* (5) Adults (supine) < 40 mIU/L Adults (ambulant) < 52 mIU/L

*See page 28 for full sampling requirements.

14 days

Salicylate ++ B Yellow top (2) Intoxication: > 350 mg/L Severe Toxicity: > 700 mg/L >280 mg/L , if under 5 years

Conversion Factor (molar into mass units) mmol/L x 138 = mg/L

1 hour

Selenium B Heparin/EDTA/plain (5)

0.8 to 2.0 µmol/L

0.2 - 0.9 µmol/L

0.5 - 1.3 µmol/L

0.7 - 1.7 µmol/L

Adult

0 - 2 years 2 - 4 years

4 - 16 years

4 days

Sex hormone-binding globulin (SHBG)

B Yellow top (10) 13 to 70 nmol/L 20 to 155 nmol/L 44 to 218 nmo/L 22 to 188 nmol/L 52 to 172 nmol/L 38 to 127 nmol/L

Male <50 years Female <50 years Boys 5 – 10 years 11 – 13 years Girls 5 – 10 years 11 – 13 years

2 days

Sodium ++ “

B U

Yellow top (2) 24 h/plain UC

133 to 146 mmol/L Varies with diet


Steroid metabolite profile

U See comments Diagnosis and investigation of inherited steroid biosynthetic disorders and steroid producing tumours. By arrangement only. Sampling requirements A 5 ml aliquot of urine from a volumed 24 hour collection (in a plain container) is preferred for adults and children over 10 years of age. Random 5 ml samples from children up to 10 years will be accepted. In babies, a minimum volume of 1ml can be processed. Samples preserved in borate are acceptable.

20 working days

Testosterone

B Yellow top (10) 10 to 36 nmol/L 0.5 to 3.2 nmol/L

Male (<50 years) Female (<50 years)

2 days 10 days if extraction required.

Free androgen index (Testo. x 100)/SHBG

Not applicable < 7

Male Female

2 days

Theophylline ++ B Yellow top (2) Neonates: 5.0 to 10.0 mg/L 1 Month - 1 year: 5.0 -15.0 mg/L

Collect pre-dose or > 8 hours post-dose for slow-release preparations.

1 day


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Adults: 10.0 to 20.0 mg/L (5.0 to 10.0 mg/L adequate in some circumstances).

Conversion Factor (molar into mass

units) µmol/l x 0.18 = mg/L.

Thyroglobulin (Tg) and Thyroglobulin antibody (TgAb)

B Yellow top (10) Tg or adults with intact thyroids TgAb <40 IU/mL

Post-thyroidectomy for thyroid cancer.

7 days

Thyroid stimulating hormone (TSH)

B Yellow top (2) 0.35 to 5.0 mU/L 2 days

Thyrotrophin receptor antibodies (TRAb)

B Yellow top (10) < 15 U/L 14 days

Thyroxine, free (fT4) B Yellow top (2) 9.0 to 21.0 pmol/L 14 days

Transferrin Transferrin saturation

B B

Yellow top (2) Yellow top (2)

2.0 to 4.0 g/L

Consider haemochromatosis if > 60% (M) or > 50% (F)

Daily. Same day if rec’d by 12 mid-day

Triglyceride

B Yellow top (2) < 2.3 mmol/L Fasting sample required. 1 day

Triiodothyronine (T3)

B Yellow top (2) 0.9 to 2.5 nmol/L 2 days

Troponin I Bl Yellow top (2) < 0.04 µg/L Take sample at least 12h after onset of symptoms to exclude acute coronary syndrome.

2 hours

Urate ++ “ “ Urate

B “ “ U

Yellow top (2) “ “ 24 h/plain UC (10)

0.20 -0.43 mmol/L 0.14 -0.36 mmol/L 0.11 -0.30 mmol/L 1.5 to 4.5 mmol/24 h

Males Female <9 years (M and F)

Daily. Same day if rec’d before 12 mid-day. Urine: Mon-Fri.

Urea ++ “

B U

Yellow top (2)l 24 h/red top

2.5 to 7.8 mmol/L 160 to 500 mmol/24h

Daily. Same day if rec’d before 12 mid-day. Urine: Mon-Fri.

Valproate B Yellow top (2) 50 to 100 mg/L (poor correlation between serum concentration and effect)

*Collect pre-dose (not critical). Only useful to detect toxicity or non-compliance. Conversion Factor (molar into mass

units) µmol/L x 0.14 = mg/L.

1 day

Vancomycin B Yellow top (2) See Prescribing Protocols.

