biochemistry laboratory users handbook - royal stoke … biochemist… · · 2016-12-02clinical...

Clinical Biochemistry Biochemistry Laboratory Handbook

Issue date: Nov 2016 Review Interval: Annual Revision 12

Author: Alexandra Yates Authorised by: Carole Draycott SOP BGP38

Biochemistry Laboratory Users Handbook

This document (BGP-38) is revision number 12, issued in November 2016 under the authority of

the Consultant Clinical Scientist.

Previous revisions are held by the biochemistry Quality manager.

This document may be reviewed and reissued automatically without notice. You should

regularly check the University Hospital of North Staffordshire website (www.uhnm.nhs.uk) to

ensure that you are using the most up to date revision.

All hard copies of this document should be considered uncontrolled.

Amendment History

Amendment

number

Date

Issued

Discarded

revision

Inserted

revision

Summary of changes Initials

Please see revision 9 for summary of

previous changes

10 Jan 2016 11 Document header updated for new trust name,

Information regarding County Hospital added

including new opening hours and emergency

samples procedure.

AY

11 Jan 2016 11 Contact details updated for RSUH and County

updated

AY

12 Jan 2016 11 Minimum volume and turnaround times updated AY

13 Jan 2016 11 Referral lab contacts updated AY

14 Jan 2016 11 Removal of clinical information on: biochemical

profiles, Troponin information, OGTT,BNP,

HbA1c, eGFR, Tumour markers, FOBs,

macroprolactin, Lipids

AY

15 Jan 2016 11 Blood specimen sampling problems updated-

info on Icteric and lipaemic samples added.

AY

16 Jan 2016 11 POCT and genetics information updated by CB

and CD

AY

17 Nov 2016 12 Faecal Calprotectin information added

Prealbumin removed

Re formated

AY




Department of Clinical Biochemistry

Laboratory Handbook

Table of Contents

Location ................................................................................................................................................ 3

Contact Information-RSUH .................................................................................................................. 3

Contact Information-County Hospital .................................................................................................. 4

Laboratory Service ............................................................................................................................... 6

Urgent Requests ................................................................................................................................... 6

Biochemistry Request Form ................................................................................................................. 7

Instructions for completing the request form .................................................................................. 7

Patient sample and request form identification policy .................................................................... 7

Protection of Personal information ..................................................................................................... 8

Add-on Requests .................................................................................................................................. 8

Minimum Re-testing Intervals ............................................................................................................. 8

Further Clinical information and Diagnostic Protocols ........................................................................ 9

Routine Sample Requirements .......................................................................................................... 10

24 hour urine collection procedure ................................................................................................... 15

Blood Specimen Sampling Problems ................................................................................................. 15

Analytical Methods ............................................................................................................................ 16

Referred Work Sample Requirements ............................................................................................... 17

Supra-Regional Assay Service ............................................................................................................ 19

Referral Laboratory Contact Information .......................................................................................... 20

Molecular Genetics ............................................................................................................................ 22

Research/Clinical Trials ...................................................................................................................... 23

Protocol for Toxicology Requesting ................................................................................................... 23

Out of hours management ................................................................................................................. 24

Reference Ranges ............................................................................................................................... 25

We hope you find this handbook useful. If you note any errors or omissions please do not hesitate to contact

the Duty Biochemist.




Location

The Department of Clinical Biochemistry is part of the Blood Sciences department and has

laboratories based on 2 sites; Royal Stoke University Hospital (RSUH) and County Hospital. In RSUH

the Pathology department can be found on the 2nd

floor(via Lift A) of the Main building.

The County Hospital Blood Sciences department is located on the 1st

floor of the Hospital

Contact Information-RSUH

Please dial 01782 6.. followed by extensions below

Head of Department and Consultant Clinical Biochemist Prof A. A. Fryer Ext. 74245

Lead Biomedical Scientist Mrs C. Draycott Ext. 74236

Point of Care Co-ordinator Mrs C Bromley Ext. 74258

Biochemistry Helpdesk 9am-5pm Ext 74224

Duty biochemist (RSUH) Ext. 74265, Bleep. 143

On-call Biomedical Scientist (RSUH) Bleep. 389

On-call Consultant Biochemist (Clinical enquiries-RSUH/County) 01782 715444




Contact Information-County Hospital

Please call switchboard to speak to automated operator

County Switchboard 01785 257731

Chemical Pathologist (County based) Dr Kevin Evans Ext 4747

Essential services Laboratory Manger Jane Connolly Ext 4761

Senior Biomedical Scientist/Point of Care Contact Mark Hawley Ext 4730

Biochemistry enquiries Line Ext. 4736/4732

Duty Biochemist (If unavailable please contact RSUH Duty Biochemist)

Ext. 4747

On-call Biomedical Scientist Bleep Ext. 4733

On-call Consultant Biochemist (Clinical enquiries-RSUH/County) Contact Switchboard

For advice regarding general Clinical Biochemistry, selection of tests and interpretation of data,

please contact the Duty Biochemist.

If there is a problem, or you are not satisfied with the service you have received:

In the first instance contact the department directly. Contact details are given above.

Otherwise contact:

Pathology Quality Manager

Mrs Katie Berger (01782) 674234

E-mail [email protected]

OR

Professional Head of Pathology

Mr David Frodsham (01782) 674227

E-mail [email protected]




Our endeavour is to be responsive to the changing needs of all users of our services. We welcome

comments on how we can improve the provision of these services. Please contact the department

if you have any queries.




Laboratory Service

RSUH Site 8:00 am – 8:00 pm Monday to Friday An Out of hours service is offered outside of these hours and on weekend/bank holidays. The

Biochemistry Laboratory is open 7 days a week 24 hours a day, however outside routine opening

hours samples should be sent only if they are required for URGENT diagnosis or monitoring

purposes.

Out of hours urgent results will be phoned to Staffordshire Doctors Urgent Care.

County Site 6:30 am-11:15 pm (7 days a week)

The County site provides an essential service laboratory for the ward and outpatient activity on

the County site. It has limited repertoire and all tests not performed by the County laboratory will

be transported to the RSUH laboratory or referred to external Laboratories in the case of

specialised test.

Urgent Requests

The facility exists for urgent requests to be made at any time.

The laboratory receives and processes approximately 6000 requests during a normal working day.

It performs approximately 25000 tests per day.

Please contact the laboratory BEFORE sending the samples if test results are urgent

Please do not mark as urgent unless the results are required for the immediate clinical

management of the patient as misuse of this service may delay analysis of genuinely urgent

samples.




