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Pathology Test List Below is a list of Pathology tests available, in alphabetical order. For further details please see individual department test lists.
Pathology Test List Dept Name BD Vacutainer Reference range Maximum TAT (Working days or weeks) Notes Immuno Acetyl Choline E Receptor Antibody (AChR) pos/neg and interpretative comment given 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem ACTH (adrenocorticotrophic hormone) 0 -40ug/L Interpret with cortisol results from sample taken simultaneously (gold tube) 14-21 days Unstable hormone; blood must arrive in laboratory with 15 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Haem Activated Protein C Resistance > 120 seconds 14 days Contact Consultant Haematologist ( part of thrombophilia screen) Biochem Acylcarnitine Guthrie card Bloodspot free carnitine 10.3 - 54.7 umol/L. Individual interpretation provided on report. 14-21 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Source of reference range - Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Micro Adenovirus Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least
14 days into illness). Micro Adenovirus PCR 5 days Immuno Adrenal Gland Antibody POS/NEG 14-21 days This assay is referred to the Protein Reference Unit, Sheffield Biochem AFP (alpha-fetoprotein) Adults (19yr+) 1-7 kiU/L *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults Used in monitoring patients with non- seminomatous germ cell tumours and in screening and diagnosis of hepatocellular carcinoma Immuno Alpha-3-Ganglionic ACHR antibodies (A3ACR) POS/NEG with values as free text comment 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem Albumin Adult 35-50 g/L *see Patient report for specific age related ranges. 24 hours Source of range – Pathology Harmony reference intervals Biochem Albumin: Creatinine Ratio Universal early am F < 3.5, M <2.5 mg/mmol 24 hours It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Biochem Alcohol (ethanol) Units mg/dL NB UK legal driving limit 80mg/100mL (17.4 mmol/L) 24 hours UK Legal driving limit for blood ethanol is 80 mg/100ml Serum Ethanol: To convert mg/100ml to mmol/L = x 0.216 Biochem Aldosterone Units: pmol/L *See patient report for specific gender & age related ranges 14- 21 days Measure with renin to determine renin:aldosterone ratio. Unstable hormone; blood must arrive in laboratory with
30 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Biochem Aldosterone:Renin Ald:Ren ratio < 91 pmol/mIU effectively excludes Conns. 14- 21 days Unstable hormone; blood must arrive in laboratory with 30 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Biochem ALP (alkaline phosphatase) age related (may be over 300U/L in infants and children) 24 hours Age-related reference ranges quoted on report forms. Higher in children and in the third trimester of pregnancy. Source of range – Pathology Harmony reference intervals Biochem ALP Isoenzymes Interpretative comment given 28 days Contact Duty Biochemist. Referred Test. Immunmo Alpha-Amino-3- Hydroxy-5-Methyl-4- Isoxazolepropionic Acid Receptor (AMPA) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Alpha-1-Antitrypsin 0.9-2.0 g/L 24 hours Contact Duty Biochemist if phenotype required. An acute phase response may cause the plasma
concentration of alpha-1- antitrypsin to rise and mask deficiency. Biochem Alpha-Feto Protein 1-10 kU/L 24 hours Used in monitoring patients with non- seminomatous germ cell tumour and in screening and diagnosis of hepatocellular carcinoma Biochem ALT (alanine transaminase) Adult 1-55 U/L *see Patient report for specific age related ranges. 24 hours. Source of range – Caliper study values for children and expected values from kit insert for adults. Biochem Aluminium <0.37 nmol/L 14- 21 days Referral Test toTrace Element Laboratory, Medical Biochemistry, University Hospital of Wales Source of reference range - Trace Element Laboratory, Medical Biochemistry, University Hospital of Wales Biochem Amikacin Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory, Department of Microbiology, Southmead Hospital Biochem Amino Acids lithium heparin Interpretative comment given 7-14 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Biochem Amino Acids (urine) Universal rand om Interpretative comment given 14 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital A plasma sample is the specimen of choice for first line Amino Acids investigation.
24 hour specimens are rarely indicated for generalised screening. Please contact laboratory for more information. Biochem Amiodarone 0.5 -2.0 mg/L 14- 21 days Measurement of levels hardly ever required; patients on amiodarone treatment require regular monitoring of TFTs and renal function. Referral Test to Toxicology Laboratory, The Academic Centre Llandough Hospital Source of reference range - Toxicology Laboratory , The Academic Centre Llandough Hospital Biochem Ammonia > 16+ 18-72 *see Patient report for specific age related ranges. 24 hours Unstable compound. Blood must arrive in the laboratory within 15 minutes, on ice. Notify Department in advance. Pathology Harmony reference intervals for children and expected values in kit insert for adults Micro Amoebic Antibodies Screen 14 days This test is referred to the Hospital for tropical Diseases, London Biochem Amphetamine Urine NEG/POS (500 ug/L cut-off) 7 days Please request individually when requesting Urine Drugs of Abuse Screen Source of range - European Workplace Testing Threshold Biochem Amylase Range u/L. *see Patient report for specific age related ranges. 24 hours Source of range- Caliper study values for children and expected values from kit insert for adults.
Biochem Androstenedione Units: nmol/L *See patient report for specific gender & age related ranges 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Angiotensin Converting Enzyme ≥16yrs: 8-52 U/L 14- 21 days Referral Test to Department of Chemical Pathology, Bristol Royal Infirmary Source of reference range - Department of Chemical Pathology, Bristol Royal Infirmary Request form must state whether patients are receiving ACE inhibitors. ACE inhibitors will result in decreased activity for up to 12 hours post dose Blood Bank Antenatal Antibody Titre follow-up Pink 1-4 days TAT dependent on urgency Micro Antenatal Virus Screen 3 days Patient must be counselled. Micro Antenatal Virus Screen With HIV 5 days Patient must be counselled. Immuno Anti - Cardiac Muscle Antibody NEG POS with clinical interpretive comment 14-21 days Referred test to Protein reference Unit, Sheffield Immuno Anticardiolipin Antibody Interpretative comment given 10 days Immuno Anti Endomysial (IgA) Antibodies POS/NEG 14 days Immuno Anti Endomysial (IgG) Antibodies POS/NEG 14 days Available for ?coeliac with confirmed IgA deficiency Immuno Anti-Hu Antibodies POS/NEG 14 days Biochem Anti Mullerian Hormone (AMH) Units: pmol/L 7days Source of range for Male and paediatric Beckman Test kit
*See patient report for specific age & gender related ranges insert Source of Adult female range previous AMH kit also from Beckman. Immuno Anti-Neutrophil Antibody or gold top Interpretative comment given 14 days Immuno Anti-Neutrophil Cytoplasmic Antibodies POS/NEG 7 days Immuno Anti-Phospholipase AZ Receptor (Anti- PLA2R) 14-21 days Referred test to Protein Reference Unit, Sheffield Immuno Anti-Purkinje Cell Antibodies POS/NEG 14 days Immuno Anti-Skin BM Antibody POS/NEG 14 days Immuno Anti-Skin ICS Antibody POS/NEG 14 days Immuno Anti-Sperm Antibodies (blood) or gold top Interpretative comment given 8 – 12 weeks This test is referred to Southmead Hospital, Bristol Haem Antithrombin III 80-120 % activity 14 days Contact Consultant Haematologist ( part of thrombophilia screen) Immuno Anti TSH Receptor Antibody POS/NEG 14 days Hcoag APTT Ratio ratio 1.5-2.5 24 hours Same bottle as APTT. Immuno Aquaporin-4 antibodies (AQP4) POS/NEG with values as free text comment 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem Arsenic (Blood) 0 - 0.13 umol/L 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Cyto Ascitic Fluid (malignant cells) 25ml white top universal 5 days* *>50% reported Reference should be made to special notes in the
within 5 days - more complex cases may take longer. Cytopathology section. Micro Aspirate Nasopharyngeal - respiratory viruses Conical Aspiration Tube 1 day Test covers RSV, Influenza A & B, Adenovirus and Parafluenza. Bacterial culture on neonates Biochem AST (aspartate transminase) 5-34 u/L Adult. *see Patient report for specific age related ranges. 24 hours Affected by Haemolysis. Source of range - Caliper study values for children and expected values from kit insert for adults. Immuno Autoantibody Screen POS/NEG 14-21 days Atypical or rare patterns may be sent to the Protein Reference Unit, Sheffield if confirmation of rare/atypical patterns is required Haem Autohaemolysis - Red cells x2 edta x2 Lithium Hep Interpretative comment given 3 days Contact Consultant Haematologist. Mortuary Autopsy Up to 3 months dependant on the material retained. Consent required. See Anatomical Pathology (Mortuary section)/Requesti ng a consented autopsy. Immuno Basal Ganglia antibodies (ABGA) NEG POS with values as free text comment and clinical interpretive comment 21 days This assay is referred to Institute of Neurology, Queen Square, London Molecular BCR/ABC1 t(9;22) qualitative BCR/ABC1 in CML/ALL Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecular BCR/ABC1 t(9;22) quantitative BCR/ABC1 monitoring trend of patient's past results given 21 days Must arrive in laboratory as soon as possible Immuno Bence Jones Protein (urine) Universal earl y am Interpretative comment given 5 days Biochem Benzodiazepine Urine NEG/POS (200 ug/L cut-off) 7 days Please request individually when requesting Urine Drugs of Abuse
Screen Source of range - European Workplace Testing Threshold Biochem Beta-2 Microglobulin 0.1 – 2.2 for all ages and sexes 14 days Referral Test to Department of Clinical Chemistry Royal Devon and Exeter Hospital Source of reference range - Department of Clinical Chemistry Royal Devon and Exeter Hospital Immuno Beta-2-Glycoprotein antibodies (B2GP1) Unit- U/ml NEG POS with clinical interpretive comment 14-21 days Referral test to Protein Reference Unit, Sheffield Source of reference range- PRU, Sheffield Biochem Beta-OH Butyrate (3-OH Butyrate) or Fasting levels 0.03 - 0.3 mmol/L. 7 -14 days Raised in hypoglycaemia when insulin is suppressed. Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Source of reference range - Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Biochem Bicarbonate (CO2) 22-29 mmol/L 24 hours Specimens from GP surgeries are not routinely tested, add on requests for this test are not possible. Source of range- Harmony reference intervals Biochem Bile Acids 0-14 umol/L 1-3 days Sometimes helpful in management of obstetric cholestatsis, RCOG guidelines available. Referral Test to Clinical Chemistry Department, Treliske Hospital Source of
reference range - Clinical Chemistry Department, Treliske Hospital Micro Bilharzia Antibody Screen 14 days This test is referred to the Hospital for tropical Diseases, London Biochem Total Bilirubin <21 umol/L 24 hours Source of range-- Caliper study values for <14 days of age and expected values from kit insert for >14 days of age. Biochem Bilirubin (CSF) "xanthochromia" Universal – Protect from light. Minimum Specimen Volume 350ul. No units Interpretative comment given. 2hrs Must be an appropriate test request, >12hours post event, in patients with Negative CT scan. Deliver to lab by hand protected from light. Minimum Specimen Volume 350ul. Cruickshank A, Auld P, Beetham R, Burrows G, Egner W, Holbrook I, Keir G, Lewis E, Patel D, Watson I, White P. Annals of Clinical Biochemistry (2008); 45: 238- 244. Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Biochem Bilirubin (direct/conjugated) Adult (19+ years) 0- 8.6 umol/l *See patient report for paediatric ranges 24 hours Performed to help elucidate cause of jaundice when total bilirubin raised. Source of range - Caliper study values for children and expected values from kit insert for adults Biochem Unconjugated Bilirubin No units 24 hours Calculated from bilirubin and conjugated bilirubin
Micro Blood Culture Blood Culture Set Interpretative comment given Telephoned same day if positive; 36 hours if neg ative. Avoid covering or defacing barcode on bottle label. Results telephoned on same day if positive Biochem BNP Units ng/L BNP is recommended for ruling out Heart Failure, but not to establish diagnosis. The upper limit of normal in the non- acute condition is 35 ng/L. A serum BNP level <100ng/L in an untreated patient makes diagnosis of heart failure unlikely. Refer patients with suspected heart failure to have transthoracic Doppler 2D echocardiography for BNP level between 100-400 ng/L within 6 weeks and refer within 2 weeks for level >400 ng/L. *see Patient report for specific age related ranges. 4 hours Urgent sample must be processed within 4 hours. Haem Bone Marrow Examination Interpretative comment given 14 days Only performed by Haematology medical staff. Micro Bordetella Pertussis Culture Perinasal Swab/Wire Stem 10 days Micro Bordetella Pertussis Serology 14 days This test is referred to the HPA RSIL, Colindale, London Micro Borrelia Burgdorferi Antibody Screen 4 days Cyto Breast Cyst Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may Reference should be made to special notes in the Cytopathology section.
take longer. Cyto FNA samples Plastic slide carrier and/or Cytospin collection Fluid in 10 ml conical tube and/or Saline solution in 10 ml conical tube 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Bronchial Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Bronchial Lavage (malignant cells) 25ml white top universal containing equal amount of Cytospin Collection fluid (obtainable from Cytology Department 52355) 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Micro Bronchial Washings - Culture Sterile plastic universal 3 days Micro Bronchial Washings - Pneumocystis Sterile plastic universal 3 days Arrange with Consultant Microbiologist prior to taking sample. Micro Brucella Antibody Screen 7-14 days This test is referred to the HPA Brucella Reference Laboratory, Liverpool Biochem Buprenorphine - Subutex (Urine) Universal Interpretative comment given. The cut-offs used to define positive results are given below; Positive Buprenorphin e >5 ug/L 14 days Source of range European Workplace Testing Threshold Biochem C - Reactive Protein (CRP) Negative < 5 mg/l 24 hours Reference range from kit insert Immuno C1 Esterase Inhibitor 0.1 - 5 mg/l 5 days
Immuno C1 Esterase Inhibitor Function < 40% abnormal; 41-67%=equivocal > 68% =normal 5 days Biochem CA 19-9 0-37 kU/L 3-4 days Useful in the follow up of pancreatic cancer and in differential diagnosis of an ovarian mass. Not proven use in screening. Expected values from kit insert Biochem CA125 0-35 kU/L 24 hours Useful in follow up of ovarian cancer. Limited role in screening. Source of reference range is kit insert Biochem Caeruloplasmin Units: g/L *See patient report for specific gender & age related ranges 14 days Useful as a second-line test in the investigation of liver disease, together with the measurement of copper. Referral Test to Department of Clinical Chemistry Northern General Hospital Source of reference range - Department of Clinical Chemistry Northern General Hospital Biochem Calcitonin On ice SSTx2 F < 5.5, M <18.9 ng/L 28 days Unstable hormone. Blood must arrive in the laboratory within 15 minutes, on ice. Notify Department in advance. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology
Charing Cross Hospital Biochem Calcium Adult 2.20-2.5 mmol/L. *see Patient report for specific age related ranges. 24 hours Suggest use corrected value to interpret calcium status unless marked change in albumin concentration. Source of range - Pathology Harmony reference intervals for children and expected values from kit insert for adults. Biochem Adjusted Calcium Adult 2.10 – 2.55 mmol//L *see patient report for specific age related ranges 24hrs Calculated from calcium and albumin concentration Molecular Calreticulin (CALR) exon 9 gene mutations in MPV Interpretive comment given 14 days Micro Campylobacter Antibody Screen 14 days This test is referred to the HPA, Preston Biochem Cannabis Universal NEG/POS (50 ug/L cut-off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Carbamazepine Pre-dose 4-12 mg/L 24 hours See Therapeutic Drug Monitoring Section Micro Carbapenemase resistant enterobacteriacae (CRE) screen Faeces in sterile plastic universal + spoon 3 days Biochem Carboxyhaemoglobin Carboxyhaemoglobi n reference range is 0 – 2.0% Heavy smokers may have levels in excess of 6.0% 24hrs "RC Baselt: Carbon monoxide. RC Baselt Disposition of toxic drugs and chemical in man. 10th ed 2014 Biomedical Publications Seal Beach, CA 354-357" Biochem Carcinoembryonic Antigen (CEA) 0-5 ug/L 24 hours Useful in follow- up of colorectal and some other cancers. Very limited role in diagnosis. Expected values
from kit insert. Biochem Carnitine Profile Interpretative comment given 4-6 weeks Referral Test to Department of Clinical Chemistry and Newborn Screening Sheffield Children’s NHS Trust Biochem Anti-CCP Negative <20 Weak positive 20 - 39 Moderate positive 40 -59 Strong positive >=60 7 days Test referred away. Royal Devon and Exeter Hospital (Roche assay) Cerebrospinal Fluid - see CSF If sending CSF to more than one Department please send adequate fluid and separate request forms Cyto Cervical Cytology ThinPrep LBC container Service transferred to Royal Cornwall Hospital, Truro RCHT enquiry line 01872 252550 Micro Chickenpox Antibody Screen 5 days If from contact result available same day Micro Chickenpox Antigen Screen Send swab of lesion in UTM (Red liquid Medium) 2 days Collect fluid from outer edge of the vesicle. Contact laboratory on 52376. Molecular Chimerism (post- stem cell transplant) Interpretive comment given 7 days Referred test: Sent to NHSBT, Filton Micro Chlamydia Antigen PCR Test Chlamydia Transport Medium 3 days First catch urine sample or self- taken vulvovaginal swab. Use white topped sterile universal for Urine samples (Boric acid containers are not suitable). Use white topped sterile universal for Urine samples (Boric acid containers are not suitable)
Micro Chlamydia Group Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Chlamydia Trachomatis Antibody Screen 14 days This test is only indicated for cases of infertility / PID Biochem Chloride 95-108 mmol/L 24 hours Source of range - Pathology Harmony reference intervals Biochem Cholesterol Units mmol/L Interpret result with reference to current clinical guidelines for prevention of vascular disease 24 hours Source of range- Caliper reference interval for under 19yrs. (1.1 – 4.4 mmol/L) Biochem Cholesterol/HDL ratio No units 24 hours Calculated from cholesterol and HDL Biochem Cholinesterase Interpretative comment given 12 weeks Useful in investigation of suxamethonium sensitivity. Referral Test to Department of Clinical Biochemistry Cholinesterase Investigation Unit Pathology Sciences Building Southmead Hospital Biochem Chromogranin A and B (GAWK) Chromogranin A: <60 pmol/L Chromogranin B: <150 pmol/L 4-6 weeks Unstable proteins. Blood must arrive in laboratory within 15 minutes, on ice. Notify department in advance. Referral Test to The SAS Laboratories Clinical
Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Ciclosporin (cyclosporin) Trough/predose Units ug/L No reference range given. 72hrs See Therapeutic Drug monitoring Section. Measured Monday, Wednesday and Friday Hcoag Coagulation factor assays 2 samples required 50-150 % 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Hcoag Coagulation factor inhibitor 2 samples required 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Hcoag Coagulation screen Interpretative comment given 24 hours Biochem Cocaine Urine NEG/POS (300 ug/L cut- off) 7 days Please request individually when requesting Urine Drugs of Abuse Screen Source of range - European Workplace Testing Threshold Blood Bank Cold agglutinins Pink 48 hours Requires overnight incubation Immuno Collagen Type II antibodies (COLLA2) NEG POS with clinical interpretive comment 14-21 days Referred test to Protein Reference Unit, Sheffield Histo Colorectal Bowels 3-14 days Reference should be made to special notes in histopathology section. Most specimens are reported within the 3-14 days period. Complex or specimens that need more consideration or
additional special investigations will take longer to report. Immuno Complement C3 & C4 Units g/L *see Patient report for specific age related ranges. 24 hours Source of range - Caliper study values for children and expected values from kit insert for adults. Immuno Contactin- Associated Protein & LG/1 Leucine-Rich Glioma Inactivated 1 (CASPR) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Copper Trace Elements 11-25.1 umol/L 24 hours R.D. Eastman; Biochemical Values in Clinical Medicine. Histo Copper (Dry weight) Dry container 6 weeks Annotate 'DRY COPPER WEIGHT REQUEST' on request form. Place specimen dry in wide mouth container. DO NOT ADD FORMALIN. Specimen sent to another centre for testing. Biochem Copper (urine) Plain 24 hour 0-1.1 µmol/24 hr 2 days R.D. Eastman; Biochemical Values in Clinical Medicine. Biochem Cortisol No reference range quoted. Units: nmol/L 24 hrs Values > 440 nmol/L make adrenal failure improbable. This value was derived in house as part of the verification of the assay. Contact duty biochemist to discuss. Biochem Cortisol (urine) Plain 24 hour <165 nmol/24h 3-4 weeks Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Coxiella Burnetti Antibody Screen 14- 21 days Adequate clinical information must be given to ensure appropriate tests
are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Coxsackie Virus Antibody Screen 7-14 days Biochem C-Peptide Units: pmol/L *See patient report for specific gender & age related ranges 28 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Creatine Kinase F 25-200 U/L M 40-320 U/L 24 hours Marker of skeletal and cardiac muscle damage. Collect sample at least 8 hours after suspected MI. Source of range- Pathology Harmony reference intervals Biochem Creatinine Units umol/L *see Patient report for specific age related ranges. 24 hours Source of range - Caliper study values for children and expected values from kit insert for adults. Biochem Creatinine Clearance (urine) Plain 24 hour M 85–125 F 75-115 ml/minute Not generally available - refer to eGFR associated with serum creatinine report or contact Duty Biochemist to discuss Reference range sourced: Baseline renal function screening. Am J Cardiol. 2006 Sep 18;98(6A):21K- 26K. Epub 2006
Feb 20 Blood Bank Crossmatch Pink 1-2 hours Results will take longer depending on the nature of the antibodies Immuno Cryoglobulin 10 days Contact lab to arrange this test- flask required for collection-cannot be done Friday after 12.00 Micro Cryptococcal Antigen Detection 14 days This test is referred to HPA SW Laboratory, Bristol Molecular CSF3R gene mutation in CNL Interpretive comment given 28 days This test is referred to Southmead, Bristol or WRGL Micro CSF - 14.3.3 & S100 for CJD Sterile plastic universal 14.3.3 - normally negative S100 <0.41 ng/ml 7 -14 days Stored frozen in microbiology. Neurology to arrange transport to CJD Surveillance Unit (Edinburgh) for testing. Please note blood contamination invalidates test. Biochem CSF - AFP Plain Universal No reference range quoted Units: kiU/L 24hrs ‘This assay has not been validated for measurement on fluids’ Biochem CSF - Bilirubin See Bilirubin Micro CSF - Culture Sterile plastic universal 2 days Haem CSF - Cytospin Plain Universal 7 days State origin of fluid on request form Biochem CSF - Ferritin Plain Universal No reference range quoted. Units: ug/L 24hrs ‘This assay has not been validated for measurement on fluids’ Biochem CSF - Glucose Grey/yellow paed No reference range quoted. Units: mmol. Interpret in relation to plasma glucose taken simultaneously 24 hours ‘This assay has not been validated for measurement on fluids’ Biochem CSF – hCG Plain Universal No reference range quoted. Units IU/L 24 hours Biochem CSF Lactate Plain Universal 1.1-2.4 mmol/L 24hrs Adult reference interval from previous Roche assay.
