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INTEGRATED PATHOLOGY SERVICE BLOOD SCIENCES DOCUMENT

HAEMATOLOGY USER GUIDE[PD-HAE-UserGuide]

AUTHOR: Darern RookesAPPROVED BY: Darern RookesDATE OF ISSUE: 07/01/2020DATE EFFECTIVE FROM: 07/01/2020VERSION NO: 2REVIEW INTERVAL: BiennialCOPY: 1LOCATION OF COPIES: 1 Electronic – Q-Pulse

2 Electronic StaffNet

Page 1 of 35Haematology Users Guide [PD-HAE-UserGuide] – Version: 2

Approved Darren Rookes on 07/01/2020 – Review period: BiennialAuthor(s): Darren Rookes


Contents Page

1. Overview............................................................................................................................32. Contact details of key members of staff.......................................................................33. The location of the laboratories......................................................................................44. Times of opening of the Haematology/Transfusion laboratory.................................45. Details of out of hours service........................................................................................56. Services offered by the Haematology Laboratory.......................................................57. Referred Tests................................................................................................................108. Reference Ranges.........................................................................................................219. Consent............................................................................................................................2410. Instructions for requesting Haematology Tests......................................................2411. Instructions for requesting Blood Transfusion Tests.............................................2812. Instructions for transportation of samples...............................................................2913. Reporting of Results...................................................................................................3014. Clicical advice and interpretation.............................................................................3215. Anticoagulant Control.................................................................................................3316. Common interferences in Haematology tests........................................................3317. Time limits for requesting additional examinations...............................................3318. Comments/Complaints Procedure...........................................................................3419. Data Protection...........................................................................................................3420. Quality Assurance and Accreditation.......................................................................3421. Useful Links.................................................................................................................35




1. Overview

Haematology forms part of the Blood Sciences Service, along with Blood Transfusion andBiochemistry. All services are provided by Western Sussex Hospitals NHS FoundationTrust.

The information in this user guide is related to Haematology Services.

There is a separate user guide for Biochemistry via the Trust Intranet. Information relatingto Blood Transfusion services can be found on the Trust Intranet.

Expert clinical and scientific advice is available on the investigation of haematologicaldisorders, the interpretation of test results, and on any further investigations which may berequired.

2. Contact details of key members of staff

Contact Position ExtensionNumber

E-mail

Clinical Haematology TeamDr John Laurie Clinical Lead of Laboratory

ServiceWRG 85568SRH 33598

[email protected]

Dr Santosh Narat

Haematology Consultant WRG 85568SRH 33598

[email protected]

Dr Jamie Wilson Haematology Consultant SRH Bleep [email protected]

Dr Ronwyn Cartwright

Haematology Consultant Clinical Lead for Thrombosis and Haemostasis

WRG 85702/84600

SRH 33598

[email protected]

Dr George Double

Haematology Consultant WRG 85568SRH 33598

[email protected]

Laboratory Service ManagementRoger Peatey Head BMS Pathology SRH 01243 788122

ext. 33545WRG– 01903 205111 ext. 85263

[email protected]




Steve Short Lead BMS Blood Sciences 85201 [email protected] Sammut Chief BMS Blood

[email protected]

Darren Rookes Chief BMS Haematology 85209 [email protected] of hours Biomedical Scientist (8pm to 9am)

WRG Bleep

SRH Bleep

3. The location of the laboratories

Site Address Telephone Number

ST Richards Hospital Spitafield LaneChichesterWest SussexPO19 6SE

01243788122 ext 33585

Worthing Hospital Lyndhurst RoadWorthingWest SuusexBN11 2DH

01903205111 ext 85575

4. Times of opening of the Haematology/Transfusion laboratory

Monday to Friday 09:00-17:30 Routine service- Please ensure thatsamples for routine requests are sentto the laboratory within these hours.

Monday to Friday 17:30- 20:00 Restricted service provided on sitecovering Haematology/Transfusion

Saturday, Bank Holidays 09:00- 1300 Restricted service provided on sitecovering Haematology/Transfusion

Monday to Friday 20:00- 09:00

Weekends

One BMS providing a service forURGENT work required for immediatemanagement of the patient. The BMSmust be contacted prior to urgentsamples being sent

Haematology medical staff are available for advice. During normal working hours theycan be contacted using the phone numbers provided above and via switchboard at allother times.




5. Details of out of hours service

Please send haematology and blood transfusion sampels via the pneumatic tubesystem to Blood Sciences specimen reception.

Results will be available on SEMA; Request forms MUST have a contact number toadvice of grossly abnormal results/

The out of hours service is for urgent work required for the immediate management ofthe patient. The following services are available:

Full Blood Count- for patients where this information is essential to theirmanagement before routine laboratory hours commence.

Erythrocyte Sedimentation Rate for all urgent ?Temporal Artheritis INR, APTT, Fibrinogen and D.Dimer- ? acute DIC, massive transfusion or

active bleeding Malarial Parasites Screen- Urgent Blood Films Urgent Sickle Screening in emergency pre-operations Blood Tranfusion Provision

6. Services offered by the Haematology Laboratory

Full Blood Count (FBC):Abbott Cell Dyn Sapphire analysers produce a complete automated blood count result with adifferential and platelet count - individual parameters need not be requested. Reticulocytesand Nucleated Red Blood Cell Analysis can also be undertaken where appropriate.Blood films are made and examined if requested or if the parameters suggest that a manualfilm and/or differential will be helpful.

Erythrocyte Sedimentation Rate (ESR) :The ESR is an indirect measure of the degree of inflammation present in the body. It is anon-specific test and has to be interpreted within the clinical context in which it is requested.It may be helpful in diagnosing inflammatory disorders such as temporal arteritis/polymyalgiarheumatica and may also be used to monitor disease activity and response to therapy inthese and other inflammatory disorders. It is affected by age, gender and anaemia.Analysed on request.

Paul Bunnell Test:A test for the presence of heterophile antibodies in the serum produced in infectiousmononucleosis.

