clinical chemistry and toxicology laboratory … · title: clinical chemistry laboratory handbook...
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NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 1 of 68
NORTHUMBRIA HEALTHCARE FOUNDATION
NHS TRUST
9585
Department of Clinical Chemistry
CLINICAL CHEMISTRY AND TOXICOLOGY LABORATORY HANDBOOK
This SOP supersedes all previous versions
REFERENCE & VERSION No. LH-CCH-GEN-G-001 Version 21
REPLACES DOCUMENT No. LH-CCH-GEN-G-001 Version 20
LOCATION OF COPIES
1. Q Pulse
2. Northumbria Healthcare NHS Trust Intranet
3. Northumbria Healthcare NHS Trust Internet
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 2 of 68
Clinical Chemistry and Toxicology Department
Overview The Clinical Chemistry and Toxicology Department is part of the Pathology Service at Northumbria Healthcare NHS Foundation Trust. Analytical Laboratory services are provided at three Trust locations for Clinical Chem-istry; The Northumbria Specialist emergency care Hospital, North Tyneside and Wansbeck Hospitals. Toxicology services are centralised at Wansbeck Hospital. The department also refers specialised tests by arrangement to relevant reference centres. Our aim is to provide an accessible and comprehensive diagnostic support service to both hospital and primary care clinicians. The Clinical Chemistry department is committed to providing a quality service and as such is accredited by the United Kingdom Accreditation Service (UKAS) to ISO 15189 standards. This is the national accreditation body for the UK ensuring laboratories meet the required national standard for Medical laboratories necessary for quality and competence. The department was awarded UKAS accreditation on the 27th April 2018. As part of the on-going requirement to maintain compliance with ISO 15189 standards UKAS will undertake annual surveillance visits with a full inspection every 4 years. Not all tests in the laboratory repertoire fall under the scope of accreditation therefore it is recommended that the UKAS website is checked for an up to date list of all tests covered. https://www.ukas.com/wp-content/uploads/schedule_uploads/00007/9585%20Medical%20Multiple.pdf In addition to analytical services, the Department provides an electronic result reporting service to General Practices, in accordance with National Pathology Messaging Guidelines.
When the department or referral laboratory changes a test or procedures it may result in that test having to be taken out of scope until UKAS have undertaken an assessment of the test. (Although a test is out of scope, please be assured that the test has been verified to ISO15189 standards). In the event that this does occur the laboratory will highlight that the test is not currently within scope and therefore not accredited by indicating this on the report where possible or highlighted within this manual in the test repertoire section.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 3 of 68
PROTECTION OF PERSONAL INFORMATION Northumbria health care Foundation Trust takes the security of personal information very seriously. Everyone working for the NHS has a legal duty to keep information about patients confidential. Patients’ health information is protected through a number of measures; all Trust staff are required to: a. Record patient information accurately and consistently b. Keep patient information private c. Keep patient information physically secure d. Disclose and use information with appropriate care Any breaches of security or incidents relating to Information Governance are investigated, actioned and reported via the Trust’s Governance Structure. In order to support our staff in ensuring personal information is kept securely the Trust have a number of policies which set out the requirements staff must fulfil when accessing or sharing personal information. Furthermore, all staff receive Information Governance Training which includes topics such as information security, confidentiality and data protection.
The Clinical Chemistry and Toxicology department work to all Trust policies regarding the protection of personal information. These policies are available on the trust intranet under Data Governance and Information Governance. These policies can be viewed via the trusts intranet page through Enyware.
Compliments, Concerns and Complaints Clinical Chemistry and Toxicology aims to provide a high quality of service to patients and users. We realise that there may be times when we do not always get things right. On these occasions we welcome your feedback as this helps us to improve the services we provide. If you have any problems with any aspect of the Clinical Chemistry or Toxicology Ser-vices, please tell us by contacting a member of senior Pathology staff team (refer to contacts list on page 5 and 6). The trust has a Complaints Policy and Procedure for raising Concerns Policy (RMP14). Concerns and complaints can be raised verbally or in writing with the Pathology Quality manager, departmental manager or via the Patients Services/PALS. The department encourages users to raise any concerns to ensure the continued provision of the highest quality service possible. We endeavour to resolve any issues raised as quickly as possible. The contact details for patient services and PALS is shown below;
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 4 of 68
Patient services Northumbria Healthcare NHS Foundation Trust Freepost PATIENT SERVICES Tel: 0191 203 1340 Email: [email protected]
PALS
Patient Advice & Liaison Service (PALS) Freepost RLTC-SCHH-EGXJ North of Tyne PALS The Old Stables Grey’s Yard Morpeth Northumberland NE61 1QD Tel: 0800 032 0202 Text: 01670 511 098 Email: [email protected]
Clinical Advice Dr Stewart Pattman, Dr Nigel Brown (Toxicology), Dr Roy Talbot and Elizabeth Robinson are available to provide advice on appropriate investigations and interpretation of results. Out of normal working hours the on call biochemist may be contacted via the hospital switchboard for advice over urgent matters. The quality of the service is continuously monitored by internal quality control procedures and participation in National External Quality Assessment Schemes for the range of analytes provided. In additional the department regularly participates in clinical audit.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 5 of 68
*International Carriage of Dangerous Goods by Road (ADR)
Flow of responsibilities
Step 1. The requesting clinician ensures
The correct patient
At the correct time
Requesting the ap-propriate analysis
Documents the patients cir-cumstances appropriate to the
analysis e.g Fasting
Step 2. The phlebotomist, nurse or clinician collecting the specimen checks and ensures ( for example us-ing the patient wrist band double checked against the request form and specimen label)
The correct patient and correct time
The analysis
requested
The correct specimen
taken
Correct and complete labelling
Safe handling and
waste disposal
Step 3. The ward, theatre, department or surgery ensures
Safe handling & infection control
Secure and appropri-ate storage
Timely onward transfer by the most appro-priate means depending on urgency
Step 4. The person undertaking the logistics stage (Transport, Courier)
Reasonable scheduling for transit
Safe handling
Secure and appropriate carriage, to health and
safety regulations
Meeting ADR * regulations on transport
of dangerous goods 2009
Timely transfer to laboratory
Step 5. The laboratory checks and ensures
The correct patient
The correct Specimen received
The correct result / advice given
Step 6 . The responsible clinician checks and ensures
Receipt of the result /advice
The correct patient
The correct therapeutic action
The validity of the patient record
Correct result released / returned
to requestor
Patient consent
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 6 of 68
Useful Telephone numbers
Specimen reception:
Hexham 01434 655942 Internal ext 35942
Wansbeck 01670 529743 Internal ext 33743
North Tyneside 0191 293 2764 Internal ext 32764
The Northumbria 0191 607 2244 Internal ext 72244/ 72245/72246
RESULT ENQUIRIES
Wansbeck 01670 529711 / 13 Internal ext 33711/13 Wansbeck (Toxicology) 01670 529714 Internal ext 33714 North Tyneside 0191 293 2592 / 2373 Internal ext 32592 / 32373 (Including all GP enquires) The Northumbria 01916072237 Internal Ext 72237 /72238 SENIOR STAFF
Consultant Chemical Pathologist / Head of Department Dr. Stewart Pattman. BSc. MBChB (Edinburgh), MCRP, FRCPath Telephone NTGH 0191 2932546 (EXT 32376) Mobile 07785728264 [email protected]
Consultant Clinical Biochemist Dr Roy Talbot, BSc, MSc, PhD, FRCPath Telephone NSECH 0191 6072235 (Ext 72235) WGH 01670 592710 (Ext 33710)
NTGH via switch board Internal Ext 32375 / 32376 [email protected]
Clinical Scientist Elizabeth Robinson. BSc, MSc Telephone WGH 01670 592710 (Ext 33710) NTGH via switch board Internal Ext 32376 NSECH 0191 6072235 (Ext 72235) [email protected]
BMS 4, Clinical Chemistry Trust wide Mr.David Dodds, BSc, MSc, FIBMS, CSci Telephone) WGH 01670 5923678 (Ext 33678) NTGH 01912934014 (Ext 34014) NSECH 0191 6072235 int ext 72235 / 72236) [email protected]
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 7 of 68
BMS 3, Wansbeck Ms Susan Carey, BSc, FIBMS, DLM Telephone WGH 01670 592678 Ext 33678 [email protected]
BMS 3, Clinical Chemistry NTGH /HGH Mrs Elizabeth Purvis, BSc, MSc, NVQ5 Diploma in Management, FIBMS, CSci Telephone NTGH 01912934014 (Ext 34014) NSECH 0191 6072235 (int ext 72235 / 72236) [email protected]
Point of Care Coordinator Mrs Gemma Gowland, BSc, MSc, LIBMS Telephone WGH 01670 529387 (ext 33387) NSECH 0191 6072235 (int ext 72235 / 72236) NTGH Internal ext 32375 Mobile 07824607210 [email protected]
Secretary to Consultants Telephone Direct line 0191 293 2546
Toxicology Laboratory Phone: 01670 529714 (internal extension 33714) e-mail: [email protected]. This has a secure link to the following e-mail systems:@gcsx.gov.uk, @pnn.police.uk, @cjsn.net. However the link to nhct.nhs.uk e-mails is NOT secure. Consultant Clinical Scientist (Toxicology) Dr Nigel Brown BSc, MSc, PhD, FIBMS, FRCPath, MRSC Telephone 01670 5293714 (Ext 33714), work mobile 07554 555052 [email protected], [email protected] (Dr Nigel Brown is currently chair of the Toxicology Specialist Advisory Panel for the Royal College of Pathologists) Senior Biomedical Scientist (Toxicology) Leanne Boxshall BSc MSc Telephone 01670 529714 [email protected]
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 8 of 68
LABORATORY OPENING HOURS The Northumbria specialist emergency care Hospital The department is open 24/7 for the receipt and handling of specimens for Clinical Chemistry and includes ethylene glycol analysis as part of Toxicology. North Tyneside Open for the receipt and handling of specimens from 08:30 to 18:00 for Inpatient and until 22:00 for GP work, Monday to Friday. During these periods we assay most of the routinely available tests every day. Outside these hours i.e. between 18:00 and 08:30, Monday to Friday and all day at weekends Point of care equipment is available for the analysis of tests that are deemed too urgent to transfer to the Northumbria site for processing. Wansbeck The laboratory is open for receipt of samples between the hours of 08:30 and 18:00 Monday to Friday for receipt and processing work. Outside these of hours i.e. between 18:00 and 08:30, Monday to Friday and, all day at weekends Point of care equipment is available for the analysis of tests that are deemed too urgent to transfer to the Northumbria site for processing. Toxicology - The laboratory at Wansbeck Hospital is open between 08:30 and 17:00 Monday to Friday for the receipt of routine samples. For urgent drug screens this can be extended to 18:00 subject to staff availability. The laboratory at the Northumbria Hospital is open 24/7 but urgent ethylene glycol / methanol requests should only be sent to this laboratory after discussion with the Toxicologist or Duty Biochemist. The laboratory holds a Home Office Licence to Possess controlled drugs, so is able to receive and store samples of suspected illicit drugs for analysis. Hexham The laboratory is open for receipt of samples Monday to Friday between the hours of 08:30 and 17:00. A range of urgent requests are available via point of care equip-ment on this site, otherwise samples are transferred off site for analysis.