‘This assay has not been validated for measurement on fluids’ Biochem CSF LDH Plain Universal No reference range quoted Units: U/L 24hrs ‘This assay has not been validated for measurement on fluids’ Cyto CSF - Malignant cells 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Arrange with lab prior to sending on ext 52355. If an out of hours request, refrigerate overnight before delivery to the department between 9 and 10 am the following morning. Contact on-call BMS via the Hospital Switchboard to inform them CSF has been taken. Reference should be made to special notes in the Cytopathology section. If sending CSF to more than one department, please send adequate amounts of fluid and separate request forms appropriate to the tests required. Micro CSF - Microscopy Sterile plastic universal Same day Immuno CSF - Oligoclonal bands Universal 7 days Send blood sample (gold) simultaneously Immuno CSF Oligoclonal Bands (accompanying blood sample) Universal 10 days Must always be sent with the CSF Oligoclonal bands request Micro CSF - PCR Sterile plastic universal 3 days Performed on suspected viral meningitis (Enterovirus, Herpes or Varicella Zoster, Mumps) or suspected Meningococcal
Meningitis. Biochem CSF – Protein Plain Universal 0.15-0.45 g/L 24hrs Reference range sourced: Tietz textbook of Clinical Chemistry Biochem CSF - Tau Protein (Beta 2 Transferrin) Universal POS/NEG 21 days May be useful to differentiate CSF, in which it is present, from nasal fluid. Referral Test to Sheffield NGH Protein Reference Unit, Northern General Hospital, Sheffield Molecular Cyclin D1 Over Expression Interpretative comment given 14 days Must arrive in laboratory as soon as possible Cyto Cyst Fluids 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cytogenetics x2 edta x2 Lithium Hep Interpretive comment given 28 days Cytogenetics ( karyotying, chromosome studies) - It is the responsibility of the requesting clinician to ensure such samples reach their destination Micro Cytomegalovirus Antibody Screen (IgG/IgM) 3 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Cytomegalovirus PCR Detection 3 days As part of Pathology's Servi ce Improvement
programme, the CMV/Epstein- Barr Virus (EBV) molecular testing service will transfer to new Abbott equipment/ reagents as from Monday 17 July. Validation testing has shown that CMV results are comparable, but EBV results are on average slightly lower than the current method (by approximately 0.3 Log10 value). Results will continue to be reported in IU/ml format. It is also requested that separate EDTA tubes are supplied for each test. Haem Cytospin Analysis (CSF or aspirates) Universal 7 days State origin of fluid on request form Hcoag D-Dimer <0.5 FEU mg/ml 24 hours Biochem Dehydroepi- androsterone Sulphate (DHEAS) Units: umol/L *See patient report for specific gender & age related ranges 7 -14 days Referral Test to Clinical Chemistry Department, Treliske Hospital Source of reference range - Clinical Chemistry Department, Treliske Hospital Hcoag DIC screen 24 hours Includes fibrinogen and D- dimer Biochem Digoxin 6-10 hours Post- dose 0.5-1.0 ug/L 24 hours Samples for Digoxin should be drawn at least 6 and preferably 18 hours post- dose. Target
range in heart failure, 0.5-1.0 ug/L. Source of range – Pathology Harmony reference intervals Blood Bank Direct Coombs Test (DCT) Pink 1-2 hours Biochem Downs Screen Interpretative comment given 7 – 14 days Referral Test to Department of Clinical Chemistry Royal Devon and Exeter Hospital Refer to Obstetric Department for specific guidance. Immuno Ear Shock Protein- Anti-68KD (HSP-70) autoantibodies (EAR) NEG POS with clinical interpretive comment 21 days Purchase Order required: This test can only be ordered by the Immunology clinicians &/or in discussion senior BMS in Immunology. Referred test to Cambridge Life Sciences Micro EBV PCR 3 days As part of Pathology's Servi ce Improvement programme, the CMV/Epstein- Barr Virus (EBV) molecular testing service will transfer to new Abbott equipment/ reagents as from Monday 17 July. Validation testing has shown that CMV results are comparable, but
EBV results are on average slightly lower than the current method (by approximately 0.3 Log10 value). Results will continue to be reported in IU/ml format. It is also requested that separate EDTA tubes are supplied for each test. Biochem eGFR No reference range quoted. Units: ml/min/1.73m2 24 hours Calculated from serum creatinine - reported as part of the renal profile. Estimated GFR (eGFR) should be multiplied by 1.159 for patients of Arfican- Caribbean origin. eGFR is now calculated using CKD-EPI equation. Molecular EGFR (epidermal growth factor receptor) gene muations in NSCLC Tissue provided by Cellular pathology Interpretive comment given 7 days Biochem Profile 1 Electrolytes (serum) See individual test details. 24 hours Term used inappropriately to indicate a request for sodium, potassium, creatinine and bicarbonate Biochem Electrolytes (urine) Plain 24 hours Random sample often helpful. Contact Duty Biochemist to discuss if required Histo Electron Microscopy 4.0% gluteral- dehyde 28 days Arrange with the Histopathology laboratory prior to taking sample- tel extn 52362 Immuno Endothelial Cell Antibodies (ECAB) NEG POS with clinical 14-21 days Referred test to Protein Reference Unit,
interpretive comment Sheffield Micro Enterobius Sellotape impression 1 day See Threadworm microscopy Immuno Eosinophilic Cationic Protein (EOCP) Reported as values; POS with clinical interpretive comment 14-21 days Referred test to Protein Reference Unit, Sheffield. Biochem Epilim (valproate) Pre-dose 24 hours See Therapeutic Drug Monitoring Section. Pre- dose sample required Micro Epstein-Barr Virus IgG Screen 3 days Micro Epstein-Barr Virus IgM Screen 3 days Biochem Erythropoietin 5 – 25U/L (for an individual with a Hb within limits). 7- 14 days Referral Test to Clinical Biochemistry, King’s College Hospital Source of reference range - Clinical Biochemistry, King’s College Hospital Biochem Ethanol nb legal driving limit 80mg/100mL (17.4 mmol/L) 24 hours Immuno Extractable Nuclear Antigen Screen POS/NEG 14 days Immuno Extractable Nuclear Antigens Type POS/NEG 21 days Hcoag Factor IX assay 50-150% 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Molecular Factor V Leiden & Prothrombin gene mutations Interpretative comment given 14 days Haem Factor VIII Assay 50-150% <7 days Contact laboratory prior to taking samples - Ext 33244 or 33245. This test is referred to Oxford Haemophilia and Thrombosis Centre. Biochem Faecal Calprotectin Blue Faecal pot Units: ug/g <45 ug/g - Calprotectin within 14 days Refer to NICE guidance DG11 and any locally developed guidelines for patient management.
reference range not suggestive of intestinal inflammation ≥ 45 ug/g an Interpretative comment given. Please ‘phone if you wish to discuss - Duty Biochemist 01752 517936. Biochem Faecal Elastase 1 Blue Universal + Spoon > 200 Normal ugE1/g stool < 100 Severe pancreatic insufficiency ugE1/g stool 14- 21 days Referral Test to Clinical Chemistry Department, Treliske Hospital Source of reference range - Clinical Chemistry Department, Treliske Hospital Cyto Faecal Fat Globules (cytology) Universal + Spoon 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Restricted to investigation of paediatric cases only. Micro Faeces - Clostridium Difficile GDH & Toxin Sterile plastic universal + Spoon 1 day No need to send follow-up samples if initial test is positive for toxin. (Toxin can persist up to 2 weeks) Micro Faeces - Culture Sterile plastic universal + Spoon 3 days Do not overfill container. Include details of foreign travel. Include details of food consumed if food poisoning suspected Micro Faeces - Enteric PCR Test Sterile plastic universal + Spoon 2 days Do not overfill container. Include details of foreign travel. Include details of food consumed if food poisoning suspected Micro Faeces - Microscopy (Parasitology) Sterile plastic universal + Spoon 2 days Do not overfill container. Include details of foreign travel. If amoebic dysentery is suspected then a hot stool sample is preferred.
Arrange with laboratory prior to submission on 01752 792380. Micro Faeces - Norovirus Sterile plastic universal + Spoon If Norovirus outbreak suspected, notify Infection Control for urgent testing 1 day from request Micro Faeces - other Virology Sterile plastic universal + Spoon 14 days Biochem Ferritin Adult (19+ years) F 10-204 ug/L M 22-275 ug/L *see Patient report for specific gender and age related ranges. 24 hours Caliper study values for children under 19yrs and expected values from kit insert for adults but with a LLN of 10 ug/L for adult females. Hcoag Fibrinogen 1.5-4.5 ug/ml 24 hours H&I Flow Cytometric Crossmatch Interpretative comment given <7 days For renal transplant. Must be booked with H&I lab 52390 Biochem Flucytosine Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory Department of Microbiology, Southmead Hospital Arrange with Consultant Microbiologist prior to taking sample. Biochem Fluid Albumin Universal container No reference range quoted Units: g/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Amylase Universal container No reference range quoted Units: U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Bilirubin Universal container No reference range quoted Units umol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Cholesterol Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on
fluids’ Biochem Fluid Chloride Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Bicarbonate Universal container No reference range quoted Units: mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Creatinine Universal container No reference range quoted Units umol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Glucose Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Potassium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid LDH Universal container No reference range quoted Units U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Lipase Universal container No reference range quoted Units U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Magnesium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Sodium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Protein Universal container No reference range quoted Units g/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Triglyceride Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’
Biochem Fluid Urea Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid AFP Universal container No reference range quoted Units kIU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CA125 Universal container No reference range quoted Units kU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CA19-9 Universal container No reference range quoted Units kU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CEA Universal container No reference range quoted Units ug/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid hCG Universal container No reference range quoted Units IU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid pH Universal (FULL) Unit: pH No reference range given 2hr A full specimen pot is required and must be received in lab as soon as possible and analysed with 2 hours of collection. Notify Duty Biochemist in advance, when requesting this test. Micro Fluid - Vesicle Herpes Virus PCR / IFT Swab of lesion in PCR (UTM) transport medium 5 days Collect fluid from within the vesicle or swab the periphery of lesion collecting matter and fluid if possible. Micro Fluid CAPD - Culture CAPD dialysis bag sealed with clip 3 days Send complete dialysis bag in a sealed double white plastic bag Micro Fluid CAPD - Microscopy Sealed dialysis bag Same day Micro Fluid Cerebrospinal - PCR Sterile plastic universal 1 day Performed on suspected viral
meningitis (Enterovirus, Herpes or Varicella Zoster) or suspected Meningococcal Meningitis. Note: EDTA Blood sample can also be tested for Meningococcal PCR Micro Fluid Culture eg ascitic, pleural, joint, csf Sterile plastic universal 3 days State site on request form and sample Micro Fluid Microscopy eg ascitic,csf, pleural, joint Sterile plastic universal 1 day State site on request form and sample Micro Fluid Mycobacteria - Culture Sterile plastic universal 12 weeks Micro Fluid Mycobacteria - Microscopy Sterile plastic universal 1 day Cyto Fluids -ascitic, joint, pleural 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Biochem Folate (serum) Adult 3.1 - 20 ug/L. *see Patient report for specific age related ranges. Caliper study values for children and expected values from kit insert for adults. Biochem Free Androgen Index M: (0-49yr) – 24.5 – 113.3 M (50yr+) – 19.3 – 118.4 F: (0-49yr) – 0.7 – 8.7 F: (50yr+) – 0.5 – 4.7 24hrs Calculated from testosterone and SHBG. Reference intervals taken from Abbott product alert notice – September 14th , 2015 Biochem Free Fatty Acids Send to Laboratory immediately. Usually requested with 3-
Fasting levels 0.1-0.9 mmol/L 14 days hydroxybutyrate and glucose. Referral Test to Biochemical Genetics Unit, Southmead Hospital Source of reference range - Biochemical Genetics Unit , Southmead Hospital Glucose concentration required for referral. Biochem Free T3 Adult 2.6 - 5.7 pmol/L. *see Patient report for specific gender and age related ranges. 24 hours Caliper study values for children and expected values from kit insert. Biochem Free Thyroxine, FT4 Adult (19+ years)9.0-19.0 pmol/L. *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert. Histo Frozen Section Send sample in dry pot Less than 1 hour *complex/multi ple blocks/multiple specimens may take longer. Arrange with Histopathology Laboratory prior to taking sample - tel extn 52362. See notes in 'Sending High Risk Specimens' section if patient is known, or suspected, to be an infection hazard.*Please note that we are no longer able to offer a frozen section service to count neutrophils in specimens from orthopaedic joint revision surgery (see explanatory note in Histopathology Section) Biochem FSH Male 1.0 - 12.0 iu/L. Female - dependent on menstrual phase. *see Patient report for specific age related ranges. 24 hours Expected values from kit insert
Haem Full Blood Count *see Patient report for specific age related ranges and red cell parameters including white cell count and differential. 24 hours Micro Fungal Culture - dermatophytes Sterile wide- mouthed container or folded black paper. 16 days Micro Fungal Culture - yeasts Charcoal swab or pink top -E-swab 2 days Micro Fungal Microscopy - dermatophytes Sterile wide- mouthed container or folded black paper. 2 days Micro Fungal Serology 21 days This test is referred to HPA SW Laboratory, Bristol Haem G6PD Deficiency screen Interpretative comment given 7 days Contact laboratory prior to taking sample - Ext.33244 or 33245 Immuno GAD Antibodies (IDDM) (GADAD) POS/NEG Positive results with interpretative comment Referred test to Immunology Dept, R,D&E, Exeter. Immuno GAD Antibodies (Stiff man syndrome) (GADAS) POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Gamma Glutamyl Transferase (GGT) F Adult (19+ yrs) 9-36 U/L, M Adult (19+yrs) 12-64 U/L *see patient report for specific age related ranges 24 hours Caliper study values for children under 19yrs and expected values from kit insert for adults. Immuno Ganglioside/Glycolipi d/GM antibodies (AGLY1) POS/NEG Positive results with interpretative comment 21 days Referred test to Dept of Neurology, Southern General Hospital, Glasgow Cyto Gastric Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section.