Malarial Parasites: Thick and thin blood films are stained with Giemsa stain and examinedfor the presence of malarialparasites. A rapid immunological test is also performed as a complementary test to thestandard blood film examination.Blood films for malarial parasites will be made on request if clinical indications suggest thepatient is at risk of malaria. Positive blood films are sent to the London School of Hygieneand Tropical Medicine for confirmation.SAMPLE SHOULD ARRIVE IN THE LABORATORY NO LATER THAN 4 HOURS AFTERBEING TAKEN.




Haemoglobinopathy Screening:Haemoglobinopathy screens can be requested for any patient who might be considered tobe at riskof having a haemoglobin variant or thalassaemia. A haemoglobinopathy screenconsists of a Full Blood Count and Hb HPLC analysis. If haemoglobin variants are detectedby HPLC, confirmation will be performed by electrophoresis and the Sickle SolubilityTest.Rare haemoglobin variants thatcannot be identified by our laboratory are referred to the red cell reference centre at CentralMiddlesex Hospital.These tests should be requested by the patient’s clinician with prior consent. The laboratorydoes not take telephone requests for add-on haemoglobinopathy screening unless made bya ConsultantHaematologist.

Sickle Cell Solubility Screen:This is a rapid test to detect the presence of sickle haemoglobin, eg. HbS but in itself doesn’tdistinguish between sickle cell trait and sickle cell disease. Positive screen results will bereferred for further confirmatory tests. This test is performed when Hb HPLC indicates thepresence of a haemoglobin variant or if a rapid result on sickle status is required.

Antenatal Sickle Cell and Thalassaemia screening:WSHFT participates in the National Screening Programme as a “low prevalence area”.Screening is performed according to the National Screening Programme guidelines usingFBC, family of origin questionnaire and, when indicated, HPLC..Glucose-6-phosphate dehydrogenase (G-6-PD) Screening Test:G-6-PD deficiency is the most common inherited genetic enzyme deficiency. Mostindividuals areasymptomatic, but devastating haemolysis can occur when susceptible patients are exposedtooxidative drugs or infection. It is important to identify individuals at risk as certain drugsmay then beavoided. The screening test is based on a qualitative visual fluorescencescreening procedure.

Cerebrospinal Fluid (CSF) AnalysisCSF is centrifuged, the resulting preparation stained and a manual count made of any cellspresent.Usually only performed if requested by Haematology Registrar/Consultant if there is asuspicion of CNS involvement in haematological neoplasms. Any other reasons for cellcounting should be referred to Microbiology or Cytology.Sample requirement: 1ml CSF.

Bone Marrow Sample Analysis:Bone Marrow samples are only taken by a Haematology medical staff.All diagnostic samples (morphology, cytogenetics, molecular genetics) are sent to KingsCollege Hospital (HMDC) for analysis. Depending on the clinical indication some bonemarrow aspirate slides are also processed in duplicate at WSHFT to allow for a provisionalresult and assist with patient management.Turn-around times depend on the assays required. Discuss with haematologist.

Peripheral blood Leucocyte Immunophenotyping:Samples are sent to Kings College Hospital HMDC. See above




Routine Coagulation TestsCoagulation Screening:Prothrombin Time/International Normalised Ratio (PT/INR) and Activated PartialThromboplastin Time (APTT) are our standard coagulation tests. Prolonged clotting timesare an indication of abnormal clotting which could lead to an increased risk of bleeding.Further coagulation investigations may be reflexed by the laboratory depending on thenature of the coagulation results and previous test results to aid interpretation.Clauss fibrinogen is reflex tested if the coagulation analyser indicates that the fibrinogenlevel is likely to be low (derived fibrinogen). Fibrinogen can also be requested by therequesting clinician.When requesting coagulation screening tests it is important to include relevant clinicalinformation as to why the test was requested to enable laboratory staff to determine the bestcourse of action inthe event of an abnormal result.

It is not appropriate to request a coagulation screen for patients receiving warfarin orheparin as the reference ranges will not be valid. If monitoring of anticoagulants requiredselect the appropriate test (warfarin monitoring or heparin monitoring).

Anticoagulant monitoring:Always ensure the request form contains details of any anticoagulants given.All INR results >4.0 will be telephoned to the patient by specialised anticoagulant nurses. Noother INR results are routinely telephoned. For queries related to the anticoagulant monitoring service contact the anticoagulationservice.

VTE (venous thromboembolism) screening:D-dimer is used to help venous thromboembolism. It is a restricted test and should only beused in conjunction with a clinical probability score e.g. Wells score and when the result willaffect patient management (e.g. allow VTE to be excluded without radiology tests). D-dimerresults are generally raised in in-patients and should not be requested.

Specialist Coagulation Tests:Discuss with a Consultant Haematologist.




TESTS SPECIMENREQUIRED

TURNAROUNDTIMES

SPECIALINSTRUCTIONS

KEY FACTORSAFFECTING TEST PERFORMANCE ORINTERPRETATION

Full Blood Count(FBC)

4ml Mauve topEDTA or 1.4 Mauve Paediatric top

4 hrs1 Hour for urgent samples

Red cell Cold autoagglutinns Lipaemia(these are corrected in lab)

ErythrocyteSedimentation Rate(ESR)

4ml Mauve topEDTA

6 hrs Minimum volume 2ml

Red cell Cold autoagglutinns (test will not be reported)

Reticulocyte count 4ml Mauve topEDTA

4 hrs

Blood film (manualdifferential)

4ml Mauve topEDTA

24 hrs where clinically Urgentotherwise upto 72 hours.

Prolonged exposure to EDTA anticoagulant may result in abnormal cell morphology.

Infectiousmononucleosis screen (Glandular fever)

4ml Mauve topEDTA

8 hrsSome patients do notproduce antibody.In early stage antibody may be undetectable.

Malarial Parasites 4ml Mauve topEDTA

4 hrs Rapid test within1 hr.

If initial screen negative this should be repeated if strong suspicion of malaria present. Ensure been to VHF regiosn VHF questionnaire sent with sample

HaemoglobinopathyScreen.