REQUEST FORMS AND SPECIMEN CONTAINERS Wherever possible we would ask that you give full clinical and drug therapy details – this helps us process your request accurately and efficiently as well as allowing us to add additional tests to facilitate patient management .The information helps us to deal with abnormal results which may need urgent transmission e.g. out-of-hours. Full information is given on the specimen requirements for the common Biochemistry assays on the Vacutainer Tube Guide distributed to each ward and practice. The Sunquest ICE ordering system is in use with in Northumbria Trust. This system will provide information on specimen tubes required based on the tests requested, on the generated request form.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 9 of 68
The majority of toxicology requests are not made using ICE as service users are gen-erally outside Northumbria Healthcare. A form providing the required information (see Sample Labelling Requirements below) must be provided with every specimen. For chain of custody urine toxicology analysis special tubes and forms are available from the laboratory. For drug substance analysis please discuss requirements with the laboratory BE-FORE sending the sample.
BLOOD AND BODY FLUID SPILLAGES PROCEDURE Staff dealing with spillages must have received training in this procedure and must protect themselves by wearing gloves and a plastic apron. The effective management of blood and body fluid spillage is a crucial factor in the successful control of infection. Exposure to any such fluid presents a risk to the health of all persons involved. However, these risks are easily minimised by following the principles of standard precautions, in addition to maintaining a routine approach to simple cleaning and disinfection procedures. It is of course essential that all blood and body fluid spillages are cleaned and disinfected as soon as is practicable. Refer to the procedures in your location for dealing with spillages and breakages or seek advice from a senior member of staff in your area. If necessary contact the Laboratory for advice on any aspect of dealing with spillages and breakages of pathology specimens. The Clinical Chemistry department uses the Clinell spill wipes for dealing with spillages of blood and body fluids. For directions on use see the reverse of the packet.
High Risk specimens High‐risk groups can include patients suffering from, or thought to be suffering from TB, E coli 0157 and other notifiable diseases. Patient history of recent foreign travel with unexplained high pyrexia should also be treated as high risk. Request forms and samples MUST be labelled with "Danger of Infection" labels, placed in a Bio‐hazard bag and transported to the laboratory with care. To protect all healthcare workers, requests for investigations on high risk samples should be the minimum required for diagnosis and good patient management. Great care must be taken when obtaining specimens, and equipment such as needles and blades must be immediately disposed of safely, in approved sharps boxes. Should a spillage of blood, fluids or tissue occur, this should be made safe and disposed of appropriately.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 10 of 68
All toxicology samples are treated as being High Risk. If the Client or the Deceased is known to be in a high risk category please affix warning labels to the samples and specimen bag.
Specimen Ordering on ICE/Electronic Requesting Guidance for Use There are comprehensive manuals built into ICE, available to all users.
Contact Names for ICE For pathology Trust wide: Please email [email protected] or phone the Application Management | Computer Services Tel: 0191 203 1327 Or Contact Computer services help desk on ext 31311
REPORT TURNAROUND TIME The majority of the commonly requested non-urgent Clinical Chemistry tests will have results available within 4 hours. See individual test details for further information. Toxicology Basic drug screens will be turned round within 4 days, with urgent screens possible within 2 – 3 hours depending on analyser availability only if the request is discussed with the department. More complex screens may take 1 – 2 weeks with interim results available from the department. Results are available on WebICE as well as printed reports. Ethylene glycol results will be available within 24 hours of receipt. Methanol results will be available as soon as possible depending on clinical need and staff availability. Post mortem requests will be turned round within 15 working days. If delays are antic-ipated, for example due to the need to order a drug compound, the Coroner and Pathologist will be informed. Analyses required with a fast turnaround time should be discussed with the department.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 11 of 68
Test Code 90% Target TAT from Receipt to Reporting in Hrs
Amphetamines con-firm
UAMCON 96
Drug confirmations
UFCOMC 192
Full target drug screen
UFCOMT 96
Opiate confirms
UOPCON 96
Other abused drugs
APD 96
Urine Alcohol
UALC 72
Urine Buprenor-phine
UBUP 96
Urine Drug Screen UDAP, OUDA
72
Urine EDDP confirm
UEDCON 96
Ethylene Glycol GLYE 24
GC Alcohol GCALC 48
Employment screen UEMPE 96
Urine Barbiturates UBARB 192
ADD ON TESTS
Additional tests on blood samples will only be performed on receipt of an add-on test request form which can be created using the ‘Biochemistry Add On’ test option in ICE. The request form can then be sent to the department. Retrieval of samples already in the laboratory to add on additional requests may take some time, particularly if the sample is still being processed for the tests originally requested. They can therefore not be processed as urgent tests. If the further tests are urgent, please send a new request. Samples are stored for 5 to 7 days after analysis. The decision to perform add on tests will depend on the delay in receiving the request and the stability of the analyte concerned. You will be advised if the sample is too old or unsuitable for the test you are requesting. If there is insufficient sample remaining for your additional request, this will be reported in the same way that a result would be (by paper report and
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 12 of 68
electronically) – the person taking your call will not know at the time that there is insufficient sample. Toxicology All drug screening samples are held in the laboratory for 3 months for additional anal-yses if required. We do not require formal paper requests for additional analyses, but would require (for example) a confirmatory e-mail from Social Services. Samples from HM Coroner are held until no longer required or for around 6 months after the analyses are completed.
URGENT AND PLEASE PHONE RESULTS URGENT requests MUST be accompanied by a telephoned request from the clinician indicating the degree of urgency and the form marked as Urgent, unless there are agreed alternative arrangements in place e.g. Red Pouches in A/E
Assays available under the Urgent System are: Blood Alcohol Ammonia Amylase Blood Gases and Carboxy Hb BHCG Calcium/Albumin Carbamazepine Creatine Kinase Digoxin Ethylene glycol (ONLY after discussion with Toxicology or Duty Biochemist) Glucose Lactate Lithium Liver function tests Magnesium Methanol (ONLY after discussion with Toxicology or Duty Biochemist) Osmolality Paracetamol Salicylate Theophylline Troponin T Urate U/E, Bicarbonate and Chloride
CSF Glucose Protein Xanthochromia (Spectophotometry) Lactate
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 13 of 68
Urine Albumin/Creatinine ratio Osmolality Porphyrin screen Protein/Creatinine ratio (pregnancy) U/E
Test profiles
1. U & E A routine U&E consists of Na, K, Urea and Creatinine. Chloride and Bicarbonate are added to urgent requests or if specifically requested. 2. Liver Function Tests. This routinely consists of Bilirubin, Alkaline Phosphatase, ALT, Total Protein, Albumin and calculated Globulins. AST and GGT are available on request. Conjugated bilirubin is available if specifically requested but will only be done if the total bilirubin is raised. An abnormal globulin level together with appropriate clinical details may in addition be subjected to a paraprotein screen if not previously done. 3. Thyroid Function Tests. A cascade system is used where TSH is measured initially. If raised then Free Thyroxine (fT4) is also measured. If the TSH is low then fT4 and fT3 are also measured. If hypopituitarism is suspected than fT4 should be specifically requested. Please indicate on the request form if the patient is on thyroid replacement, on therapy for hyperthyroidism or has been treated for thyroid cancer.
Useful clinical information ‐ Common causes of spurious results Please ensure that you follow instructions when collecting and storing samples. Inappropriate sample collection, storage and transport can interfere with a number of results. Some examples are given in the table below:
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 14 of 68
Problem Common causes Effect
Inappropriate collection site
Sample taken from drip arm
Increased drip analyte e.g. K , Glucose, albumin and total protein Dilution effect low results
Prior use of Ametop anal-gesic gel
Increased Na.
Incorrect container or anticoagulant
No fluoride oxalate
Decreased glucose
NA+ Fluoride / K+ Oxalate contamination
Increased NA and K. Decreased CA and en-zymes including LDH , ALP and Amylase.
K+ E.D.T.A. contamination Decreased Ca and Alk P Increased K
Li sample collected into Li Heparin
Increased Li
Sodium citrate contamina-tion
Increased serum sodium and normal osmolality
Incorrect tube fill/mixing ALL analytes may be compromised
Delay in separation of serum/plasma
overnight storage delay in transit
Increased K, PO4, LDH Decreased bicarbonate
Labile analytes Not immediately separated and frozen
Decreased ACTH, Insulin, C Peptide and Gastrin
Storage Biochemistry samples in a fridge
Increased K
Haemolysis Expelling blood through a needle into the tube Vigorous shaking Extremes of temperature
Increased K, PO4, ALT, LDH, Mg, Iron
Urine drug screen issues A number of ‘methods’ may be used by clients to adulterate urine samples which is most likely to af-fect the initial immunoas-say based screens.