Biochemistry Request Form

The majority of GP requests are now made electronically using the ICE system. Additional

information, such as dose and times for therapeutic drug monitoring, is essential for meaningful

interpretation of data. All requests (add-ons, urine and blood samples) need a card to be printed

and sent to the laboratory, the ICE IT system and the laboratory IT system are not linked.

Private tests can be requested by selecting the private option from the category drop down box,

found on the same page that the clinical details are entered.

Instructions for completing the request form

A request form must accompany all specimens to the laboratory. This should show clearly the

patient’s details including:

• Name

• Unit number/NHS number

• Age (date of birth preferred)

• Ward/GP name and number

• Type of specimen

• Date and time of sample collection

• Tests required

• All relevant clinical data

The Pathology Laboratory will not process requests when there is insufficient information for

unequivocal identification of the patient. Please follow the information given in the sample and

request form identification policy.

Patient sample and request form identification policy

Before accepting samples for analysis, staff must ensure that the minimum criteria for sample

identification are met.

Minimum requirements for sample and request form are:

1) Patients full name or coded identifier

(Casualty number for unknowns/registration number for GUM patients)

2) Date of birth and/or unit no./NHS no.




Samples and request forms failing to meet the minimum criteria will not be processed. In this case,

the laboratory will request repeat samples and forms. A record will be kept of these and reported

to the Clinical Risk Manager on a regular basis.

Protection of Personal information

The recommendations of the Caldicott Report (1997) and the subsequent Information Governance

Review (2013) have been adopted by the National Health Service as a whole. These

recommendations relate to the security of Patient Identifying Data (PID) and the uses to which

they are put. Please refer to the UHNM NHS Trust policy No. IT07 Trust Policy for Information

Security Management for further details.

Add-on Requests

Please do not ring the laboratory to request add-on tests. Instead please send a new request card,

electronic or handwritten, stating that the sample has already been sent previously. Please state

on the card any clinical details to support the add-on request. The previous sample must have

been sent within the preceding 24 hours. Please also check that the previous Biochemistry sample

type is correct for the requested add-on.

For urgent add-ons – please contact Duty biochemist.

Minimum Re-testing Intervals

The following table details the minimum time interval between subsequent measurements. Please

do not send in requests for tests more frequently than documented in this table as they will not be

analysed. Before requesting any tests please check to ensure the test has not been recently

requested. Unnecessary duplicate requesting is a waste of resources. If re-testing to confirm

previous abnormal results or due to a change in clinical picture e.g. repeat of test when patient

clinically well, please indicate on request card to avoid inappropriate rejection of requests.

Testing Minimum retesting interval

Thyroid function testing 6 weeks

Lipids 1 month

HbA1c 2 months

Ferritin/Iron Studies 1 month

CEA 21 days

Ca19.9 21 days

Ca125 21 days

Ca15.3 21 days




PTH 3 months (unless on Cinacalcet)

Vitamin B12 3 months

Folate 3 months

Protein Electrophoresis 6 months

CRP 1 day (except paediatrics)

PSA 21 days

SFLC 1 month

Vitamin D 3 months

Further Clinical information and Diagnostic Protocols

For further information on specific tests please contact the Duty Biochemist or see the Pathology

pages on the trust intranet. ( www.uhnm.nhs.uk).

Located on the GP’s section of the trust website under information referral and advice section.

GP pathology information please click the link if required.

These pages are regularly updated with information on new tests and guidance.




Routine Sample Requirements

Request Sample

Type

Minimum

Amount

(ml)

Remarks

Turnaround

time

(non-

urgent

Max. TAT)

Adrenocorticotropic hormone

(ACTH) EDTA 2 2 weeks

Alanine transaminase (ALT) G or C 1 24 hours

Albumin G or C 1 24 hours

Alcohol Fl. Ox. 2 Bottle must be

completely full 24 hours

Alkaline Phosphatase G or C 1 24 hours

α fetoprotein (Maternal) G or C 1 1 week

α fetoprotein (Oncology) G or C 1 24 hours

α-1-Antitrypsin levels G or C 1 2 days

Ammonia H 1 On ice - contact lab 24 hours

Amylase, serum G or C 1 24 hours

Angiotensin Converting Enzyme

(ACE)

G or C 1 1 week

Aspartate transaminase (AST) G or C 1 24 hours

Vitamin B12 G or C 1 24 hours

B2 Microglobulin C 2 2 days

B-type Natriuretic Peptide (BNP) EDTA 1

Dedicated

Biochemistry

sample required

(cannot share with

Haematology)

24 hours

Bence-Jones Protein

Plain 24hr

urine

or MSU

5 2 weeks

Human chorionic gonadotropin

(β-HCG)

G or C 1 24 hours

Bicarbonate G or C 1 24 hours

Bile Acids C 1 Fasting 1 week

Bilirubin G or C 1 24 hours

Ca125 G or C 2 24 hours

Ca19.9 G or C 2 24 hours

Ca15.3 G or C 2 24 hours

Caeruloplasmin G or C 1 2 days

Calcium, serum G or C 1 24 hours




Request Sample

Type

Minimum

Amount

(ml)

Remarks

Turnaround

time

(non-

urgent

Max. TAT)

Calcium, urine Plain 24 hr

urine - 24 hours

Carbamazepine G or C 1 Pre-dose 24 hours

Carbon Monoxide

(Carboxyhaemoglobin) H 5

Fill bottle to rim

Transport urgently 24 hours

Catecholamines - ?

Phaeochromocytoma

Acidified 24

hr urine -

Diet sheet. Contact

Lab. 2 weeks

Paediatric Catecholamines –

? Neuroblastoma Plain MSU - 4 weeks

Carcinoembryonic Antigen (CEA) G or C 2 24 hours

Chloride H or G 1 24 hours

Cholesterol G or C 1 24 hours

Copper C 1 1 week

Cortisol, serum G or C 1

Please send pre

and post short

synacthen test

samples together

24 hours

Cortisol, urinary free Plain 24 hr

urine - 1 month

Creatine Kinase (CK/CPK) G or C 1 24 hours

Creatinine, serum/plasma G or C /H* 1 24 hours

CRP (C-Reactive Protein) G or C 1 24 hours

Cryoglobulins C and EDTA 5+5

Must be put into

37°C flask

IMMEDIATELY.