Cyto Gastric Washings (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Biochem Gastrin (also part of Gut Hormone Screen) x2 On ice Fasting 0-40 pmol/L 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories, Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Referral Lab Genetic Tests - see also Cytogentics It is the responsibility of the requesting clinician to ensure such samples reach their destination. Please ensure that the appropriate request form is used for all Genetic Test Requests. For those which are sent to Bristol Genetics Laboratory - attached below: Bristol Genetics Form (2).pdf Link to Bristol Genetics lab Website is attached below: bristol_genetics Biochem Gentamicin Trough/pre-dose Units mg/L 24 hours Trough level should be taken immediately before a dose. Peak level should usually be taken an hours after a dose. State drug
regime and time of last dose on sample. Trough - In adults when gentamicin is being given once daily, a trough level of >1 mg/L indicates the need to increase the interval between doses. Further advice is available via the on call microbiologist via 30010 or bleep via the switchboard. Multiple daily doses of gentamicin are usually only indicated in endocarditis. In such cases the optimal ranges are as follows; Predose <1 mg/L, Postdose 3-5 mg/L at one hour post- infusion. Further advice is available via the on call microbiologist via 30010 or bleep via switchboard. Source of range - ? Biochem Globulin 18-36 g/L 24 hours Calculated from difference between total protein and albumin concentrations. Source of range – Pathology Harmony reference intervals Pathology Test List (continued) Pathology Test List Immuno Glomerular Base Membrane Antibodies POS/NEG 7 days
Biochem Glucose - plasma and fasting (GP & Hospital) Normal reference range 3.5 - 5.4 mmol/L fasting. 11.1 (random) consistent with diabetes mellitus, at 2 hours. *see report in pregnancy range fasting blood glucose >= 5.3 mmol/L and 2 hours blood glucose >= 7.8 mmol/L during OGTT is consistent with gestational DM 24 hours Fasting plasma glucose >7 mmol/L is consistent with diabetes. Fasting plasma glucose 5.5- 6.9 mmol/L indicates a patient is at high risk of developing type 2 diabetes [NICE guideline PH38]. Biochem Glucose - CSF interpret in relation to plasma glucose taken simultaneously 24 hours Biochem Glucose (GP) 24 hours Biochem Glucose (Serum – Fasting – Hospital ONLY) No reference range 24 hours Glucose concentrations in serum specimens can be spuriously low due to the absence of preservative in the tube. Please interpret with caution and follow up glucose results with measurement on a plasma fluoride oxalate sample where appropriate. Biochem Glucose Tolerance Test Sample 1 – Fasting Sample 2 – 2hr Diabetes Mellitus Fasting 2 hours 7.0 or more 11.1 or more Impaired glucose tolerance <7.0 7.8 - 11.0 Impaired fasting glycaemia 6.1 - 6.9 <7.8 In pregnancy a fasting blood glucose greater than or equal to 5.3 mmol/L and/or 2 hour blood glucose greater than or equal to 7.8 mmol/L during oGTT is consistent with gestational DM 24 hours A GTT is not appropriate or necessary in the presence of diagnostic fasting/random plasma glucose concentrations as above. Provide a fasting sample & 2hr sample. Immuno Glycine Receptor antibody POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Blood Bank Group and Save 1-2 hours Each group and antibody screen takes 40 minutes-
Pink however, they are run in batches. Biochem Growth Hormone Growth hormone ≥5 µg/L suggests adequate secretion. Growth hormone < 0.4µg/L suggests that acromegaly is unlikely. 48hrs NICE guidelines TA64 A single measurement is of limited value, suppression/stimulati on tests are often required. Biochem Gut Hormone Screen x2 On ice fasting Interpretative comment given 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Haemoglobin A1c (HbA1c) 48 mmol/mol is the recommended cut off point for diagnosing DM and considered good control for DM 24 hours Performing this test less than 3 months after a previous test is very rarely required except in pregnancy. NICE Guidelines. Haem Haemoglobinopathy Screen Interpretative comment given Maybe up to 14 days (3 days for antenatal patients) Sickle cell and thalassaemia screening. For antenatal requests please use FOQ form Biochem Haptoglobin or Male – 0-1yr: 0.0-3.0; >1-12: 0.03 – 2.70; >12-60: 0.14 – 2.58; >60: 0.40-2.68 Female- 0-1yr: 0.0- 2.35; >1-12: 0.11 – 2.2; >12-60: 0.35 – 2.5; >60: 0.63-2.73 Units -g/L 7 days Reference ranges from kit insert Biochem HDL – Cholesterol (Part of LIPID profile) F: Adult (19+yrs) 0.9 – 1.8 mmol/L M:Adult (19+yrs) 0.9 – 1.6 mmol/L *see patient report for specific age related ranges 24hrs Caliper study values for children, Ranges from NICE Guidleines
Hist Helicobacter Pylori Formalin 7-14 days Endoscopy also perform a breath test commonly known as CLO. Micro Helicobacter pylori faecal antigen test Sterile plastic universal + spoon 5 days Do not overfill. Hcoag Heparin Induced Thrombocytopenia 90% in 5 working days This test is referred to NHS-BT Filton. Contact lab on 33244 or 33245 Samples must be delivered to laboratory by hand. NBS request form must be filled out and 4T score completed. Micro Hepatitis A IgG Antibody Screen 3 days For immunity check prior to foreign travel. These tests are not covered by the NHS and a private charge will be made. Only those >50 years old or who have resided in developing countries should be checked for past immunity. Treat all others as susceptible and vaccinate. Micro Hepatitis A IgM Antibody Screen 3 days For Hepatitis A Acute Infection. Micro Hepatitis B Core Antibody Screen 3 days This should be used to test for past infection Micro Hep B DNA 5 days Micro Hepatitis B ‘e’ antigen/antibody 3 days Micro Hepatitis B Immunity Screen 3 days This should be used to test for Hepatitis B immunity post vaccination Micro Hepatitis B Surface Antigen Screen 3 days This should be used to test for acute Hepatitis B or carriage. An emergency 24hr service is available (contact on-call technician out of hours) Micro Hepatitis C Antibody Screen 3 days A positive sero- conversion will not be detectable for 3-6
months after infection Micro Hepatitis C PCR 5 days Abbott HCV quantitative (viral load): It is recommended that blood samples are received in the laboratory within 6 hrs. after being drawn so that centrifugation can be done within time period stated in manufacturers guidelines. Micro Hep E IgG/M 5 days Micro Hepatitis C PCR Genotyping 5 days Hist Her 2 testing of tissue 2-6 weeks Make request on request form. Sent to Royal Cornwall Hospital for testing. Molecul ar Hereditary Haemochromatosis Interpretative comment given 14 days Micro Herpes Simplex PCR 4 days Micro Herpes simplex virus PCR Send swab of lesion in UTM (Red liquid Medium) 5 days Biochem 5HIAA Plain 24 hour 4.7- 36.2 umol/24hr 14 days Special dietary restrictions apply prior to collection. Contact Duty Biochemist for advice. Tietz textbook of clinical chemistry, 2nd edition Histo Histological examination Formalin unless frozen section or other specialist request 3-14 days Most specimens are reported within the 3- 14 days period. Complex or specimens that need more consideration or additional special investigations will take longer to report. Micro HIV Antibody Screen 3 days Must be authorised by the requesting clinician or counsellor - result can be available same day if urgent
Micro HIV PCR Viral Load 5 days EDTA sample must arrive in the laboratory as ASAP after taking H&I HLA-B*57:01 POS or NEG 7 days Linked with hypersensitivity to abacavir in HIV+ patients H&I HLA-B27 POS or NEG 7 days Linked with Ankylosing Spondylitis and Uveitis H&I HLA-DQ2/DQ8 Interpretative comment given 7 days Linked with Coeliac Disease Biochem Homocysteine On ice – contact laboratory in advance. F <11.3, M <14.3 umol/L, umol/L 14- 21 days Unstable analyte. Blood must arrive in the laboratory within 30 minutes, on ice. Notify department in advance. Referral Test to Department of Chemical Pathology Bristol Royal Infirmary Source of reference range - Department of Chemical Pathology Bristol Royal Infirmary Micro HTLV type I + II Antibody 3 days Biochem Human Chorionic Gonadotrophin (beta) 0-5 U/L 24 hours Expected values from kit insert. Measured to confirm pregnancy or as a tumour marker in patients with gestational trophoblastic disease and non- seminomatous germ cell tumours Immuno 3-Hydroxy-3-Methyl- Glutaryl-CoA Reductase antibodies (HMGCoA) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular medicine, Oxford
Biochem IgA Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Biochem IgG Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Biochem IgM Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Immuno IgE, Allergen Specific 0 28 days Results given as RAST grade. Please list all allergen tests required. Immuno IgE, Total 0 - 108 IU <7 days Biochem IGF1 (Ins L Growth Factor 1) Units: ug/L *See patient report for specific gender & age related ranges 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital
NB: Some Paediatric samples may be referred to Royal Surrey County Hospital NHS Trust Guildford. Biochem IGFBP3 Units: mg/L *See patient report for age related ranges 28 days Referral Test to SAS Peptide Hormone Section Clinical Laboratory Royal Surrey County Hospital Source of reference range - SAS Peptide Hormone Section Clinical Laboratory Royal Surrey County Hospital Immuno IgG Sub-Classes age related 14 days Molecul ar IgH B cell clonality Interpretative comment given 14 days Haem IM Screen POS/NEG comment given 3 days Gold top sample viable for up to 8 days. Histo Immunofluorescence (IMF) - skin/mucosal biopsies In time for the next Dermatolo gy CPC Meeting (following the date of the biopsy) Reference should be made to special notes in 'Immunofluorescenc e (IMF) on skin and mucosal biopsies' section Immuno Immunophenotyping for Leukaemia <7 days Also known as 'cell markers', please give as much clinical information as possible, especially whether acute or chronic leukaemia suspected. Micro Influenza A Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Influenza B Antibody Screen 5 days Adequate clinical information must be given to ensure
appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Hcoag INR See BSH guidelines on warfarin dosing 24 hours Non anti-coagulated patient Ratio Biochem Insulin On ice Results are dependent upon plasma glucose concentrations: 1. Normal fasting levels <10 mU/ 2. Hypoglycaemia (glucose <2.5mmol/L) <5 mU/L 3. Severe hypoglycaemia (glucose <1.5 mmol/L)<2 mU/L 28 days Unstable Hormone. Blood must arrive in laboratory within 15 minutes, on ice. Notify department in advance. Glucose concentration required for referral. Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Immuno Insulin Autoantibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Protein Reference Unit, Sheffield Immuno Insulinoma-like Antigen 2 antibodies (IA2) Units U/ml POS/NEG Positive results with interpretative comment Referred test to Dept of Immunology, R,D & E, Exeter Source of reference range Dept of Immunology, R,D & E, Exeter Neuro Intra-operative diagnosis -Frozen section/brain smear Send sample in dry pot Less than 1 hour Arrange with laboratory prior to taking sample - tel extn 54408 . See notes in 'Sending High Risk Specimens' section if patient is known, or suspected, to be an infection hazard. Immuno Intrinsic Factor Antibodies POS/NEG Positive comments with interpretative comment 14 days Referred test to Dept Haematology, Torbay Hospital Molecul ar inv(16) in AML Interpretative comment given 7 days Must arrive in laboratory as soon as possible
Biochem Iron Units – umol/L *See patient’s report for specific gender & age related ranges 24 hours Primarily indicated in the investigation of suspected iron overload. Caliper study values for children under 19 years and expected values from kit insert for adults. Histo Iron (Dry weight) Dry container 6 weeks Annotate 'DRY IRON WEIGHT REQUEST' on request form. Place specimen dry in wide mouth container. DO NOT ADD FORMALIN. Specimen sent away for testing. Immuno Islet Cell Antibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Protein Reference Unit, Sheffield Molecul ar JAK2 in MPN Interpretative comment given 14 days Blood Bank Kleihauer Test Pink Same day Biochem Lactate (Blood Lactate CSF) 0.5-2.2 mmol/L 1.1-2.4 mmol/L (CSF) 24 hours Unstable, blood must come to the laboratory as soon as possible Blood - Expected values from kit insert. CSF - Adult reference interval from previous Roche assay. CSF - 'This assay has not been fully validated for measurement on fluids' Biochem Lamotrigine 3-15 mg/L 14- 21 days Referral Test to TDM Unit Chalford St Peter Chesham Lane Buckinghamshire Source of reference range - TDM Unit Chalford St Peter Chesham Lane Buckinghamshire See Therapeutic Drug monitoring
section. Biochem LDH (Lactate Dehydrogenase) Adult (19+ years) 125- 200 U/L *See patient’s report for specific gender & age related ranges 24 hours Caliper study values for children under 19 years and expected values from kit insert for adults. Biochem LDL – Cholesterol Units – mmol/L 24 hours Calculated from cholesterol, triglyceride and HDL Biochem Lead 0.1 – 35 ug/100ml 7-14 days Referral Test to Department of Clinical Chemistry Northern General Hospital Source of reference range - Department of Clinical Chemistry Northern General Hospital Biochem LH (Luteinising Hormone) Male 0.6-12.1 Female depends on ovulation cycle or post menopausal. * See patient report for specific ranges 24 hours Expected values from kit insert. Biochem Lipase Adult (19+yrs) 8 – 78U/L *see patient report for specific gender & age related ranges 24hrs Caliper study values up to 19yrs, expected values from kit insert for adults Biochem Lithium 12 hours Post-dose 0.4-1.0 mmol/L 24 hours See Therapeutic Drug Monitoring section. Steady state lithium concentrations should be in the range 0.4-1.0 mmol/L. Samples should be drawn at least 12 hours after the last dose. The minimum requirement for lithium level monitoring is every three months with measurement of thyroid and kidney function every six months. Pathology Harmony reference interval. Biochem Profile 2 Liver Function Tests See individual test details. 24 hours Term usually applied inappropriately to indicate a request for total protein, albumin, bilirubin, ALP and ALT globulin
Immuno Liver Kidney Microsomal Antibodies POS/NEG 7 days Molecul ar Loss of hetrozygosity at chromosomes 1p and 19q in oligodendrogliomas 10ml EDTA blood 14 days Tissue provided by Neuropathology. Bloods to be sent to Molecular Biology. Hcoag Low Dose Heparin Assay (Clexane) or anti- Xa assay. Interpretative comment given 24 hours Contact laboratory prior to taking sample - ext.33244 or 33245. Sample must be taken 3 hours post dose Hcoag Lupus Anticoagulant Screen Send 2 x citrate samples plus 1 gold (for ACL) Ratio <1.2 7 days Please book with laboratory - Ext 33244 or 33245 Micro Lyme Screening <3 days DCL and Micro Lyme Testing CSF This test is performed by the Rare and Imported Pathogens Laboratory (PHE). Please send: 1. CSF sample: Send one bottle to DCL requesting albumin and total immunoglobulin Send another bottle (>3ml) to Microbiology requesting cell count and storage pending receipt of completed Lyme request form (reference laboratory requires at least 2mls, and cell count must be performed first – if other testing is also required then please specify on request and ensure sufficient volume of CSF sent). 2. Serum sample on same day to DCL requesting albumin and total
immunoglobulin 3. Separate serum sample on same day to Microbiology (requesting storage pending receipt of completed Lyme request form). If serum Lyme antibodies have not already been performed, these can be requested on this sample. Requester must come to Microbiology to complete a Lyme referral form, including the albumin and total immunoglobulin results for both serum and CSF. On receipt of the completed request form we will forward the stored CSF and serum to RIPL reference laboratory for Lyme testing. H&I Lymphocytotoxic Antibody Screen Reported as HLA specificities with normalised MFI. Donor specific antibodies requests as interpretative comments 14- 21 days Routine samples collected every 1 month. Additional samples should be sent 2 weeks after blood transfusion or infections. Use this test to request Donor Specific Antibody which can be performed urgently after contacting the H&I lab 52390 Immuno Lymphocytotoxic Crossmatch x4 <7 days For renal transplant. Must be booked with Immunology lab 52293 Hist Lymphoma Studies 3-14 days Reference should be made to special notes in histopathology section. Complex or specimens that need more consideration or additional special investigations will
take longer to report. Immuno M2 Mitochondrial Antibodies POS/NEG 7 days Biochem Magnesium 0-4 weeks : 0.6 – 1.0 mmol/L >4 weeks : 0.7-1.0 mmol/L 24 hours Source of range – Pathology Harmony reference intervals Haem Malarial Parasite Screen 24 hours Contact laboratory - Ext 33244 or 33245.Samples must be treated as urgent. Please give details of travel. Reference should be made to special notes in haematology section Immuno Mast Cell Tryptase (MCT) 14 days Take sample straight away and then repeat 1 hour later Micro Measles IgG 5 days Micro Meningococcal Antibody Screen 5 days This test is referred to the HPA, Meningococcal Reference Laboratory, Manchester Micro Meningococcal PCR 5 days This test is referred to the HPA, Meningococcal Reference Laboratory, Manchester. See also CSF for PCR Biochem Mercury Sample required depends on exposure; contact Duty Biochemist to discuss <20 nmol/L 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital Biochem Urine Mercury Universal Unexposed persons < 2 nmol/mmol creatinine Dental workers < 10 nmol/mmol creatinine Industrial workers < 45 nmol/mmol creatinine Neurological changes > 50 nmol/mmol 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital
creatinine Biochem Methadone Universal NEG/POS (300 ug/L cut-off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Methotrexate Units umol/L No range quoted. 24 hours Rarely required; contact Duty Biochemist to arrange. Patients taking the drug for treatment of chronic disorders require regular full blood count, renal and liver profiles. IMPORTANT: Specimen must be protected from light. Molecul ar MGMT Methylation in Glioma Interpretative comment given 14 days Tumour tissue provided by Neuropathology Department. Biochem Monomeric Prolactin (Macroprolactin) Male: 72 – 229 mIU/L Female:79-347 mIU/L 7 days Clinical Chemistry, 2010, 56 (3), 484-90 Molecul ar MPL exon 10 gene mutation in MPN Interpretative comment given 14 days Micro MRSA - PCR (nose swab) Red Top Swab without Charcoal 1 day Specified patient categories only - please contact the laboratory if in doubt. Sample must be received before 1pm to be processed on that day. Micro MRSA/MSSA triple swab screen - Nose, throat, perineum. Triple MRSA/MSS A Collection kit (using 3 separate E- swabs) 2 days For sampling information, click here: E Swab.pdf Micro Mumps IgG 4 days Neuro Muscle Biopsies 14 days Reference should be made to special notes in the 'Muscle and Nerve Biopsies' section. Immuno Muscle-specific tyrosine kinase (MuSK) antibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford
Biochem Mycophenolate Pre-dose 1-3.5 mg/L 7-14 days Referral Test to IDM Service, King’s College Hospital Source of reference range - IDM Service King’s College Hospital Micro Mycoplasma genitalium PCR “First catch“ urine samples. Genital and rectal swabs (red topped UTM swab) 7 days This test is currently referred to Micropathology, Warwick. Micro Mycoplasma Pneumoniae Antibody Screen 5 days Molecul ar MYD88 gene mutation in WM Interpretive comment given 28 days This test is referred to RD&E, Exeter Immuno Myelin Associated Glycoprotein antibodies (MAGA) POS/NEG Positive results with interpretative comment Referred test to Oxford University Hospital, Oxford Immuno Myeloperoxidase Antibody POS/NEG 10 days Micro Neisseria gonorrhoeae PCR test 4 days First catch urine sample or self-taken vulvovaginal swab Neuro Nerve Biopsies 4-6 weeks Reference should be made to special notes in the 'Muscle and Nerve Biopsies' section. Immuno Neutrophil Function Test (BURST) Special <7 days Must be booked with Immunology lab 52293 Cyto Nipple Discharge Plastic slide carrier. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in Cytopathology section. Biochem Non-HDL cholestrol Units mmol/L 24 hours Calculated from HDL and Cholesterol Molecul ar Nucleophosmin Gene Mutation in AML Interpretative comment given 14 days Cyto Oesophageal Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more Reference should be made to special notes in the Cytopathology section.
complex cases may take longer. Biochem Oestradiol Male <161 pmol/L Female varies with stage of menstrual cycle or post menopausal (+HRT) * See patient report for specific ranges 24 hours Expected values from kit insert Immuno Oligoclonal Bands (CSF) -see CSF Interpretative comment given 10 days Biochem Opiate Universal NEG/POS (300 ug/L cut off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Opiate Identification (Urine) Universal Interpretative comment given. The cut-offs used to define positive results are given below Opiate Positive 6-monoacetyl morphine >10 ug/L DHC >150 ug/L Codeine >150 ug/L Morphine >30 ug/L Tramadol >50 ug/L and metabolite area >1800 6- acetylcodein e >50 ug/L 14 days Source of range - European Workplace Testing Threshold Biochem Organic Acids (urine) Universal random Interpretative comment given 14- 21 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital 24 hour specimens are rarely indicated for generalised screening. Please contact laboratory for more information. Biochem Osmolality (urine) Universal ra ndom No range quoted. Units mm/kg 24 hours Interpret with reference to serum osmolality and hydration status. The urine osmolality should be interpreted with knowledge of the patient’s serum osmolality and hydration status.
Urine collection containers with preservatives are unsuitable for analysis. (i.e. Boric Acid) Urine specimens must be analysed within 36 hours of collection. Biochem Osmolality (serum/plasma) or 275-295mmol/kg 24 hours Serum specimens must be analysed within 36 hours of collection. Source of range- Pathology Harmony reference intervals. Immuno Ovarian Antibodies POS/NEG 15 days Histo Ovarian tumours Dry container 3-14 days Reference should be made to special notes in the 'Gynaecological (ovarian and endometrial tumours)' section. Most specimens are reported within the 3- 14 days period. Complex or specimens that need more consideration or additional special investigations will take longer to report. Biochem Pancreatic Polypeptide (also part of Gut Hormone Screen) x 2 On ice fasting 0-300 pmol/L 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Paracetamol Units mg/L Interpret relative to time of ingestion using 24hrs Sample should be taken at least 4 hours post ingestion. 'Please note that
standard charts e.g BNF high concentrations of N-acetylcysteine may interfere with measurement of paracetamol' Immuno Paraprotein Concentration 5 days Immuno Parathyroid Antibodies POS/NEG 14 days Biochem Parathyroid Hormone Adult (19+ years) 1.6- 7.2 pmol/L *see Patient report for specific age related ranges. 24 hours Must arrive in the laboratory within 6 hours Caliper study values for children and expected values from the kit insert for adults Immuno Paroxysmal Nocturnal Haemaglobinuria Pos/Neg <7 days Positive result indicates a clone of CD59 day deficient red cells detected Micro Parvovirus IgG Antibody Screen 5 days Micro Parvovirus IgM Antibody Screen 5 days Cyto Pericardial Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Peritoneal Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Hcoag PFA-100 2 samples required Interpretative comment given 24 hours Contact laboratory prior to taking samples - Ext 33244 or 33245 Biochem Phenobarbitone Pre-dose 10-40 mg/L 24 hours See Therapeutic Drug Monitoring Section
Source of range – Pathology Harmony reference intervals Biochem Phenytoin Pre-dose 5-20 mg/L 24 hours See Therapeutic Drug Monitoring Section Source of range – Pathology Harmony reference intervals Biochem Phosphate 16+yrs: 0.8-1.5 mmol/L *see Patient report for specific age related reference ranges in children. 24 hours Source of range – Pathology Harmony reference intervals Haem Plasma Viscosity 1.39-1.70 mPas 2 days Hcoag Platelet Aggregation studies x6 Interpretative comment given 24 hours Contact laboratory prior to taking samples - Ext 33244 or 33245 Follow on testing may be referred to Oxford Haemophilia and Thrombosis Centre. Cyto Pleural Fluid (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Immuno Pneumococcal Antibodies >20mg/ml is protective (> 40 mg/ml if post splenectomy) 14 days Micro Polyoma (BK) Virus 5 days Biochem Porphyrin (faecal) Universal Stool < 200 nmol/g dry weight 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales
Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales Biochem Porphyrin (urine) Universal Interpretative comment given 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales. Biochem Porphyrin (whole blood) Plasma porphyrin screen – increased/not increased Red blood cell porphyrin screen – Pos/Neg Red blood cell total porphyrin – 0.4 – 1.7 umol/L 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales. Mortuar y Post Mortem Examination Up to 3 months dependant on the material retained Consent required. See Anatomical Pathology (Mortuary section)/Requesting a consented autopsy.