If this is suspected, please discuss with the service.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 15 of 68
Specimen and request form minimum requirements. Samples should be sent to the laboratory fully labelled in a safe manner. Samples should be in a separate transport bag with the completed request form attached. Samples can only be accepted for routine processing if there is no leakage, correct labelling, accompanying request form and appropriate container used. Rejection of samples will depend on: - Ability to obtain a repeat sample e.g. Lumbar puncture for CSF analysis. The health risk to staff Ability to correctly identify the patient To ensure samples and form can be uniquely linked to a patient and historical data, the minimum labelling for the form and sample is as follows: -
Specimen Labelling Requirements To comply with Trust Policies and the Safer Practice Notice NPSA/2009/SPN002, the NHS number must be given on all correspondence etc.
All specimens must be labelled with; First Name and Surname Date of birth NHS or Trust number and should have the following included Date and time of specimen taken Location
All request forms must give; NHS number Full patient name Trust Number (for hospital patients only) Date of birth and include with the following information Location of request Identity of the person collecting the primary sample. Date and time of specimen taken Requesting Doctor/Practitioner and Consultant/GP All appropriate Clinical Information relevant to tests requested
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 16 of 68
To assist with handling of abnormal results out of hours, all GP request forms should give the patient’s address and a contact telephone number.
If the NHS number is not available, the reason should be written on the request form and specimens will be analysed as usual if otherwise compliant with above policy. If the patient identification details need to be handwritten, then allowance will be made for the difficulties of writing the details on a specimen, but those on the request form must be clear and legible.
Otherwise, unlabelled or inadequately labelled specimens will not be processed except in exceptional circumstances after discussion with the appropriate Consultant Pathologist. All requests/specimens failing the above criteria will be subject to IR1 reporting.
If you require any further advice please contact either Dr Stewart Pattman, Consultant Chemical Pathologist (0191 2932546 or ext 32376) Toxicology specimen acceptance criteria is the same as required by the Clinical Chemistry department. However full patient details may not be known at the time of collection, or the sample may be unrepeatable (for example a neonatal drug screen or a set of post mortem samples). Therefore we are willing to accept a degree of flexibility on the labelling require-ments. The report will highlight any issues with sample labelling. We DO NOT accept urine drug screens from adults that are unlabelled or where there is a clear discrepancy between the details on the tube and request form. All samples will be reported as unsuitable for analysis but held for 3 months. Drug substances sent for analysis should be labelled in an appropriate manner, ideally in an evidence bag.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 17 of 68
TELEPHONING OF RESULTS
The values used are based on guidance from the Royal College of Pathologists doc-ument G158 ‘The communication of critical and unexpected pathology results’
Updated Northumbria Healthcare Clinical Chemistry Lab Telephone Criteria IP/OP/GPs (Re-
porting lab units apply)
Analyte lower limit Upper limit Comments
Sodium ≤120 if
<16yrs ≤130 >155 unless consistent with previously reported results and improving
Potassium ≤2.5 ≥6.5 will report to clinician if a Stage 1,2 or 3 AKI alert has been addi-tionally reported on the sample.
Urea ≥30 or ≥10 if
<16years unless consistent with previously reported results and improving
Creatinine ≥354
or ≥200 if <16years
If consistent with previously reported results and improving does not need to be telephoned. Note if sample has an AKI alert on the set refer to the telephoning process for AKI alerts.
Corrected Calci-um
<1.8 ≥3.5
Urate >700 Only in females <50years in order to identify those in whom this may be part of a pre-eclampsia screen.
Glucose ≤2.5 ≥25 ≥15if 16years
Magnesium ≤0.4 >2.0
Phosphate ≤0.3
Ketone >3
Carbamazepine >25
Digoxin >2.5
Theophylline >25
Phenytoin >25
Lithium ≥1.5
Phenobarb >50
Valproate >150
AST or ALT >600
CK ≥5000
Amylase >300
Troponin T >14 GPs only Primary care samples only
CO2 <12
Lactate >3.9
CRP ≥300 GPs only Primary care samples only
Paracetamol All detected
Salicylate All detected
CSF Xantho-chromia
All detected
Bile Acid >14 If requestor not available phone NSECH Pregnancy Assessment 08.30-20.00. After 20.00 phone NSECH Ward 16
Triglyceride >20 only if new patient with high triglycerides
ammonia ≥100
cortisol <100* If not known/on steroids/part of Dexamethasone suppression test.
AKI 1 Stage 1 only if Potassium ≥6.0
AKI 2
Stage 2 ALL GP samples, only phone for Inpatient locations if new alert/creatinine value rising
AKI 3
Stage 3 ALL GP samples, only phone for Inpatient locations if new alert/creatinine value rising
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 18 of 68
Note that if results from outpatient locations reported out of hours require telephone communication, the appropriate on call team will be contacted. Results from primary care reported after a practice has closed will be reported to the out of hours GP service. For further information please contact the laboratory on the number below, or the Du-ty Biochemist via the Northumbria Hospital Switchboard.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 19 of 68
Tumour Markers – indications for measurement Marker Organ General
Screening Diagnosis Prognostic
Indicator Monitoring Treatment Other causes of raised levels
PSA Prostate No Supportive Yes Yes Benign Prostatic Hypertrophy, Prostatitis, Retention, Catheterisation,
Biopsy, pressure or manipulation of prostate.
AFP Liver In high risk groups e.g.
cirrhosis
Yes Yes Yes Conditions ass’d with hepatic necrosis & regeneration
AFP and Beta-hCG
Germ cell tumours
No Yes No Yes AFP – Chronic Liver disease Beta HCG–Pregnancy, other malignancies
CA125 Ovarian No Supportive with scanning if pelvic mass
or ovarian cyst present. Follow NICE
Guidance
Yes Yes Other malignancies (GI, lung, breast), ascites of any cause, endometriosis, pelvic inflammatory disease, chronic liver disease, uterine
fibroids, pregnancy.
CA15-3 Breast No No Yes Yes Liver disease, Benign & malignant disease of lung, GI & reproductive system
CA19-9 Pancreas (upper GI)
No
Supportive with scanning if pancreatic mass or cyst
present
Yes Yes Extra-hepatic biliary obstruction, chronic liver disease, acute & chronic pancreatitis, other tumours (ovary, GI)
CEA GI Tract (colorectal)
No No Yes Yes Chronic liver disease, Inflammatory bowel disease, other malignancies
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 20 of 68
Toxicology and Drugs of Abuse service Northumbria Healthcare has a specialist toxicology section which is able to provide a wide range of analyses. Drugs of abuse. Screening is provided on a routine basis and is available on random urine in a white capped universal. This screen is designed for clinical purposes. If performing a screen for employment purposes, or specifically as required by Social Services or a court order the sample should be collected under chain of custody conditions. Sample packs are available from the Toxicology service. Screening uses a variety of techniques. The initial screen comprises of immunoassay screens for broad classes of drugs namely Amphetamines, Benzodiazepines, Cannabinoids, Cocaine, EDDP (Methadone metabolite), and Opiates. These screens have varying degrees of specificity, therefore all amphetamine and opiate screens are confirmed using liquid chromatography – tandem mass spectrometry (LC-MS/MS). Creatinine is routinely measured as a check for sample adulteration. A wide range of drugs can be screened for using LC-MS/MS with a good number of these not yet included in our scope of accreditation. In addition it is possible to detect a much wider range of drugs (and metabolites) using liquid chromatography quadrupole time of flight mass spectrometry (LC-Q-ToF), this includes new drugs currently unknown to the toxicology community in the UK. Notes on the immunoassay screens:
• The amphetamine screen is prone to false positives: The screen will detect trazodone and ecstasy, but may not detect a number of stimulant drugs such as mephedrone.
• The benzodiazepine screen detects most known benzodiazepines and will also give a positive result with sertraline and nefopam
• The cannabinoid screen detects the main THC metabolite THC-COOH.
• The cocaine and EDDP screens are generally specific for the drugs in question.
• The opiate screen does not detect tramadol, any of the fentanyls or buprenorphine. Low levels of oxycodone may not also be detected.
• Like the instant POTs the results are presumptive. Do not make significant clinical or legal decisions based on the results without discussion with the laboratory and appropriate confirmatory analyses.
Suspected poisoning. Toxicological investigations are available for a range of possible compounds which may have been ingested deliberately or accidentally. In the case of ethylene glycol or methanol a blood sample should be collected into a fluoride oxalate tube (as for blood glucose) and contact the lab to discuss during working hours or the Duty Biochemist via Switchboard out of hours. Where the
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 21 of 68
potential substance is uncertain (e.g. drink spiking) a random urine (in a white capped universal) should be collected. It is recommended that Police involvement is discussed with the patient. If presentation is more than 18 hours after the alleged spiking incident, contact Nigel Brown (Wansbeck ext 33714) as soon as possible to discuss sample requirements. The ‘date rape’ drug GHB will be undetectable around 12 or so hours after ingestion. The toxicology section also undertakes investigations in cases referred to the Coroner but these will be arranged by the Coroners Officer or by the Police. Initial screening for alcohols will use headspace gas chromatography and for drugs using the LC-Q-ToF. Drugs likely to be implicated in a fatality will be quantitated using LC-MS/MS. Additional analyses using a variety of techniques are available, these will be dis-cussed with the Pathologist performing the post mortem and / or the Coroner.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 22 of 68
Alphabetic listing of Clinical Chemistry Tests Listed below are tests done in clinical chemistry or sent away to other clinical chemistry laboratories.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Return to Clinical Chemistry Index
*Where the assay laboratory is indicated as other than Northumbria, queries about sample collection, results, interpretation or any other
issues should be via the Northumbria Trust laboratories and not direct to the referral lab.