Trough: pre-dose. 4 hours

Vitamin A (retinol)

B Heparin/EDTA/ plain (5) Heparin preferred

1.0 to 3.0 µmol/L Age-related range

0.5 to 1.5 µmol/L

0.7 to 1.5 µmol/L

0.9 to 1.7µmol/L

0.9 to 2.5 µmol/L

>18 years. Light-sensitive; wrap in tinfoil if delivery to <1 yr Lab is out with 24 h. 1-6 yrs 7-12 yrs 13-18 yrs

10 days 10 days


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Carotenoids:

α-carotene

β-carotene, Lutein Lycopene

14 to 60 µg/L

90 to 310 µg/L

80 to 200 µg/L

100 to 300 µg/L

Vitamin B1 (thiamine diphosphate)

B Heparin/EDTA (5) Heparin preferred

275 to 675 ng/g Hb Contact 0141 211 5178 for sample handling instructions if delivery is out with 72 hours of collection.

10 days

Vitamin B2 (flavin adenine nucloetide)


1.0 to 3.4 nmol/g Hb Light sensitive; wrap in tinfoil. Contact 0141 211 5178 for sample handling instructions if delivery is out with 48 hours of collection.

10 days

Vitamin B6 (pyridoxal phosphate)


250 to 680 pmol/g Hb

Light sensitive; wrap in tinfoil. Contact 0141 211 5178 for sample handling instructions if delivery is out with 48 hours of collection.

10 days

Vitamin C (ascorbic acid)

B Heparin/EDTA/ plain (5) Heparin preferred

15 to 90 µmol/L If delivery to laboratory is out with 4 h contact 0141 211 5178 for sample handling instructions.

10 days

Vitamin D 25- Hydroxy vitamin D

B Yellow top (2) < 25 nmol/L 25 - 49 nmol/L > 50 nmol/L

Vitamin D deficient, consider supplementation. Borderline low 25-hydroxyvitamin D. Risk of developing secondary hyperparathyroidism. Consider increase in Vitamin D intake. Adequate Vitamin D

14 days

1,25-Dihydroxy vitamin D

B Yellow top (2) 20 to 120 pmol/L 30 days

Vitamin E (tocopherol) B Heparin/EDTA/plain (5) Heparin preferred

3.5 to 9.5

µmol/mmol cholesterol

Light-sensitive; wrap in tinfoil if delivery to laboratory is out with 24h.

10 days

Zinc Zinc

B

U

Heparin* (5)

24 h/Plain UC (20)

10.7 - 18 µmol/L

10.0 - 18 µmol/L

3.0 - 21.0 µmol/24 h

Males Blood should be spun Females within 6 h or within 24 h if refrigerated.

4 days 10 days

Zinc protoporphyrin (ZPP)

B EDTA (5) 30 - 80 µmol/mol Hb 6 days

TURN AROUND TIME DEFINITION Turnaround time is calculated from time of receipt to printed report generation. Results are available electronically in NHSGGC Clinical Portal following authorisation.

Telephoned emergency requests are normally available electronically one hour after specimen receipt.

TUBE TYPES

Colour-coded tubes: types of preservative- Explanation of abbreviations

Early morning urine in plain Flouride/oxalate SST Tube Heparin Plain EDTA Trace element tube Universal Container- no preservative

EMU Grey top Yellow top Green top Red top Purple Dark- blue top UC

++ Test available at all times


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Maternal third trimester: reference ranges for guidance

Analyte Type of Sample

Container (Volume, ML)

Reference Range Comments

Alanine aminotransferase (ALT) B Yellow top (2) < 50 U/L

Albumin B Yellow top (2) 30 to 42 g/L Avoid venous stasis.

Alkaline phosphatase (Alk Phos) B Yellow top (2) < 40 to 150 U/L

Amylase B Yellow top (2) < 100 U/L

Aspartate aminotransferase (AST) B Yellow top (2) < 40 U/L

Bicarbonate B Yellow top (2) 17 to 26 mmol/L

Bilirubin B Yellow top (2) 3 to 14 µmol/L Protect from light.

Blood gases (arterial)

B Syringe H+: 36 - 43 nmol/L

PCO2: 3.0 - 5.0 kPa PO2: 10.5 - 13.5 kPa

Analyse promptly or send on ice, within 30 minutes.

Calcium Calcium

B Urine

Yellow top (2) Plain Universal Container

2.10 - 2.60 mmol/L 2.5 - 7.5 mmol/24 hr

Adjusted = Ca + (0.17 x (43 albumin)).

Chloride B Yellow top (2) 97 to 107 mmol/L

Creatinine Creatinine clearance “

B Urine + B

Yellow top (2) 24 h/ plain Universal Container + Yellow top (2)

40 to 85 µmol/L 80 to 140 mL/minute

Serum creatinine required on a sample taken during the urine collection period.

Gamma glutamyl transferase (GGT) B Yellow top (2) < 55 U/L

Glucose B Yellow top (2) 3.0 to 5.5 mmol/L Fasting

Hydrogen ion B 1, Syringe 36 to 43 mmol/L Analyse promptly or send on ice, within 30 minutes.