Hb S Screen

4ml Mauve topEDTA

3 days Urgent requestswill be processed

Requestor should indicate if patient has been recently transfused

Glucose-6-phosphatedehydrogenase(G6PD)

4ml Mauve topEDTA

3 days Raised reticulocyte countmay result in false normal result

Bone marrow aspirate Bone marrow 14 days Discuss withHaematologist

Refrigerate if not sending straight to laboratory. Prolonged exposure to EDTA anticoagulant may result in abnormal cell morphology.

Bone marrow trephinebiopsy

Bone marrow 14 days Discuss withHaematologist

CSF Cytospin CSF fluid in plain bottle

Send sample to laboratory before 16:30

Haematology patients only




TESTS SPECIMENREQUIRED

TURNAROUNDTIMES

SPECIALINSTRUCTIONS

KEY FACTORSAFFECTING TEST PERFORMANCE ORINTERPRETATION

Clotting Screen (PT +APTT) 3.5ml blue top citrate 3 hours

All coagulation tests require a good clean venepuncture to avoidsample activation

INR (oral anticoagulation) 3.5ml bluetop citrate

3 hours

APTT ratio (unfractionatedheparin)

3.5ml bluetop citrate

3 hours

Anti-factor Xa (Lowmolecular weight heparin)

3.5ml bluetop citrate

3 hours

D-Dimer (DD) 3.5ml bluetop citrate3 hours

Fibrinogen (FIB) 3.5ml bluetop citrate3 hours

Thrombin time (TT) 3.5ml bluetop citrate citrate

3 hours

Clotting tests (paediatric)

1.4 mlcitrate paediatric blue tube

3 hours

Coagulation factors(VIII,IX,XI,XII,)

2 x 3.5mlblue top citrate

Weekly Discuss withHaematologist

Lupus anticoagulantscreen

4 x 3.5mlblue top citrate

2 weeks Indicate if patient onanticoagulants

Thrombophilia screen (AT3, PC, FPS, APC,)

4 x 3.5mlblue n topcitrate

2 weeks See guidelinesbelow

Patient should beminimum 1 month post anticoagulant therapy orpost thrombotic episode




7. Referred Tests

Some specialized or low volume assays are referred to suitably accredited externallaboratories for analysis.

For any test not listed, please contact Haematology (ext) to discuss test availabilityand specimen requirement.

Assay ADAMTS 13 AssaySynonymsSample type Citrate (Blue top)Test instructions Sample should be analysed or manipulated

& stored in the laboratory within 4 hours of venepuncture. Please ensure sample tubes are filled exactly to the fill-line as underfilling creates a dilution error and leads to inaccurate results.

Referral laboratory Diagnostic Haemostasis and Thrombosis Department020 7188 2797St Thomas' HospitalNorth Wing - 4th and 5th FloorsWestminster Bridge RoadLondon SE1 7EH

Turnaround time 2 Weeks Test indications Thrombotic Thrombocytopaenic Purpura,

Haemolytic Uraemic SyndromeReference intervals 66.4 – 107.9 Interferences

Assay Beta-2 MicroglobulinSynonyms B2MSample type SST (Gold top)Test instructionsReferral laboratory Reference Chemistry Laboratory at St

Thomas'0207 188 12644th floor, North WingSt Thomas' HospitalWestminster Bridge RoadLondon SE1 7EH

Turnaround time 1 weekTest indications The measurement of beta-2 microglobulin is

used as prognostic indicator in myeloma. Concentrations will also be raised in patients with renal dysfunction.

Reference intervals 0.7 - 1.8 mg/LInterferences




Assay BCR-ABLSynonymsSample type EDTA (Purple top)Test instructionsReferral laboratory Haematology - Blood Sciences at King's

College Hospital020 3299 9000 ext.2418King's College HospitalBessemer WingDenmark HillLondon SE5 9RS

Turnaround timeTest indications Suspected Chronic Myeloid Leukaemia, blast

transformation to acute myeloid leukaemia oracute lymphoblastic leukaemia, chronic neutrophilic leukaemia.

Reference intervals N/AInterferences

Assay Bone marrow aspirate SynonymsSample type Bone marrowTest instructions Discuss with haematologistReferral laboratory Dependent on requestorTurnaround time 2 weeksTest indications Bone marrow assessmentReference intervals N/AInterferences

Assay Bone marrow trephineSynonymsSample type Bone marrowTest instructions Discuss with haematologistReferral laboratory Dependent on requestorTurnaround time 2 weeksTest indications Known or suspected haematological

malignancy or myelodysplasiaReference intervals N/AInterferences




Assay CALRSynonyms Calreticulin mutation screen Sample type EDTA (Purple top)Test instructions N/AReferral laboratory HMDC Department at King's College

Hospital020 3299 9000 ext 32414c/o Central Specimen ReceptionBlood Sciences LaboratoryGround Floor Bessemer WingKing’s College HospitalDenmark HillLondon SE5 9RSMon-Fri, 9.00am-5.30pm

Turnaround time 2 weeksTest indications For JAK2-negative myeloproliferative

diseaseReference intervals N/AInterferences

Assay CD4:CD8Synonyms HIV immune monitoring CD3, CD4, CD8Sample type EDTA (Purple top)Test instructionsReferral laboratory Special Haematology Department at Guy's

and St Thomas' HospitalSt Thomas’ Hospital5th Floor - North Wing Westminster Bridge RoadLondon SE1 7EHTelephone - 0207 188 8189

Turnaround time 1 weekTest indications Monitoring CD4+ and CD8+ T lymphocyte

count in patients with known HIV infection, todetermine efficacy of antiretroviral medication.





Assay Chromosomal analysis- FISH & Cytogenetics

SynonymsSample type Dependent on formTest instructions Please check that an accompanying form is

required with this test. If so please fill out completely.

Referral laboratory Dependent on formTurnaround timeTest indications Known or suspected haematological

malignancy or myelodysplasiaReference intervals N/AInterferences

Assay CSF CytospinSynonymsSample type CSF- Universal containerTest instructions Send sample to laboratory before 16:30Referral laboratory N/ATurnaround timeTest indications Cytocentrifugation is a method of gentle,

controlled centrifugation to produce a monolayer of preserved, displayed cells. These are flattened constructively on a slide offering a more open nucleus and more visually interpretable nuclear material. Slidesare reviewed by a Haematology Registrar/Consultant





Assay Exon 12Synonyms Jak 2 Exon 12Sample type EDTA (Purple top)Test instructions Due to the rarity of MPL and JAK2 exon 12

mutations these laboratory tests are not normally performed without a previous JAK2V617F negative result and a strong suspicion of an MPN. Exon 12 and MPL assays can be performed on the original JAK2V617F DNA sample. It is not necessaryto send an additional sample to perform these analyses. Please contact the laboratory to arrange this additional analysis.