**Target turnaround times given are for routine samples and for time from receipt in lab to completion of technical validation. For tests
done within Northumbria Trust the time to results may often be shorter. If a faster turnaround time is required for a particular patient, please contact the Northumbria lab by telephone. The target turnaround time for emergency analyses is 1 hour.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 23 of 68
Test Specimen (see be-
low)
Assay La-
boratory*
Target Turna-
round time** Notes
A
Acetyl choline receptor an-tibodies
Immunology, Birmingham
1 to 2 weeks
Acylcarnitine Guthrie or EDTA pas-
ma Newcastle 1 to 2 weeks Guthrie dried blood spot preferred.
Adrenocorticotrophic
hormone (ACTH)
EDTA Newcastle 1 to 2 weeks Transport to lab on ice immediately
Adenosine deaminase 1ml Pleural Fluid London 1 to 2 weeks All queries or requests must be brought to the attention of the Duty Biochemist Freeze or send immediately
Antidiuretic Hormone
(arginine – vasopressin)
(ADH)
Note that this test is no longer performed as of 2016 and Copeptin is used as an alternative. Please contact duty biochemist to discuss if required.
AKI (acute kidney alerts) These are automatically reported on U+E samples where the creatinine change compared to previous values triggers either a stage 1,2 or 3 comment to be added to the U+E result.
Alanine Aminotransferase
(ALT) SST Northumbria 4 hours Part of LFT profile
Albumin SST Northumbria 4 hours Part of LFT and Bone profiles
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 24 of 68
Albumin/Creatinine Ratio ACR (Urine)
EMU or random urine (white cap universal)
Northumbria 12 hours EMU preferred
Alcohol (blood) Fluoride Oxalate or SST
Northumbria 4 hours
Alcohol (urine) Random Urine (white cap universal)
Northumbria 24 hours
Aldosterone EDTA Newcastle 1 to 2 weeks Transport to lab within 30 mins – not on ice if Renin also requested. If possible, withdraw agents that markedly affect ARR for at least 4 weeks (e.g. spiro-nolactone, amiloride, K-wasting diuretics).
Alkaline Phosphatase SST Northumbria 4 hours Part of LFT profile
Alkaline Phosphatase Iso-enzymes
SST Newcastle 2 to 3 weeks Only sent if Total Alk Phos is significantly raised relative to gamma GT. Smaller (<2x) rises in Alk Phosp may not permit accurate reporting of Iso-enzymes.
1-Anti Trypsin & Pi Typ-ing
SST Sheffield 1 to 2 weeks A1AT quantitation is performed initially and followed by Pi typing if appropriate
Alpha feto protein SST Northumbria 24 hours When used as a tumour marker (Maternal screening samples dealt with by Northern Genetics, Newcastle)
17-Alpha Hydroxyproges-terone
SST Newcastle 1 to 2 weeks
Aluminium Newcastle 3 to 4 weeks Contact lab for tube and collection kit
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 25 of 68
AMH (Anti Mullerian Hor-mone)
SST but Lithium Hep Newcastle
1- 2 Weeks Special Requirement: Sample must be separated within 24 hours of collection. If sample is not to be analysed/posted to lab immediately, store at -20°C prior to dis-patch. Patients should be under the care of an NHS fertility service
Amino Acids (urine or se-rum)
Random Urine (white capped universal) or
SST
Newcastle 2 to 3 weeks Urine or blood specimens must be sent to the lab without delay
Ammonia EDTA or Lithium Hep (adult)
Li Hep capillary (neo-nate or child)
Northumbria 4 hours Send on ice, phone lab. A second, unused, sample container should also be sent to the lab to act as a blank
Amylase (serum) SST Northumbria 4 hours
Amylase (urine) Random Urine (white capped universal)
Northumbria 12 hours Send serum sample as well
Androstenedione SST Newcastle 1 to 2 weeks
Angiotensin converting enzyme (ACE)
SST Newcastle 1 to 2 weeks
Apolipoprotein A1 and B Serum or EDTA plasma Newcastle 1-2 weeks
Apolipoprotein E genotyp-ing
EDTA Cardiff 4 weeks
Arsenic EDTA Urine (Random or 24hr)
Birmingham
1-2Weeks
Aspartate aminotransfer-ase (AST)
SST Northumbria 24 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 26 of 68
B
Bence Jones Protein EMU or Random Urine (white capped universal)
Northumbria 4 days EMU preferred
Beta-HCG SST Northumbria 12 hours For use as tumour marker and in specific pregnancy situations (e.g. ?ectopic preg-nancy) Not for use as general pregnancy test.
Bicarbonate SST Northumbria 4 hours Cannot be added to a sample which has already been analysed for other tests
Bile Acids SST Northumbria 24 hours Results will be telephoned within 1 working days if >14
Bilirubin SST Northumbria 4 hours Part of LFT Profile
Blood Gases Arterial blood in syringe Northumbria Immediately Send directly to lab (not in air tube). Avoid air bubbles. Remove needle
C
CA125 SST Northumbria 24 hours Ovarian tumour marker
CA15-3 SST Northumbria 24 hours Breast tumour marker
CA19-9 SST Northumbria 24 hours Pancreatic tumour marker
Cadmium Birmingham 1 to 2 weeks
Caeruloplasmin SST Newcastle 1 to 2 weeks
Calcitonin SST or Lithium Hep (See also Gut hormone entry)
Newcastle 1 to 2 weeks Send on ice to lab as soon as possible, phone lab
Calcium (total) SST Northumbria 4 hours
Calcium (ionised) Separate SST Northumbria 4 Hours Full tube
Carbamazepine SST Northumbria 24 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 27 of 68
Carboxyhaemoglobin Lithium heparin or Sie-mens Rapidlyte Blood Gas sample (Lithium Heparin)
Northumbria 12 hours In cases of suspected exposure, sample must be taken as soon as possible as breathing air or oxygen can quickly reduce COHb in circulation
Carcinoembryonic Antigen (CEA)
SST Northumbria 24 hours GI tumour marker
Carnitine EDTA or Guthrie card Newcastle 2 to 3 weeks
(Catecholamines ) No longer routinely avail-able
See Metadrenaline
Chloride SST Northumbria 4 hours
Cholesterol SST Northumbria 4 hours
Cholinesterase EDTA Bristol 2 to 3 weeks To check for suxamethonium apnoea
Chromium (Urine) Chromium (Blood)
Random urine EDTA (Trace elements 368381)
Newcastle
1 to 2 weeks If industrial screen, collect after last shift of week
Chromogranin A EDTA Belfast 2 to 3 weeks On ice, part of Gut Hormones
Cobalt (blood) EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
Complement (C3 and C4) SST Northumbria 48 hours
Copeptin SST Newcastle 4-6 weeks Copeptin values are of most benefit when taken under an osmotic stimulus.
Copper (Plasma EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
Copper (Urine) 24h Urine Newcastle 1 to 2 weeks
Cortisol SST Northumbria 24 hours
Cortisol (Urine) 24h Urine Newcastle 1 to 2 weeks
C-Peptide SST Newcastle 1 to 2 weeks On ice, contact lab
Creatine Kinase (CK) SST Northumbria 4 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 28 of 68
Creatinine SST Northumbria 4 hours Part of U/E Profile
C-Reactive Protein (CRP) SST Northumbria 4 hours
Cryoglobulins Plain @ 37oC
Northumbria 72 hours Contact lab for details of specimen collection Cryoglobulin testing is not covered by the current scope of UKAS accreditation.
CSF Glucose Fluoride Oxalate Northumbria 4 hours
CSF Lactate Fluoride Oxalate Northumbria 4 hours
CSF Protein Universal Northumbria 4 hours
CSF Bilirubin See Protocol Northumbria 8 hours Special collection protocol & kit available from lab
CSF Oligoclonal bands CSF Serum
Newcastle 1-2 weeks Send serum of approximately the same date.
Ciclosporin EDTA Newcastle 1 to 2 weeks Trough level preferred. Arrange in advance if weekend analysis required
Cystine (Urine) 24h Urine Newcastle 2 to 3 weeks Random urine acceptable in children
D
Direct/Conjugated Bilirubin SST Northumbria 4 hours
DHEAS SST Newcastle 1 to 2 weeks
Digoxin SST
Northumbria 4 hours Take sample at least 6 hours after dose. Give dose/time details on request
E
Ethylene Glycol + Glycolic acid
Fluoride oxalate or urine Northumbria By arrange-ment
Phone lab to discuss with duty biochemist
F
Faecal Elastase Faeces (plain universal) Newcastle 1 to 2 weeks Sample must contain some solid matter
Faecal Calprotectin Faeces (plain universal) Northumbria 1 week
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 29 of 68
Fluid Tests (i.e TP, U/E etc) White capped Universal Northumbria 4 hours Indicate what type of fluid on request form. Discussion with Duty Biochemist may be required for some fluid tests. Fluid testing other than Blood, CSF and Urine are not covered by the current scope of UKAS accreditation
Fluid Glucose Fluoride Oxalate Northumbria 4 hours
Fluid pH Blood gas syringe Northumbria 2 hours Only available on pleural fluids
FSH SST Northumbria 12 hours
G
Gamma GT SST Northumbria 4 hours
eGFR Northumbria 4 hours Calculated as part of GP or outpatient U&E. If required on in-patient, contact lab
Glucose Fluoride Oxalate Northumbria 4 hours
Growth Hormone SST Newcastle 1 to 2 weeks
Gut Hormones EDTA on ice (multiple tubes required)
Belfast 3 to 4 weeks Contact lab for collection details
H
Haemochromatosis Geno-typing
EDTA Newcastle 2 to 3 weeks Sample cannot be used for any other tests
HbA1c EDTA Northumbria 24 hours Send separate sample for FBC if required
HDL Cholesterol SST Northumbria 4 hours Fasting sample
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 30 of 68
5HIAA (Urine) (5- hydroxyindole acetic acid)
Overnight or 24h urine Newcastle 1 to 2 weeks Obtain urine bottle containing preservative (sand & acid) from laboratory.