Biochem Potassium 16 years+ 3.5-5.3 mmol/L *see Patient report for paediatric ranges. 24 hours Analysis affected by Haemolysis. Specimens older than 12hrs will not be tested. Source of range – Pathology Harmony reference intervals. Biochem Procalcitonin 0-0.5 ug/L 24 hours Reference interval taken from Vidas kit insert Biochem Progesterone No reference range quoted Units: nmol/L 24 hours If sample taken 7 days before a period, a progesterone concentration <15 nmol/L indicates that ovulation has not occurred; >30 nmol/L indicates that ovulation has occurred. Biochem Prolactin Male 73-407 Female 109-557 mIU/L 24 hours Expected values from kit insert Biochem Protein (urine) Plain 24hr 0-0.12g/24hr 24 hours Biochem Protein Adult (19+ years) 60- 80 g/L *see Patient report for specific age related ranges. 24 hours For urine protein see urine section Hcoag Protein C 70-130 % 14 days Contact Consultant Haematologist (part of thrombophilia screen) Hcoag Protein S (Free Protein S) 65-140 % 14 days Contact Consultant Haematologist (part of thrombophilia screen). Follow on testing may be referred to Royal Free Hospital, London - Haemophilia centre and Haemostasis Unit Immuno Proteinase 3 Antibodies POS/NEG 14 days Biochem PSA 40-49 years 0-2.5 ug/L 50-59 years 0-3.5 ug/L 60-69 years 0-4.5 ug/L 70-79 years 0-6.5 ug/L 24 hours Ranges sourced from journal : Serum Prostate-Specific Antigen in a Community-Based Population of Healthy Men Establishment of Age-Specific Reference Ranges, JAMA. 1993;270(7):860- 864. doi:10.1001/jama.19
93.03510070082041 Haem Pyruvate Kinase No longer offered- contact lab if required - - Contact laboratory Ext 33244 or 33245 Micro Quantiferon TB Test Contact lab 52376/ 01752 792376 for tubes 7 days Same day sample delivery required before 16.30 - Read kit insert carefully for sample volume and handling Haem Red Cell Enzyme Assays x 2 Variable, depending on enzyme assayed 14 days Contact lab on Ext 33244 or 33245 before taking sample. This test is referred to King’s College Hospital, London. Note that a G6PD deficiency screen is also available. Haem Red Cell Membrane studies Interpretative comments given 14 days Contact lab on Ext 33244 or 33245 before taking sample This test is referred to King’s College Hospital, London. Haem Red Cell Osmotic Fragility 3 days Contact laboratory for an appointment - Ext 33244 or 33245 Histo Renal Biopsy Provided by BMS on attendance at the biopsy. Alternatively biopsies may be transported direct to the lab in saline soaked gauze for examination and transfer to the correct containers. 3-14 days BMS attendance at renal biopsies is by arrangement. Telephone the laboratory 52362. A BMS will attend if possible; this may be difficult over the lunchtime period 12.30 – 13.30. (Biopsies may be transported direct to the laboratory for examination, in cases of emergency). Biopsies must be received before 16.00 to ensure processing overnight. Biochem Renal Calculus (stone) Universal Interpretative comment given 6 weeks Referral Test to University College London Hospitals Biochem Renin 0 – 7 days 4 – 340 mU/L >7 days – 1yr 4 – 190mU/L >1yr – 11yrs 4 – 85 mU/L >11yrs – 15yrs 4 – 75 mU/L Adults: Supine 2 – 30 mU/L Ambulant 3 – 40 mU/L 21-28 days Measure with renin to determine renin:aldosterone ratio. Unstable hormone; blood must arrive in laboratory with 30
minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Micro Respiratory Antigen Screen - Adeno Aspiration tube 1 day Micro Respiratory Antigen Screen - Flu A Aspiration tube 1 day Micro Respiratory Antigen Screen - Flu B Aspiration tube 1 day Micro Respiratory Antigen Screen - Paraflu Aspiration tube 1 day Micro Respiratory Antigen Screen - RSV Aspiration tube 1 day Micro Respiratory PCR Send throat swab in UTM (Red liquid Medium) 1 day Haem Reticulocytes 30-120 *109/L 24 hours Biochem Rheumatoid Factor 0 – 30 IU/ml 24hrs A negative Rhf does not exclude rheumatoid arthritis. A positive Rhf can be seen in rheumatoid arthritis, infection, inflammation and healthy individuals. Reference intervals are sourced from the Kit insert Micro Rickettsia Antibody Screen 5 days This test is referred to HPA, CAMR Micro Rubella IgG Serology Screen 3 days Micro Rubella IgM Serology Screen 5 days Send sample 4 days after onset of rash Biochem Salicylate Units: mg/L No range quoted. 24 hours Immuno Salivary Gland Antibodies POS/NEG 14 days Immuno Salivary IgA Universal 5 days
Micro Schistosoma Antibody Screen 14 days This test is referred to the Hospital for Tropical Diseases, London Immuno Scleroderma panel (SCLER1) POS with clinical interpretive comment NEG with panel list 14 days – up to 12 weeks Referral test to Bird Institute for Rheumatic Diseases, Bath Biochem Selenium Blue trace metal. < 16 yrs – 35 -113 umol/L > 16 yrs – 70-130 umol/L 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital Immuno Semen analysis (fertility) Collect pot and instructions from GP 10 days By appointment basis only – contact lab – see instruction sheet. Immuno Serum Protein Analysis Interpretative comment given 5 days Biochem Sex Hormone Binding Globulin F 16-49yrs 14.7-122.5 nmol/L F 50yrs and older 16.7-124.4 nmol/L M 16-49yrs 16.2-68.5 nmol/L M 50yrs and older 13.7-69.9 nmol/L 24 hours Reference intervals taken from Abbott Product Alert notice – September 14th ; 2015 Haem Sickle cell screen POS/NEG will include FBC & haemoglobinopathy screen 3 days* Contact laboratory if patient is pre-op - Ext 33244 or 33245 * Can be performed urgently Biochem Sirolimus Trough/Pre- dose Renal transplant patients: First 6 months maintain at 10-15μg/L. After 6 months maintain at 5-10μg/L. 7 days Source of range – Southmead Hospital Histo Skin for Immunofluorescence (IMF) 21 days Reference should be made to special notes in 'Immunofluorescenc e (IMF) on skin and mucosal biopsies' section Neuro Skin biopsy for small fibre neuropathy 14 days Arrange with lab prior to sending on ext 54408 and see special notes in 'Skin biopsies for Intraepidermal Nerve Fibre Density' section. Biochem Sodium 133-146 mmol/L 24 hours Source of range – Pathology Harmony reference intervals
Immuno Specific IGG to Bee Venom 14 days Immuno Specific IGG to Wasp Venom 14 days Cyto Sputum (malignant cells) Wide Mouth containing an equal volume of cytospin collection fluid. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Micro Sputum Culture - Mycobacteria Sterile wide mouthed container up to 12 weeks Micro Sputum Culture - Routine Sterile wide mouthed container 3 days Micro Sputum Mycobacteria - Microscopy Sterile wide mouthed container 1 day Micro Staphylococcal Serology 5 days Micro Streptococcal Serology 5 days Immuno Striated Muscle Antibodies POS/NEG 14 days Micro Swab Cervical Culture Pink top E- swab 4 days Micro Swab Cervical Gonococcal Culture Pink top E- swab 4 days Micro Swab Ear - Culture Orange Swab / Wire Stem 4 days Place the swab in the ear canal. Rotate gently. Micro Swab High Vaginal Culture Pink top E- swab 4 days Micro Swab High Vaginal Microscopy Pink top E- swab 1 day Micro Swab Mouth Pink top E- swab 2 days Micro Swab MRSA Screen Pink top E- swab 2 days Please state the name of the site in the clinical details and on the specimen. Micro Swab Rectal - Gonococcal Culture Pink top E- swab 4 days Micro Swab Throat - Gonococcal Culture Pink top E- swab 4 days Micro Swab throat – routine culture Pink top E- swab 4 days
Micro Swab urethral – gonococcal culture Orange swab / wire stem 4 days Micro Swab 'Wound' and for other sites not stated -see separate Microbiology test list Pink top E- swab 4 days Please state the name of the site in the clinical details and on the specimen Micro Swab Eye - Eye Acanthamoeba Contact lens, corneal swab, sterile eye swab. 5 days Tested by PCR. Laboratory supplies sterile dry swabs and universal containers. Micro Swab Wound - Eye Routine Culture Pink top E- swab 2 days Biochem Sweat Test (sweat chloride) Macroduct collection tubing *See patient report for specific age related ranges 24hr Contact Duty Biochemist to discuss Guidelines for the Performance of the Sweat Test for the Investigation of Cystic Fibrosis in the UK v.2 Micro Syphillis Antibody screen 3 days Immuno T cell Subsets <7 days Includes CD4 counts for HIV+ patients, CD3 or CD19 counts for immunotherapy (ring 52293 for urgent results) Molecul ar t(11;14) in mantle cell lymphoma Interpretative comment given 14 days Molecul ar t(14;18) in follicular lymphoma Interpretative comment given 14 days Molecul ar t(15;17) in AML Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecul ar t(8;21) in AML Interpretative comment given 14 days Must arrive in laboratory as soon as possible Biochem Tacrolimus Trough/ Pre- dose Renal transplant patients: Initially maintain at 10- 15μg/L. After 8 weeks maintain at 5-10μg/L. 72hrs Measured Monday, Wednesday and Friday European consensus target concentrations for Renal transplant patients Biochem TAU Protein (Beta 2 Transferrin, CSF) See CSF- Tau protein Molecul ar TCR Beta Clonality Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecul ar TCR Gamma Clonality Interpretative comment given 14 days Biochem Teicoplanin Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory Department of Microbiology
Southmead Hospital Pathology test list (continued) Pathology Test List Immuno Testicular Antibodies NEG POS with clinical interpretive comment 14-21 days Referral test to Protein Reference Unit, Sheffield Biochem Testosterone F 16-49yrs 0.5-1.7 nmol/L F 50yrs and older 0.5- 1.2 nmol/L M 16-49yrs 8.8-27.9 nmol/L M 50yrs and older 8.6- 23.4 nmol/L 24 hours Reference intervals taken from Abbott Product Alert notice – September 14th , 2015 Haem Thalassaemia Screen Interpretative comments given 14 days Contact lab on Ext 33244 or 33245 before taking sample Sometimes samples may need to be referred to King’s College Hospital, London for genotyping. Biochem Theophylline 10-20 mg/L 24 hours See Therapeutic Drug Monitoring Section. Source of range – Pathology Harmony reference intervals Biochem Thiopurine Methyl Transferase Normal 35 -79 nmol/gHb/hour Low 6 -34 nmol/gHb/hour Deficient <6 nmol/gHb/hour 7 -14 days Request form must indicate intention to commence patient on aziothioprine Referral Test to Clinical Biochemistry Department City Hospital Source of reference range - Clinical Biochemistry Department City Hospital Micro Threadworm Micro scopy Sellotape impression of anal margin attached to slide 1 day If sellotape not available then use moistened perianal swab submitted in few mls of saline. Hcoag Thrombophilia Screen x4 14 days All requests must be authorised by Consultant Haematologist. Contact laboratory for sample requirements - Ext 33244 or 33245
x2 bottles Biochem Thyroglobulin Units: ug/L Where applicable, interpretative comment given. The Beckman reference interval for thyroglobulin in a euthyroid individual is 1.6 to 50 ug/L 48rs Useful in monitoring patients with thyroid cancer, sometime confused with “thyroid auto-antibodies” Source of range - expected values from Beckman kit insert. Biochem Anti-thyroglobulin Antibodies Units: iu/ml Where applicable, interpretative comment given. 48 hours Paired request with Thyroglobulin Useful in monitoring patients with thyroid cancer, sometime confused with “thyroid auto-antibodies” Biochem Thyroid Function Tests (Profile 8) *see Patient report for specific age related ranges. see TSH, FT4. Request FT3 separately. 24 hours TSH in all patients, thyroid hormones as appropriate according to clinical details Biochem Anti-Thyroid peroxidase (Thyroid Peroxidase Antibody/anti TPO) POS/NEG Units IU/ml 24 hours Expected values from kit insert Biochem Thyroid Stimulating Hormone Adults (19+ yrs) - 0.35- 4.94 mIU/L *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Micro Tip Culture eg line, wire, tube Sterile wide mouthed container 2 days Please state the name of the site in the clinical details and on the specimen. Micro Tissue Mycobacteria - Culture Sterile wide mouthed container up to 12 weeks Micro Tissue Mycobacteria - Microscopy Sterile wide mouthed container 1 day Micro Tissue Routine - Culture Sterile wide mouthed container 4 days Under aseptic conditions transfer material to a sterile universal container that does not contain formalin as this inactivates pathogens very rapidly. Micro Tissue Routine - Microscopy Sterile wide mouthed container 1 day Immuno Tissue Transglutaminase Anti POS/NEG 10 days For coeliac disease H&I Tissue Type, HLA Class I and Class II 3x edta 7 days
H&I Tissue Type, HLA Class I only 3x edta 7 days Usually for disease association requests H&I Tissue Type, HLA class II only 3x edta 7 days Usually for disease association requests Biochem Tobramycin Units mg/L 24 hours Trough level should be taken immediately before a dose. Peak should usually be taken an hour after a dose. State drug regime and time of last dose on sample. When Tobramycin is being given once daily, a trough level of >1mg/L indicates the need to increase the interval between doses. Further advice is available via the on call microbiologist via 30010 or bleep via the switchboard Biochem Total Protein Adult (19+yrs) 60-80 g/L. *see Patient report for specific age related ranges. 24 hours Caliper study values for children and Pathology Harmony reference interval for adults. Micro Toxocara Canis Antibody Screen 14 days This test is referred to the Hospital for Tropical Diseases, London Micro Toxoplasma Antibody Screen 3 days Biochem Transferrin Units: g/L *see patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Biochem Transferrin Saturation 16-45% 24hrs Reference source: Upper limit from EASL Clinical Practice Guideline for haemochromatosis. Please note that the lower limit is under review pending new National Guidelines
being published. Biochem Triglyceride Adult (19+yrs) 0.4-1.7 mmol/L *see patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Triglyceride concentration > 12 mmol/L indicates severe hypertriglyceridaemi a and a high risk of pancreatitis Biochem Troponin I F: +15days : 3-16ug/L M: +15days: 3-34 ng/L *see patient reports for age related reference ranges in children <15days old. 24 hours Sample should be taken at least 6 hours after the onset of worst chest pain Neonatal reference interval from the Caliper study and expected values for adults taken from kit insert. Troponin I >34 ng/L in males and >16 ng/L in females is indicative of myocardial damage, but not its cause. Note that elevated Troponin I concentrations may be seen in conditions other than ACS. For exclusion of ACS samples should be taken at least 3-6 hours after the time of worst chest pain. Biochem Tumour markers Please phone Duty Biochemist to discuss marker Please phone Duty Biochemist to discuss Micro Ulcer swab Pink top E- swab 2 days Please state the name of the site in the clinical details and on the specimen. Biochem Urea Adults/16+ yrs: 2.5-7.8 mmol/L *see patient report for specific age related ranges. 24 hours Source of range – Pathology Harmony reference intervals
Biochem Urate (Uric Acid) F: Adult (19+yrs) 140 – 360 umol/L M:Adult (19+yrs) 220 - 430 umol/L *see patient report for specific age related ranges 24hrs Caliper study values for children and Pathology Harmony reference interval for adults. Cyto Urine (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer.> Reference should be made to special notes in the Cytopathology section. Biochem Urine Albumin Urine 24hr plain 0-30 mg/24hr 24hrs Reference range : Annals of Clinical Biochemistry 50(4) 296–300 Biochem Urine Albumin: creatinine ratio Universal e arly am F < 3.5, M <2.5 mg/mmol 24 hours Expected values from test kit. It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Biochem Urine Calcium Plain rando m urine No reference range quoted. Units: mmol/L 24 hours Random sample often helpful. Contact duty biochemist to discuss if required. Biochem 24hr Urine Calcium 24hr plain urine 2.5-7.5 mmol/24hr 24hrs Tietz textbook of Clinical Chemistry Biochem Urine Calcium:Creatinine ratio 24hr plain urine Urine Calcium:Creatinine ratio – Adults <0.6 The values for children quoted in the literature vary considerably but they are higher than those seen in adults and decline slowly with increasing age. For example- <7mths <2.42 7-18 mths <1.69 19mths-6yrs <1.18 24hrs Adult and paediatric ranges sourced: J.Paediatrics 123 (3) 393-7, Sep.93 Micro Urine Chlamydia Antigen PCR Sterile plastic Universal 3 days Biochem Urine Citrate (24 hr) Plain 24 hr 1.52 – 7.00 mmol/24hrs 14-21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General
Hospital Biochem Urine Creatinine Urine 24hr plain No reference range quoted. Units: mmol/24hr 24hr Micro Urine Culture Routine Sterile plastic universal with boric acid 1 day Fill container to the line. If low sample volume (<5ml) remove the boric acid crystals first. Biochem Urine Cystine (24hr) Plain 24hr Units: umol/24hrs Interpretative comments given 14-21 days Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Urine Cytomegalovirus Sterile plastic universal 14 days Must arrive in laboratory as soon as possible. Biochem Urine Drugs of Abuse Screen Universal Interpretative comment given 2-3 days It is essential to list all drugs/medications on the request form Biochem Urine Ethanol (Alcohol) Plain random urine Units mg/dL UK Legal driving limit for urine ethanol = 107mg/100ml. Urine ethanol: To convert mg/100ml to mmol/L = x0.216 24hrs Hcoag Urine Haemosiderin Universal 3 days Biochem Urine Kidney Stone Screen- consisting of Urine Calcium, Phosphate, Urate, Chloride, Cystine and oxalate. Universal Urine Calcium, phosphate, urate – In house. Urine Cystine, Citrate and Oxalate – referred tests see individual test. 6 weeks Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Urine Legionella Antigen Detection Sterile plastic universal with boric acid 1 day Please contact Laboratory on 52376 prior to submitting request. Biochem Urine Magnesium Plain random urine No reference range quoted. Units: mmol/L 24 hrs Random sample often helpful. Contact duty biochemist to discuss if required. Biochem 24hr Urine Magnesium 24 hr Plain urine 2.4-6.5 mmol/24hr 24 hrs Pathology Harmony reference intervals Biochem Urine Metanephrines (24hr) 24hr Plain Normetadrenaline Male <5.3 µmol/24hr Female<4.3µmol/24hr Metadrenaline <2.0 µmol/24hr 3-Methoxytyramine 0-18 yrs <2.80 µmol/24hr 18-39 yrs <2.80 µmol/24hr 40-60 yrs <2.60 µmol/24hr >60 yrs <2.30 µmol/24hr 14 days Source of range – Salford Hospital (NMT & MT), 3-MT set according to Clin Chem 2006, 52(11), 2060-4. Paediatric results are calculated as Catecholamine /
Creatinine ratios and interpreted on the basis of reference ranges (Ref: Reed et al. Ann. Clin. Biochem. 1991, 28; 297 – 298) Biochem Urine Microalbumin Universal e arly am No reference range quoted. Units: mg/l 24 hours It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Micro Urine Microscopy Routine Automated (Not CSU) Sterile plastic universal with boric acid 2 days Micro Urine Mycobacteria Cultu re Sterile plastic universal with boric acid up to12 weeks Biochem Urine Myoglobin Not available 24 hours Suggest look for elevated creatine kinase (CK) and positive urine dipstix for haem ("blood") both of which support a diagnosis of muscle breakdown (rhabdomyolysis) Biochem Urine Oxalate (24 hr) Plain 24hr 0.04 – 0.5 mmol/24hr Interpretative comments given 14-21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospita Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Urine pH Universal (FULL) Unit: pH No reference range given 2hr A full specimen pot is required and must be received in lab as soon as possible and analysed with 2 hours of collection. Notify Duty Biochemist in advance, when requesting this test. Biochem Urine Phosphate Plain 24hr 15-50 mmol/24hr 24 hrs Pathology Harmony range Micro Urine Pneumococcal Antigen Sterile plastic universal with boric acid Same day Please contact Laboratory on 52376 prior to submitting request. Biochem Urine Potassium Plain 24hr 25-125 mmol/24hr 24 hrs Tietz textbook of Clinical Chemistry Biochem Specimen must be analysed within 24hrs of collection.