Magnesium B Yellow top (2) 0.6 to 0.8 mmol/L

Osmolality B Yellow top (2) 270 to 285 mmol/kg

PCO2 (arterial) B Syringe (1) 3.0 to 5.0 kPa Analyse promptly or send on ice, within 30 minutes.

Phosphate B Yellow top (2) 0.9 to 1.5 mmol/L Invalid in old/haemolysed samples.

PO2 (arterial) B Syringe (1) 10.5 to 13.5 kPa Analyse promptly or send on ice, within 30 minutes.

Potassium B Yellow top (2) 3.2 to 4.6 mmol/L Invalid in old/haemolysed samples.

Protein B Yellow top (2) 55 to 70 g/L Avoid venous stasis.

Sodium B Yellow top (2) 132 to 140 mmol/L

Urate B Yellow top (2) < 0.34 mmol/L

Urea B Yellow top (2) 1.0 to 4.0 mmol/L


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PREMATURE NEONATES Analyte Type of

sample Container & Volume (mL)

Reference range Comments

Adrenocorticotrophin (ACTH) B Purple top (0.5) < 25 mU/L Arrange with Duty Biochemist Ext 24362. Send on ice ASAP.

Alanine aminotransferase (ALT) B Green top (*) < 80 U/L

Albumin B Green top (*) 25 to 35 g/L

Aldosterone B Green top (1) < 5500 pmol/L 500 - 4450 pmol/L

< 1 month. 1 to 6 months. Arrange with Duty Biochemist Ext 24362. Send on ice ASAP.

Alkaline phosphatase (Alk Phos)

B Green top (*) < 600 U/L If > 1000U/L x-ray for rickets.

Ammonia B Green top (0.2) < 100 µmol/L

> 200 µmol/L

Send promptly to Biochemistry, RSHC, Yorkhill, for analysis. Investigate further.

Aspartate aminotransferase (AST)

B Green top (*) < 80 U/L

Bicarbonate B Green top (*) 15 to 25 mmol/L

Bilirubin: total conjugated

B B

Green top (*) Green top (*)

<10 µmol/L

See transfusion/phototherapy chart. Protect from light.

Blood gases (arterial)

B Syringe H+: 36 - 44 nmol/L

PCO2:4.0- 6.5 kPa PO2: 6.5 - 9.0 kPa

Analyse promptly. Aim to maintain. Aim to maintain within stated range. Aim to maintain within stated range.

Calcium B Green top (*) 2.00- 2.70 mmol/L Not adjusted for variation in albumin.

Chloride B Green top (*) 95 to 110 mmol/L

Copper B Green top (0.2)

Creatinine B Green (*) < 80 µmol/L Initially reflects Mother’s then falls over first 6 weeks of life.

Gamma glutamyl transferase (GGT)

B Green (*) < 100 U/L

Glucose “

B CSF

Grey top (*) Grey top

2.5 to 10 mmol/L 2.5 to 4.0 mmol/L

Random. When on IV fluids. > 70% of plasma concentration.

Hydrogen ion B Syringe 36 to 44 mmol/L Analyse promptly. Aim to maintain.

17-Hydroxy progesterone B Green top (0.5) Blood spot

< 40 nmol/L > 50 nmol/L

Arrange with Duty Biochemist Ext 24362. Send on ice. Congenital adrenal hyperplasia.

Hypoglycaemia screen insulin cortisol

B Green top (1) Discuss Discuss

Only take when hypoglycaemic (Glu < 2.6 mmol/L) and on high glucose intake (> 12mg/kg/min). Arrange with laboratory. Send on ice ASAP.

Lactate B Green top (0.2) 0.7 to 2.5 mmol/L Send to the Biochemistry Department , RSHC, Yorkhill, for analysis.

Magnesium B Green top (*) 0.7 to 1.2 mmol/L

Manganese B Green top (0.5)

Methaemoglobin B Green top (0.5) < 2.5% > 5% > 7%

Target: Only if on nitrous oxide (NO) Treatment. Send ASAP. Protect from light. Decrease NO by 50%. Stop NO.

Osmolality B Green top (*) 270 to 300 mmol/kg

Parathyroid hormone (PTH) B Purple Top

1.0, E 1.6 to 7.5 pmol/L Sample stable for up to 8 hrs in EDTA.

PCO2 (arterial) B 1, Syringe 4.0 to 6.5 kPa Analyse promptly. Aim to maintain within stated range.

Phenobarbitone B Green top (0.5) 15 to 30 mg/L 1 hour post 5th dose, or random.

Phenytoin B Green top (0.5) 6 to 15 mg/L 1 hour post 5th dose, or random.


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Container & Volume (mL)

Reference range Comments

Phosphate B Green top (*) 1.5 to 2.6 mmol/L Invalid in old/haemolysed samples.

PO2 (arterial) B Syringe (1) 6.5 to 9.0 kPa Analyse promptly. Aim to maintain within stated range.