• Intake of food with a high content of serotonin (avocados, bananas, plums, walnuts, pineapple, aubergine,
tomatoes/tomato products, kiwifruit, dates, grapefruit, nuts, cantaloupe/honeydew melon) within 48 hours of the urine collection could result in falsely elevated 5-HIAA excretion.Drugs that can increase 5-HIAA secretion include paracetamol, caffeine, diazepam (Valium), nicotine, some cough medicines (containing ephedrine or glyceryl guaiacolate, and phenobarbital. Drugs that can decrease 5-HIAA include aspirin, ethyl alcohol, imipramine, levodopa, MAO inhibitors, heparin, isoniazid, methyldopa, and tricyclic antidepressants.
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 31 of 68
HMMA (urine) HVA
Random urine Newcastle 1 to 2 weeks Reference ranges exist for children up to 16 years. can be elevated in the presence of neuroblastoma Administration of L-dopa may falsely in-crease vanillylmandelic acid (VMA) results. Patients receiving L-dopa should stop taking it for 24 hours before and during the collection. All patients receiving L-dopa should be identified to the laboratory when VMA and homovanillic acid tests are ordered. Administration of L-dopa may falsely increase vanillylmandelic acid (VMA) results. Pa-tients receiving L-dopa should stop taking it for 24 hours before and during the collection. All patients receiving L-dopa should be identified to the laboratory when VMA and homovanillic acid tests are ordered.
I
Ionised calcium SST Northumbria 4 hours Full tube required.
Immunoglobulins G,A,M SST Northumbria 48 hours If not checked previously, will usually also have a paraprotein screen performed
IgE SST Northumbria 1 week
Insulin SST and Fluoride Oxa-late
Newcastle 2 to 3 weeks Transport Insulin sample to lab immediate-ly on ice. Send fluoride oxalate tube and request glucose at the same time Contact lab for sample collection protocol
Intermediary Metabolites PCA Newcastle 2 to 3 weeks Special tube and collection details available from laboratory
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 32 of 68
Iron SST Northumbria 4 hours Only requested without transferrin for iron overdose cases
L
Lactate Fluoride Oxalate Northumbria 4 hours Send to lab immediately
Lactate Dehydrogenase (LD)
SST Northumbria 24 hours
Lead EDTA Birmingham 2 to 3 weeks
LFT SST Northumbria 4 hours Bil, ALP, ALT, TP, Alb
LH SST Northumbria 12 hours
Lithium SST Northumbria 12 hours Sample at least 12 hours post dose
M
Magnesium SST Northumbria 4 hours
Manganese (Whole blood) EDTA (Trace ele-ments 368381)
Newcastle 1 to 2 weeks
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 33 of 68
Metadrenalines (urine) Overnight or 24 hr urine Newcastle 1 to 2 weeks Obtain urine bottle containing preservative (sand & acid) from laboratory.
• Many drugs are now known to increase catecholamine and metabolite concentrations, including tricyclic
antidepressant's, selective serotonin reuptake inhibitors, serotonin and nora-drenaline reuptake inhibitors, α- and β- adrenergic receptor blockers, calcium channel blockers, monoamine oxidase inhibitors, Levo(L)-Dopa, methyldopa and several stimulant/sympathomimetic drugs. Ideally patients should discontinue all medications that may affect plasma and urinary catecholamine or metanephrine concentrations prior to sampling. In practice, it is not always possible to discontinue medication before testing and it might be better to repeat testing only when initial tests are elevated.
Metanephrines (plasma) EDTA Newcastle 1 to 2 weeks Transport to lab immediately on ice. Only usually requested once urine screen has identified possible problem. See notes above under urine metadrenalines for details on potential drug interferences.
Mercury (Urine) Random or 24 hr urine Birmingham 1 to 2 weeks Sample of choice for chronic exposure to vapour or inorganic salts. Analysis of urine or blood has not proved useful in people concerned about dental amalgams
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 34 of 68
Mercury (Blood) EDTA or Lithium Hep Birmingham 1 to 2 weeks Sample of choice for exposure to organic mercury compounds or acute exposure to vapour or inorganic salts
Microalbumin See Albumin / creatinine ratio
N
NT-proBNP SST Northumbria 4 days
O
Oestradiol SST Northumbria 24 hours
Osmolality SST Northumbria 4 hours
Osmolality (urine) Random (white capped universal)
Northumbria 4 hours A fresh sample is best. A sample for serum osmolality should be sent to the lab at the same time
P
Paracetamol SST Northumbria 4 hours In overdose situations, sample 4 hours after ingestion
Paraprotein Screen SST Northumbria 3 days (See Bence Jones Protein for urine paraprotein screen)
Parathyroid Hormone EDTA (separate tube re-quired)
Northumbria 4 days Send to lab within 12 hours, also request calcium on SST sample
Phenobarbitone SST Northumbria 12 hours Trough sample recommended
Phenytoin SST Northumbria 12 hours Trough sample recommended
Phosphate SST Northumbria 4 hours
Porphyrin Profile Blood, Urine and Faeces Cardiff 1 to 2 weeks For investigation of full spectrum of porphyrias. Wrap all samples in foil, black plastic or paper bag to protect from light
Porphyrin Screen (for acute porphyrias during possible attack only)
Random Urine Newcastle 7 days Send directly to lab. Protect from light
Potassium SST Northumbria 4 hours
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 35 of 68
Progesterone SST Northumbria 24 hours
Prolactin SST Northumbria 24 hours Samples with raised levels will be checked for the presence of macroprolactin and this will delay the turnaround time
Prostate Specific Antigen (PSA)
SST Northumbria 24 hours
Protein/creatinine ratio (PCR)
EMU or random urine (white capped universal)
Northumbria 24 hours
R
Renin EDTA Newcastle 1 to 2 weeks Send to lab immediately (NOT on ice). Provide details as to current antihypertensive therapy. If possible, withdraw agents that markedly affect ARR for at least 4 weeks (e.g. spi-ronolactone, amiloride, K-wasting diuret-ics).
Rheumatoid Factor SST Northumbria 24 Hours
S
Salicylate SST Northumbria 4 hours
Selenium EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks
SHBG SST Northumbria 24 Hours
Sodium SST Northumbria 4 hours
T
TSH (Thyroid Profile) SST Northumbria 12 hours Free T4 and FreeT3 will be added as cascade tests as appropriate
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 36 of 68
Tacrolimus (FK506)or Siro-limus
EDTA Newcastle 1 to 2 weeks
Testosterone SST Northumbria 24 hours
Theophylline SST Northumbria 24 hours
Troponin T SST Northumbria 2 hours Haemolysed samples are unsuitable for analysis.
Total protein SST Northumbria 4 hours Part of LFT profile
TPMT EDTA (needs to be full) Birmingham 1 to 2 weeks Used prior to azathioprine therapy
Triglycerides SST Northumbria 4 hours Fasting sample preferred
Tryptase SST Newcastle 1 to 2 weeks Take at 1and 24 hrs hours after possible anaphylactic shock
U
U & E (and eGFR on OP and GP patients)
SST Northumbria 4 hours Sodium, Potassium, urea, creatinine (urgent in patient samples will also get bicarbonate and chloride)
Urea SST Northumbria 4 hours Part of U&E
Urate SST Northumbria 4 hours
Urine tests (electrolytes, calcium, protein, magnesi-um, uric acid etc)
Contact lab for appropriate 24 hour collection bottle
Urinary c peptide. Urine 20ml Boric acid
Universal
Exeter Clin-ical Chem-istry lab
1 week Routinely requestable by Endocrinology specialists. Otherwise will require discussion with duty biochemist.
V
Valproate SST Northumbria 24 hours Monitoring not recommended in epilepsy therapy. Measurement may be useful in some cases of bipolar disorder.
Vitamin A and E SST, Lithium Hep or EDTA Rotherham 1 to 2 weeks Protect from light
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 37 of 68
Vitamins B1, B2 and B6 EDTA or Lithium Heparin Glasgow 1 to 2 weeks Samples must arrive in the lab during the morning, Monday to Wednesday to allow for sample processing and transport. Handled by Haematology
Vitamin C 5ml Lithium Heparin de-livered immediately to lab .Requires further storage
in preservative prior to dispatch.
Rotherham
1 to 2 weeks
Discuss with duty Biochemist. Requires advance notice of testing to obtain appropriate tubes with preservative.