Urine Pregnancy Universal (EMU) POS/NEG 24hrs Boric Acid preservative collection pot unsuitable Biochem Urine Protein Plain 24hr 0 - 0.3g/24hr 24 hours National Kidney Foundation – Kidney Disease Outcomes Quality Initiative recommendation Biochem Urine Protein: Creatinine Ratio Universal 2 nd void am (not EMU) <15 mg/mmol 24 hours Reference range – UK eCKD Guide 2017 Biochem Urine Sodium Plain 24 hr* 40-220 mmol/24 hr 24 hours * Random sample also useful urinary sodium >20mmol/L makes sodium deficiency unlikely and is consistent with adrenal failure and with SIADH/chronic hypodilution. Reference source - Tietz textbook of Clinical Chemistry Biochem Urine Toxicology (Save) Universal Interpretative comment given N/A Referred to various specialist centres. This analyses are performed in specialist centres and results are not available for immediate management of patients. Samples will be stored frozen unless specifically discussed with a Consultant. Biochem Urine Urate (Uric Acid) Plain 24hr 1.5-4.5 mmol/24hr 24hrs Pathology Harmony range Biochem Valproate Pre-dose 24 hours See Therapeutic Drug Monitoring Section. Pre-dose sample required Haem Variant Haemoglobin identification Interpretative comment given 14 days Contact lab on Ext 33244 or 33245 before taking sample Sometimes samples may need to be referred to King’s College Hospital, London for genotyping and/or IEF Biochem Vancomycin Pre-dose Optimal range for pre- dose is 10-20mg/L. See guidelines on intranet concerning how to dose 24 hours Trough level should be taken immediately before a dose. Peak should usually be taken an hour
Pathology test-list for-christian_13022019
Pathology test-list for-christian_13022019

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Pathology test-list for-christian_13022019

  • 1. Pathology Test List Below is a list of Pathology tests available, in alphabetical order. For further details please see individual department test lists.
  • 2.
  • 3. Pathology Test List Dept Name BD Vacutainer Reference range Maximum TAT (Working days or weeks) Notes Immuno Acetyl Choline E Receptor Antibody (AChR) pos/neg and interpretative comment given 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem ACTH (adrenocorticotrophic hormone) 0 -40ug/L Interpret with cortisol results from sample taken simultaneously (gold tube) 14-21 days Unstable hormone; blood must arrive in laboratory with 15 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Haem Activated Protein C Resistance > 120 seconds 14 days Contact Consultant Haematologist ( part of thrombophilia screen) Biochem Acylcarnitine Guthrie card Bloodspot free carnitine 10.3 - 54.7 umol/L. Individual interpretation provided on report. 14-21 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Source of reference range - Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Micro Adenovirus Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least
  • 4. 14 days into illness). Micro Adenovirus PCR 5 days Immuno Adrenal Gland Antibody POS/NEG 14-21 days This assay is referred to the Protein Reference Unit, Sheffield Biochem AFP (alpha-fetoprotein) Adults (19yr+) 1-7 kiU/L *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults Used in monitoring patients with non- seminomatous germ cell tumours and in screening and diagnosis of hepatocellular carcinoma Immuno Alpha-3-Ganglionic ACHR antibodies (A3ACR) POS/NEG with values as free text comment 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem Albumin Adult 35-50 g/L *see Patient report for specific age related ranges. 24 hours Source of range – Pathology Harmony reference intervals Biochem Albumin: Creatinine Ratio Universal early am F < 3.5, M <2.5 mg/mmol 24 hours It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Biochem Alcohol (ethanol) Units mg/dL NB UK legal driving limit 80mg/100mL (17.4 mmol/L) 24 hours UK Legal driving limit for blood ethanol is 80 mg/100ml Serum Ethanol: To convert mg/100ml to mmol/L = x 0.216 Biochem Aldosterone Units: pmol/L *See patient report for specific gender & age related ranges 14- 21 days Measure with renin to determine renin:aldosterone ratio. Unstable hormone; blood must arrive in laboratory with
  • 5. 30 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Biochem Aldosterone:Renin Ald:Ren ratio < 91 pmol/mIU effectively excludes Conns. 14- 21 days Unstable hormone; blood must arrive in laboratory with 30 minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Biochem ALP (alkaline phosphatase) age related (may be over 300U/L in infants and children) 24 hours Age-related reference ranges quoted on report forms. Higher in children and in the third trimester of pregnancy. Source of range – Pathology Harmony reference intervals Biochem ALP Isoenzymes Interpretative comment given 28 days Contact Duty Biochemist. Referred Test. Immunmo Alpha-Amino-3- Hydroxy-5-Methyl-4- Isoxazolepropionic Acid Receptor (AMPA) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Alpha-1-Antitrypsin 0.9-2.0 g/L 24 hours Contact Duty Biochemist if phenotype required. An acute phase response may cause the plasma
  • 6. concentration of alpha-1- antitrypsin to rise and mask deficiency. Biochem Alpha-Feto Protein 1-10 kU/L 24 hours Used in monitoring patients with non- seminomatous germ cell tumour and in screening and diagnosis of hepatocellular carcinoma Biochem ALT (alanine transaminase) Adult 1-55 U/L *see Patient report for specific age related ranges. 24 hours. Source of range – Caliper study values for children and expected values from kit insert for adults. Biochem Aluminium <0.37 nmol/L 14- 21 days Referral Test toTrace Element Laboratory, Medical Biochemistry, University Hospital of Wales Source of reference range - Trace Element Laboratory, Medical Biochemistry, University Hospital of Wales Biochem Amikacin Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory, Department of Microbiology, Southmead Hospital Biochem Amino Acids lithium heparin Interpretative comment given 7-14 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Biochem Amino Acids (urine) Universal rand om Interpretative comment given 14 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital A plasma sample is the specimen of choice for first line Amino Acids investigation.
  • 7. 24 hour specimens are rarely indicated for generalised screening. Please contact laboratory for more information. Biochem Amiodarone 0.5 -2.0 mg/L 14- 21 days Measurement of levels hardly ever required; patients on amiodarone treatment require regular monitoring of TFTs and renal function. Referral Test to Toxicology Laboratory, The Academic Centre Llandough Hospital Source of reference range - Toxicology Laboratory , The Academic Centre Llandough Hospital Biochem Ammonia > 16+ 18-72 *see Patient report for specific age related ranges. 24 hours Unstable compound. Blood must arrive in the laboratory within 15 minutes, on ice. Notify Department in advance. Pathology Harmony reference intervals for children and expected values in kit insert for adults Micro Amoebic Antibodies Screen 14 days This test is referred to the Hospital for tropical Diseases, London Biochem Amphetamine Urine NEG/POS (500 ug/L cut-off) 7 days Please request individually when requesting Urine Drugs of Abuse Screen Source of range - European Workplace Testing Threshold Biochem Amylase Range u/L. *see Patient report for specific age related ranges. 24 hours Source of range- Caliper study values for children and expected values from kit insert for adults.
  • 8. Biochem Androstenedione Units: nmol/L *See patient report for specific gender & age related ranges 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Angiotensin Converting Enzyme ≥16yrs: 8-52 U/L 14- 21 days Referral Test to Department of Chemical Pathology, Bristol Royal Infirmary Source of reference range - Department of Chemical Pathology, Bristol Royal Infirmary Request form must state whether patients are receiving ACE inhibitors. ACE inhibitors will result in decreased activity for up to 12 hours post dose Blood Bank Antenatal Antibody Titre follow-up Pink 1-4 days TAT dependent on urgency Micro Antenatal Virus Screen 3 days Patient must be counselled. Micro Antenatal Virus Screen With HIV 5 days Patient must be counselled. Immuno Anti - Cardiac Muscle Antibody NEG POS with clinical interpretive comment 14-21 days Referred test to Protein reference Unit, Sheffield Immuno Anticardiolipin Antibody Interpretative comment given 10 days Immuno Anti Endomysial (IgA) Antibodies POS/NEG 14 days Immuno Anti Endomysial (IgG) Antibodies POS/NEG 14 days Available for ?coeliac with confirmed IgA deficiency Immuno Anti-Hu Antibodies POS/NEG 14 days Biochem Anti Mullerian Hormone (AMH) Units: pmol/L 7days Source of range for Male and paediatric Beckman Test kit
  • 9. *See patient report for specific age & gender related ranges insert Source of Adult female range previous AMH kit also from Beckman. Immuno Anti-Neutrophil Antibody or gold top Interpretative comment given 14 days Immuno Anti-Neutrophil Cytoplasmic Antibodies POS/NEG 7 days Immuno Anti-Phospholipase AZ Receptor (Anti- PLA2R) 14-21 days Referred test to Protein Reference Unit, Sheffield Immuno Anti-Purkinje Cell Antibodies POS/NEG 14 days Immuno Anti-Skin BM Antibody POS/NEG 14 days Immuno Anti-Skin ICS Antibody POS/NEG 14 days Immuno Anti-Sperm Antibodies (blood) or gold top Interpretative comment given 8 – 12 weeks This test is referred to Southmead Hospital, Bristol Haem Antithrombin III 80-120 % activity 14 days Contact Consultant Haematologist ( part of thrombophilia screen) Immuno Anti TSH Receptor Antibody POS/NEG 14 days Hcoag APTT Ratio ratio 1.5-2.5 24 hours Same bottle as APTT. Immuno Aquaporin-4 antibodies (AQP4) POS/NEG with values as free text comment 21 days This assay is referred to Immunology Laboratory, Oxford University Hospital Biochem Arsenic (Blood) 0 - 0.13 umol/L 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Cyto Ascitic Fluid (malignant cells) 25ml white top universal 5 days* *>50% reported Reference should be made to special notes in the
  • 10. within 5 days - more complex cases may take longer. Cytopathology section. Micro Aspirate Nasopharyngeal - respiratory viruses Conical Aspiration Tube 1 day Test covers RSV, Influenza A & B, Adenovirus and Parafluenza. Bacterial culture on neonates Biochem AST (aspartate transminase) 5-34 u/L Adult. *see Patient report for specific age related ranges. 24 hours Affected by Haemolysis. Source of range - Caliper study values for children and expected values from kit insert for adults. Immuno Autoantibody Screen POS/NEG 14-21 days Atypical or rare patterns may be sent to the Protein Reference Unit, Sheffield if confirmation of rare/atypical patterns is required Haem Autohaemolysis - Red cells x2 edta x2 Lithium Hep Interpretative comment given 3 days Contact Consultant Haematologist. Mortuary Autopsy Up to 3 months dependant on the material retained. Consent required. See Anatomical Pathology (Mortuary section)/Requesti ng a consented autopsy. Immuno Basal Ganglia antibodies (ABGA) NEG POS with values as free text comment and clinical interpretive comment 21 days This assay is referred to Institute of Neurology, Queen Square, London Molecular BCR/ABC1 t(9;22) qualitative BCR/ABC1 in CML/ALL Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecular BCR/ABC1 t(9;22) quantitative BCR/ABC1 monitoring trend of patient's past results given 21 days Must arrive in laboratory as soon as possible Immuno Bence Jones Protein (urine) Universal earl y am Interpretative comment given 5 days Biochem Benzodiazepine Urine NEG/POS (200 ug/L cut-off) 7 days Please request individually when requesting Urine Drugs of Abuse
  • 11. Screen Source of range - European Workplace Testing Threshold Biochem Beta-2 Microglobulin 0.1 – 2.2 for all ages and sexes 14 days Referral Test to Department of Clinical Chemistry Royal Devon and Exeter Hospital Source of reference range - Department of Clinical Chemistry Royal Devon and Exeter Hospital Immuno Beta-2-Glycoprotein antibodies (B2GP1) Unit- U/ml NEG POS with clinical interpretive comment 14-21 days Referral test to Protein Reference Unit, Sheffield Source of reference range- PRU, Sheffield Biochem Beta-OH Butyrate (3-OH Butyrate) or Fasting levels 0.03 - 0.3 mmol/L. 7 -14 days Raised in hypoglycaemia when insulin is suppressed. Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Source of reference range - Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital Biochem Bicarbonate (CO2) 22-29 mmol/L 24 hours Specimens from GP surgeries are not routinely tested, add on requests for this test are not possible. Source of range- Harmony reference intervals Biochem Bile Acids 0-14 umol/L 1-3 days Sometimes helpful in management of obstetric cholestatsis, RCOG guidelines available. Referral Test to Clinical Chemistry Department, Treliske Hospital Source of
  • 12. reference range - Clinical Chemistry Department, Treliske Hospital Micro Bilharzia Antibody Screen 14 days This test is referred to the Hospital for tropical Diseases, London Biochem Total Bilirubin <21 umol/L 24 hours Source of range-- Caliper study values for <14 days of age and expected values from kit insert for >14 days of age. Biochem Bilirubin (CSF) "xanthochromia" Universal – Protect from light. Minimum Specimen Volume 350ul. No units Interpretative comment given. 2hrs Must be an appropriate test request, >12hours post event, in patients with Negative CT scan. Deliver to lab by hand protected from light. Minimum Specimen Volume 350ul. Cruickshank A, Auld P, Beetham R, Burrows G, Egner W, Holbrook I, Keir G, Lewis E, Patel D, Watson I, White P. Annals of Clinical Biochemistry (2008); 45: 238- 244. Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Biochem Bilirubin (direct/conjugated) Adult (19+ years) 0- 8.6 umol/l *See patient report for paediatric ranges 24 hours Performed to help elucidate cause of jaundice when total bilirubin raised. Source of range - Caliper study values for children and expected values from kit insert for adults Biochem Unconjugated Bilirubin No units 24 hours Calculated from bilirubin and conjugated bilirubin
  • 13. Micro Blood Culture Blood Culture Set Interpretative comment given Telephoned same day if positive; 36 hours if neg ative. Avoid covering or defacing barcode on bottle label. Results telephoned on same day if positive Biochem BNP Units ng/L BNP is recommended for ruling out Heart Failure, but not to establish diagnosis. The upper limit of normal in the non- acute condition is 35 ng/L. A serum BNP level <100ng/L in an untreated patient makes diagnosis of heart failure unlikely. Refer patients with suspected heart failure to have transthoracic Doppler 2D echocardiography for BNP level between 100-400 ng/L within 6 weeks and refer within 2 weeks for level >400 ng/L. *see Patient report for specific age related ranges. 4 hours Urgent sample must be processed within 4 hours. Haem Bone Marrow Examination Interpretative comment given 14 days Only performed by Haematology medical staff. Micro Bordetella Pertussis Culture Perinasal Swab/Wire Stem 10 days Micro Bordetella Pertussis Serology 14 days This test is referred to the HPA RSIL, Colindale, London Micro Borrelia Burgdorferi Antibody Screen 4 days Cyto Breast Cyst Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may Reference should be made to special notes in the Cytopathology section.
  • 14. take longer. Cyto FNA samples Plastic slide carrier and/or Cytospin collection Fluid in 10 ml conical tube and/or Saline solution in 10 ml conical tube 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Bronchial Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Bronchial Lavage (malignant cells) 25ml white top universal containing equal amount of Cytospin Collection fluid (obtainable from Cytology Department 52355) 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Micro Bronchial Washings - Culture Sterile plastic universal 3 days Micro Bronchial Washings - Pneumocystis Sterile plastic universal 3 days Arrange with Consultant Microbiologist prior to taking sample. Micro Brucella Antibody Screen 7-14 days This test is referred to the HPA Brucella Reference Laboratory, Liverpool Biochem Buprenorphine - Subutex (Urine) Universal Interpretative comment given. The cut-offs used to define positive results are given below; Positive Buprenorphin e >5 ug/L 14 days Source of range European Workplace Testing Threshold Biochem C - Reactive Protein (CRP) Negative < 5 mg/l 24 hours Reference range from kit insert Immuno C1 Esterase Inhibitor 0.1 - 5 mg/l 5 days
  • 15. Immuno C1 Esterase Inhibitor Function < 40% abnormal; 41-67%=equivocal > 68% =normal 5 days Biochem CA 19-9 0-37 kU/L 3-4 days Useful in the follow up of pancreatic cancer and in differential diagnosis of an ovarian mass. Not proven use in screening. Expected values from kit insert Biochem CA125 0-35 kU/L 24 hours Useful in follow up of ovarian cancer. Limited role in screening. Source of reference range is kit insert Biochem Caeruloplasmin Units: g/L *See patient report for specific gender & age related ranges 14 days Useful as a second-line test in the investigation of liver disease, together with the measurement of copper. Referral Test to Department of Clinical Chemistry Northern General Hospital Source of reference range - Department of Clinical Chemistry Northern General Hospital Biochem Calcitonin On ice SSTx2 F < 5.5, M <18.9 ng/L 28 days Unstable hormone. Blood must arrive in the laboratory within 15 minutes, on ice. Notify Department in advance. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology
  • 16. Charing Cross Hospital Biochem Calcium Adult 2.20-2.5 mmol/L. *see Patient report for specific age related ranges. 24 hours Suggest use corrected value to interpret calcium status unless marked change in albumin concentration. Source of range - Pathology Harmony reference intervals for children and expected values from kit insert for adults. Biochem Adjusted Calcium Adult 2.10 – 2.55 mmol//L *see patient report for specific age related ranges 24hrs Calculated from calcium and albumin concentration Molecular Calreticulin (CALR) exon 9 gene mutations in MPV Interpretive comment given 14 days Micro Campylobacter Antibody Screen 14 days This test is referred to the HPA, Preston Biochem Cannabis Universal NEG/POS (50 ug/L cut-off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Carbamazepine Pre-dose 4-12 mg/L 24 hours See Therapeutic Drug Monitoring Section Micro Carbapenemase resistant enterobacteriacae (CRE) screen Faeces in sterile plastic universal + spoon 3 days Biochem Carboxyhaemoglobin Carboxyhaemoglobi n reference range is 0 – 2.0% Heavy smokers may have levels in excess of 6.0% 24hrs "RC Baselt: Carbon monoxide. RC Baselt Disposition of toxic drugs and chemical in man. 10th ed 2014 Biomedical Publications Seal Beach, CA 354-357" Biochem Carcinoembryonic Antigen (CEA) 0-5 ug/L 24 hours Useful in follow- up of colorectal and some other cancers. Very limited role in diagnosis. Expected values
  • 17. from kit insert. Biochem Carnitine Profile Interpretative comment given 4-6 weeks Referral Test to Department of Clinical Chemistry and Newborn Screening Sheffield Children’s NHS Trust Biochem Anti-CCP Negative <20 Weak positive 20 - 39 Moderate positive 40 -59 Strong positive >=60 7 days Test referred away. Royal Devon and Exeter Hospital (Roche assay) Cerebrospinal Fluid - see CSF If sending CSF to more than one Department please send adequate fluid and separate request forms Cyto Cervical Cytology ThinPrep LBC container Service transferred to Royal Cornwall Hospital, Truro RCHT enquiry line 01872 252550 Micro Chickenpox Antibody Screen 5 days If from contact result available same day Micro Chickenpox Antigen Screen Send swab of lesion in UTM (Red liquid Medium) 2 days Collect fluid from outer edge of the vesicle. Contact laboratory on 52376. Molecular Chimerism (post- stem cell transplant) Interpretive comment given 7 days Referred test: Sent to NHSBT, Filton Micro Chlamydia Antigen PCR Test Chlamydia Transport Medium 3 days First catch urine sample or self- taken vulvovaginal swab. Use white topped sterile universal for Urine samples (Boric acid containers are not suitable). Use white topped sterile universal for Urine samples (Boric acid containers are not suitable)
  • 18. Micro Chlamydia Group Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Chlamydia Trachomatis Antibody Screen 14 days This test is only indicated for cases of infertility / PID Biochem Chloride 95-108 mmol/L 24 hours Source of range - Pathology Harmony reference intervals Biochem Cholesterol Units mmol/L Interpret result with reference to current clinical guidelines for prevention of vascular disease 24 hours Source of range- Caliper reference interval for under 19yrs. (1.1 – 4.4 mmol/L) Biochem Cholesterol/HDL ratio No units 24 hours Calculated from cholesterol and HDL Biochem Cholinesterase Interpretative comment given 12 weeks Useful in investigation of suxamethonium sensitivity. Referral Test to Department of Clinical Biochemistry Cholinesterase Investigation Unit Pathology Sciences Building Southmead Hospital Biochem Chromogranin A and B (GAWK) Chromogranin A: <60 pmol/L Chromogranin B: <150 pmol/L 4-6 weeks Unstable proteins. Blood must arrive in laboratory within 15 minutes, on ice. Notify department in advance. Referral Test to The SAS Laboratories Clinical
  • 19. Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Ciclosporin (cyclosporin) Trough/predose Units ug/L No reference range given. 72hrs See Therapeutic Drug monitoring Section. Measured Monday, Wednesday and Friday Hcoag Coagulation factor assays 2 samples required 50-150 % 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Hcoag Coagulation factor inhibitor 2 samples required 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Hcoag Coagulation screen Interpretative comment given 24 hours Biochem Cocaine Urine NEG/POS (300 ug/L cut- off) 7 days Please request individually when requesting Urine Drugs of Abuse Screen Source of range - European Workplace Testing Threshold Blood Bank Cold agglutinins Pink 48 hours Requires overnight incubation Immuno Collagen Type II antibodies (COLLA2) NEG POS with clinical interpretive comment 14-21 days Referred test to Protein Reference Unit, Sheffield Histo Colorectal Bowels 3-14 days Reference should be made to special notes in histopathology section. Most specimens are reported within the 3-14 days period. Complex or specimens that need more consideration or
  • 20. additional special investigations will take longer to report. Immuno Complement C3 & C4 Units g/L *see Patient report for specific age related ranges. 24 hours Source of range - Caliper study values for children and expected values from kit insert for adults. Immuno Contactin- Associated Protein & LG/1 Leucine-Rich Glioma Inactivated 1 (CASPR) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Copper Trace Elements 11-25.1 umol/L 24 hours R.D. Eastman; Biochemical Values in Clinical Medicine. Histo Copper (Dry weight) Dry container 6 weeks Annotate 'DRY COPPER WEIGHT REQUEST' on request form. Place specimen dry in wide mouth container. DO NOT ADD FORMALIN. Specimen sent to another centre for testing. Biochem Copper (urine) Plain 24 hour 0-1.1 µmol/24 hr 2 days R.D. Eastman; Biochemical Values in Clinical Medicine. Biochem Cortisol No reference range quoted. Units: nmol/L 24 hrs Values > 440 nmol/L make adrenal failure improbable. This value was derived in house as part of the verification of the assay. Contact duty biochemist to discuss. Biochem Cortisol (urine) Plain 24 hour <165 nmol/24h 3-4 weeks Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Coxiella Burnetti Antibody Screen 14- 21 days Adequate clinical information must be given to ensure appropriate tests
  • 21. are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Coxsackie Virus Antibody Screen 7-14 days Biochem C-Peptide Units: pmol/L *See patient report for specific gender & age related ranges 28 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Creatine Kinase F 25-200 U/L M 40-320 U/L 24 hours Marker of skeletal and cardiac muscle damage. Collect sample at least 8 hours after suspected MI. Source of range- Pathology Harmony reference intervals Biochem Creatinine Units umol/L *see Patient report for specific age related ranges. 24 hours Source of range - Caliper study values for children and expected values from kit insert for adults. Biochem Creatinine Clearance (urine) Plain 24 hour M 85–125 F 75-115 ml/minute Not generally available - refer to eGFR associated with serum creatinine report or contact Duty Biochemist to discuss Reference range sourced: Baseline renal function screening. Am J Cardiol. 2006 Sep 18;98(6A):21K- 26K. Epub 2006
  • 22. Feb 20 Blood Bank Crossmatch Pink 1-2 hours Results will take longer depending on the nature of the antibodies Immuno Cryoglobulin 10 days Contact lab to arrange this test- flask required for collection-cannot be done Friday after 12.00 Micro Cryptococcal Antigen Detection 14 days This test is referred to HPA SW Laboratory, Bristol Molecular CSF3R gene mutation in CNL Interpretive comment given 28 days This test is referred to Southmead, Bristol or WRGL Micro CSF - 14.3.3 & S100 for CJD Sterile plastic universal 14.3.3 - normally negative S100 <0.41 ng/ml 7 -14 days Stored frozen in microbiology. Neurology to arrange transport to CJD Surveillance Unit (Edinburgh) for testing. Please note blood contamination invalidates test. Biochem CSF - AFP Plain Universal No reference range quoted Units: kiU/L 24hrs ‘This assay has not been validated for measurement on fluids’ Biochem CSF - Bilirubin See Bilirubin Micro CSF - Culture Sterile plastic universal 2 days Haem CSF - Cytospin Plain Universal 7 days State origin of fluid on request form Biochem CSF - Ferritin Plain Universal No reference range quoted. Units: ug/L 24hrs ‘This assay has not been validated for measurement on fluids’ Biochem CSF - Glucose Grey/yellow paed No reference range quoted. Units: mmol. Interpret in relation to plasma glucose taken simultaneously 24 hours ‘This assay has not been validated for measurement on fluids’ Biochem CSF – hCG Plain Universal No reference range quoted. Units IU/L 24 hours Biochem CSF Lactate Plain Universal 1.1-2.4 mmol/L 24hrs Adult reference interval from previous Roche assay.