Potassium B Green top (*) 3.5 to 6.0 mmol/L Invalid in old/haemolysed samples.

Protein “

B CSF

Green top (*) Plain UC

45 to 70 g/L 250 to 900 mg/L 250 to 700 mg/L 150 to 450 mg/L

Neonate. Unsuitable if blood stained or xanthochromic. 1 month. 6 months.

Renin concentration B 1, E Arrange with Duty Biochemist Ext 24362.

Sodium B Green top (*) 130 to 145 mmol/L

Theophylline B Green top (*) 5 to 10 mg/L *Collect pre-dose (not critical).

Thyroid function tests: Thyroid stimulating hormone (TSH) Thyroxine (free T4)

B B

Green top (1.0)

0.2 to 15 mU/L > 50 mU/L 6 to 30 pmol/L

5-day olds to adults. Congenital hypothyroidism.

Trace element screen copper manganese zinc

B Green top (0.5)

Triglyceride B Green top (*) < 2.5 mmol/L Target value when on TPN.

Urea B Green top (*) < 7.0 mmol/L < 3.5 mmol/L

Days 1 to 7: Days 7 + If >8.0 mmol/L analyse creatinine.

Zinc B Green top (0.5)


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HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS

A) Assays performed in serum or plasma

Sample requirements Analyte

Type of sample

Container & volume (ml)

Precautions

Subjects

Reference values & action limits

Adrenocorticotrophin (ACTH) Blood Purple top (1) a, b, e, f, tf Adults 0700-0900 hours < 20 mU/L

Aldosterone

Blood Yellow top (1.5)

Adults Adults Neonates 0-1 month Neonates 1-6 month

100 - 400 pmol/L (supine) 100 - 800 pmol/L (upright) 1060 - 5480 pmol/L 500 - 4450 pmol/L

Androstenedione Blood Yellow top (1) - Adult men 18 - 40 years Adult men 41 - 65 years Adult Women 18 - 40 years Adult Women 41 - 65 years Prepubertal children

1.6 - 8.4 nmol/L 1.3 - 6.6 nmol/L 0.6 - 8.8 nmol/L 0.9 - 6.8 nmol/L < 2 nmol/L

Cortisol Blood Yellow top (2) e, f Adults 7- 9 am Adults 9 pm – 12 mid-night Morning to Evening

240 - 600 nmol/L 50 - 290 nmol/L > 100 nmol/L

Dehydroepiandrosterone sulphate (DHAS)

Blood Yellow top (1) - Adult men (16-50 years) Women (16-50 years) Prepubertal children

2.5 - 16 µmol/L 2 – 12.5 µmol/L < 2.5 µmol/L

17-Hydroxyprogesterone Blood Yellow top (0.5 to 2)

e Adults 7- 9 am Normal infants (>4 days) Stressed/Premature infants Proven Congenital Adrenal Hyperplasia

< 13 nmol/L < 13 nmol/L < 40 nmol/L > 50 nmol/L

Plasma Renin Concentration Blood Purple top (5) b, tf, g Supine Ambulant Screening for Primary Aldosteronism is positive if an Aldosterone (pmol/L)/ Renin concentration ratio is >35 in samples where the Aldosterone is >300 pmol/L. Patients with a positive screening test require more detailed investigation (ie, salt loading test)to confirm the presence of primary Aldosteronism.

< 40 mIU/L < 52 mIU/L

Symbols

a - Haemolysed specimen unsuitable b - Separate and freeze specimen d - Collect after overnight fast e - Timing of collection important f - Avoid Stress g - Do not store or centrifuge at 4° C h - Contact Laboratory j - Ful EDTA tube required tf - Transport frozen (not whole blood)


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B) ASSAYS PERFORMED IN URINE

Sample requirements

Analyte

Type of

sample


Precautions

Subjects

Reference values &

action limits

Cortisol (UFC) Urine 5, Pl/EMU or 24 hours NP Adults (EMU)

Adults (24 hour)

Children ≤10 yrs

< 25 µmol/mol creatinine

< 250 nmol/24 hours

< 40 nmol/mmol creatinine

Urinary steroid profile

Urine 24 hours NP Analysis of more than 30 steroid metabolites available in selected patients.

Contact Duty Endocrine Biochemist for full details.

Commonly performed dynamic tests

Synacthen test - cortisol 0.25 mg Synacthen i.v. between 8 am and 10 am. Blood sample at times 0 and 30 minutes for serum cortisol.