Flask from

Haematology

3 days

Ciclosporin EDTA 1 Pre-dose 4 days

Dehydroepiandosterone Sulphate

(DHEAS) G or C 2 2 weeks

Digoxin G or C 1 Minimum 6 hrs

post dose 24 hours

Erythropoietin G or C 2 1 week

Faecal Calprotectin Spot faeces 3 weeks

Faecal Elastase Spot faeces 3 weeks

Ferritin G or C 1 24 hours

Folate G or C 2 24 hours

FSH (Follicle stimulating

hormone)

G or C 1 24 hours




Request Sample

Type

Minimum

Amount

(ml)

Remarks

Turnaround

time

(non-

urgent

Max. TAT)

Gases (Capillary) H/Capill.x2 - Contact Lab 24 hours

Gases (Arterial) H/Syringe 2 On ice -

Contact Lab 24 hours

Gamma Glutamyl transferase

(γGT) G or C 1 24 hours

Glucose, plasma Fl. Ox. 1 24 hours

Glucose, CSF Fl. Ox. 0.5 24 hours

Growth Hormone (GH) G or C 2 2 weeks

Haptoglobin G or C 1 24 hours

HbA1C (Glycosylated Hb.) EDTA 1 24 hours

HDL Cholesterol G or C 1 24 hours

Hydroxyindole acetic acid (HIAA) Acidified

24hr Urine 10

Diet Sheet.

Contact Lab. 1 week

IGF-1 C 2 2 weeks

Immunoglobulins (IgG, IgA, IGM) G or C 1 24 hours

Inorganic Phosphate G or C 1 24 hours

Iron G or C 1 24 hours

Lactate, CSF Fl. Ox. 0.5 24 hours

Lactate, plasma Fl. Ox. 1

Within 2 hrs of

venepuncture-

Contact Lab

24 hours

Lactate dehydrogenase (LDH) G or C 1 24 hours

Luteinising hormone (LH) G or C 1 24 hours

Lipids G or C 1 24 hours

Lithium G or C 1 12 hours post

evening dose 24 hours

Magnesium G or C 1 24 hours

Methaemoglobin H Full tube 24 hours

Myoglobin Plain MSU 5 24 hours

Oestradiol G or C 2 24 hours

Osmolality, blood G or C or H 1 24 hours

Osmolality, urine Plain MSU 1 24 hours

Oxalate, urine Plain 24 hr

urine - 1 week

Paracetamol G or C 1 24 hours

Phenobarbitone G or C

1 Sample can be

taken any time 24 hours

Phenytoin G or C

1 Sample can be

taken any time 24 hours




Request Sample

Type

Minimum

Amount

(ml)

Remarks

Turnaround

time

(non-

urgent

Max. TAT)

Phosphate, urine Plain 24 hr

urine - 24 hours

Potassium, serum/plasma G or C /H* 1

Ref range

dependent on

sample type

24 hours

Potassium, urine

Plain 24 hr

urine or

MSU

- 24 hours

Prealbumin G or C 2 24 hours

Progesterone G or C 2 Write day of cycle

on card 24 hours

Prolactin G or C 2 24 hours

Protein (Total), serum G or C 1 24 hours

Protein, CSF Plain CSF 0.5 24 hours

Protein, urine Plain 24 hr

urine - 24 hours

Protein electrophoresis G or C 1 24 hours

Prostate Specific Antigen (PSA) G or C 1 24 hours

Parathyroid Hormone (PTH) EDTA 2 Bottle must be

completely full 2 weeks

Salicylates G or C 1

Analysis only

performed if

request card

indicates patient

has taken a toxic

overdose and/or is

displaying signs of

salicylate poisoning

24 hours

Sex Hormone Binding Globulin

(SHBG) G or C 2 2 weeks

Sodium, serum/plasma G or C /H* 1 24 hours

Sodium, urine

Plain 24 hr

urine or

MSU

- 24 hours

Tacrolimus EDTA 1 Pre-dose 4 days

Testosterone G or C 1 24 hours

Theophylline G or C

1 Pre-dose or 3 hours

post dose 24 hours




Request Sample

Type

Minimum

Amount

(ml)

Remarks

Turnaround

time

(non-

urgent

Max. TAT)

Thyroglobulin (including antibody

analysis) ONCOLOGY ONLY C 2 1 week

Thyroid function tests (TFTs) G or C 2 State if on

treatment 24 hours

Transferrin G or C 1 24 hours

Transferrin Saturation G or C 1 24 hours

Triglycerides G or C 1 12 hour fast 24 hours

Troponin I G or C 1 24 hours

Urea, serum/plasma G or C /H* 1 24 hours

Urea, urine

Plain 24 hr

urine or

MSU

- 24 hours

Uric Acid, serum G or C 1 24 hours

Uric Acid, urine Plain 24 hr

urine - 24 hours

Valproate, Sodium G or C 1 Contact Lab 24 hours

Vitamin D G or C 1 2 weeks

Zinc C 1 1 week

NB: In most cases, requests for multiple tests on the same sample type require only one bottle of

the required type to be taken. Key

Italics Only available at RSUH

G gel clotted gold top C clotted red top

H heparinised green top Fl.Ox fluoride oxalate grey top

EDTA EDTA purple top MSU Mid-stream urine white top universal

* IMPORTANT INFORMATION REGARDING: Sample Type for Urea and electrolytes.

Two sample types are appropriate for U&E, serum (gold/red Top) and lithium heparin plasma

(green top). In most cases serum samples are the most suitable as these allow for most other

routine biochemistry tests to be measured on the same sample.

Lithium heparin plasma samples should only be used if a previous potassium result is suspected to

be falsely raised due the patient having a high concentration of platelets or white cells. Lithium

heparin samples can also be sent on renal patients to ensure the integrity of the sample.

If a lithium heparin sample is sent it is essential that a serum sample is also sent for any further

biochemistry tests.

Please note when using electronic requesting portals it is essential that only serum UE or plasma

UE is requested, requesting both will result in two sets of results and two charged tests.

If you have any queries regarding choice of tubes please contact the Blood Science Helpdesk

before venepuncture.




24 hour urine collection procedure

Bottles are available from the Clinical Biochemistry Department with instructions attached.

1) Patients must first empty bladder and discard the urine. This time must be recorded.

2) For the next 24 hours all urine passed must be collected into the urine container.

3) At the end of the 24 hour period the patient must again empty their bladder, this time

collecting the urine. No more urine is to be added to the container once the 24 hour collection

period is over.

If the container becomes full before completion of the collection, continue collecting into a second

container and send both to the laboratory. If any specimen of urine is accidentally discarded

during the collection discontinue the collection and start again. This allows an accurately timed

complete urine collection. This is vital for correct calculation of the results. If collecting on a ward,

it may be convenient to have a routine time for starting all collections.