Vitamin D SST Northumbria Daily Sample must arrive at lab on same day
Z
Zinc (Plasma) EDTA (Trace elements 368381)
Newcastle 1 to 2 weeks Haemolysed samples are unsuitable
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 38 of 68
Specimen Types
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 39 of 68
Specimen Types EDTA K3 Purple topped vacutainer EDTA K2 (Trace metal) Royal Blue topped vacutainer Fluoride Oxalate Grey topped vacutainer Lithium Heparin Green topped vacutainer Plain Red topped vacutainer SST Gold topped vacutainer (Serum Separator tube)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 40 of 68
REFERRED TESTS
Address Accreditation Tests referred
Regional Regulatory Peptide La-boratory, 2nd Floor, Kelvin Building Royal Victoria Hospital Belfast BT12 6BA
CPA No. 1338
(at 03/07/18)
Calcitonin gene related peptide
Carcinoid Screen Blood
Chromogranin A
Gastrin,
Gastrin releasing peptide
Glucagon
Gut Hormones
Neurokinin A
Pancreastatin
Pancreatic Polypeptide
Dept of Clinical Biochemistry Queen Elizabeth Hospital Birmingham
Mindelson way West midlands Birmingham B15 2WB
UKAS No. 8910
(at 03/07/18)
Alpha Sub Unit
Clinical Chemistry Birmingham Children's Hospital Laboratory Medicine Block Children’s Hospital Whittall Street Birmingham B4 6NL
CPA No. 1287
(at 03/07/18)
Steroid sulphatase
Dept Clinical Biochemistry City Hospitals NHS Trust Dudley Road Birmingham B18 7QH www.cityassays.org.uk
CPA No. 1267
(at 03/07/18)
TPMT (Thiopurine S-methyltransferase)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 41 of 68
Regional Toxicology Lab City Hospitals NHS Trust Dudley Road Birmingham B18 7QH
CPA No. 1267
(at 03/07/18)
Cadmium Lamotrigine Blood Lead Blood Mercury Nickel Zinc Protoporphyrin Random Urine Arsenic Random Urine Cadmium Random Urine Copper Random Urine Cu/Chr/Ars Random Urine Mercury Random Urine Trace Elements 24h Urine Copper 24h Urine Cu/Chrom/Ars 24h Urine Mercury
Newborn Screening & Biochemical Genetics Dept Blood Sciences Laboratory Southmead Hospital Westbury-on-Trym Bristol BS10 5NB
UKAS No. 8071
( at 03/07/18)
Cholinesterase GAL-1-PUT ( Galatose -1-phosphate uridyl transferase) Galactose -1-phosphate
Dept of Clinical Biochemistry, Box 232 Addenbrooke’s Hospital, Hills Road Cambridge CB2 0QQ
CPA No. 0244
(at 03/07/18)
Leptin
(Purine Lab) Medical Biochemistry & Immunol-ogy University Hospital of Wales Heath Park Cardiff CF14 4XW www.cardiff-porphyria.org, e-mail [email protected]
UKAS No. 8989
(at 03/07/18)
Apo E Genotype Apo E Phenotyping Homocysteine (as CHD risk factor) Porphyrin Profile (Cardiff) Urine Porphyrine (Quant)
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 42 of 68
Biochemistry Department Freeman Hospital Newcastle upon Tyne NE7 7DN
UKAS No. 8543
(at 03/07/18)
Aluminium Chromium & Cobalt Copper Cyclosporin Faecal Elastase Lipase Blood Manganese Plasma Catecholamines Plasma Metanephrines Selenium Tacrolimus Sirolimus Zinc Overnight Metadrenalines Random Urine DPD/Creat ratio Random Urine HIAA Random Urine HVA 24hr Urine HIAA 24h Urine Metadrenalines
Clinical Biochemistry Queen Elizabeth Hospital Gateshead NE9 6SX
CPA No. 1481
(at 03/07/18)
Beta 2 microglobulins SCC (SCCA; Squamous Cell Cancer Antigen) Calculi
Institute of Human Genetics International Centre for Life Times Square Central Parkway Newcastle upon Tyne, NE1 3BZ
CPA No. 2212
(at 03/07/18)
Chromosome Typing or Cystic Fibrosis Gene Haemochromatosis genotyping (HFE genotyping)
Department of Biochemistry McEwan Building Glasgow Royal Infirmary Castle Street Glasgow G4 0SF
UKAS No. 9572
(at 03/07/18)
Beta-Carotene 1,25-OH Vitamin D
Specialist Biochemistry Section Clinical Biochemistry Hull Royal Infirmary Anlaby Road Hull HU3 2JZ
CPA 0407
(at 03/07/18)
Fructosamine HbA1c by Boronate Affinity
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 43 of 68
SAS Steroid Centre Specialist Laboratory Medicine Block 46 St James University Hospital Beckett St LEEDS LS9 7TF
CPA 1120 (Suspended)
(at 03/07/2018)
Oestrone Testosterone (Mass Spec) Serotonin (and Plasma 5HIAA)
Medical Toxicology Lab, Guys & St Thomas Hospital Trust, 2nd Floor Apex Yard Godfree Court 29 Long Lane London SE1 4PL
Ethosuximide Vigabatrin Random Urine Nickel 24h Urine Nickel
Chemical Pathology Dept Great Ormond Street Hospital Gt Ormond St London WC1N 3JH www.gosh.nhs.uk/gosh/services/chemicalpathology for lab hand-book
CPA No. 0250
(at 03/07/18)
CK isoenzymes (electrophore-sis)
Viapath Analytics LLP Biochemistry Blood Sciences Laboratory Ground Floor Bessemer Wing King’s College Hospital Denmark Hill London SE5 9RS
UKAS No. 9067
(at 03/07/18)
Steroid Profile Urine Steroid Profile Serum
Viapath Analytics LLP Purine Research Laboratory 4th Floor, North Wing St Thomas’ Hospital Lambeth Palace Road London SE1 7EH
CPA No. 8710
(at 03/07/18)
Adenosine deaminase
Immunology Dept Institute of Neurology Queen Square London WC1N 3BG
UKAS No 8045
(at 03/07/18)
Transferrin glycoforms
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 44 of 68
Protein Ref Unit St George’s PO Box 10295 St Georges’s Hospital Medical School Backshaw Road London SW17 0NH
CPA No 1929
(at 03/07/18)
Faecal Alpha 1-antitrypsin
HSL (Analytics) LLP Department of Clinical Biochemistry
University College London Hospital 60 Whitfield Street London W1T 4EU
UKAS No 8169
(at 03/07/18)
Citrate Oxalate Oxalate – plasma
The Walton Centre NHS Founda-tion Trust The Neurosciences Laboratories The Walton Centre Lower Lane Fazakerley Liverpool L9 7LJ United Kingdom
UKAS No. 8642
(at 03/07/18)
Beta -2 Transferrin
Dept Clinical Biochemistry 4th Floor Duncan Building Royal Liverpool University Hospital Prescot Street Liverpool L7 8XP
CPA No 0771
(at 03/07/18)
Testosterone (Bioavailable)
Department of Clinical Biochemis-try University Hospital South Man-chester Southmoor Road Wythenshawe Manchester M23 9LT
UKAS No. 9063
(at 03/07/18)
Prednisolone
Willink Biochemical Genetics Unit 6th Floor, Pod 1 St Mary’s Hospital Oxford Road Manchester M13 9WL
CPA No. 4015
(at 03/07/18)
Alpha Galactosidase Mucopolysaccharides, 2-D Mucopolysaccharide elec-trophoresis Urine Glycosaminoglycans Urine Oligosaccharides Urine Mucopolysaccharides
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 45 of 68
Dept of Medicine / ESRG University of Manchester Room 3.825 The Stopford Building Oxford Road Manchester M13 9PT
Research lab not accredited
POMC (Pro-opiomelanocortin)
Specimen Reception Laboratory Medicine, Level 1 East Block Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY
CPA No 0868
(at 03/07/18)
Parathyroid Hormone rp (PTHrp)
Biochemistry Dept Rotherham General Hospital Moorgate Rd Rotherham S Yorks S60 2UD
CPA No. 0013
(at 03/07/18)
Vitamns A and E
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 46 of 68
Clinical Biochemistry Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP Duty Biochemist 0191 2829719
UKAS No. 8543
(at 03/07/18)
Alk Phos Isoenzymes 17-Alpha Hydroxyprogesterone
ACE (Angiotensin Converting enzyme) ACTH (Adrenocorticotrophic hormone)LIPOA request Aldosterone Serum Amino Acids Androstenedione Anti-Mullerian hormone Apolipoprotein A1 Apolipoprotein B Apo E Phenotype (Newcastle) Beta Crosslaps CSF ACE Caeruloplasmin Calcitonin C-Peptide DHEA-Sulphate Growth Hormone IGF-1 Insulin Immunoreactive Trypsin Lipoprotein (a) Methotrexate NEFA Neurokinin A Phenobarbitone Phenylalanine Renin Thyroglobulin Urine Amino Acids Urine Organic Acids Urine PBG 24h Urine Cortisol 24h Urine Cystine Methotrexate Non-esterified fatty acids (NEFA) Phenylalanine TBII (thyrotrophin binding in-hibiting immunoglobulin) Thyroglobulin