Criteria for normal response Adequate >450 nmol/L Inadequate <450 nmol/L


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HORMONES OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS

A) Assays performed in serum


Type of sample

Container & volume (mL)

Precautions

Subjects


Tiiodothyronine (T3) Blood Yellow top (2) Adults 0.9 - 2.5 nmol/L

Thyroid stimulating hormone (TSH) Blood Yellow top (2)

Adults Infants < 15 days

0.35 - 5.0 mU/L < 25 mU/L

Free thyroxine (fT4) Blood Yellow top (2) Adults 9.0 - 21 nmol/L

Anti-thyroid peroxidase antibody (anti-TPOAb)

Blood Yellow top (2) Adults < 6 IU/L

Thyrotrophin receptor antibody (TRAb)

Blood Yellow top (1) Adults < 15 U/L


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HORMONES OF THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS

A) Assays performed in serum


Type of sample


Precautions

Subjects


Prolactin Blood Yellow top (2) f Males Females

< 400 mU/L < 630 mU/L

Follicle stimulating homone (FSH)

Blood Yellow top (2) Infants < 11 years Menstruating women - follicular phase - mid-cycle - luteal phase Postmenopausal women

*

Men (<50 years)

0.6 - 3.6 U/L 3 - 8 U/L 2 -16 U/L 1 - 5 U/L 18 - 150 U/L 1 - 12 U/L

Luteinising hormone (LH)

Blood Yellow top (2) Infants < 11 years Menstruating women - follicular phase - mid-cycle - luteal phase Postmenopausal women

Men (<50 years)

ud - 3.4 U/L 2 - 13 U/L 34 - 115 U/L 1 - 16 U/L 16 - 64 U/L 2 - 12 U/L

Oestradiol (E2) Blood Yellow top (2) -

Women: follicular phase mid-cycle luteal phase Postmenopausal Men

77 - 920 pmol/L 140 - 2380 pmol/L 77 - 1145 pmol/L <100 pmol/L <160 pmol/L

Progesterone Blood Yellow top (2) e Menstruating women - follicular phase - mid-cycle - luteal phase Pregnant women 9 - 16 weeks gestation 16 - 18 weeks gestation 28 - 30 weeks gestation Term Postmenopausal women Men (<50 years)

<2 nmol/L >1 - 4 nmol/L 18 - 72* nmol/L 50 - 130 nmol/L 65 - 250 nmol/L 180 - 490 nmol/L 350 - 790 nmol/L <2 nmol/L <2 nmol/L *Progesterone > 20 nmol/L in an untreated cycle is consistent with ovulation

Testosterone Blood Yellow top (1) -

Men (<50 years) Women (<50 years)

10 - 36 nmol/L 0.5 - 3.2 nmol/L

Sex hormone- binding globulin (SHBG)

Blood Yellow top (1) -

Men (<50 years) Women (<50 years)

13 - 70 nmol/L 20 - 155 nmol/L

Free androgen index (FAI)

Testo x100 SHBG

- Male Female

Not Applicable <7

Symbols

f – avoid stress

e - timing of collection important

FSH > 25 U/L in an amenorrhoeic woman suggests ovarian failure/menopause


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More information can be found in Laboratory Investigation of the Menopause. Contact Duty Endocrine Biochemist (ext 24362).

B) Commonly performed dynamic tests

Test/ sample requirements Reference values & action limits

Gonadotrophin releasing hormone (GnRH) test

100 µg GnRH i.v. Blood samples at 0, 30 and 60 minutes for serum FSH and LH

i) Normal basal FSH and LH. ii) FSH increment (men and women < 40 years) >2.0 U/L iii) LH increment (men and women <40 years) >15 U/L.


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OTHER HORMONES AND BONE MARKERS

Sample requirements

Analyte

Type of sample


Precautions

Subjects


Growth Hormone Blood Yellow top (2) d, f Adults (unstressed) <6 ug/L

Insulin-like growth factor 1 (IGF-1)

Blood Yellow top (1) Children 2 - 4 years 5 - 7 years 8 - 10 years 1113 years 14 - 16 years Adults 17 - 25 years 26 - 39 years 40 - 54 years 55 - 65 years 65+ years

13 - 180 µg/L 26 - 200 “ 70 - 460 “ 150 - 600 “ 200 - 650 “

100 - 580 µg/L 65 - 350 “ 50 - 315 “ 35 - 240 “ 30 - 240 “

Insulin Amended insulin/glucose ratio

Blood Green top (2) a, b, d, *tf Fasting adults Insulin (mU/L)/ glucose (mmol/L) - 1.7: Proven insulinoma

<13 mU/L <5.0 >30

Insulin C-peptide Blood Green top ((1) b, d, *tf Fasting adults 0.36 - 1.12 nmol/L

Gastrin Blood Green top (2) a, b, d, *tf Fasting adults <120 ng/L

Parathyroid Hormone (PTH) Blood Purple top (2) a, j Normal adults 1.6 – 7.5 pmol/L

Calcitonin Blood Green top (5) a, b, *tf Normal adults <15 ng/L

25-Hydroxy vitamin D3 (25-HCC)

Blood Yellow top (2) Normal adults <25 nmol/L = subnormal; 25-49 = borderline low >50 = adequate