Please ensure that the urine bottles are fully labelled with patient identifiers and a request card

for the test is sent with the sample

Containers containing acid preservative for catecholamine or HIAA analyses are also available

from Biochemistry.

For advice on other tests that may be available but are not listed please contact the Biochemistry

Help Desk (ext. 74224) or the Duty Biochemist.

Blood Specimen Sampling Problems

There are a number of non-pathological factors that may influence levels of specific analytes giving

falsely elevated or reduced levels.

Delay

Overnight storage or delayed transport:

Increase in: potassium, magnesium, inorganic phosphate, AST, LDH.

Decrease in: glucose, occasionally sodium.

Please note that refrigeration of samples may result in falsely elevated potassium levels.

Haemolysis

Expulsion of blood via needle, over-vigorous mixing of sample, storage in deep freeze, sample

left in hot place:

Increase in: potassium, magnesium, inorganic phosphate, AST, LDH.

Decrease in: glucose, occasionally sodium.




Icteric

Due to high concentration of Bilirubin >275umol/L

Decrease in: Creatinine (interpret results with caution)

Suspected to effect bone and liver analytes

Lipaemia

Due to high concentration of triglycerides in the sample.

Decrease in Sodium and glucose

As lipeamia increase more analytes are affected and will not be reported.

Other sample problems which may affect analyte levels

(Contact Duty Biochemist, bleep 143, for details)

• Prolonged venous stasis

• Vigorous exercise

• Certain drug treatments

• Radio-dyes/injections

• Sunlight on samples

• Drip contamination

• Patient not fasted

**Please note Fasted is defined as nothing but water to eat of drink for 10hrs previous to test-

it is recommened patient blood is taken before 12noon.**

Measurement of uncertainty

All biochemical results are subject to a degree of uncertainty of measurement. This may be

due to a range of factors, including:

• Biological variation within individuals

• Analytical measurement imprecision

• Pre-analytical factors

If you require more information regarding the effects of these factors on the outcome of an

individual test result please contact the Duty Biochemist .

Analytical Methods

Since August 2015 laboratories on both sites have used the same manufacturers machines

(Siemens, UK) this should allow for the confident of transfer of result between sites and the use of

the same reference ranges.

Should you require information regarding the principles of analytical methods currently in use in

Clinical Biochemistry, please contact the Duty Biochemist.




Referred Work Sample Requirements

A number of tests are available at other specialised laboratories. For these tests please allow a

turnaround time between 14 and 28 days. For advice on other tests that may be available but

are not listed please contact the Biochemistry Help Desk ext. 74224.

Please note prior discussion with the Duty biochemist is suggested before ordering these tests.

Please provide clinical details (including medication) as these tests may require additional

information prior to processing and for accurate interpretation.

For referral laboratory contact details use the codes next to the desired test and refer to the

referral laboratory information that follows the tables.

Request Sample

type

Minimum

amount

Remarks Turn-

around-

Time

Referral

Lab code

17-

Hydroxyprogesterone C or G 1 2 weeks BM3

7-Dehydrocholesterol H 2 4 weeks BM3

Acyl Carnitine H 1 4 weeks BM3

Alpha Galctosidase A EDTA 1 4 weeks

Alpha Glucosidase EDTA 1 4 weeks CF64

Amino Acids, blood H 2

Please send

urine sample

also 4 weeks LN10

Amino Acids, urine Plain MSU 5

Please send

blood

sample also 4 weeks BM1

Androstenedione C 2 weeks BM3

Biotinidase H 1 4 weeks BM3

Cadmium, blood EDTA 1 2 weeks BM3

Cadmium, urine Plain MSU 5 2 weeks BM3

Copper, urine Plain 24hr 2 weeks BM3

C-Peptide C 2 4-6 weeks CF64

Drugs of Abuse

screen, urine Plain MSU 5

Contact

bleep 143

before taking

sample. 2 weeks BM1

Erythrocyte

protoporphyrin EDTA 2

KEEP IN

DARK 4 weeks BM1

Free Carnitine H 1 4 weeks BM1

Free Fatty Acids Fl.Ox 1 4 weeks BM1

Gabapentin EDTA 2 4 weeks BM1

H 2 Contact 2 weeks BM1




Galactose-1-

Phosphate

bleep 143

before taking

sample.

Request Sample

type

Minimum

amount

Remarks Turn-

around-

Time

Referral

Lab code

Gut hormone screen EDTA 3

Contact

bleep 143

before taking

sample. 6 weeks BM1

Homocystine (for

Homocystinuria

patients only) H 2 4 weeks BM1

IGF-BP3 C 4-6 weeks BM1

Lamotrigine C 2 2 weeks BM1

Laxative Screen,

urine Plain MSU 5 2 weeks BM1

Lead EDTA 1 2 weeks BM1

Mercury, blood EDTA 2 4 weeks BM1

Mercury, urine Plain MSU 5 4 weeks BM1

Mucopolysaccharides Plain MSU 5 4 weeks BM1

Oligosaccharides Plain MSU 5 4 weeks BM1

Organic Acids Plain MSU 5 4 weeks CF1

Plasma

Metanepharines EDTA 2 2 weeks CF1

Porphyrin Screen –

Analysed in house Plain MSU 5

KEEP IN

DARK 24 hours CF1

Porphyrin, faeces Spot Faeces

KEEP IN

DARK 4 weeks CF1

Porphyrin, urine Plain MSU 5

KEEP IN

DARK 4 weeks CF1

Porphyrins, blood EDTA 2

KEEP IN

DARK 4 weeks BM1

Procollagen III

peptide C 2 4 weeks BM1

Renin EDTA 2 4weeks BM4

Toxicology Screen,

urine

Plain MSU 5 Contact

bleep 143

before taking

sample.

2 weeks BM3

TPMT EDTA 5 2 weeks BM7

Urine 5HIAA Acid 24hr 2 weeks BM4

Urine Cortisol Plain 24hr 2 weeks BM4

Very long chain fatty

acids

H 1 4 weeks BM5

Vigabatrin EDTA 2 6 weeks CF64

Request Sample

type

Minimum

amount

Remarks Turn-

around-Time

Referral Lab

code




Vitamin A&E C or H 2 weeks BM7

White Cell Cystine H 5 Contact

bleep 143

before taking

sample.