  • 23. ‘This assay has not been validated for measurement on fluids’ Biochem CSF LDH Plain Universal No reference range quoted Units: U/L 24hrs ‘This assay has not been validated for measurement on fluids’ Cyto CSF - Malignant cells 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Arrange with lab prior to sending on ext 52355. If an out of hours request, refrigerate overnight before delivery to the department between 9 and 10 am the following morning. Contact on-call BMS via the Hospital Switchboard to inform them CSF has been taken. Reference should be made to special notes in the Cytopathology section. If sending CSF to more than one department, please send adequate amounts of fluid and separate request forms appropriate to the tests required. Micro CSF - Microscopy Sterile plastic universal Same day Immuno CSF - Oligoclonal bands Universal 7 days Send blood sample (gold) simultaneously Immuno CSF Oligoclonal Bands (accompanying blood sample) Universal 10 days Must always be sent with the CSF Oligoclonal bands request Micro CSF - PCR Sterile plastic universal 3 days Performed on suspected viral meningitis (Enterovirus, Herpes or Varicella Zoster, Mumps) or suspected Meningococcal
  • 24. Meningitis. Biochem CSF – Protein Plain Universal 0.15-0.45 g/L 24hrs Reference range sourced: Tietz textbook of Clinical Chemistry Biochem CSF - Tau Protein (Beta 2 Transferrin) Universal POS/NEG 21 days May be useful to differentiate CSF, in which it is present, from nasal fluid. Referral Test to Sheffield NGH Protein Reference Unit, Northern General Hospital, Sheffield Molecular Cyclin D1 Over Expression Interpretative comment given 14 days Must arrive in laboratory as soon as possible Cyto Cyst Fluids 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cytogenetics x2 edta x2 Lithium Hep Interpretive comment given 28 days Cytogenetics ( karyotying, chromosome studies) - It is the responsibility of the requesting clinician to ensure such samples reach their destination Micro Cytomegalovirus Antibody Screen (IgG/IgM) 3 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Cytomegalovirus PCR Detection 3 days As part of Pathology's Servi ce Improvement
  • 25. programme, the CMV/Epstein- Barr Virus (EBV) molecular testing service will transfer to new Abbott equipment/ reagents as from Monday 17 July. Validation testing has shown that CMV results are comparable, but EBV results are on average slightly lower than the current method (by approximately 0.3 Log10 value). Results will continue to be reported in IU/ml format. It is also requested that separate EDTA tubes are supplied for each test. Haem Cytospin Analysis (CSF or aspirates) Universal 7 days State origin of fluid on request form Hcoag D-Dimer <0.5 FEU mg/ml 24 hours Biochem Dehydroepi- androsterone Sulphate (DHEAS) Units: umol/L *See patient report for specific gender & age related ranges 7 -14 days Referral Test to Clinical Chemistry Department, Treliske Hospital Source of reference range - Clinical Chemistry Department, Treliske Hospital Hcoag DIC screen 24 hours Includes fibrinogen and D- dimer Biochem Digoxin 6-10 hours Post- dose 0.5-1.0 ug/L 24 hours Samples for Digoxin should be drawn at least 6 and preferably 18 hours post- dose. Target
  • 26. range in heart failure, 0.5-1.0 ug/L. Source of range – Pathology Harmony reference intervals Blood Bank Direct Coombs Test (DCT) Pink 1-2 hours Biochem Downs Screen Interpretative comment given 7 – 14 days Referral Test to Department of Clinical Chemistry Royal Devon and Exeter Hospital Refer to Obstetric Department for specific guidance. Immuno Ear Shock Protein- Anti-68KD (HSP-70) autoantibodies (EAR) NEG POS with clinical interpretive comment 21 days Purchase Order required: This test can only be ordered by the Immunology clinicians &/or in discussion senior BMS in Immunology. Referred test to Cambridge Life Sciences Micro EBV PCR 3 days As part of Pathology's Servi ce Improvement programme, the CMV/Epstein- Barr Virus (EBV) molecular testing service will transfer to new Abbott equipment/ reagents as from Monday 17 July. Validation testing has shown that CMV results are comparable, but
  • 27. EBV results are on average slightly lower than the current method (by approximately 0.3 Log10 value). Results will continue to be reported in IU/ml format. It is also requested that separate EDTA tubes are supplied for each test. Biochem eGFR No reference range quoted. Units: ml/min/1.73m2 24 hours Calculated from serum creatinine - reported as part of the renal profile. Estimated GFR (eGFR) should be multiplied by 1.159 for patients of Arfican- Caribbean origin. eGFR is now calculated using CKD-EPI equation. Molecular EGFR (epidermal growth factor receptor) gene muations in NSCLC Tissue provided by Cellular pathology Interpretive comment given 7 days Biochem Profile 1 Electrolytes (serum) See individual test details. 24 hours Term used inappropriately to indicate a request for sodium, potassium, creatinine and bicarbonate Biochem Electrolytes (urine) Plain 24 hours Random sample often helpful. Contact Duty Biochemist to discuss if required Histo Electron Microscopy 4.0% gluteral- dehyde 28 days Arrange with the Histopathology laboratory prior to taking sample- tel extn 52362 Immuno Endothelial Cell Antibodies (ECAB) NEG POS with clinical 14-21 days Referred test to Protein Reference Unit,
  • 28. interpretive comment Sheffield Micro Enterobius Sellotape impression 1 day See Threadworm microscopy Immuno Eosinophilic Cationic Protein (EOCP) Reported as values; POS with clinical interpretive comment 14-21 days Referred test to Protein Reference Unit, Sheffield. Biochem Epilim (valproate) Pre-dose 24 hours See Therapeutic Drug Monitoring Section. Pre- dose sample required Micro Epstein-Barr Virus IgG Screen 3 days Micro Epstein-Barr Virus IgM Screen 3 days Biochem Erythropoietin 5 – 25U/L (for an individual with a Hb within limits). 7- 14 days Referral Test to Clinical Biochemistry, King’s College Hospital Source of reference range - Clinical Biochemistry, King’s College Hospital Biochem Ethanol nb legal driving limit 80mg/100mL (17.4 mmol/L) 24 hours Immuno Extractable Nuclear Antigen Screen POS/NEG 14 days Immuno Extractable Nuclear Antigens Type POS/NEG 21 days Hcoag Factor IX assay 50-150% 7 days Contact laboratory prior to taking samples - Ext.33244 or 33245 Molecular Factor V Leiden & Prothrombin gene mutations Interpretative comment given 14 days Haem Factor VIII Assay 50-150% <7 days Contact laboratory prior to taking samples - Ext 33244 or 33245. This test is referred to Oxford Haemophilia and Thrombosis Centre. Biochem Faecal Calprotectin Blue Faecal pot Units: ug/g <45 ug/g - Calprotectin within 14 days Refer to NICE guidance DG11 and any locally developed guidelines for patient management.
  • 29. reference range not suggestive of intestinal inflammation ≥ 45 ug/g an Interpretative comment given. Please ‘phone if you wish to discuss - Duty Biochemist 01752 517936. Biochem Faecal Elastase 1 Blue Universal + Spoon > 200 Normal ugE1/g stool < 100 Severe pancreatic insufficiency ugE1/g stool 14- 21 days Referral Test to Clinical Chemistry Department, Treliske Hospital Source of reference range - Clinical Chemistry Department, Treliske Hospital Cyto Faecal Fat Globules (cytology) Universal + Spoon 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Restricted to investigation of paediatric cases only. Micro Faeces - Clostridium Difficile GDH & Toxin Sterile plastic universal + Spoon 1 day No need to send follow-up samples if initial test is positive for toxin. (Toxin can persist up to 2 weeks) Micro Faeces - Culture Sterile plastic universal + Spoon 3 days Do not overfill container. Include details of foreign travel. Include details of food consumed if food poisoning suspected Micro Faeces - Enteric PCR Test Sterile plastic universal + Spoon 2 days Do not overfill container. Include details of foreign travel. Include details of food consumed if food poisoning suspected Micro Faeces - Microscopy (Parasitology) Sterile plastic universal + Spoon 2 days Do not overfill container. Include details of foreign travel. If amoebic dysentery is suspected then a hot stool sample is preferred.
  • 30. Arrange with laboratory prior to submission on 01752 792380. Micro Faeces - Norovirus Sterile plastic universal + Spoon If Norovirus outbreak suspected, notify Infection Control for urgent testing 1 day from request Micro Faeces - other Virology Sterile plastic universal + Spoon 14 days Biochem Ferritin Adult (19+ years) F 10-204 ug/L M 22-275 ug/L *see Patient report for specific gender and age related ranges. 24 hours Caliper study values for children under 19yrs and expected values from kit insert for adults but with a LLN of 10 ug/L for adult females. Hcoag Fibrinogen 1.5-4.5 ug/ml 24 hours H&I Flow Cytometric Crossmatch Interpretative comment given <7 days For renal transplant. Must be booked with H&I lab 52390 Biochem Flucytosine Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory Department of Microbiology, Southmead Hospital Arrange with Consultant Microbiologist prior to taking sample. Biochem Fluid Albumin Universal container No reference range quoted Units: g/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Amylase Universal container No reference range quoted Units: U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Bilirubin Universal container No reference range quoted Units umol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Cholesterol Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on
  • 31. fluids’ Biochem Fluid Chloride Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Bicarbonate Universal container No reference range quoted Units: mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Creatinine Universal container No reference range quoted Units umol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Glucose Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Potassium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid LDH Universal container No reference range quoted Units U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Lipase Universal container No reference range quoted Units U/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Magnesium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Sodium Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Protein Universal container No reference range quoted Units g/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid Triglyceride Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’
  • 32. Biochem Fluid Urea Universal container No reference range quoted Units mmol/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid AFP Universal container No reference range quoted Units kIU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CA125 Universal container No reference range quoted Units kU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CA19-9 Universal container No reference range quoted Units kU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid CEA Universal container No reference range quoted Units ug/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid hCG Universal container No reference range quoted Units IU/L 24 hrs ‘This assay has not been fully validated for measurement on fluids’ Biochem Fluid pH Universal (FULL) Unit: pH No reference range given 2hr A full specimen pot is required and must be received in lab as soon as possible and analysed with 2 hours of collection. Notify Duty Biochemist in advance, when requesting this test. Micro Fluid - Vesicle Herpes Virus PCR / IFT Swab of lesion in PCR (UTM) transport medium 5 days Collect fluid from within the vesicle or swab the periphery of lesion collecting matter and fluid if possible. Micro Fluid CAPD - Culture CAPD dialysis bag sealed with clip 3 days Send complete dialysis bag in a sealed double white plastic bag Micro Fluid CAPD - Microscopy Sealed dialysis bag Same day Micro Fluid Cerebrospinal - PCR Sterile plastic universal 1 day Performed on suspected viral
  • 33. meningitis (Enterovirus, Herpes or Varicella Zoster) or suspected Meningococcal Meningitis. Note: EDTA Blood sample can also be tested for Meningococcal PCR Micro Fluid Culture eg ascitic, pleural, joint, csf Sterile plastic universal 3 days State site on request form and sample Micro Fluid Microscopy eg ascitic,csf, pleural, joint Sterile plastic universal 1 day State site on request form and sample Micro Fluid Mycobacteria - Culture Sterile plastic universal 12 weeks Micro Fluid Mycobacteria - Microscopy Sterile plastic universal 1 day Cyto Fluids -ascitic, joint, pleural 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Biochem Folate (serum) Adult 3.1 - 20 ug/L. *see Patient report for specific age related ranges. Caliper study values for children and expected values from kit insert for adults. Biochem Free Androgen Index M: (0-49yr) – 24.5 – 113.3 M (50yr+) – 19.3 – 118.4 F: (0-49yr) – 0.7 – 8.7 F: (50yr+) – 0.5 – 4.7 24hrs Calculated from testosterone and SHBG. Reference intervals taken from Abbott product alert notice – September 14th , 2015 Biochem Free Fatty Acids Send to Laboratory immediately. Usually requested with 3-
  • 34. Fasting levels 0.1-0.9 mmol/L 14 days hydroxybutyrate and glucose. Referral Test to Biochemical Genetics Unit, Southmead Hospital Source of reference range - Biochemical Genetics Unit , Southmead Hospital Glucose concentration required for referral. Biochem Free T3 Adult 2.6 - 5.7 pmol/L. *see Patient report for specific gender and age related ranges. 24 hours Caliper study values for children and expected values from kit insert. Biochem Free Thyroxine, FT4 Adult (19+ years)9.0-19.0 pmol/L. *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert. Histo Frozen Section Send sample in dry pot Less than 1 hour *complex/multi ple blocks/multiple specimens may take longer. Arrange with Histopathology Laboratory prior to taking sample - tel extn 52362. See notes in 'Sending High Risk Specimens' section if patient is known, or suspected, to be an infection hazard.*Please note that we are no longer able to offer a frozen section service to count neutrophils in specimens from orthopaedic joint revision surgery (see explanatory note in Histopathology Section) Biochem FSH Male 1.0 - 12.0 iu/L. Female - dependent on menstrual phase. *see Patient report for specific age related ranges. 24 hours Expected values from kit insert
  • 35. Haem Full Blood Count *see Patient report for specific age related ranges and red cell parameters including white cell count and differential. 24 hours Micro Fungal Culture - dermatophytes Sterile wide- mouthed container or folded black paper. 16 days Micro Fungal Culture - yeasts Charcoal swab or pink top -E-swab 2 days Micro Fungal Microscopy - dermatophytes Sterile wide- mouthed container or folded black paper. 2 days Micro Fungal Serology 21 days This test is referred to HPA SW Laboratory, Bristol Haem G6PD Deficiency screen Interpretative comment given 7 days Contact laboratory prior to taking sample - Ext.33244 or 33245 Immuno GAD Antibodies (IDDM) (GADAD) POS/NEG Positive results with interpretative comment Referred test to Immunology Dept, R,D&E, Exeter. Immuno GAD Antibodies (Stiff man syndrome) (GADAS) POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Biochem Gamma Glutamyl Transferase (GGT) F Adult (19+ yrs) 9-36 U/L, M Adult (19+yrs) 12-64 U/L *see patient report for specific age related ranges 24 hours Caliper study values for children under 19yrs and expected values from kit insert for adults. Immuno Ganglioside/Glycolipi d/GM antibodies (AGLY1) POS/NEG Positive results with interpretative comment 21 days Referred test to Dept of Neurology, Southern General Hospital, Glasgow Cyto Gastric Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section.