Referral laboratory HMDC Laboratory for Molecular Haemato-Oncology at King's College Hospital020 7848 5809King's College HospitalDenmark HillLondon SE5 9RS

Turnaround time 2 weeksTest indications For JAK2-negative myeloproliferative

diseaseReference intervals N/AInterferences

Assay Factor V LeidenSynonyms FVLSample type EDTA (Purple top)Test instructions Transport at ambient temperature.Referral laboratory Haematology Department at Guy's and St

Thomas' HospitalSt Thomas’ Hospital5th Floor - North Wing Westminster Bridge RoadLondon SE1 7EHTelephone - 0207 188 8189

Turnaround time 7 daysTest indications Increased thrombophilia risk.

Activated Proten C Resistance (APCr)Reference intervals N/AInterferences




Assay HaptoglobinSynonymsSample type SST (Gold top)Test instructionsReferral laboratory Clinical Biochemistry - Blood Sciences at

King's College Hospital020 3299 4126King's College HospitalBessemer WingDenmark HillLondon SE5 9RS

Turnaround time 2 weeksTest indications Suspected haemolysisReference intervals 0.8-2.2 g/LInterferences

Assay HFESynonyms Haemochromatosis mutationsSample type SST (Gold top)Test instructionsReferral laboratory Haematology Department at Guy's and St


Turnaround time 2 weeksTest indications The iron storage disorder hereditary

hemochromatosis (HH) is an autosomal recessive genetic disorder that usually results from defects in this gene. Hereditary haemochromatosis (HH) is an adult-onset disorder characterized by inappropriately high absorption of iron by the gastrointestinalmucosa, resulting in excessive storage of iron, particularly in the liver, pancreas, heart, joints, and testes.





Assay HIT ScreenSynonyms Heparin Induced thrombocytopenia (HIT)Sample type Citrate and serum (Blue and Gold)Test instructions The samples should be analysed or

manipulated & stored in the laboratory within 4 hours of venepuncture.Please ensure citrate sample tubes are filled exactly to the fill-line as underfilling creates adilution error and leads to inaccurate results.

Referral laboratory Haematology Department at Guy's and St Thomas' HospitalSt Thomas’ Hospital5th Floor - North Wing Westminster Bridge RoadLondon SE1 7EHTelephone - 0207 188 8189

Turnaround time 7-10 daysTest indications Heparin induced thrombocytopeniaReference intervals NegativeInterferences

Assay HLA B27SynonymsSample type EDTA (Purple top)Test instructionsReferral laboratory Haematology Department at Guy's and St


Turnaround time 3 WeeksTest indications Suspected inflammatory disease, ankylosing

spondylitisReference intervals N/AInterferences




Assay JAK 2

Synonyms JAK2V617FSample type EDTA (Purple top)Test instructions N/AReferral laboratory HMDC Department at King's College


Turnaround time 2 weeksTest indications Suspected myeloproliferative neoplasm

(Polycythaemia vera, essential thrombocythaemia, primary myelofibrosis)


Assay Mature lymphocyte marker panelSynonyms MLMPSample type EDTA (Purple top)Test instructions Keep at room temperatureReferral laboratory Special Haematology Department at Guy's

and St Thomas' HospitalSt Thomas’ Hospital5th Floor - North Wing Westminster Bridge RoadLondon SE1 7EHTelephone - 0207 188 8189

Turnaround time 2 weeksTest indicationsReference intervals N/AInterferences




Assay MPLSynonymsSample type EDTA (Purple top)Test instructions N/AReferral laboratory HMDC Department at King's College


Turnaround time 2 Weeks Test indications For diagnosis of essential thrombocythaemia

if JAK2-negative.Reference intervals N/AInterferences

Assay Plasma viscositySynonymsSample type EDTA (Purple top)Test instructions Must be tested within 24 hours of specimen

collectionReferral laboratory Blood Sciences Department-Guy's And St

Thomas' HospitalResult Query: 020 7188 8008St Thomas' HospitalNorth Wing - 5th FloorWestminster Bridge RoadLondon SE1 7EHContact: 020 7188 9247

Turnaround time 1 WeekTest indications Myeloma, Macroglobulinaemia, Autoimmune

conditionsReference intervals 1.50 - 1.72 mPa @ 25°CInterferences




Assay Platelet function assaySynonymsSample type 2 x Citrate (blue top)Test instructions The sample should be analysed within 4

hours of venepuncture.Referral laboratory Diagnostic Haemostasis and Thrombosis

Department020 7188 2797St Thomas' HospitalNorth Wing - 4th and 5th FloorsWestminster Bridge RoadLondon SE1 7EH

Turnaround time 1 WeekTest indications Platelet function disorders; von Willebrand

diseaseReference intervals Contact referral laboratory Interferences

Assay PT20210G>A polymorphismSynonyms PT20210 F2 Leiden (FII Leiden)Sample type 1 x EDTA Mauve top)Test instructions Transport at ambient temperature.Referral laboratory Molecular Haemostasis Laboratory

St Thomas' HospitalNorth Wing - 4th and 5th FloorsWestminster Bridge RoadLondon SE1 7EH02071882798

Turnaround time 7 daysTest indications Increased thrombophilia risk.

Increased plasma Prothrombin levels.Reference intervals Contact referral laboratory Interferences




Assay Taipan snake venom timeSynonyms TSVTSample type 2 X Citrate (blue top)Test instructions The samples should be analysed or

manipulated & stored in the laboratory within 4 hours of venepuncture.