4 weeks SD1

Request Sample

type

Minimum

amount

Remarks Turn-

around-

Time

Referral

Lab code

White Cell Cystine H 5 4 weeks MR1

White Cell Enzymes EDTA 5 Contact

bleep 143

before taking

sample.

6 weeks BM4

White Cell Enzymes EDTA 5 6 weeks BM1

β-hydroxybutyrate Fl. Ox 1 4 weeks BM1

Key

G gel clotted gold top C clotted red top

H heparinised green top Fl.Ox fluoride oxalate grey top

EDTA EDTA purple top MSU Mid stream urine white top universal

Supra-Regional Assay Service

Certain analyses not listed are undertaken by regional specialist laboratories. Please contact the

Help Desk or the Duty Biochemist for information relating to such investigations.




Referral Laboratory Contact Information

Referral Laboratory

Code Referral Laboratory Address Telephone Number

BM1 Birmingham Children’s

Clinical Chemistry Department

Paediatric Laboratory Medicine Block

Birmingham Children’s Hospital NHS Trust

Whittall Street

Birmingham

B4 6NH

0121 333 9942




BM3 Birmingham Toxicology

Regional Toxicology Laboratory

City Hospital

Dudley Road

Birmingham

B18 7QH

0121 507 5353

BM4 Regional Endocrinology

Regional Endocrinology Labs

Clinical Biochemistry Department

Selly Oak Hospital

Raddlebarn Road

Selly Oak

Birmingham, B29 6JD

0121 627 2000

BM5 Birmingham Heart of

England NHS Trust

Clinical Chemistry Department

Heartlands Hospital

Bordesley Green East

Birmingham

B9 5SS

0121 424 2000 ext 3198

BM7 Birmingham City

Vitamin Laboratory

Clinical Biochemistry Department

City Hospital

Dudley Road

Birmingham

B18 7QH

0121 554 3801 ext. 5348

CF1 Cardiff Porphyria Service

Medical Biochemistry Department

University Hospital of Wales

Heath Park

Cardiff

CF4 4XW

02920 743565

CF64 Cardiff Toxicology

Toxicology Laboratory

The Academic Centre

Llandough Hospital

Penarth

Vale of Glamorgan

CF64 2XX

0292 071 6894

GD1 Guildford Hormone Centre

Guildford SAS Hormone Centre

Clinical Laboratory

Royal Surrey County Hospital

Guildford

Surrey

GU2 5XX

01483 464121

LN10 Charing Cross Hospital

SAS Reception

Clinical Biochemistry and Medical

Oncology

Charing Cross Hospital

Fulham Palace Road

0208 383 3381

MR1 Royal Manchester

Children’s Hospital

Clinical Biochemistry

Oxford Road

Manchester

M13 9WL

0161 701 2137




Molecular Genetics

The Molecular Diagnostics section is based at the Clinical Biochemistry Department RSUHand

currently provides genetic testing for:

• thrombophilia risk factors (Factor V Leiden and prothrombin c.20210G>A variants)

• alpha-1-antitrypsin deficiency (Z and S mutations)

• genetic haemochromatosis (C282Y and H63D variants)

• HLA-B27

• cytochrome P450 CYP2D6*4 genotype

Enquiries

General enquiries and interpretation advice should be addressed to Dr Chris Duff on ext. 74252.

Note: A range of other genetic analyses are available from other laboratories. Contact the

laboratory before sending sample(s). For specialist molecular tests, please use the dedicated

molecular genetics request form (available on Trust intranet) and ensure that all fields have been

completed, clearly indicating that the patient has given consent for the testing to be carried out. It

should also be noted that invoices for such specialised tests will be forwarded to the requestor.

Sample Requirements/Considerations

1x 5mL EDTA blood is required for most investigations.

• Requests will generally not be processed unless full relevant clinical details are provided on

the request form.

• For genetic analysis of factor V deficiency: the analysis will not be performed without a

prior thrombophilia screen (Haematology Dept. test). Exceptions to this are if the patient is

already taking an anticoagulant or has a family history of factor V deficiency.

• For genetic analysis of haemochromatosis: the analysis will not be performed without prior

transferrin saturation and ferritin measurement, or unless there is a clear family history of

genetic haemochromatosis.

• For genetic analysis of alpha-1-antitrypsin deficiency: the analysis will not be performed

unless serum alpha-1-antitrypsin (AAT) levels have been measured. Genotyping will only

normally be performed on those with an abnormally low serum AAT result, or on those

with a clear family history.




• For genetic analysis of cytochrome P450 CYP2D6*4 genotype: please give a full current

drug history.

• Where requests are on patients with a family history, the genotype of and relationship

with family member should be provided with the request.

• The laboratory must be informed of any limitations to consent.

NOTE: Inappropriate requests for genetic tests may be rejected by the laboratory. Please

provide as much relevant clinical details as possible to reduce the chance of rejection. Rejected

samples will be stored in the laboratory for two months.

Turnaround Time

For detection of a known mutation e.g. alpha-1-antitrypsin and haemochromatosis genotyping,

thrombophilia genetic risk factors, HLA B27 and CYP2D6*4 there is a 3 week turnaround time.

Research/Clinical Trials

The department actively supports clinical research projects. It has an on-going research and

development programme and has facilities to undertake molecular biological and cell culture

techniques. Clinicians wishing to initiate research projects are invited to contact the Consultant

Clinical Biochemist or Consultant Chemical Pathologist.

For general enquiries regarding clinical trials please email [email protected].

Participation in clinical trials requiring clinical biochemistry analysis should be discussed Dr Chris

Duff ext 74252,prior to commencement. For queries regarding on-going trials contact Libby

Williamson (bleep 15101).

Protocol for Toxicology Requesting

Toxicology analysis is rarely indicated in the majority of patients presenting with symptoms of

poisoning. Within the Biochemistry Department of the University Hospital of North Midlands we

offer paracetamol, salicylate and alcohol analysis but refer most other analyses to the West

Midlands Toxicology laboratory for analysis (http://www.toxlab.co.uk/). The toxicology laboratory

can be contacted directly on 0121 507 4135/4. As a result of this we have to tightly monitor our

referrals to ensure an efficient service. In order to facilitate this we have drafted the following

protocol:

Requesting




• Toxicology requests will only be processed on a case-by-case basis following direct

contact between the Consultant Clinician and the Duty Biochemist.

• Investigations should only be requested if they are to aid diagnosis or directly influence

the management of the patient.