1,25 Dihydroxy vitamin D3 (1,25-DHCC)

Blood Yellow top (3) Normal adults 20 - 120 pmol/L

Symbols and abbreviations

a .......Haemolysed specimen unsuitable b .......Separate and freeze specimen immediately d ......Collect after overnight fast e ......Timing of collection important EMU .Early morning urine in Plain Universal Container

f ....... Avoid stress h ....... Contact laboratory j ....... Full EDTA tube required *tf ..... Transport frozen (not whole blood)

COMMONLY PERFORMED DYNAMIC TESTS

Test/sample requirements Criteria for ‘normal’ response

Insulin-induced hypoglycaemia test (ITT) of growth hormone reserve Test between 8am and 10am after overnight fast Insulin given IV in doses varying between 0.1 and 0.3 U/kg depending on pathology Blood samples at times 0, 30, 60, 90 and 120 minutes for plasma glucose and serum GH NB: Dextrose and hydrocortisone solutions should be available for IV administration if clinical hypoglycaemia is excessive.

Plasma glucose trough <2.2 mmol/L.

Peak GH >6 µg/L excludes GH deficiency in children.

Peak GH <5 µg/L suggests GH deficiency in children, repeat test (after sex steroid priming in children).

Peak level of < 3 µg/L indicates GH deficiency in adults.

Glucose tolerance test (GGT) of growth hormone suppressibility 75 g of glucose orally as a drink.

Trough HGH <1 µg/L excludes acromegaly.

Emergency analysis should be discussed with Duty Endocrine Biochemist (Ext 24362)


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TRACE ELEMENTS

*Diagnosis of Wilson’s Disease: A simple dynamic test - 65Cu-oral uptake test - is available for the diagnosis of Wilson’s disease. Contact GRI Ext 24288 or website.

**Identifying Source of Lead Contamination: Lead from different sources may have different isotopic compositions. Lead from Broken Hill in Australia (used in lead additives for petrol) has a 206Pb/207Pb ratio of 1.04, while old lead pipes in the UK have a ratio of 1.18. In a case of lead poisoning the isotopic composition of whole blood can be compared with the isotopic composition of lead from the suspected source.

Please telephone the laboratory (Ext 24288) for additional information. Current information on the trace element analytical service is available on the Internet (http://www.trace-elements.co.uk)

Contact Persons:

Dr Dinesh Talwar.............. 0141 211 4490 (24490)

Dr Andy Duncan............... 0141 211 5178 (25178)

Dr Anthony Catchpole ...... 0141 211 5178 (25178)

Dr Fiona Stefanowicz ....... 0141 211 5178 (25178)


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MICRONUTRIENT SCREEN

The Scottish Trace Element & Micronutrient Reference Laboratory is part of Biochemistry North Glasgow and is located at GRI. It offers the following analyses as part of the Micronutrient Screen (each of these tests may also be requested separately): Trace elements: copper, zinc, selenium, manganese. Vitamins: A, E, B1, B2, B6, C. Screens for Scottish customers also include vitamin D Specimens required:

• 1 Heparin tube (5ml)

• 1 EDTA tube (5ml)

• The assessment of nutritional status should also include measurements of urea & electrolytes, calcium, glucose, magnesium, protein/albumin and CRP.

Notes:

• Medical staff should contact a member of the local Nutrition Team or Duty Biochemist if requiring nutritional screening.

• Blood specimens should be sent to the laboratory promptly, accompanied by one request card appropriately filled and marked ‘Micronutrient screen’ (Monday to Thursday).

• Micronutrient screening for patients on TPN: blood samples for micronutrient screening should be taken at least eight hours after TPN infusion has been completed to allow micronutrients to distribute from the central compartment to tissues. In patients who depend on long-term TPN micronutrient concentrations should be measured no more frequently that every 2-3 months.

• The inflammatory status of the patient should be assessed (by measuring CRP) before requesting a micronutrient screen, if: o CRP levels <15 mg/l, laboratory assessment of micronutrient status is reliable. o CRP levels >15 mg/l laboratory assessment of selenium, zinc, copper and Vitamins A and E is unlikely to be reliable. o CRP levels >5mg/l laboratory assessment of Vitamin C is unlikely to reliable. o CRP levels >50 mg/l laboratory assessment of selenium, zinc, copper and Vitamins A, C and E is of no value.


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PORPHYRINS

Sample requirements

Test Type of sample


Precautions Reference values & action limits

Turnaround time

Porphobilinogen (PBG)

Urine Plain Universal Container (20)

All samples for PBG analysis should be protected from light, eg by placing in a brown envelope

<10 µmol/L 1 week

Porphyrin (Urine) “ (Faeces) “ (Serum/plasma)++ “ (DNA)**

Urine Faeces Blood

Plain Universal Container (20) Plain Universal Container (10g) Purple/yellow top(5) Purple top (5)

All samples for porphyrin analysis should be protected from light, eg by placing in a brown envelope

<300 nmol/L 10-200 nmol/L dry wt Porphyrin peak normally undetectable.