Turnaround time 2 WeeksTest indications Antiphospholipid syndrome, acquired

thrombophiliaReference intervals TSVT: 0.87 – 1.14

ET: 0.88 – 1.14Interferences

Assay von Willebrand factorSynonyms vWFSample type Citrate (Blue top)Test instructions The sample should be analysed or

manipulated & stored in the laboratory within 4 hours of venepuncture


Turnaround time Contact laboratoryTest indications Family history of von Willebrand Disease,

investigation of bleeding tendencyReference intervals N/AInterferences




8. Reference Ranges

The reference ranges which have been applied by the laboratories Haematology service forthe reporting of Full Blood Count, ESR and HbA2 and HbF requests is based upon theparameter reference ranges quoted in the following text:D. Bain, I. Bates, M.A. Laffan. (2016). Dacie and Lewis Practical Haematology. Philadelphia:Churchill Livingstone/Elsevier

Reference ranges are reviewed at regular intervals according to local laboratory standardoperating procedures.

Full Blood Count Parameters and Cell Counts

Reference Ranges for Infants

Test Birth Day 3 Day 7 Day 14 1 month 2 months

3-6 months

RBC x1012/l

5.00 – 7.00

4.00 – 6.60

3.90 – 6.30

3.60 – 6.20

3.00 – 5.40

3.10 – 4.30

4.10 – 5.30

Hb g/l 140 - 220

150 – 210

135 - 215

125 - 205

115 - 165

94 - 130 111 - 141

Hct l/l 0.450 – 0.750

0.450 – 0.670

0.420 – 0.660

0.310 – 0.710

0.330 – 0.530

0.280 – 0.420

0.300 – 0.400

MCV f 100 - 120

92 - 118

88 - 126

86 - 124

92 - 116 87 - 103 68 – 84

MCH pg 31.0 – 37.0

31.0 – 37.0

31.0 – 37.0

31.0 – 37.0

30.0 – 36.0

27.0 – 33.0

24.0 – 30.0

MCHC g/l 300 - 360

290 - 370

280 - 380

280 - 380

290 - 370

285 - 355

300 - 360

Retic x109/l

120 - 400

50 - 350

50 - 100

50 - 100

20 - 60 30 - 50 40 - 100

WBC x109/l

10.0 – 26.0

7.0 – 23.0

6.0 – 22.0

6.0 – 22.0

5.0 – 19.0

5.0 – 15.0

6.0 – 18.0

Neuts x109/l

4.0 – 14.0

3.0 – 5.0

3.0 – 6.0

3.0 – 7.0

3.0 – 9.0

1.0 – 5.0 1.0 – 6.0

Lymphs x109/l

3.0 -8.0 2.0 – 8.0

3.0 – 9.0

3.0 – 9.0

3.0 – 16.0

4.0 – 10.0

4.0 – 12.0

Mono x109/l

0.5 – 2.0

0.5 – 1.0

0.1 – 1.7

0.1 – 1.7

0.3 – 1.0

0.4 – 1.2 0.2 – 1.2

Eos x109/l

0.1 – 1.0

0.1 – 2.0

0.1 – 0.8

0.1 – 0.9

0.2 – 1.0

0.1 – 1.0 0.1 – 1.0

Baso x109/l

0.02 – 0.1

0.02 – 0.1

0.02 – 0.1

0.02 – 0.1

0.02 – 0.1

0.02 – 0.1

0.02 – 0.1

Plats x109/l

100 - 450

210 - 500

160 - 500

170 - 550

200 - 500

210 - 650

200 - 550

Reference: Dacie & Lewis Practical Haematology 12th Edition




Reference Ranges from Children to Adults

Test 1 Year 2-6 Years 6-12 Years Adult male Adult female

RBC x1012/l 3.90 – 5.10 4.00 – 5.20 4.00 – 5.20 4.50 – 5.50 3.80 – 4.80Hb g/l 111 – 141 110 - 140 115 – 155 130 - 170 120 - 150Hct l/l 0.300 –

0.3800.340 – 0.400

0.350 – 0.450

0.400 – 0.500

0.360 – 0.460

MCV f 72 - 84 75 - 87 77 – 95 83 - 101 83 - 101MCH pg 25.0 – 29.0 24.0 – 30.0 25.0 – 33.0 27.0 – 32.0 27.0 – 32.0MCHC g/l 320 - 360 310 – 370 310 – 370 315 - 345 315 - 345Retic x109/l 30 - 100 30 – 100 30 – 100 50 - 100 50 - 100WBC x109/l 6.0 – 16.0 5.0 – 15.0 5.0 – 13.0 4.0 – 10.0 4.0 – 10.0Neuts x109/l 1.0 – 7.0 1.5 – 8.0 2.0 – 8.0 2.0 – 7.0 2.0 - 7.0Lymphs x109/l

3.5 – 11.0 6.0 – 9.0 1.0 – 5.0 1.0 – 3.0 1.0 – 3.0

Mono x109/l 0.2 – 1.0 0.2 – 1.0 0.2 – 1.0 0.2 – 1.0 0.2 – 1.0Eos x109/l 0.1 – 1.0 0.1 – 1.0 0.1 – 1.0 0.02 – 0.5 0.02- 0.5Baso x109/l 0.02 – 0.1 0.02 – 0.1 0.02 – 0.1 0.02 – 0.1 0.02 – 0.1Plats x109/l 200 - 550 200 - 490 170 - 450 150 - 410 150 - 410Reference: Dacie & Lewis Practical Haematology 12th Edition

ESR Reference Ranges for adults

Test 17-50 Years 50-61 Years 61-70 Years >70 YearsESR (male) mm/hr

≤ 10 ≤ 12 ≤ 14 ≤ 30

ESR (female) mm/hr

≤ 12 ≤ 19 ≤ 20 ≤ 35

Reference: Dacie & Lewis Practical Haematology 12th Edition

HbA2 and HbF Reference Ranges for adults

TestHbA2 % 2.2 – 3.5%HbF % < 1.0%Reference: Dacie & Lewis Practical Haematology 12th Edition




The reference ranges which have been applied by the laboratories Haematology service forthe reporting of Coagulation requests is based upon the parameter reference ranges quotedin the a number of articles which laboratorty has a record off within Quality ManagementSystem. For article related to reference range for parameters shown below, please contactlaboratory.