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 47 of 68
Immunology Department Royal Victoria Infirmary Newcastle on Tyne NE1 4LP
UKAS No. 8543
(at 03/07/18)
CSF Oligoclonal Bands IgG Subclasses Tryptase
Spence Biochemical Genetics Unit Department of Clinical Biochemis-try, RVI Newcastle on Tyne NE1 4LP
UKAS No 8543
(at 03/07/18)
Acylcarnitine Biotinidase Carnitine/Carnitine profile Intermediary Metabolites Pyruvate,Lactate and beta hy-droxybuterate) Very long chain fatty acids
Trace Element Lab Chemical Pathology, Mail Point 804 Level D Southampton General Hospital Tremona Road Southampton, Hants SO16 6YD
UKAS No. 8483
(at 03/07/18)
Molybdenum Red Cell Magnesium
Department of Immunology Laboratory Medicine Centre Northern General Hospital Herries Road Sheffield S5 7AU
UKAS No. 8494
(at 03/07/18)
A-1-Antitrypsin A-1-AT & Typing A-1-Antitrypsin typing C1 Esterase inhibitor Carbohydrate deficient trans-ferrin Pro-collagen Type 3 C1 Esterase & Complement GAD antibody Urine Methyl Histamine
Dept Clinical Biochemistry Children’s Hospital Western Bank Sheffield S10 2TH
CPA No. 0001
(at 03/07/18)
Trimethylamine Trimethylamine-N-OX Phosphoethanolamine (Urine PEA) 7-Dehydrocholesterol
SAS Peptide Section Clinical Laboratory, Level B Royal Surrey County Hospital Egerton Road Guildford Surrey GU2 7XX
CPA No. 1167
(at 03/07/18)
Insulin autoantibodies IGF Binding Protein 3
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 48 of 68
Centre for Clinical Science and Measurement School of Biological Sciences University of Surrey Guildford GU2 7XH
CPA No. 1167
(at 03/07/18)
Silver
Viapath Analytics LLP Blood Sciences Laboratory 5th Floor, North Wing St. Thomas’ Hospital Westminster Bridge Road London SE1 7EH
UKAS No 8710
(at 03/07/18)
11-Deoxycortisol Infliximab Adalimumab
Department of Clinical Chemistry, Exeter Level 2 Area A Barrack Road Exeter
CPA No 57
(At 03/07/18)
Urine C-peptide
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 49 of 68
Current reference ranges for Northumbria
Spec Expanded Telepath Units d.p Age range Telepath Range Abnormal Ranges as comments Delta Date
Type Test name Testcode Limits (in place of ref range) Limits of intro
U&E
S Sodium Na mmol/L 0 >1y 133-146 <130 : >150 +/- 4 05/07/2010
S Potassium K mmol/L 1 Up to 1m 3.4-6.0
1m - 1y 3.5-5.7
>1y-15y 3.5-5.0
>15y 3.5-5.3 <3.0 : > 5.5 +/- 0.5 05/07/2010
S Chloride CL mmol/L 0 Up to 3m 95 - 112
> 3m 95-108 < 90 : > 110 +/- 5 05/07/2010
S Total CO2 CO2 mmol/L 0 <16y 19-28
>16y 22 - 29 <12 : > 35 +/- 5
S Urea U mmol/L 1 Up to 1m 0.8-5.5
1m-1y 1.0-5.5
<16y 2.5-6.5
>16y 2.5-7.8 <1.0 : > 20 +/- 2
S Creatinine CREAEZ umol/L 0 Adult Male (≥16) 64-104 01/11/2017
Adult Female (≥16) 49-90
Neonate (<2 months) 22-90
Infant (2months - 11-34
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 50 of 68
<3yrs)
Child (3-15yrs) 21-65
S eGFR eGFR mL/min/1.73m2 0 Adult >90 Normal GFR
60 - 89
Mild impair-ment with other evidence of chronic kidney damage
30 - 59 Moderate im-pairment
15 - 29 Severe impair-ment
<15 Established renal failure
Liver and Bone
S Total Protein TP g/L 0 Up to 1m 50 - 70
1m - 6m 52 - 72
6m - 1y 56 - 76
1y - 10y 60 - 82
>10y 60 - 80 <30 : >85 +/- 7
S Albumin ALB g/L 0 Up to 1y 30 - 45
1y-15y 30-50
>15y 35-50 <20 : > 54 +/- 4
S Calcium CA mmol/L 2 Up to 1m 2.0-2.70
& Corr Calcium 1m - 15y 2.2-2.70
Over 15y 2.2-2.60 <1.8 : > 2.8 +/- 0.2
S Ionised Calcium ICA mmol/L 2 1.16 -1.32 <1.0 : >1.50
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 51 of 68
S Magnesium MG mmol/L 2 Up to 4w 0.60 - 1.00
> 4w 0.70 - 1.00 <0.5 : >2.0 05/07/2010
S Phosphate PO4 mmol/L 2 Up to 1m 1.3-2.6 <1.0 : >2.8
1m - 1y 1.3-2.4 < 1.0 : >2.6
1y - 15y 0.9-1.8 <0.6 : >2.0
>15y 0.8-1.5 < 0.4 : > 1.7 +/- 0.4 05/07/2010
S Bilirubin (Total) BIL umol/L 0 1d <110
2d <150
3d - 1w <170
1w - 2w <80
>2w <21 <3 : >50 +/- 10
S Alkaline Phosphatase ALP U/L 0 Up to 1m 70-380
1m - 15y 60-425
Male Fe-
male
16y-17y 40-250 30-130
>17y 30-130 +/- 25
S Alanine Transami-nase ALT U/L 0 <40 <3 : >80 +/- 25
S Aspartate transaminase AST U/L 0 <40 <3 : >80 +/- 25
S Gamma Glutamyl transferase GT U/L 0 Up to 3m 0 - 200
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 52 of 68
3m - 6m 0 - 150
>6m M <70
F <45 >120 +/- 25
S Lactate Dehydrogen-ase LD U/L 0 < 270 >600
+/- 200
Routine Serum
P Glucose (fasting) GLU mmol/L 1 3.0 - 6.0 Non fast
<3.0 : > 10
S Osmolality OSM mmol/kg 0 275 - 295 05/07/2010
S Amylase AMY U/L 0 <100 <10 : > 300 +/- 50
S Troponin T TNTHS ng/L ≤14
TnTHS on paired sam-ples both ≤14or 1 sam-ple >12 hrs after chest pain is nega-tive An increase of 100% in TnThs (initial TnThs <30) between paired sam-ples is posi-tive An increase
01/02/2011
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 53 of 68
of <100% (initial TnThs <30) between paired sam-ples is equiv-ocal A TnThs >30 corresponds to a TnT>0.01ug/L and should be managed as previously
S Iron FE umol/L 0 Over 3y 9 - 28 <5 : > 40 +/- 5
S Transferrin TRFG g/L 1 >1m 2.0 -3.6 +/-10
S Transferrin Saturation TRFS
(PSAT) % 0 <16y 15 - 50 <15 : >50
M 16 - 55y 20 - 55 <15 : >60
F 16 - 55y 15 - 50 <15 : >55
All >55y 20-55 <15 : >60
S Cholesterol CHOL mmol/L 1
See local guidelines for interpretation +/- 1.0
S Triglycerides (fasting) TRIG mmol/L 1 <1.7
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 54 of 68
S HDL Cholesterol HDL mmol/L 1 Male >1.0 +/-0.3
Female >1.2
S Total/HDL Cholesterol ratio 1
See local guidelines for interpretation
S LDL Cholesterol LDL mmol/L 1
See local guidelines for interpretation
S Urate URATE umol/L 0 Up to 1y 100 - 500 >500
> 1y M 200-430
>1y F 140-360 >700 +/- 30
S Creatine Kinase (To-tal) CK U/L 0 Up to 1m < 900
M>1m 40-320 +/- 70
F>1m 25-200
S NT proBNP PROBNP ng/L 0 <60y 0 - 50 >450 Aug-11
60 - 74y 0 - 100 >900
>74y 0 - 250 >1800
Endocrine
S TSH TSH mU/L 2 Adults 0.30-4.50 <0.30 : >4.50 1/11/2013
>11-18 yrs 0.5 – 4.3
Paediatric rang-es from Manu-facturer, added January 2019
>6-11 yrs 0.6 – 4.8
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 55 of 68
>1-6 yrs 0.7 – 6.0
>3 m-1 yr 0.7 – 8.4
>6 d-3 m 0.7 – 11.0
0-6 d 0.7 – 15.2
S Free Thyroxine EFT4 pmol/L 0 Adults 10.0 – 22.0 1/11/2013
>11-18 yrs 12.6 – 21.0
Paediatric rang-es from Manu-facturer, added January 2019
>6-11 yrs 12.5 – 21.5
>1-6 yrs 12.3 – 22.8
>3 m-1 yr 11.9 – 25.6
>6 d-3 m 11.5 – 28.3
0-6 d 11.0 – 32.0
S Free T3 EFT3 pmol/L 1 Adults 3.1 – 6.8 1/11/2013
>11-18 yrs 3.9 – 7.7
Paediatric rang-es from Manu-facturer, added January 2019
>6-11 yrs 3.9 – 8.0
>1-6 yrs 3.7 – 8.5
>3 m-1 yr 3.3 – 9.0
>6 d-3 m 3.0 – 9.3
0-6 d 2.7 – 9.7
S LH LH U/L 1 Under 13y < 6
Male >13y 1.8 - 8.2
Follicular 2 - 10
Mid-Cycle 10 - 96
Luteal 2 - 11
Post-Menop >30
Pregnant <2.0
Female > 55y >20
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 56 of 68
S FSH FSH U/L 1 Under 13y 1.2 - 7.8
Male >13y 1.4 - 14
Follicular 2 - 10
Mid-Cycle 5 - 28
Luteal 2 - 8
Post-Menop >30
Pregnant <2
Female > 55y >23 29/03/10
S Prolactin PROLE mU/L 0 Males >15yrs 86 - 324 1/11/2013
Females >15y 102 - 496