10 days 10 days 2-6 weeks

Symbols abbreviations and notes

EDTA GEL Plain Universal Container

Purple top Yellow top No Preservative

Definitive Testing for Diagnosis of Type of Porphyria

** Samples sent to the Reference Laboratory in Cardiff

++ Samples currently sent to Photobiology Unit, Ninewwells Hospital, Dundee


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REQUEST INTERVENTION

Request intervention (RI) procedures have been set up for a number of tests to facilitate more appropriate testing and help reduce unnecessary repeat testing. Appropriate time intervals for repeat testing have been discussed with clinical colleagues before being introduced. Requests for repeat analyses for a limited set of tests are held for viewing by the Duty Biochemist and may be over-ridden if deemed appropriate. Comprehensive clinical details assist the Biochemist in this task. Note requests from relevant clinics/consultants will be exempted from RI and full details of clinic, location and consultant code should be provided on all requests

Analyte Request Intervention interval

HbA1C 60 days

Lipids 28 days

Protein electrophoresis 90 days

Prostate Specific Antigen (PSA) 21 days

Thyroid Function Tests (TFT) 30 days

Vitamin D 340 days


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REFERRAL LABORATORIES

Analyte Referral Laboratory Sample

5- Hydroxy Dihydrotestosterone Royal London Hospital, Whitechapel Road Serum

5-Hydroxy indole acetic acid Crosshouse Hospital, Ayr. 24 Hr Urine (Aliquot)

ACTH precursors Endocrine Sciences Research Group, University of Manchester.

Heparin

Alpha-1-antitrypsin phenotype Western General Hospital, Edinburgh. Serum/EDTA

Alpha subunits Selly Oak Hospital, Birmingham. Serum

Amino acids Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Heparin *

Ammonia Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Heparin *

Amiodarone Analytical Unit, St George’s Hospital Medical School, London SW17 0RE.

Serum (Plain tube)

Amitryptyline Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Arginine vasopressin (AVP) Royal Gwent Hospital, Newport Heparin

Beta-2-transferrin Walton Centre of Neurology, Liverpool. Serum/CSF

Bile acids Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ

Serum

Bupivacaine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum(Plain tube)

Catecholamine metabolites Crosshouse Hospital, Ayr. 24 h Acid Urine (10mL aliquot)

CA 15-3 Ninewells Hospital, Dundee. Serum

CA 19.9 Charing Cross Hospital, London. Serum

Cholinesterase phenotype/genotype

Southmead Hospital, Westbury-on-Trym Whole Blood EDTA (5mL)

CSF ACE Charing Cross Hospital, London. Contact Lab

Diuretic screen Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Urine (plain container)

Erythropoietin Ninewells Hospital, Dundee. Heparin

Faecal α1-antitrypsin Pru Immunology, St George’s Hospital, London. Faeces

Faecal elastase Western General Hospital, Edinburgh. Faeces

Fluoxetine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Gliclazide Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Glucose-6-phosphate dehydrogenase

Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Serum

Gut hormones Hammersmith Hospital, London. Heparin * (+trasylol)

Homocysteine Royal Hospital for Sick Children Plasma (Lithium Heparin or EDTA)

IGF2 Royal Surrey County Hospital, Guildford. Serum

Lamotrigine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Laxative confirmation City Hospital, Birmingham. Urine

LDH isoenzymes City Hospital, Nottingham. Serum/Plasma

Lipase Pathology Department, Royal Infirmary, Huddersfield. Serum

LSD University Hospital Aintree, Liverpool. Urine (plain container)

Macro CK Crosshouse Hospital, Ayr. Heparin

Metadrenalines (Plasma) Freeman Hospital, Newcastle EDTA *

Mycophenolic acid Analytical Unit, St George’s Hospital Medical School, London SW17 0RE.

Serum (Plain tube) or EDTA

NSAID Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Neurone specific enolase (NSE) Supra-regional Assay Service, Sheffield. Serum

Olanzapine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Oligoclonal bands Neuroimmunology, Southern General Hospital, Glasgow. CSF/Serum

Phencyclidine University Hospital Aintree, Liverpool. Urine (plain container)

Porphyrin classification University Hospital of Wales, Cardiff. Serum

Porphyrin (serum)

Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Serum


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Analyte Referral Laboratory Sample

PTH-RP Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich

EDTA + trasylol Collect on ice, separate and store frozen

Procollagen Type III Peptide (P3NP)

Manchester Royal Infirmary, Manchester. Serum (Red top tube- plain. SST tube also acceptable )

Quinine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube) Shield from light.