Reference ranges are reviewed at regular intervals according to local laboratory standardoperating procedures.

Adult normal rangeTest Ref/Normal

Range (+/- 2SD)

Alert/CriticalValue

Source of reference range

INR 0.8-1.2 6 ED-HAE-EssentialBloodCoagAPTT(APTR)

0.8-1.2 4 ED-HAE-SynthASilED-HAE-SynthasilLI-HAE-APTRConfirmED-HAE-PracHemThrom2ndED

Fibrinogen-Clauss

1.5 – 4.0g/L Reflex to low orhigh curve.

ED-HAE-BSHGuideFib

TT 10-17 seconds 17 HemosIL Thrombin Time reagent kitinsert ED-HAE-ACLThrombinED-HAE-ThrombinTime

D-Dimer 2.2 LR-HAE-ACL-APCRassayCutOff

Protein C 70-140% ED-HAE-HemosILProtCFree ProteinS

Male = 74-146 %Female = 55-124 %

ED-HAE-ACLFreeProteinS

LupusDRVVTscreen


9. Consent

It is the responsibility of the requesting clinician to obtain consent from the patient forthe collection of blood specimens. For certain tests (e.g. bone marrow aspiration) aconsent form may be required on addition to the request form.

10. Instructions for requesting Haematology Tests

Patient preparation and blood sampling:

Any patient preparation requirements for tests are detailed in the Haematology TestRepertoire above.

All specimens must be fully labelled and accompanied by a completed combinedBlood Sciences Request form. Each request accepted by the laboratory forexamination(s) sheall be deemed an agreement.

Inadequately or incorrectly labelled samples will not be processed.

Request form:

NHS number or hospital number (ONLY if patient’s name given) Patient’s full name or unique coded identifier

Date of birth Gender Patient’s location and destination for report Patient’s consultant, GP or name of requesting practitioner Investigation(s) required

along with:

Clinical information including relevant medication (which is sometimes essential)

Date and time sample collected (which is sometimes essential)

Patient’s address including postcode Practitioner’s contact number (bleep or extension) Sample type

The Specimen:

Details of specimen type and volume required are shown below.




Figure 1: Microtainer EDTA forNeonatal samples

This pink top sample tube is primarily used for whole blood tests such as Full Blood Count. The minimum sample volume is 0.75mL. The sample bottle can also be used for neonatal/paediatric blood transfusion testing. Please note it may not be possible to complete all investigations with this sample bottle size. See section 9.2 for details on labelling.

Figure 2: Sodium Citrate 3.0mL

This blue top sample tube is used primarily inHaemostasis testing. It is essential that the tube is filled only to the line (total volume 3.0mL). Under or over filled samples are not able to be processed (see section 9.4). A microtainer tube for neonatal/paediatric patients is also available; this needs to be filled to the line, total volume is1.3mL.

Figure 3: EDTA 4mL

This purple top sample tube is used primarily for wholeblood tests such as Full Blood Count, but can be used for plasma tests. The minimum sample volume is 2mL for FBC and ESR requests.

Figure 4: EDTA 6mL

This pink top sample bottle is primarily used for Transfusion testing. The minimum sample volumeis 3mL. Please note, it may be necessary to provide further samples where additional investigations are required. See section 0 for details on labelling.

Figure 5: Serum Separating Tube(SST) 6mL

This yellow top sample bottle is used for serum tests. The minimum sample volume is 2mL.

Figure 6: Serum (clotted) tube 6mL

This red top sample bottle is used for serum tests. The minimum sample volume is 2mL.

Figure 7: Universal Container

This universal container contains no additives and is used for collection of urine and CSF samples.




Check expiry dates on the specimen before use.

NHS number or hospital number (ONLY if patients name given) Patients full name or unique coded identifier

Date of birth

along with:

Date and time Nature of sample, including qualifying details, e.g.

left, distal etc especially if more than one sample per request is submitted. Location of patient. Signature of specimen taker.

High Risk status must be indicated by a label on the sample if appropriate. Coagulation and ESR samples must be correctly filled.

NB. At no time should blood be transferred from one container to another.This may result in contamination of the specimen with inappropriateanticoagulant and will invalidate the results obtained.

Urgent Samples

Requests to process samples urgently should be conveyed by a phone call to thelaboratory or a personal request when the sample is delivered.

Non compliance

Unlabelled specimens will be cancelled and discarded. An attempt will be made tocontact the requestor and request a repeat sample.

Unlabelled specimens

Unlabelled specimens, whether received in a transport bag accompanying its request form or received separately from the request form will not be accepted for analysis unless the specimen is deemed to be unrepeatable (See unrepeatable specimens).

Incorrectly labelled specimens

Incorrectly labelled specimens (when compared with its accompanying request form) will notbe accepted for analysis unless the specimen is deemed to be unrepeatable.

Specimens received without request form

If a specimen is received without a request form, the location from where it has originated (if known) will be informed. The specimen will not be processed. A new specimen and request is required, unless the specimen is deemed to be unrepeatable.

Specimens received that are leaking or damaged




Leaking or damaged specimens will not be accepted for analysis unless the specimen is deemed to be unrepeatable

Specimens received in incorrect container for test requested

Specimens received in unapproved or incorrect containers for the test requested will notbe accepted for analysis unless the specimen is deemed to be unrepeatable anddependant upon if the analysis can be performed on the specimen received.

Specimens received that are in expired containers containers

Specimens received in expired containers will not be accepted for analysis unless the specimen is deemed to be unrepeatable

Request forms that have incorrect demographic details with respect to the specimen

Request forms that have incorrect demographic details when compared with thespecimen will not be accepted for analysis unless the specimen is deemed to beunrepeatable

Specimens received with a request form that is devoid of any patient demographic details

If a specimen is received with a request form that is devoid of any patient demographic details, the location from where it has originated (if known) will be informed. A new request and specimen is required.

Request forms received without any specimenA new request and specimen is required.

Specimens received that have been delayed in transitSamples that have been delayed in transit may be rejected as unsuitable for processing. Generally speaking, 24 hours will be rejected, dependant upon sample type, unless the specimen is deemed to be unrepeatable.