• If the request is accepted the following information must also be provided:

History of the patient

Signs and symptoms of poisoning

Specify what drugs are suspected to have been taken - this will direct the analysis

carried out

Medication given since admission

Date and time of ingestion in relation to hospital admission

Name and bleep/pager number of requesting consultant

Any medico-legal issues

• Cases where there is a suspicion of drink spiking should be referred to the police and will

not be processed by the laboratory unless the result will directly affect clinical

management. The urine must be collected within 12-24 hours of the suspected incident as

drugs such as Gamma-hydroxybutyrate (GHB), also known as the date rape drug, are

undetectable in the urine 12-24 hours following administration/ingestion.

Out of hours management

• For on-call management contact TOXBASE on 0844 892 0111 or the West Midlands

Toxicology laboratory directly on 0121 507 4135/4 to determine best practice.

• Our laboratory cannot provide a service for sending specimens out of hours and should

any samples require urgent analysis, the wards are responsible for the sending of

specimens.

• Please inform the laboratory of any discussions and specimens sent.




Reference Ranges

It should be noted that results outside the reference range do not necessarily indicate disease.

Similarly, results within the reference range do not preclude abnormality. The Duty Biochemist is

available for discussion of individual patient results.

From time to time, methods are subject to change in the course of improving our service,

sometimes with resulting changes in reference ranges. Consequently, it is important to check

current ranges if this is in doubt.

For paediatric reference ranges please refer to table below.

Reference ranges for blood/serum/plasma

Test Age/Sex Subsets Range

α-1-Antitrypsin Adult (> 15 years) 0.864 - 1.92 g/L

γGT Females (and males <16 yrs)

Males >16 yrs

0 - 35 U/L

0 - 50 U/L

β-HCG (Pregnancy)

(Gestational Age)

0-1 week

1-2 weeks

2-3 weeks

3-4 weeks

1-2 months

2-3 months

2nd Trimester

3rd Trimester

0-50 mIU/mL

40-300 mIU/mL

100-1,000 mIU/mL

500-6,000 mIU/mL

5,000-200,000 mIU/mL

10,000-100,000 mIU/mL

3,000-50,000 mIU/mL

1,000-50,000 mIU/mL

ACE 18 - 55 IU/L

Albumin 35 - 50 g/L

Alkaline Phosphatase Adult 30-130 U/L

Alanine transaminase (ALT) 0-40 U/L

Ammonia Adults (>16 yrs) <40 umol/L

Amylase, Serum 15-90 U/L

Arterial Gases

pCO2

pO2

pH (Arterial)

(Venous)

4.8-6.0 kPa

10.0-13.5 kPa

7.35-7.45

7.35-7.42

AST Adult <40 U/L

B12 200-900 pg/mL

Bicarbonate Adult (> 16 yrs) 24 - 32 mmol/L

Bile acids Fasting

Random

<6 umol/L

<14 umol/L





Bilirubin, Total Adult <21 µmol/L

Bilirubin, Conjugated 0-7 µmol/L

Caeruloplasmin 0.2-0.42g/L

Calcium Adult (>16 yrs) 2.2 - 2.6 mmol/L

Carbon Monoxide Non-Smokers

Smokers

<1.5%

<6.5%

Chloride 95-108 mmol/L

Cholesterol Adult (>16 yrs) 3.5 - 5.0 mmol/L

Copper, Blood 13 - 24 µmol/L

Cortisol, Serum 0900 hrs

2400 hrs

200 - 600 nmol/L

<160 nmol/L

Creatine Kinase (CK) Female

Male

15 - 165 U/L

15 - 185 U/L

Creatinine 16 - 50 yrs

>50 yrs

55 - 108 µmol/L

60 - 125 µmol/L

CRP (Wide range) <5 mg/L

DHEAS Females

Males

0.9 - 11.6 µmol/L

2.2 - 15.2 µmol/L

Ferritin Females

Males

10 - 300 ng/mL

20 - 300 ng/mL

Folate 3-12 ng/mL

FSH

Female

Male

Follicular

Ovulatory

Luteal

Post-Menopausal

1 - 11 IU/L

6 - 26 IU/L

1 - 11 IU/L

30 - 118 IU/L

1 - 8 IU/L

Free T3 2.1 - 6.0 pmol/L

Free T4 8 - 19 pmol/L

Free T4 (On Thyroxine) Target Range 13 - 22 pmol/L

GH Fasting, Resting, Unstressed Contact Laboratory

Glucose, plasma Fasting

Random

3.5 - 6.0 mmol/L

3.5 - 9.0 mmol/L

Haptoglobin 0.16 - 2.0 g/L

HbA1c Normal (Non-Diabetic) <48 mmol/mol

HDL Females

Males

1.0 - 2.1 mmol/L

0.9 - 2.0 mmol/L

IGF-1

16-20 yrs

21-30 yrs

31-45 yrs

>45 yrs

25 - 64 nmol/L

14 - 48 nmol/L

13 - 37 nmol/L

8.0 - 32 nmol/L

Immunoglobulin A Adult (>14 yrs) 0.71 -3.79 g/L





Immunoglobulin G Adult (> 13 yrs) 6.21- 17.02 g/L

Immunoglobulin M Males (> 13 yrs)

Females (> 13 yrs)

0.41- 2.18 g/L

0.41 -2.02 g/L

Inorganic Phosphate Adult (>16 yrs) 0.8 - 1.5 mmol/L

Iron Female

Male

10-25 µmol/L

13-32 µmol/L

Lactate, Fasting plasma All ages 0.6 - 2.5 mmol/L

LDH 115 - 235 U/L

LDL Cholesterol 1.5 - 4.0 mmol/L

LH

Female

Male

Follicular

Ovulatory

Luteal

Post-Menopausal

1 - 12 IU/L

16 - 104 IU/L

1 - 12 IU/L

16 - 66 IU/L

1 - 8 IU/L

Magnesium, Serum 0.7 - 1.0 mmol/L

Oestradiol

Female – Follicular

Ovulatory

Luteal

Male

Up to 220 pmol/L

430 - 1400 pmol/L

93 - 606 pmol/L

Up to 206 pmol/L

Osmolality, Serum 285-295 mmol/Kg

Oxalate Female (> 14 yrs)

Males (> 14 yrs)