Sulphonylurea Royal Surrey County Hospital, Guildford. Serum/ Urine

Sulpiride Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Thiopurine methyltransferase Department of Biochemistry, Southern General Hospital, Glasgow

Whole blood

THRB Addenbrooke’s Hospital, Cambridge. EDTA

Topiramate Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Transthyretin St George’s Hospital, London. Serum

Tricyclic Antidepressants City Hospital, Birmingham Serum (Plain tube)

Urine citrate University College London Hospitals, London. 24 Hr Urine (Plain, aliquot)

Verapamil Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)

Xanthochromia Southern General Hospital, Glasgow. CSF

* Special sample treatment required


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USEFUL TELEPHONE NUMBERS

Name/Site Phone

Emergency Lab (GRI)........................................................................ 24487 Emergency Lab (WIG) ....................................................................... 52476 Reception (GGH) ................................................................................ 53347 Reception (GRI) .................................................................................. 24047 General Enquiries/Duty Biochemist................................................. 0141 211 (2) 4003/4

Endocrine Biochemist (GRI) ............................................................ 0141 211 (2) 4362

Glasgow SAS Centre for Cardiovascular Biomarkers (WIG).......... 0141 211 6373

Name Site Phone

Ms Dorothy Bedford ............ (WIG)...............52864

Mrs Christine Brownlie ....... (GRI) ...............25534

Ms Sheena Brownlie ........... (GRI) 24628/24629

Ms Donna Chantler ............. (GRI) ...............24784

Prof Muriel Caslake............. (WIG)...............52161

Dr Anthony Catchpole………(GRI)………….25178

Prof Marek Dominiczak....... (GGH)..............52788

Dr Andy Duncan.................. (GRI) ...............25178

Mrs Charlotte Syme ............ (GRI) ...............24317

Dr Janet Horner……………..(GRI)…………..24631

Mr Jim Irvine ....................... (GRI) ...............24637

Mrs Susan Johnston ........... (GRI) ...............24365

Mr Ian Louden..................... (GGH)..............52652

Dr Jennifer Logue…………..(Univ of Gla)….330 2569

Dr Caroline Millar…………..(GRI)…………...24390

Name Site Phone

Mrs Linda Mackinnon.......... (GRI) ...............24339

Prof Chris Packard.............. (WIG) 52872/51723

Dr Maurizio Panarelli........... (GRI)) ..............20830

Mr Ian Pattie........................ (GRI) ...............24494

Mrs Karen Rankin ............... (GRI) ...............24235

Prof Naveed Sattar ............ (Univ of Gla) ....330 3419

Prof Naveed Sattar .............Mobile 07971189415

Dr David Shapiro................. (GRI) ...............24635

Ms Karen Smith .................. (GRI) ...............24424

Dr Fiona Stefanowicz.......... (GRI) ...............25178

Dr Dinesh Talwar ................ (GRI) ...............24490

Mr Tom Walker ................... (GRI) ...............24339

Mrs Cathie Williamson ........ (GGH)..............53339

Dr Laura Willox……………..(GRI)…………...25178

If telephoning from out with NHSGGC, the main switchboard numbers are: Gartnavel General Hospital....... 0141 211 3000 Glasgow Royal Infirmary........... 0141 211 4000 Western Infirmary (WIG) ........... 0141 211 2000 For direct dialling to a hospital extension from out with the hospitals, replace the last four digits of the hospital number with the last four digits of the Extension you require (i.e., to contact General Enquiries at GRI, one would dial 0141 211 4003). Please note that some numbers may change.

• In case of doubt please contact the Reporting Office

• After 17:00hrs and at weekends call the Operator


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THINGS TO DO TO KEEP THE SERVICE EFFICIENT

Please remember the following: 1. Tell us who the patient is. Put labels on both the top and the bottom copy of the request form. If there are no labels, please write legibly the patient’s name, CHI No, date-of-birth and the ward. Please put the date and time of the collection on the form and the specimen bottle. Do not put more than one patient’s specimens into one primary specimen bag. 2. Tell us where you are. Write your name and the name or number of your ward so that we know where to send the report. Many results are not delivered because we do not know where to send them. 3. If you are using the phlebotomy service, fill the request form the night before blood collection but make sure that the date of collection is correct. Make sure that there is patient ID on each specimen bottle, that the bottles are not leaking and that they are placed in the polythene bag for transport. We will not analyse blood, which comes in an unmarked bottle. 4. Please send specimens to the laboratory as soon as possible.

5. If you are sending emergency samples notify the laboratory. This ensures priority handling. 6. On Saturdays, Sundays and Public Holidays you need to send samples early. They must reach us before 11am. 7. Use computer terminals to obtain results if at all possible. 8. Call the Duty Biochemist if you need advice.

This handbook is also available on the website at http://www.nhsggc.org.uk/biochemistry. To view the handbook click on the Users Handbook tab on the left. To view the Handbook on StaffNet: Type ‘Clinical Biochemistry Service’ into the Search box. This will take you to our homepage.

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