Specimens deemed to be unrepeatable

It may be necessary to process some specimens even though they are not clearly identified if they are difficult to repeat or are unrepeatable. This should be a very unusual occurrence.The most obvious examples of these difficult to repeat or unrepeatable specimens are:

Cord Blood Sample New-born/paediatric samples CSF Cytospin Bone marrow Renal Stones Cyst, Ascitic and Pleural fluids




CSF samples for Chemistry

A exception form is required to be completed by the requesting clinican in all case of unrepeatable speicmens see [LF-BLS-ConForm], before processing.

11. Instructions for requesting Blood Transfusion Tests

Please note specimen request form and sample criteria are mucg more stringent for Blood Transfusion. Full details of sample and request form requirements are detailed below.

Request Form

Completion of request forms or making a telephone request can be delegated to acompetent nurse or midwife who has been appropriately trained. However, it is a medicalresponsibility to prescribe blood components. All telephoned requests must be followed upby a written request Clinical staff are encouraged to discuss transfusion indications andrequirements with transfusion Biomedical Scientist (BMS) staff (advice is also available fromHaematology Consultants or Transfusion Practitioner if required.) Requests for transfusionshould only be sent ‘out of hours’ when clinically necessary. The form must contain thefollowing information: Surname First name Date of birth Gender Hospital number Patientlocation Diagnosis/Indication for sample/Indication for transfusion Consultant Signature ofthe requester.

If a crossmatch is being taken the following information is also required:

Blood components required (the maximum blood order schedule is available to aidclinicians in requesting red cells for elective surgery).

Date blood component is required and the urgency.

Any special requirements (i.e. irradiated blood, CMV negative, etc.).

Previous transfusions, transfusion reactions, pregnancies, reported red cell antibodies.

Date (DD/MM/YY), time (24 hour clock) and signature of the phlebotomist.

Patient Identification

The collection of a blood sample from the patient and subsequent labelling of the sampletubes should be performed as one continuous, uninterrupted event at the patient’ side,involving one patient and one competent practitioner only. Bottles must not be pre-labelled.Positive identification of the patient is essential:

In the case of patients who are judged capable of giving an accurate, reliable responseask them to state their surname, first name and date of birth.




For hospital patients check that all the details on the wristband match those on therequest form and the answers given by the patient. All hospital patients must have a patientidentification number and wristband; otherwise blood must not be collected.

In the case of patients who cannot communicate the information must be taken from thewristband and should be verified by another healthcare practitioner.

The person who has taken the sample must fully label the bottle immediately after samplingnext to the patient. Bottles must be labelled by hand (addressograph labels must not beused on samples for the Blood Transfusion Department) Patient core identifiers must exactlymatch the request form and wristband; otherwise blood must not be collected.

Emergencies The minimum identification for an unconscious or trauma patient is theemergency random, unique number, hospital number and gender. The sample should betaken and labelled, and the form and sample signed by the prescribing doctor as onecontinuous procedure.

Obtaining Consent and Communication

Obtain the patient’s consent and allow time for the patient to ask questions which may helpto reduce the patient’s anxiety - a relaxed patient will have relaxed veins. Consent may beconsidered obtained if the patient presents their straightened arm to the phlebotomist.Discuss any preferences or problems experienced at previous venepunctures. Occasionally,you may encounter a patient who is violent or abusive. If working on a ward, the staff shouldforewarn you and offer assistance but if the patient continues to be obstructive leave therequest forms and let a Doctor deal with the situation. If working in the laboratory refer thepatient to their Consultant or GP for advice.

12. Instructions for transportation of samples

Various personnel within the Trust will be involved in transport of specimens to andfrom the laboratory either by hand or via the POD system. In order to protect theirs andothers safety the following guidelines should be followed.

Cover any cuts and grazes with a waterproof dressing. Touch specimen containers aslittle as possible, washing hands as soon as practicable afterwards. Diagnosticsamples must be sealed in the plastic bag attached to the request form. Carry allspecimens in the trays or boxes, where provided, never in pockets. If a specimen leaksin a tray or box, tell the laboratory reception staff and ask them to make it safe.If a specimen is dropped or broken, do not touch it or try to clear up the mess. Staywith the specimen to prevent other people touching it and send someone to thelaboratory for help. If you spill the specimen onto your overall, you must remove it atonce and wash your hands and put on a clean overall. Report the accident to asupervisor as soon as possible. Handle specimen containers gently at all times.

The use of the pneumatic tube system for the transport of specimens to the Blood




Sciences laboratory must be performed in accordance with Trust policy. Guidance onthe use of the pneumatic tube transfer system can be found on the pathology page.

13. Reporting of Results

Some results are automatically validated if they fulfil stringent pre-set criteria;otherwise they are clinically validated by appropriately qualified laboratory personnel.Comments may be appended and additional analyses undertaken based on theclinical details provided and on previous results.

Results are produced in electronic form in the electronic patient record (Sema,Cyberlab). Please note: if any element of the report or test is marked Interim, then finalvalidation for the whole test is incomplete and results may be subject to change,therefore clinicians are advised to contact laboratory before making any clinicaldecisions based on an interim result.

The laboratory will endeavour to telephone results when they have changedsignificantly from a previous episode or are grossly abnormal, to facilitate this pleaseensure the correct patient location is provided on the request form.

Telephoning Limits




The laboratory will endeavour to telephone results when they have changedsignificantly from a previous episode or are grossly abnormal. To facilitate this pleaseensure the correct patient location is provided on the request form.

The following results will be telephoned by the laboratory to the requesting locationunder the following circumstances.

Parameter Unit Level CommentHaemoglobin g/L 50 Consider referral.Platelets x109/L 1000 Requires urgent

but not immediatereferral if unexplained.

Blood FilmPresence of blasts or diagnosis suggestive of chronic myeloid leukaemia.

Discuss with covering Haematologist prior to deciding what action should be taken.

Malarial Parasites PositiveTaken from “The communication of critical and unexpected pathology results”Document number G158 from the Royal College of Pathologists

Parameter Unit Level Comment




ESR mm/hour >20 In cases of ? temporal arteritis

CoagulationINR >6.0 For patients on

warfarinAPTT ratio >4.0D-Dimer ng/mL >230 Phone to surgery

during routine hours.