S Oestradiol E2 pmol/L 0 M >13y 50 - 220 Follicular 90 -
720
F > 55y 145 Mid cycle 240 - 510
F<55y See Comment Luteal 150 - 960
Post Meno-pause <145
S Progesterone PROG nmol/L 0 Pre ovulation <5
Post Ovula-tion >20
S Testosterone TESTE nmol/L 1 Male 18 - 49 8.6 - 29 18/11/2011
Male >49y 6.7 - 25.7
Female >16y <1.7
S Cortisol COR nmol/L 0 9am Cortisol refer-
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 57 of 68
ence range -
9.00am 170 - 540
S BHCG BHCG IU/L 0 Adult male: <2 IU/L
Adult Female: Pre-
menopausal <5IU/L
Peri-
menopausal <7IU/L
Post-
menopausal <10 IU/L
P PTH PTHE pmol/L 1 1.6 - 6.9
S Vitamin D VITD nmol/L 0 >17y >50
Guidance given about lower levels as text
Tumour markers
S AFP AFP kU/L 0 Male and Fe-
male:
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 58 of 68
Aged 18 and
above <6 IU/mL
4month-17years <10 IU/mL
S Prostate Specific Ag PSAE ng/mL 1 <50y 2.5
50y – 59y 3.5
60y - 69y 4.5
70y and over 6.5
S Carcino Embryonic Ag CEAE ug/L 1 <5
S CA 19-9 CA199 U/mL 0 <34
S CA 125 CA125 kU/L 0 <35 >100
S CA 15-3 CA153 kU/L 0 <25
TDM
S Digoxin DIG ug/L 1 0.5 - 2.0 <0.4 : >2.1 +/- 25%
S Paracetamol PARA mg/L 0
S Salicylate SAL mg/L 0
S Theophylline THEO mg/L 0 10 - 20
S Carbamazepine CARB mg/L 0 4 - 12 <3 : >15 +/- 15%
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 59 of 68
S Phenytoin PHY mg/L 0 5 - 20 <4 : > 20 +/- 20%
S Valproate VALP mg/L 0 50 - 100 <49 : >101
S Phenobarbitone PHENO mg/L 0 10 - 40 <9 : >41 +/-15%
S Lithium LI mmol/L 1 0.4 - 1.0 <0.4 : >1.0
Specific Proteins
S C-Reactive Protein CRP mg/L 0 >27d <5 >400 +/- 50%
S C3 C3 g/L 1 0.90 - 1.8
S C4 C4 g/L 1 0.1 - 0.4
S IgG IGG g/L 1 <13w None
14w - 26w 2.4 - 8.8
27w - 39w 3.0 - 9.0
40w - 51w 3.0 - 10.9
1y 3.1 - 13.8
2y 3.7 - 15.8
3y - 5y 4.9 - 16.1
6y - 14y 5.4 - 16.1
>15y 6.0 - 16.0 <3 : > 20
S IgA IGA g/L 2 <13w None
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 60 of 68
14w - 26w 0.1 - 0.5
27w - 51w 0.2 - 0.7
1y 0.3 - 1.2
2y 0.3 - 1.3
5y 0.4 - 2.0
8y 0.5 - 2.4
11y 0.7 - 2.5
12y - 45y 0.8 - 2.8
>45y 0.8 - 4.0 <0.4 : > 5
S IgM IGM g/L 2 <13w None
14w - 26w 0.2 - 1.0
27w - 39w 0.4 - 1.6
40w - 51w 0.6 - 2.1
1y - 2y 0.5 - 2.2
3y - 5y 0.5 - 2.0
6y - 11y 0.5 - 1.8
12y - 45y 0.5 - 1.9
>45y 0.5 - 2.0 <0.1 : >4.0
S IgE IGE kU/L 1 <27 days Up to 1.5
27d to 1y Up to 15
1 - 5 y Up to 60
5 - 9y Up to 90
9 - 15y <200
>15y <100
S Rheumatoid Factor RHF kU/L 1 >14
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 61 of 68
Blood Gases
B pH PH 2 7.35 - 7.45 <7.30 : > 7.50 +/- 0.1
B pCO2 PCO2 KPa 1 Up to 2y 3.5 - 5.5
>2y 4.5 - 6.1 <3.5 : >8.0 +/- 1.0
B pO2 KPa 1 12.0 - 14.0 <10 : >16 +/- 3.0
B Actual Bicarbonate ABIC mmol/L 0 <2y 16 - 24
>2 y 21 - 25
B Base Excess BXS mmol/L 0 4w -10 - -2
2y -7
>2y -3 to +3
B Standard Bicarbonate SBIC mmol/L 0 <2y 20 - 26
>2y 21 - 25
B % O2 Saturation SAT % 0 96 - 97
Metabolites
P Plasma Lactate LACT mmol/L 1 <15y 0.6 - 2.5
>15y 0.5 - 2.2
B Ammonia AMM umol/L 0 0 - 4w <100 >100
>1m <50
Misc Blood
B HbA1c HBA1 mmol/mol 1
Non-diabetic range 20 - 42 (IFCC stand-
01/10/2011
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 62 of 68
ardised)
B Blood Alcohol mg/L 0 Comment
B Carboxyhaemoglobin COHB % 1 <5.0
B Methaemoglobin METHB % 1 <1.5
CSF
C CSF Appearance A
C CSF Protein CTP g/L 1 <0.4 <1.0
C CSF Glucose CGLU mmol/L 1 2.2 - 4.4 <1.0 : >10.0 +/- 0.3
C CSF Lactate CLACT mmol/L 1 >3d 1.1-6.7
3-10d 1.1-4.4
10d-18y 1.1-2.8
>18y 1.1-2.4 <0.5 : >4.0
C CSF Bilirubin CBIL Abs units <0.007
Faeces
F Faecal Porphyrins A
F Faecal Calprotectin Interpretation
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 63 of 68
as per local GI Pathway
Fluid
W Fluid Volume mL 0
W Fluid Protein FTP g/L 0 Not Available. *
W Fluid Albumin FALB g/L 0 Not Available. *
W Fluid LDH FLD U/L 0 Not Available. *
W Fluid pH FPH 2 Not Available. *
W Fluid Amylase FAMY U/L 0 Not Available. *
W Fluid Sodium mmol/L 0 Not Available. *
W Fluid Potassium mmol/L 0 Not Available. *
W Fluid Urea mmol/L 1 Not Available. *
W Fluid Creatinine umol/L 0 Not Available. *
W Fluid Osmolality mmol/kg 0 Not Available. *
W Fluid Lactate mmol/L 1 Not Available. *
W Fluid Bilirubin umol/L 0 Not Available. *
W Fluid Cholesterol mmol/L 1 Not Available. *
W Fluid Triglycerides mmol/L 1 Not Available. *
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 64 of 68
W Fluid Glucose mmol/L 1 Not Available. *
W Fluid CO2 mmol/L 0 Not Available. *
W Fluid CA19-9 U/mL 0 Not Available. *
W Fluid CEA ug/L 0 Not Available. *
W Fluid Iron umol/L 1 Not Available. *
W Fluid AFP ug/L 0 Not Available. *
Urine U&E
U Urine Volume mL 0
U Urine Sodium mmol/L 0
U 24h Urine Sodium UNA24 mmol/24h 0 40 - 250
U Urine Potassium mmol/L 0
U 24h Urine Potassium UK24 mmol/24h 0 25 - 125
U Urine Urea mmol/L 0
U 24h Urine Urea UU24 mmol/24h 0 250 - 600
U Urine Creatinine mmol/L 1
U 24h Urine Creatinine UCR24 mmol/24h 1 M 9.0 - 17.7
F 7.0 - 15.9
U Urine Chloride mmol/L 0
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 65 of 68
U 24h Urine Chloride UCL24 mmol/24h 0 40 - 250
U 24h Creat Clearance CRCL mL/min 0 Adult Male 90 - 125
Adult Female 85 - 120
U Urine Osmolality UOSM mmol/kg 0
Misc Urine
U Urine Albumin (Micro-albumin) UALB mg/L >100
U Urine Albumin /Creatinine ratio ACR
mg/mmol Creat 1 >16y 0 - 3.0 <0.1 : >30
+/-10%
U Urine Calcium mmol/24h 1
U Urine Calcium /Creatinine ratio UCACR
mmol/mmol creat 2 0 - 51w 0.09 - 2.20
1y 0.07 - 1.50
2y 0.06 - 1.40
3y - 4y 0.05 - 1.10
5y - 6y 0.04 - 0.80
7y - 17y 0.04 - 0.70
>17y <0.70
U 24h Urine Calcium UCA24 mmol/24h 1 2.5 - 7.5
U Urine Magnesium mmol/L 1
U Urine Mg/Creat UMGCR mmol/mmol
creat 1 51w 0.4 - 2.2
1y 0.4 - 1.7
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 66 of 68
2y 0.3 - 1.6
4y 0.3 - 1.3
6y 0.3 - 1.0
9y 0.3 - 0.9
13y 0.2 - 0.7
17y 0.2 - 0.6
>17y 0 - 0.6
U 24h Urine Magnesium UMG24 mmol/24h 1 2.4-6.5
U Urine Phosphate mmol/L 1
U Urine Phosphate /Creatinine ratio UPO4CR
mmol/mmol creat 1 26w - 51w 1.2 - 19.0
1y 1.2 - 14.0
2y 1.2 - 12.0
3y - 4y 1.2 - 8.0
5y - 6y 1.2 - 5.0
7y - 9y 1.2 - 3.6
10y - 13y 0.8 - 3.2
14y - 17y 0.8 - 2.7
>17y <2.9
U 24h Urine Phosphate UPO424 mmol/24h 1 15 - 50
U Urine Protein mg/L 1
U Urine Pro-tein/Creatinine ratio UTPCR mg/mmol creat 1 Up to 1y 0 - 56
>1y 0 -15
U 24h Urine Protein UTP24 mg/24h 1 <150
U Urine Urate mmol/L 1
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 67 of 68
U Urine Urate/Creatinine ratio UURACR
mmol/mmol creat 1 7d 0.10 - 1.9
16w 0.30 - 1.7
1y 0.4 - 1.5
3y 0.5 - 1.3
4y 0.3 - 1.1
6y 0.3 - 0.8
9y 0.26 - 0.56
13y 0.2 - 0.44
17y 0.2 - 0.4
>17y 0.2 - 0.4
U 24h Urine Urate UURA24 mmol/24h 1 0 - 6.0
U Urine pH 2
U Urine Hydroxy Indole Acetic Acid umol/L 0
U HIAA/Creatinine ratio UHIACR umol/mmol
creat 1 <4
U 24h Urine HIAA UHIACR umol/24h 1 0-40
U Urobilin A
U Urobilinogen A
U Porphobilinogen A
U Urinary Bilirubin A
U Urinary Haemoglobin A
NHS GENERAL
Title: Clinical Chemistry laboratory handbook
QP Ref: LH-CCH-GEN-G-001v21 Author: D Dodds Authorised by: S Pattman
Created Date: 17th October 2019 Disposal date: October 2049 Page 68 of 68
U Urine Glucose
U Urine Alcohol mg/L 0 Comment
U Urine Ketones A
U Urine Amylase U/L 0
U Amylase/Creat ratio 1
Sweat
SW Sweat Chloride SWCL mmol/L 0 <40
SW Sweat Rate SWRATE uL/30 minutes 0 >15
*For interpretation of Fluid results please contact the department if required