0.04 - 0.32 mmol/24hr

0.08 - 0.49 mmol/24hr

Potassium, Plasma 3.6 - 5.0 mmol/L

Potassium, Serum 3.5 - 5.3 mmol/L

Progesterone Female - Follicular

Luteal

2 - 8 nmol/L

16 - 60 nmol/L

Prolactin

Female <50 yrs

Female Post-Menopausal

Male

80 - 420mu/L

30 - 280mu/L

60 -380mu/L

PTH <7.6 pmol/L

SHBG Female

Male

18 - 114 nmol/L

13 - 71 nmol/L

Sodium All ages 133 - 146 mmol/L

Testosterone Female

Male

1 - 3.5 nmol/L

11 - 40 nmol/L

Total Protein, Serum 62 - 80 g/L

Transferrin 1.68 - 3.36 g/L

Triglyceride 0.8 - 1.8 mmol/L

Troponin I Contact Laboratory

TSH 0.3 - 5.0 mU/L

Urea Adults 2.5 – 7.8 mmol/L





Uric Acid Female (> 16 yrs)

Male (> 16 yrs)

170 - 420 µmol/L

230 - 480 µmol/L

Vitamin D > 50 nmol/L

Zinc 8 - 23 µmol/L

Reference ranges for blood/serum/plasma drugs


Carbamazepine Target Range 4 - 12 mg/L

Ciclosporin Range not available

Digoxin Target Range 0.5 - 2.0 µg/L

Lithium Target Range (12 Hours Post

Evening Dose) 0.4 - 1.0 mmol/L

Phenobarbitone Target Range 10 - 40 mg/L

Phenytoin Target Range 5 - 20 mg/L

Salicylate Associated with Toxicity >300 mg/L

Tacrolimus Range not available

Theophylline Target Range, Adult

Neonatal

10.0 - 20.0 mg/L

5.0 - 10.0 mg/L

Reference ranges for urine


Calcium, urine 2.5 -7.5 mmol/24hr

Cortisol, urine <220 nmol/24hr

Creatinine Clearance Females

Males

75 - 115 ml/min

85 - 125 ml/min

Creatinine, urine Females

Males

8-13 mmol/24hr

10-18 mmol/24hr

Magnesium, urine 2.4 – 6.5 mmol/24hr

Osmolality, urine Contact lab

Phosphate, urine 15 - 50 mmol/24hr

Potassium, urine 35 - 90 mmol/24hr

Protein, urine <0.1g/L

Approx. <0.3g/24hr

Sodium, urine 30 - 230 mmol/24hr

Urea, urine 150 - 600 mmol/24hr

Uric Acid, urine 1.5 – 4.5 mmol/24hr




Reference ranges for CSF/sweat/faeces


Chloride, Sweat Test 4-60 mmol/L

Faecal Elastase >200 ug/g stool

Glucose, CSF Approximately 60% Of

Plasma Value.

Lactate, CSF 1.2 - 2.1 mmol/L

Sodium, Sweat Test 10-80 mmol/L

Total Protein, CSF <0.8 g/L

Paediatric Reference Ranges.


α – 1 antitrypsin At 20 Days 0.48 – 0.625 g/L < 1 year 0.72 – 1.68 g/L 1 – 2 years 0.912 – 1.825 g/L 2 – 4 years 0.79 – 1.78 g/L 5 – 7 years 0.72 – 1.87 g/L 8 – 10 years 0.82 – 1.825 g/L 11 – 15 years 0.864 – 1.68 g/L > 15 years 0.864 – 1.92 g/L

γ-glutamyl transferase

Females 0 – 35 U/L Males < 16 years 0 – 35 U/L > 16 years 0 – 50 U/L

Alkaline Phosphatase

0 – 1 month 70 – 380 U/L 1 month – 16 years 60 – 425 U/L

Ammonia Pre-term/Sick neonate < 150 µmol/L Term neonate < 100 µmol/L 1 month - 16 years < 50 µmol/L

AST 1 – 5 days < 90 U/L 6 – 14 days < 75 U/L 14 days – 1 year < 60 U/L 1 – 3 years 15 – 45 U/L

Bicarbonate < 16 years 20 – 28 mmol/L Bile acids Fasting < 6 umol/L

Random < 14 umol/L Bilirubin, Total < 10 days < 200 µmol/L

10 days-1 month < 40 umol/L > 1 month 0 – 21 µmol/L

Bilirubin, 0 – 12 µmol/L





Conjugated Caeruloplasmin Females 0.16 – 0.45 g/L Males 0.15 – 0.30 g/L Cholesterol < 16 years 3.0 - 5.0 mmol/L

> 16 years 3.5 - 5.0 mmol/L Copper, Blood

13 - 24 µmol/L

Cortisol, Serum 09:00 200 - 600 nmol/L Creatine Kinase (CK)

Females 15 - 165 U/L Males 15 - 185 U/L

Creatinine Males

0 – 14 days 27 – 81 µmol/L 15 days – 1 year 14 – 34 µmol/L 1 – 3 years 15 – 31 µmol/L

3 – 5 years 23 – 37 µmol/L 5 – 7 years 25 – 42 µmol/L 7 – 9 years 30 – 48 µmol/L 9 – 11 years 28 – 57 µmol/L 11 – 12 years 36 – 64 µmol/L 12 – 13 years 36 – 67 µmol/L 13 – 14 years 38 – 76 µmol/L 14 – 15 years 40 – 83 µmol/L 15 – 16 years 47 – 99 µmol/L 16 years 54 – 99 µmol/L Females 0 – 14 days 27 – 81 µmol/L 15 days – 1 year 14 – 34 µmol/L 1 – 3 years 15 – 31 µmol/L 3 – 5 years 23 – 37 µmol/L 5 – 7 years 25 – 42 µmol/L 7 – 9 years 30 – 48 µmol/L 9 – 11 years 28 – 57 µmol/L 11 – 12 years 36 – 64 µmol/L 12 – 13 years 36 – 67 µmol/L 13 – 14 years 38 – 74 µmol/L 14 – 15 years 43 – 75 µmol/L 15 – 16 years 44 – 79 µmol/L 16 years 48 – 81 µmol/L Digoxin Target Range 0.5 - 2.0 µg/L





Ferritin Females 10 - 300 ng/mL

Males 20 - 300 ng/mL FSH Child < 10yr < 3 IU/L

Females 1 - 11 IU/L Males 1 - 8 IU/L

GH Fasting, Resting, Unstressed Contact Laboratory Glucose, plasma Fasting 3.0 – 6.0 mmol/L