Local values for communication of unexpected pathology results.

Please note that the primary method for transmission of results is to SEMA andCyberlab.

Whilst internal and external quality assurance programmes are in operation to ensureaccuracy and precision of results, occasionally random errors may occur and escapedetection. The clinician is often best placed to detect such errors. Therefore if there isany doubt about a result, it is vital the laboratory is contacted at once to investigateand re-test samples where possible.

Certain factors may affect and possibly invalidate some test results, causing potentialbiological and analytical interference. For example, blood transfusion and otherintravenous fluids, anticoagulants, drugs, timing of specimen in relation to drug dose,type of tube. Please remember to give details of recent or current treatment on therequest forms.

Uncertainty of Measurement

All tests are subject to a degree of uncertainty of measurement. This may be due to arange 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 ofan individual test result please contact laboratory.

14. Clicical advice and interpretationClinical advice and interpretation of results is available by contacting a consultantHaematologist or Specialist Registrar via switchboard or direct dial/bleep. Interpretivecomments are included in the laboratory reports of a number of specialist tests.




15. Anticoagulant ControlAnticoagulant control (warfarin, heparin etc.) is undertaken by the medical teammanaging the patient.

For patients on warfarin, the request form must indicate that patient is on warfarin andthat INR is required. The INR result will be available on SEMA to allow the patient to bedosed by the doctor responsible for their care.

A policy for the Magament of Patients on Anticoagulants is on the intranet under trustdocuments.

A full set of Anticoagulation guidelines is available for every ward. For any furtheradvice, please contact the Haematology registrar or Consultants.

16. Common interferences in Haematology tests

Certain factors may affect some tests results, causing potential biological andanalytical interference. For example, intravenous fluids, anticoagulants, iv feed. Pleaseremember to give details of recent or current treatment on the request form.

17. Time limits for requesting additional examinations

Requests for additional tests on haematology samples will normally only be availablefor the day the specimen was taken. However the following tests can be added withinthe time limits stated.Specimen Type in Lab Test to be added Time limit from

sample being taken.EDTA Reticulocytes Same dayEDTA Infectious

MononucleosisSame day

EDTA Malarial Parasites Same dayEDTA Blood Film Same dayEDTA G6PD screen 48 hoursEDTA Sickle Screen Within 2 daysEDTA Erythrocyte

Sedimentation RateSame day

EDTA HaemoglobinElectrophoresis

Within 2 days

CITRATE D-Dimer, Fibrinogen,Thrombin time

Same day




18. Comments/Complaints Procedure

Any complaints or concerns about any aspect of the service should be raised initiallywith the Blood Sciences Manager, Mr Steve Short, telephone

We are keen to know about any problems arising from the laboratory service. feedbackfrom our users will help in our constant efforts to improve our service.

Feedback: There is a user satisfaction survey available for completion.

19. Data Protection

Western Sussex Hospitals NHS Foundation Trust Pathology department is committedto delivering a first class confidential service ensuring that all patient information isprocessed fairly, lawfully and transparently. Confidential information about patients canonly be used for healthcare purposes. All staff are required to comply fully with theTrusts Information Governance and Security Policy for handling of patient confidentialinformation.http://nww.westernsussexhospitals.nhs.uk/resources/information-governance-policy-and-management-framework/?from_search=information%20governance

In addition to this all HCPC registered staff follow the HCPC confidentiality guidancefor registrants.

20. Quality Assurance and Accreditation

Quality Statement: the laboratory examinations, procedures and reports of test resultsare currently not compliant with the requirements for quality and competence inmedical laboratories according to United Kingdom Accreditation Service against theInternational Standard ISO15189:2012.The department participates in all appropriate National External Quality assuranceSchemes (NEQAS) where available. Documentation relating to Internal Quality Controland performance in NEQAS are available for scrutiny by users of the service.

AccreditationThe Haematology department is currently not accredited by UKAS in conformance with‘Standards for the Medical Laboratory’ incorporating ISO15189:2012.

The department is approved by the Institute of Biomedical Science (IBMS) as aTraining Laboratory and all our qualified scientists are rgistered with the Health &Care Professions Council (HCPC).

The Blood Transfusion service conforms with the UK Blood Safety and QualityRegulations and is deemed compliant as such by the Medicines and Healthcareproducts Regulatory Agency (MHRA).

The department participates in Internal Quality Contreol (IQC) and External QualityAssurance (EQA) for all the tests undertaken within the laboratory. Performance ismonitored and subject to rigorous control, to ensure that analyses are accurate,



http://nww.westernsussexhospitals.nhs.uk/resources/information-governance-policy-and-management-framework/?from_search=information%20governancehttp://nww.westernsussexhospitals.nhs.uk/resources/information-governance-policy-and-management-framework/?from_search=information%20governance


precise and results are comparable with other laboratories.

The laboratory also regularly monitors the UKAS accreditation status of the referrallaboratories used for specialist testing.

21. Useful Links

Lab tests Online: https://labtestsonline.org.uk/



https://labtestsonline.org.uk/

1. Overview2. Contact details of key members of staff3. The location of the laboratories4. Times of opening of the Haematology/Transfusion laboratory5. Details of out of hours service6. Services offered by the Haematology Laboratory7. Referred Tests8. Reference RangesAdult normal rangeTestRef/Normal Range(+/- 2SD)Alert/Critical ValueSource of reference rangeINR0.8-1.26ED-HAE-EssentialBloodCoagAPTT(APTR)0.8-1.24Fibrinogen-Clauss1.5 – 4.0g/LReflex to low or high curve.ED-HAE-BSHGuideFibTT10-17 secondsHemosIL Thrombin Time reagent kit insertED-HAE-ACLThrombinED-HAE-ThrombinTimeD-Dimer2.2Protein C70-140%ED-HAE-HemosILProtCFree Protein SMale = 74-146 %Female = 55-124 %ED-HAE-ACLFreeProteinSLupus DRVVT screen

haematology user guide · cerebrospinal fluid (csf) analysis csf is centrifuged, the resulting...

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