  • 36. Cyto Gastric Washings (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Biochem Gastrin (also part of Gut Hormone Screen) x2 On ice Fasting 0-40 pmol/L 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories, Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Referral Lab Genetic Tests - see also Cytogentics It is the responsibility of the requesting clinician to ensure such samples reach their destination. Please ensure that the appropriate request form is used for all Genetic Test Requests. For those which are sent to Bristol Genetics Laboratory - attached below: Bristol Genetics Form (2).pdf Link to Bristol Genetics lab Website is attached below: bristol_genetics Biochem Gentamicin Trough/pre-dose Units mg/L 24 hours Trough level should be taken immediately before a dose. Peak level should usually be taken an hours after a dose. State drug
  • 37. regime and time of last dose on sample. Trough - In adults when gentamicin is being given once daily, a trough level of >1 mg/L indicates the need to increase the interval between doses. Further advice is available via the on call microbiologist via 30010 or bleep via the switchboard. Multiple daily doses of gentamicin are usually only indicated in endocarditis. In such cases the optimal ranges are as follows; Predose <1 mg/L, Postdose 3-5 mg/L at one hour post- infusion. Further advice is available via the on call microbiologist via 30010 or bleep via switchboard. Source of range - ? Biochem Globulin 18-36 g/L 24 hours Calculated from difference between total protein and albumin concentrations. Source of range – Pathology Harmony reference intervals Pathology Test List (continued) Pathology Test List Immuno Glomerular Base Membrane Antibodies POS/NEG 7 days
  • 38. Biochem Glucose - plasma and fasting (GP & Hospital) Normal reference range 3.5 - 5.4 mmol/L fasting. 11.1 (random) consistent with diabetes mellitus, at 2 hours. *see report in pregnancy range fasting blood glucose >= 5.3 mmol/L and 2 hours blood glucose >= 7.8 mmol/L during OGTT is consistent with gestational DM 24 hours Fasting plasma glucose >7 mmol/L is consistent with diabetes. Fasting plasma glucose 5.5- 6.9 mmol/L indicates a patient is at high risk of developing type 2 diabetes [NICE guideline PH38]. Biochem Glucose - CSF interpret in relation to plasma glucose taken simultaneously 24 hours Biochem Glucose (GP) 24 hours Biochem Glucose (Serum – Fasting – Hospital ONLY) No reference range 24 hours Glucose concentrations in serum specimens can be spuriously low due to the absence of preservative in the tube. Please interpret with caution and follow up glucose results with measurement on a plasma fluoride oxalate sample where appropriate. Biochem Glucose Tolerance Test Sample 1 – Fasting Sample 2 – 2hr Diabetes Mellitus Fasting 2 hours 7.0 or more 11.1 or more Impaired glucose tolerance <7.0 7.8 - 11.0 Impaired fasting glycaemia 6.1 - 6.9 <7.8 In pregnancy a fasting blood glucose greater than or equal to 5.3 mmol/L and/or 2 hour blood glucose greater than or equal to 7.8 mmol/L during oGTT is consistent with gestational DM 24 hours A GTT is not appropriate or necessary in the presence of diagnostic fasting/random plasma glucose concentrations as above. Provide a fasting sample & 2hr sample. Immuno Glycine Receptor antibody POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford Blood Bank Group and Save 1-2 hours Each group and antibody screen takes 40 minutes-
  • 39. Pink however, they are run in batches. Biochem Growth Hormone Growth hormone ≥5 µg/L suggests adequate secretion. Growth hormone < 0.4µg/L suggests that acromegaly is unlikely. 48hrs NICE guidelines TA64 A single measurement is of limited value, suppression/stimulati on tests are often required. Biochem Gut Hormone Screen x2 On ice fasting Interpretative comment given 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Haemoglobin A1c (HbA1c) 48 mmol/mol is the recommended cut off point for diagnosing DM and considered good control for DM 24 hours Performing this test less than 3 months after a previous test is very rarely required except in pregnancy. NICE Guidelines. Haem Haemoglobinopathy Screen Interpretative comment given Maybe up to 14 days (3 days for antenatal patients) Sickle cell and thalassaemia screening. For antenatal requests please use FOQ form Biochem Haptoglobin or Male – 0-1yr: 0.0-3.0; >1-12: 0.03 – 2.70; >12-60: 0.14 – 2.58; >60: 0.40-2.68 Female- 0-1yr: 0.0- 2.35; >1-12: 0.11 – 2.2; >12-60: 0.35 – 2.5; >60: 0.63-2.73 Units -g/L 7 days Reference ranges from kit insert Biochem HDL – Cholesterol (Part of LIPID profile) F: Adult (19+yrs) 0.9 – 1.8 mmol/L M:Adult (19+yrs) 0.9 – 1.6 mmol/L *see patient report for specific age related ranges 24hrs Caliper study values for children, Ranges from NICE Guidleines
  • 40. Hist Helicobacter Pylori Formalin 7-14 days Endoscopy also perform a breath test commonly known as CLO. Micro Helicobacter pylori faecal antigen test Sterile plastic universal + spoon 5 days Do not overfill. Hcoag Heparin Induced Thrombocytopenia 90% in 5 working days This test is referred to NHS-BT Filton. Contact lab on 33244 or 33245 Samples must be delivered to laboratory by hand. NBS request form must be filled out and 4T score completed. Micro Hepatitis A IgG Antibody Screen 3 days For immunity check prior to foreign travel. These tests are not covered by the NHS and a private charge will be made. Only those >50 years old or who have resided in developing countries should be checked for past immunity. Treat all others as susceptible and vaccinate. Micro Hepatitis A IgM Antibody Screen 3 days For Hepatitis A Acute Infection. Micro Hepatitis B Core Antibody Screen 3 days This should be used to test for past infection Micro Hep B DNA 5 days Micro Hepatitis B ‘e’ antigen/antibody 3 days Micro Hepatitis B Immunity Screen 3 days This should be used to test for Hepatitis B immunity post vaccination Micro Hepatitis B Surface Antigen Screen 3 days This should be used to test for acute Hepatitis B or carriage. An emergency 24hr service is available (contact on-call technician out of hours) Micro Hepatitis C Antibody Screen 3 days A positive sero- conversion will not be detectable for 3-6
  • 41. months after infection Micro Hepatitis C PCR 5 days Abbott HCV quantitative (viral load): It is recommended that blood samples are received in the laboratory within 6 hrs. after being drawn so that centrifugation can be done within time period stated in manufacturers guidelines. Micro Hep E IgG/M 5 days Micro Hepatitis C PCR Genotyping 5 days Hist Her 2 testing of tissue 2-6 weeks Make request on request form. Sent to Royal Cornwall Hospital for testing. Molecul ar Hereditary Haemochromatosis Interpretative comment given 14 days Micro Herpes Simplex PCR 4 days Micro Herpes simplex virus PCR Send swab of lesion in UTM (Red liquid Medium) 5 days Biochem 5HIAA Plain 24 hour 4.7- 36.2 umol/24hr 14 days Special dietary restrictions apply prior to collection. Contact Duty Biochemist for advice. Tietz textbook of clinical chemistry, 2nd edition Histo Histological examination Formalin unless frozen section or other specialist request 3-14 days Most specimens are reported within the 3- 14 days period. Complex or specimens that need more consideration or additional special investigations will take longer to report. Micro HIV Antibody Screen 3 days Must be authorised by the requesting clinician or counsellor - result can be available same day if urgent
  • 42. Micro HIV PCR Viral Load 5 days EDTA sample must arrive in the laboratory as ASAP after taking H&I HLA-B*57:01 POS or NEG 7 days Linked with hypersensitivity to abacavir in HIV+ patients H&I HLA-B27 POS or NEG 7 days Linked with Ankylosing Spondylitis and Uveitis H&I HLA-DQ2/DQ8 Interpretative comment given 7 days Linked with Coeliac Disease Biochem Homocysteine On ice – contact laboratory in advance. F <11.3, M <14.3 umol/L, umol/L 14- 21 days Unstable analyte. Blood must arrive in the laboratory within 30 minutes, on ice. Notify department in advance. Referral Test to Department of Chemical Pathology Bristol Royal Infirmary Source of reference range - Department of Chemical Pathology Bristol Royal Infirmary Micro HTLV type I + II Antibody 3 days Biochem Human Chorionic Gonadotrophin (beta) 0-5 U/L 24 hours Expected values from kit insert. Measured to confirm pregnancy or as a tumour marker in patients with gestational trophoblastic disease and non- seminomatous germ cell tumours Immuno 3-Hydroxy-3-Methyl- Glutaryl-CoA Reductase antibodies (HMGCoA) NEG POS with clinical interpretive comment 14-21 days Referred test to Institute of Molecular medicine, Oxford
  • 43. Biochem IgA Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Biochem IgG Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Biochem IgM Units – g/L *see patient report for specific gender & age related ranges 24hrs Caliper study values for children under 19yrs and expected values from kit insert for adults. Immuno IgE, Allergen Specific 0 28 days Results given as RAST grade. Please list all allergen tests required. Immuno IgE, Total 0 - 108 IU <7 days Biochem IGF1 (Ins L Growth Factor 1) Units: ug/L *See patient report for specific gender & age related ranges 14- 21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital
  • 44. NB: Some Paediatric samples may be referred to Royal Surrey County Hospital NHS Trust Guildford. Biochem IGFBP3 Units: mg/L *See patient report for age related ranges 28 days Referral Test to SAS Peptide Hormone Section Clinical Laboratory Royal Surrey County Hospital Source of reference range - SAS Peptide Hormone Section Clinical Laboratory Royal Surrey County Hospital Immuno IgG Sub-Classes age related 14 days Molecul ar IgH B cell clonality Interpretative comment given 14 days Haem IM Screen POS/NEG comment given 3 days Gold top sample viable for up to 8 days. Histo Immunofluorescence (IMF) - skin/mucosal biopsies In time for the next Dermatolo gy CPC Meeting (following the date of the biopsy) Reference should be made to special notes in 'Immunofluorescenc e (IMF) on skin and mucosal biopsies' section Immuno Immunophenotyping for Leukaemia <7 days Also known as 'cell markers', please give as much clinical information as possible, especially whether acute or chronic leukaemia suspected. Micro Influenza A Antibody Screen 5 days Adequate clinical information must be given to ensure appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Micro Influenza B Antibody Screen 5 days Adequate clinical information must be given to ensure
  • 45. appropriate tests are performed, particularly onset date. Acute samples may be held to await receipt of convalescent samples (at least 14 days into illness). Hcoag INR See BSH guidelines on warfarin dosing 24 hours Non anti-coagulated patient Ratio Biochem Insulin On ice Results are dependent upon plasma glucose concentrations: 1. Normal fasting levels <10 mU/ 2. Hypoglycaemia (glucose <2.5mmol/L) <5 mU/L 3. Severe hypoglycaemia (glucose <1.5 mmol/L)<2 mU/L 28 days Unstable Hormone. Blood must arrive in laboratory within 15 minutes, on ice. Notify department in advance. Glucose concentration required for referral. Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Immuno Insulin Autoantibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Protein Reference Unit, Sheffield Immuno Insulinoma-like Antigen 2 antibodies (IA2) Units U/ml POS/NEG Positive results with interpretative comment Referred test to Dept of Immunology, R,D & E, Exeter Source of reference range Dept of Immunology, R,D & E, Exeter Neuro Intra-operative diagnosis -Frozen section/brain smear Send sample in dry pot Less than 1 hour Arrange with laboratory prior to taking sample - tel extn 54408 . See notes in 'Sending High Risk Specimens' section if patient is known, or suspected, to be an infection hazard. Immuno Intrinsic Factor Antibodies POS/NEG Positive comments with interpretative comment 14 days Referred test to Dept Haematology, Torbay Hospital Molecul ar inv(16) in AML Interpretative comment given 7 days Must arrive in laboratory as soon as possible
  • 46. Biochem Iron Units – umol/L *See patient’s report for specific gender & age related ranges 24 hours Primarily indicated in the investigation of suspected iron overload. Caliper study values for children under 19 years and expected values from kit insert for adults. Histo Iron (Dry weight) Dry container 6 weeks Annotate 'DRY IRON WEIGHT REQUEST' on request form. Place specimen dry in wide mouth container. DO NOT ADD FORMALIN. Specimen sent away for testing. Immuno Islet Cell Antibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Protein Reference Unit, Sheffield Molecul ar JAK2 in MPN Interpretative comment given 14 days Blood Bank Kleihauer Test Pink Same day Biochem Lactate (Blood Lactate CSF) 0.5-2.2 mmol/L 1.1-2.4 mmol/L (CSF) 24 hours Unstable, blood must come to the laboratory as soon as possible Blood - Expected values from kit insert. CSF - Adult reference interval from previous Roche assay. CSF - 'This assay has not been fully validated for measurement on fluids' Biochem Lamotrigine 3-15 mg/L 14- 21 days Referral Test to TDM Unit Chalford St Peter Chesham Lane Buckinghamshire Source of reference range - TDM Unit Chalford St Peter Chesham Lane Buckinghamshire See Therapeutic Drug monitoring
  • 47. section. Biochem LDH (Lactate Dehydrogenase) Adult (19+ years) 125- 200 U/L *See patient’s report for specific gender & age related ranges 24 hours Caliper study values for children under 19 years and expected values from kit insert for adults. Biochem LDL – Cholesterol Units – mmol/L 24 hours Calculated from cholesterol, triglyceride and HDL Biochem Lead 0.1 – 35 ug/100ml 7-14 days Referral Test to Department of Clinical Chemistry Northern General Hospital Source of reference range - Department of Clinical Chemistry Northern General Hospital Biochem LH (Luteinising Hormone) Male 0.6-12.1 Female depends on ovulation cycle or post menopausal. * See patient report for specific ranges 24 hours Expected values from kit insert. Biochem Lipase Adult (19+yrs) 8 – 78U/L *see patient report for specific gender & age related ranges 24hrs Caliper study values up to 19yrs, expected values from kit insert for adults Biochem Lithium 12 hours Post-dose 0.4-1.0 mmol/L 24 hours See Therapeutic Drug Monitoring section. Steady state lithium concentrations should be in the range 0.4-1.0 mmol/L. Samples should be drawn at least 12 hours after the last dose. The minimum requirement for lithium level monitoring is every three months with measurement of thyroid and kidney function every six months. Pathology Harmony reference interval. Biochem Profile 2 Liver Function Tests See individual test details. 24 hours Term usually applied inappropriately to indicate a request for total protein, albumin, bilirubin, ALP and ALT globulin
  • 48. Immuno Liver Kidney Microsomal Antibodies POS/NEG 7 days Molecul ar Loss of hetrozygosity at chromosomes 1p and 19q in oligodendrogliomas 10ml EDTA blood 14 days Tissue provided by Neuropathology. Bloods to be sent to Molecular Biology. Hcoag Low Dose Heparin Assay (Clexane) or anti- Xa assay. Interpretative comment given 24 hours Contact laboratory prior to taking sample - ext.33244 or 33245. Sample must be taken 3 hours post dose Hcoag Lupus Anticoagulant Screen Send 2 x citrate samples plus 1 gold (for ACL) Ratio <1.2 7 days Please book with laboratory - Ext 33244 or 33245 Micro Lyme Screening <3 days DCL and Micro Lyme Testing CSF This test is performed by the Rare and Imported Pathogens Laboratory (PHE). Please send: 1. CSF sample: Send one bottle to DCL requesting albumin and total immunoglobulin Send another bottle (>3ml) to Microbiology requesting cell count and storage pending receipt of completed Lyme request form (reference laboratory requires at least 2mls, and cell count must be performed first – if other testing is also required then please specify on request and ensure sufficient volume of CSF sent). 2. Serum sample on same day to DCL requesting albumin and total
  • 49. immunoglobulin 3. Separate serum sample on same day to Microbiology (requesting storage pending receipt of completed Lyme request form). If serum Lyme antibodies have not already been performed, these can be requested on this sample. Requester must come to Microbiology to complete a Lyme referral form, including the albumin and total immunoglobulin results for both serum and CSF. On receipt of the completed request form we will forward the stored CSF and serum to RIPL reference laboratory for Lyme testing. H&I Lymphocytotoxic Antibody Screen Reported as HLA specificities with normalised MFI. Donor specific antibodies requests as interpretative comments 14- 21 days Routine samples collected every 1 month. Additional samples should be sent 2 weeks after blood transfusion or infections. Use this test to request Donor Specific Antibody which can be performed urgently after contacting the H&I lab 52390 Immuno Lymphocytotoxic Crossmatch x4 <7 days For renal transplant. Must be booked with Immunology lab 52293 Hist Lymphoma Studies 3-14 days Reference should be made to special notes in histopathology section. Complex or specimens that need more consideration or additional special investigations will
  • 50. take longer to report. Immuno M2 Mitochondrial Antibodies POS/NEG 7 days Biochem Magnesium 0-4 weeks : 0.6 – 1.0 mmol/L >4 weeks : 0.7-1.0 mmol/L 24 hours Source of range – Pathology Harmony reference intervals Haem Malarial Parasite Screen 24 hours Contact laboratory - Ext 33244 or 33245.Samples must be treated as urgent. Please give details of travel. Reference should be made to special notes in haematology section Immuno Mast Cell Tryptase (MCT) 14 days Take sample straight away and then repeat 1 hour later Micro Measles IgG 5 days Micro Meningococcal Antibody Screen 5 days This test is referred to the HPA, Meningococcal Reference Laboratory, Manchester Micro Meningococcal PCR 5 days This test is referred to the HPA, Meningococcal Reference Laboratory, Manchester. See also CSF for PCR Biochem Mercury Sample required depends on exposure; contact Duty Biochemist to discuss <20 nmol/L 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital Biochem Urine Mercury Universal Unexposed persons < 2 nmol/mmol creatinine Dental workers < 10 nmol/mmol creatinine Industrial workers < 45 nmol/mmol creatinine Neurological changes > 50 nmol/mmol 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital
  • 51. creatinine Biochem Methadone Universal NEG/POS (300 ug/L cut-off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Methotrexate Units umol/L No range quoted. 24 hours Rarely required; contact Duty Biochemist to arrange. Patients taking the drug for treatment of chronic disorders require regular full blood count, renal and liver profiles. IMPORTANT: Specimen must be protected from light. Molecul ar MGMT Methylation in Glioma Interpretative comment given 14 days Tumour tissue provided by Neuropathology Department. Biochem Monomeric Prolactin (Macroprolactin) Male: 72 – 229 mIU/L Female:79-347 mIU/L 7 days Clinical Chemistry, 2010, 56 (3), 484-90 Molecul ar MPL exon 10 gene mutation in MPN Interpretative comment given 14 days Micro MRSA - PCR (nose swab) Red Top Swab without Charcoal 1 day Specified patient categories only - please contact the laboratory if in doubt. Sample must be received before 1pm to be processed on that day. Micro MRSA/MSSA triple swab screen - Nose, throat, perineum. Triple MRSA/MSS A Collection kit (using 3 separate E- swabs) 2 days For sampling information, click here: E Swab.pdf Micro Mumps IgG 4 days Neuro Muscle Biopsies 14 days Reference should be made to special notes in the 'Muscle and Nerve Biopsies' section. Immuno Muscle-specific tyrosine kinase (MuSK) antibodies POS/NEG Positive results with interpretative comment 14-21 days Referred test to Institute of Molecular Medicine, Oxford
  • 52. Biochem Mycophenolate Pre-dose 1-3.5 mg/L 7-14 days Referral Test to IDM Service, King’s College Hospital Source of reference range - IDM Service King’s College Hospital Micro Mycoplasma genitalium PCR “First catch“ urine samples. Genital and rectal swabs (red topped UTM swab) 7 days This test is currently referred to Micropathology, Warwick. Micro Mycoplasma Pneumoniae Antibody Screen 5 days Molecul ar MYD88 gene mutation in WM Interpretive comment given 28 days This test is referred to RD&E, Exeter Immuno Myelin Associated Glycoprotein antibodies (MAGA) POS/NEG Positive results with interpretative comment Referred test to Oxford University Hospital, Oxford Immuno Myeloperoxidase Antibody POS/NEG 10 days Micro Neisseria gonorrhoeae PCR test 4 days First catch urine sample or self-taken vulvovaginal swab Neuro Nerve Biopsies 4-6 weeks Reference should be made to special notes in the 'Muscle and Nerve Biopsies' section. Immuno Neutrophil Function Test (BURST) Special <7 days Must be booked with Immunology lab 52293 Cyto Nipple Discharge Plastic slide carrier. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in Cytopathology section. Biochem Non-HDL cholestrol Units mmol/L 24 hours Calculated from HDL and Cholesterol Molecul ar Nucleophosmin Gene Mutation in AML Interpretative comment given 14 days Cyto Oesophageal Brushings (malignant cells) Plastic slide carrier and/or in Cytospin collection Fluid in 10 ml conical tube. 5 days* *>50% reported within 5 days - more Reference should be made to special notes in the Cytopathology section.