Random: 0 – 1 month 2.5 – 5.0 mmol/L > 1 month 3.5 - 9.0 mmol/L

IGF-1 < 2 years 2.6 - 17 nmol/L 2 - 3 years 4.1 - 26 nmol/L 4 - 6 years 8.2 - 28 nmol/L 7 - 9 years Females 13 - 33 nmol/L Males 6.2 - 33 nmol/L 10 – 12 years Females 15 - 70 nmol/L Males 7.8 - 70 nmol/L 13 – 15 years Females 29 - 90 nmol/L Males 19 - 90 nmol/L 16 – 20 years 25 - 64 nmol/L

Immunoglobulin A 0 – 1 months 0.00 – 0.06 g/L 1 – 2 months 0.03 – 0.14 g/L 2 – 3 months 0.06 – 0.37 g/L 3 – 4 months 0.09 – 0.48 g/L 4 – 5 months 0.10 – 0.57 g/L 5 – 6 months 0.10 – 0.60 g/L 6 – 7 months 0.11 – 0.64 g/L 7 – 8 months 0.11 – 0.71 g/L 8 – 9 months 0.13 – 0.72 g/L 9 – 10 months 0.13 – 0.80 g/L 10 – 11 months 0.14 – 0.84 g/L 11 – 12 months 0.16 – 0.91 g/L 1 – 2 years 0.17 – 1.05 g/L 2 – 3 years 0.23 – 1.12 g/L 3 – 4 years 0.27 – 1.58 g/L 4 – 5 years 0.31 – 1.93 g/L 5 – 6 years 0.40 – 2.19 g/L 6 – 7 years 0.44 – 2.46 g/L 7 – 8 years 0.47 – 2.63 g/L 8 – 9 years 0.51 – 2.81 g/L





9 – 10 years 0.57 – 2.98 g/L 10 – 11 years 0.62 – 3.17 g/L 11 – 12 years 0.67 – 3.34 g/L 12 – 13 years 0.67 – 3.51 g/L 13 – 14 years 0.67 – 3.68 g/L Immunoglobulin G 0 – 1 months 6.21 – 17.02 g/L

1 – 2 months 3.87 – 10.08 g/L 2 – 3 months 2.27 – 7.34 g/L 3 – 4 months 2.34 – 6.21 g/L 4 – 5 months 2.18 – 5.81 g/L 5 – 6 months 2.34 – 6.21 g/L 6 – 7 months 2.58 – 6.77 g/L 7 – 8 months 2.74 – 7.34 g/L 8 – 9 months 2.90 – 7.74 g/L 9 – 10 months 3.23 – 8.71 g/L 10 – 11 months 3.47 – 9.27 g/L 11 – 12 months 3.63 – 9.68 g/L 1 – 2 years 3.87 – 10.08 g/L 2 – 3 years 4.68 – 12.42 g/L 3 – 4 years 5.00 – 13.14 g/L 4 – 5 years 5.40 – 14.35 g/L 5 – 6 years 5.40 – 14.68 g/L 6 – 7 years 5.81 – 15.48 g/L 7 – 8 years 6.05 – 16.29 g/L 8 – 13 years 6.21 – 16.29 g/L

Immunoglobulin M Males 0 – 1 months 0.00 – 0.25 g/L 1 – 2 months 0.12 – 0.48 g/L 2 – 3 months 0.18 – 0.73 g/L 3 – 4 months 0.20 – 0.81 g/L 4 – 5 months 0.23 – 0.92 g/L 5 – 6 months 0.25 – 0.97 g/L 6 – 7 months 0.25 – 1.01 g/L 7 – 8 months 0.26 – 1.05 g/L 8 – 9 months 0.28 – 1.13 g/L 9 – 10 months 0.28 – 1.10 g/L 10 – 11 months 0.29 – 1.17 g/L 11 – 12 months 0.30 – 1.21 g/L 1 – 2 years 0.30 – 1.21 g/L





2 – 3 years 0.31 – 1.25 g/L 3 – 4 years 0.34 – 1.33 g/L 4 – 5 years 0.36 – 1.41 g/L 5 – 6 years 0.37 – 1.51 g/L 6 – 7 years 0.38 – 1.53 g/L 7 – 8 years 0.39 – 1.54 g/L 8 – 9 years 0.41 – 1.57 g/L 9 – 10 years 0.41 – 1.61 g/L 10 – 11 years 0.41 – 1.61 g/L 11 – 12 years 0.41 – 1.70 g/L 12 – 13 years 0.41 – 2.18 g/L

Females 0 – 1mnth 0.00 – 0.25 g/L 1 – 2 months 0.14 – 0.57 g/L 2 – 3 months 0.19 – 0.76 g/L 3 – 4 months 0.23 – 0.92 g/L 4 – 5 months 0.25 – 1.01 g/L 5 – 6 months 0.26 – 1.05 g/L 6 – 7 months 0.28 – 1.13 g/L 7 – 8 months 0.30 – 1.21 g/L 8 – 9 months 0.31 – 1.25 g/L 9 – 10 months 0.32 – 1.29 g/L 10 – 11 months 0.32 – 1.29 g/L 11 – 12 months 0.34 – 1.37 g/L 1 – 2 years 0.34 – 1.38 g/L 2 – 3 years 0.38 – 1.53 g/L 3 – 4 years 0.41 – 1.61 g/L 4 – 5 years 0.41 – 1.77 g/L 5 – 6 years 0.41 – 1.86 g/L 6 – 7 years 0.41 – 1.89 g/L 7 – 8 years 0.41 – 1.93 g/L 8 – 9 years 0.41 – 1.93 g/L 9 – 10 years 0.41 – 1.97 g/L 10 – 11 years 0.41 – 2.00 g/L 11 – 12 years 0.41 – 2.02 g/L 12 – 13 years 0.41 – 2.02 g/L

Inorganic Phosphate

< 1 month 1.30 – 2.60 mmol/L 1 month – 1 year 1.30 – 2.40 mmol/L





1 – 16 years 0.90 – 1.80 mmol/L

Lactate 0.60 – 2.55 mmol/L LH Child < 10yr < 6 IU/L

Lithium Target Range 0.4 – 1.0 mmol/L (12 Hours Post Evening

Dose) Oxalate

Children (Under 14yrs) 0.14 – 0.42 mmol/24hr

Urea 0 – 1 month 0.8 – 5.5 mmol/L 1 month – 1 year 1.0 – 5.5 mmol/L 1 – 16 years 2.6 – 6.7 mmol/L

Uric Acid < 16 years 170 – 240 µmol/L For advice on other reference ranges for tests that have been analysed but are not listed please

contact the Duty Biochemist (bleep 143).

biochemistry laboratory users handbook - royal stoke … biochemist… · · 2016-12-02clinical...

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