  • 53. complex cases may take longer. Biochem Oestradiol Male <161 pmol/L Female varies with stage of menstrual cycle or post menopausal (+HRT) * See patient report for specific ranges 24 hours Expected values from kit insert Immuno Oligoclonal Bands (CSF) -see CSF Interpretative comment given 10 days Biochem Opiate Universal NEG/POS (300 ug/L cut off) 7 days Source of range - European Workplace Testing Threshold Please request individually when requesting Urine Drugs of Abuse Screen Biochem Opiate Identification (Urine) Universal Interpretative comment given. The cut-offs used to define positive results are given below Opiate Positive 6-monoacetyl morphine >10 ug/L DHC >150 ug/L Codeine >150 ug/L Morphine >30 ug/L Tramadol >50 ug/L and metabolite area >1800 6- acetylcodein e >50 ug/L 14 days Source of range - European Workplace Testing Threshold Biochem Organic Acids (urine) Universal random Interpretative comment given 14- 21 days Referral Test to Biochemical Genetics Unit Pathology Sciences Building Southmead Hospital 24 hour specimens are rarely indicated for generalised screening. Please contact laboratory for more information. Biochem Osmolality (urine) Universal ra ndom No range quoted. Units mm/kg 24 hours Interpret with reference to serum osmolality and hydration status. The urine osmolality should be interpreted with knowledge of the patient’s serum osmolality and hydration status.
  • 54. Urine collection containers with preservatives are unsuitable for analysis. (i.e. Boric Acid) Urine specimens must be analysed within 36 hours of collection. Biochem Osmolality (serum/plasma) or 275-295mmol/kg 24 hours Serum specimens must be analysed within 36 hours of collection. Source of range- Pathology Harmony reference intervals. Immuno Ovarian Antibodies POS/NEG 15 days Histo Ovarian tumours Dry container 3-14 days Reference should be made to special notes in the 'Gynaecological (ovarian and endometrial tumours)' section. Most specimens are reported within the 3- 14 days period. Complex or specimens that need more consideration or additional special investigations will take longer to report. Biochem Pancreatic Polypeptide (also part of Gut Hormone Screen) x 2 On ice fasting 0-300 pmol/L 4-6 weeks Fasting sample required on ice. Contact Duty biochemist to arrange. Referral Test to The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Source of reference range - The SAS Laboratories Clinical Biochemistry & Medical Oncology Charing Cross Hospital Biochem Paracetamol Units mg/L Interpret relative to time of ingestion using 24hrs Sample should be taken at least 4 hours post ingestion. 'Please note that
  • 55. standard charts e.g BNF high concentrations of N-acetylcysteine may interfere with measurement of paracetamol' Immuno Paraprotein Concentration 5 days Immuno Parathyroid Antibodies POS/NEG 14 days Biochem Parathyroid Hormone Adult (19+ years) 1.6- 7.2 pmol/L *see Patient report for specific age related ranges. 24 hours Must arrive in the laboratory within 6 hours Caliper study values for children and expected values from the kit insert for adults Immuno Paroxysmal Nocturnal Haemaglobinuria Pos/Neg <7 days Positive result indicates a clone of CD59 day deficient red cells detected Micro Parvovirus IgG Antibody Screen 5 days Micro Parvovirus IgM Antibody Screen 5 days Cyto Pericardial Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Cyto Peritoneal Fluid 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Hcoag PFA-100 2 samples required Interpretative comment given 24 hours Contact laboratory prior to taking samples - Ext 33244 or 33245 Biochem Phenobarbitone Pre-dose 10-40 mg/L 24 hours See Therapeutic Drug Monitoring Section
  • 56. Source of range – Pathology Harmony reference intervals Biochem Phenytoin Pre-dose 5-20 mg/L 24 hours See Therapeutic Drug Monitoring Section Source of range – Pathology Harmony reference intervals Biochem Phosphate 16+yrs: 0.8-1.5 mmol/L *see Patient report for specific age related reference ranges in children. 24 hours Source of range – Pathology Harmony reference intervals Haem Plasma Viscosity 1.39-1.70 mPas 2 days Hcoag Platelet Aggregation studies x6 Interpretative comment given 24 hours Contact laboratory prior to taking samples - Ext 33244 or 33245 Follow on testing may be referred to Oxford Haemophilia and Thrombosis Centre. Cyto Pleural Fluid (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Immuno Pneumococcal Antibodies >20mg/ml is protective (> 40 mg/ml if post splenectomy) 14 days Micro Polyoma (BK) Virus 5 days Biochem Porphyrin (faecal) Universal Stool < 200 nmol/g dry weight 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales
  • 57. Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales Biochem Porphyrin (urine) Universal Interpretative comment given 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales. Biochem Porphyrin (whole blood) Plasma porphyrin screen – increased/not increased Red blood cell porphyrin screen – Pos/Neg Red blood cell total porphyrin – 0.4 – 1.7 umol/L 14-28 days Samples of blood, urine (plain container) and faeces should be sent protected from the light, preferably collected when patient is symptomatic (acute forms) Referral Test to Department of Medical Biochemistry and Immunology University Hospital of Wales Source of reference range - Department of Medical Biochemistry and Immunology University Hospital of Wales. Mortuar y Post Mortem Examination Up to 3 months dependant on the material retained Consent required. See Anatomical Pathology (Mortuary section)/Requesting a consented autopsy.
  • 58. Biochem Potassium 16 years+ 3.5-5.3 mmol/L *see Patient report for paediatric ranges. 24 hours Analysis affected by Haemolysis. Specimens older than 12hrs will not be tested. Source of range – Pathology Harmony reference intervals. Biochem Procalcitonin 0-0.5 ug/L 24 hours Reference interval taken from Vidas kit insert Biochem Progesterone No reference range quoted Units: nmol/L 24 hours If sample taken 7 days before a period, a progesterone concentration <15 nmol/L indicates that ovulation has not occurred; >30 nmol/L indicates that ovulation has occurred. Biochem Prolactin Male 73-407 Female 109-557 mIU/L 24 hours Expected values from kit insert Biochem Protein (urine) Plain 24hr 0-0.12g/24hr 24 hours Biochem Protein Adult (19+ years) 60- 80 g/L *see Patient report for specific age related ranges. 24 hours For urine protein see urine section Hcoag Protein C 70-130 % 14 days Contact Consultant Haematologist (part of thrombophilia screen) Hcoag Protein S (Free Protein S) 65-140 % 14 days Contact Consultant Haematologist (part of thrombophilia screen). Follow on testing may be referred to Royal Free Hospital, London - Haemophilia centre and Haemostasis Unit Immuno Proteinase 3 Antibodies POS/NEG 14 days Biochem PSA 40-49 years 0-2.5 ug/L 50-59 years 0-3.5 ug/L 60-69 years 0-4.5 ug/L 70-79 years 0-6.5 ug/L 24 hours Ranges sourced from journal : Serum Prostate-Specific Antigen in a Community-Based Population of Healthy Men Establishment of Age-Specific Reference Ranges, JAMA. 1993;270(7):860- 864. doi:10.1001/jama.19
  • 59. 93.03510070082041 Haem Pyruvate Kinase No longer offered- contact lab if required - - Contact laboratory Ext 33244 or 33245 Micro Quantiferon TB Test Contact lab 52376/ 01752 792376 for tubes 7 days Same day sample delivery required before 16.30 - Read kit insert carefully for sample volume and handling Haem Red Cell Enzyme Assays x 2 Variable, depending on enzyme assayed 14 days Contact lab on Ext 33244 or 33245 before taking sample. This test is referred to King’s College Hospital, London. Note that a G6PD deficiency screen is also available. Haem Red Cell Membrane studies Interpretative comments given 14 days Contact lab on Ext 33244 or 33245 before taking sample This test is referred to King’s College Hospital, London. Haem Red Cell Osmotic Fragility 3 days Contact laboratory for an appointment - Ext 33244 or 33245 Histo Renal Biopsy Provided by BMS on attendance at the biopsy. Alternatively biopsies may be transported direct to the lab in saline soaked gauze for examination and transfer to the correct containers. 3-14 days BMS attendance at renal biopsies is by arrangement. Telephone the laboratory 52362. A BMS will attend if possible; this may be difficult over the lunchtime period 12.30 – 13.30. (Biopsies may be transported direct to the laboratory for examination, in cases of emergency). Biopsies must be received before 16.00 to ensure processing overnight. Biochem Renal Calculus (stone) Universal Interpretative comment given 6 weeks Referral Test to University College London Hospitals Biochem Renin 0 – 7 days 4 – 340 mU/L >7 days – 1yr 4 – 190mU/L >1yr – 11yrs 4 – 85 mU/L >11yrs – 15yrs 4 – 75 mU/L Adults: Supine 2 – 30 mU/L Ambulant 3 – 40 mU/L 21-28 days Measure with renin to determine renin:aldosterone ratio. Unstable hormone; blood must arrive in laboratory with 30
  • 60. minutes. Notify Department in advance. Referral Test to Southampton Endocrine Unit. Southampton General Hospital. Source of reference range - Southampton Endocrine Unit. Southampton General Hospital Micro Respiratory Antigen Screen - Adeno Aspiration tube 1 day Micro Respiratory Antigen Screen - Flu A Aspiration tube 1 day Micro Respiratory Antigen Screen - Flu B Aspiration tube 1 day Micro Respiratory Antigen Screen - Paraflu Aspiration tube 1 day Micro Respiratory Antigen Screen - RSV Aspiration tube 1 day Micro Respiratory PCR Send throat swab in UTM (Red liquid Medium) 1 day Haem Reticulocytes 30-120 *109/L 24 hours Biochem Rheumatoid Factor 0 – 30 IU/ml 24hrs A negative Rhf does not exclude rheumatoid arthritis. A positive Rhf can be seen in rheumatoid arthritis, infection, inflammation and healthy individuals. Reference intervals are sourced from the Kit insert Micro Rickettsia Antibody Screen 5 days This test is referred to HPA, CAMR Micro Rubella IgG Serology Screen 3 days Micro Rubella IgM Serology Screen 5 days Send sample 4 days after onset of rash Biochem Salicylate Units: mg/L No range quoted. 24 hours Immuno Salivary Gland Antibodies POS/NEG 14 days Immuno Salivary IgA Universal 5 days
  • 61. Micro Schistosoma Antibody Screen 14 days This test is referred to the Hospital for Tropical Diseases, London Immuno Scleroderma panel (SCLER1) POS with clinical interpretive comment NEG with panel list 14 days – up to 12 weeks Referral test to Bird Institute for Rheumatic Diseases, Bath Biochem Selenium Blue trace metal. < 16 yrs – 35 -113 umol/L > 16 yrs – 70-130 umol/L 14 days Referral Test to Southampton Trace Elements Unit. Southampton General Hospital Source of reference range - Southampton Trace Elements Unit. Southampton General Hospital Immuno Semen analysis (fertility) Collect pot and instructions from GP 10 days By appointment basis only – contact lab – see instruction sheet. Immuno Serum Protein Analysis Interpretative comment given 5 days Biochem Sex Hormone Binding Globulin F 16-49yrs 14.7-122.5 nmol/L F 50yrs and older 16.7-124.4 nmol/L M 16-49yrs 16.2-68.5 nmol/L M 50yrs and older 13.7-69.9 nmol/L 24 hours Reference intervals taken from Abbott Product Alert notice – September 14th ; 2015 Haem Sickle cell screen POS/NEG will include FBC & haemoglobinopathy screen 3 days* Contact laboratory if patient is pre-op - Ext 33244 or 33245 * Can be performed urgently Biochem Sirolimus Trough/Pre- dose Renal transplant patients: First 6 months maintain at 10-15μg/L. After 6 months maintain at 5-10μg/L. 7 days Source of range – Southmead Hospital Histo Skin for Immunofluorescence (IMF) 21 days Reference should be made to special notes in 'Immunofluorescenc e (IMF) on skin and mucosal biopsies' section Neuro Skin biopsy for small fibre neuropathy 14 days Arrange with lab prior to sending on ext 54408 and see special notes in 'Skin biopsies for Intraepidermal Nerve Fibre Density' section. Biochem Sodium 133-146 mmol/L 24 hours Source of range – Pathology Harmony reference intervals
  • 62. Immuno Specific IGG to Bee Venom 14 days Immuno Specific IGG to Wasp Venom 14 days Cyto Sputum (malignant cells) Wide Mouth containing an equal volume of cytospin collection fluid. 5 days* *>50% reported within 5 days - more complex cases may take longer. Reference should be made to special notes in the Cytopathology section. Micro Sputum Culture - Mycobacteria Sterile wide mouthed container up to 12 weeks Micro Sputum Culture - Routine Sterile wide mouthed container 3 days Micro Sputum Mycobacteria - Microscopy Sterile wide mouthed container 1 day Micro Staphylococcal Serology 5 days Micro Streptococcal Serology 5 days Immuno Striated Muscle Antibodies POS/NEG 14 days Micro Swab Cervical Culture Pink top E- swab 4 days Micro Swab Cervical Gonococcal Culture Pink top E- swab 4 days Micro Swab Ear - Culture Orange Swab / Wire Stem 4 days Place the swab in the ear canal. Rotate gently. Micro Swab High Vaginal Culture Pink top E- swab 4 days Micro Swab High Vaginal Microscopy Pink top E- swab 1 day Micro Swab Mouth Pink top E- swab 2 days Micro Swab MRSA Screen Pink top E- swab 2 days Please state the name of the site in the clinical details and on the specimen. Micro Swab Rectal - Gonococcal Culture Pink top E- swab 4 days Micro Swab Throat - Gonococcal Culture Pink top E- swab 4 days Micro Swab throat – routine culture Pink top E- swab 4 days
  • 63. Micro Swab urethral – gonococcal culture Orange swab / wire stem 4 days Micro Swab 'Wound' and for other sites not stated -see separate Microbiology test list Pink top E- swab 4 days Please state the name of the site in the clinical details and on the specimen Micro Swab Eye - Eye Acanthamoeba Contact lens, corneal swab, sterile eye swab. 5 days Tested by PCR. Laboratory supplies sterile dry swabs and universal containers. Micro Swab Wound - Eye Routine Culture Pink top E- swab 2 days Biochem Sweat Test (sweat chloride) Macroduct collection tubing *See patient report for specific age related ranges 24hr Contact Duty Biochemist to discuss Guidelines for the Performance of the Sweat Test for the Investigation of Cystic Fibrosis in the UK v.2 Micro Syphillis Antibody screen 3 days Immuno T cell Subsets <7 days Includes CD4 counts for HIV+ patients, CD3 or CD19 counts for immunotherapy (ring 52293 for urgent results) Molecul ar t(11;14) in mantle cell lymphoma Interpretative comment given 14 days Molecul ar t(14;18) in follicular lymphoma Interpretative comment given 14 days Molecul ar t(15;17) in AML Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecul ar t(8;21) in AML Interpretative comment given 14 days Must arrive in laboratory as soon as possible Biochem Tacrolimus Trough/ Pre- dose Renal transplant patients: Initially maintain at 10- 15μg/L. After 8 weeks maintain at 5-10μg/L. 72hrs Measured Monday, Wednesday and Friday European consensus target concentrations for Renal transplant patients Biochem TAU Protein (Beta 2 Transferrin, CSF) See CSF- Tau protein Molecul ar TCR Beta Clonality Interpretative comment given 14 days Must arrive in laboratory as soon as possible Molecul ar TCR Gamma Clonality Interpretative comment given 14 days Biochem Teicoplanin Interpretative comment given 7 days Referral Test to Antimicrobial Reference Laboratory Department of Microbiology
  • 64. Southmead Hospital Pathology test list (continued) Pathology Test List Immuno Testicular Antibodies NEG POS with clinical interpretive comment 14-21 days Referral test to Protein Reference Unit, Sheffield Biochem Testosterone F 16-49yrs 0.5-1.7 nmol/L F 50yrs and older 0.5- 1.2 nmol/L M 16-49yrs 8.8-27.9 nmol/L M 50yrs and older 8.6- 23.4 nmol/L 24 hours Reference intervals taken from Abbott Product Alert notice – September 14th , 2015 Haem Thalassaemia Screen Interpretative comments given 14 days Contact lab on Ext 33244 or 33245 before taking sample Sometimes samples may need to be referred to King’s College Hospital, London for genotyping. Biochem Theophylline 10-20 mg/L 24 hours See Therapeutic Drug Monitoring Section. Source of range – Pathology Harmony reference intervals Biochem Thiopurine Methyl Transferase Normal 35 -79 nmol/gHb/hour Low 6 -34 nmol/gHb/hour Deficient <6 nmol/gHb/hour 7 -14 days Request form must indicate intention to commence patient on aziothioprine Referral Test to Clinical Biochemistry Department City Hospital Source of reference range - Clinical Biochemistry Department City Hospital Micro Threadworm Micro scopy Sellotape impression of anal margin attached to slide 1 day If sellotape not available then use moistened perianal swab submitted in few mls of saline. Hcoag Thrombophilia Screen x4 14 days All requests must be authorised by Consultant Haematologist. Contact laboratory for sample requirements - Ext 33244 or 33245
  • 65. x2 bottles Biochem Thyroglobulin Units: ug/L Where applicable, interpretative comment given. The Beckman reference interval for thyroglobulin in a euthyroid individual is 1.6 to 50 ug/L 48rs Useful in monitoring patients with thyroid cancer, sometime confused with “thyroid auto-antibodies” Source of range - expected values from Beckman kit insert. Biochem Anti-thyroglobulin Antibodies Units: iu/ml Where applicable, interpretative comment given. 48 hours Paired request with Thyroglobulin Useful in monitoring patients with thyroid cancer, sometime confused with “thyroid auto-antibodies” Biochem Thyroid Function Tests (Profile 8) *see Patient report for specific age related ranges. see TSH, FT4. Request FT3 separately. 24 hours TSH in all patients, thyroid hormones as appropriate according to clinical details Biochem Anti-Thyroid peroxidase (Thyroid Peroxidase Antibody/anti TPO) POS/NEG Units IU/ml 24 hours Expected values from kit insert Biochem Thyroid Stimulating Hormone Adults (19+ yrs) - 0.35- 4.94 mIU/L *see Patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Micro Tip Culture eg line, wire, tube Sterile wide mouthed container 2 days Please state the name of the site in the clinical details and on the specimen. Micro Tissue Mycobacteria - Culture Sterile wide mouthed container up to 12 weeks Micro Tissue Mycobacteria - Microscopy Sterile wide mouthed container 1 day Micro Tissue Routine - Culture Sterile wide mouthed container 4 days Under aseptic conditions transfer material to a sterile universal container that does not contain formalin as this inactivates pathogens very rapidly. Micro Tissue Routine - Microscopy Sterile wide mouthed container 1 day Immuno Tissue Transglutaminase Anti POS/NEG 10 days For coeliac disease H&I Tissue Type, HLA Class I and Class II 3x edta 7 days
  • 66. H&I Tissue Type, HLA Class I only 3x edta 7 days Usually for disease association requests H&I Tissue Type, HLA class II only 3x edta 7 days Usually for disease association requests Biochem Tobramycin Units mg/L 24 hours Trough level should be taken immediately before a dose. Peak should usually be taken an hour after a dose. State drug regime and time of last dose on sample. When Tobramycin is being given once daily, a trough level of >1mg/L indicates the need to increase the interval between doses. Further advice is available via the on call microbiologist via 30010 or bleep via the switchboard Biochem Total Protein Adult (19+yrs) 60-80 g/L. *see Patient report for specific age related ranges. 24 hours Caliper study values for children and Pathology Harmony reference interval for adults. Micro Toxocara Canis Antibody Screen 14 days This test is referred to the Hospital for Tropical Diseases, London Micro Toxoplasma Antibody Screen 3 days Biochem Transferrin Units: g/L *see patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Biochem Transferrin Saturation 16-45% 24hrs Reference source: Upper limit from EASL Clinical Practice Guideline for haemochromatosis. Please note that the lower limit is under review pending new National Guidelines
  • 67. being published. Biochem Triglyceride Adult (19+yrs) 0.4-1.7 mmol/L *see patient report for specific age related ranges. 24 hours Caliper study values for children and expected values from kit insert for adults. Triglyceride concentration > 12 mmol/L indicates severe hypertriglyceridaemi a and a high risk of pancreatitis Biochem Troponin I F: +15days : 3-16ug/L M: +15days: 3-34 ng/L *see patient reports for age related reference ranges in children <15days old. 24 hours Sample should be taken at least 6 hours after the onset of worst chest pain Neonatal reference interval from the Caliper study and expected values for adults taken from kit insert. Troponin I >34 ng/L in males and >16 ng/L in females is indicative of myocardial damage, but not its cause. Note that elevated Troponin I concentrations may be seen in conditions other than ACS. For exclusion of ACS samples should be taken at least 3-6 hours after the time of worst chest pain. Biochem Tumour markers Please phone Duty Biochemist to discuss marker Please phone Duty Biochemist to discuss Micro Ulcer swab Pink top E- swab 2 days Please state the name of the site in the clinical details and on the specimen. Biochem Urea Adults/16+ yrs: 2.5-7.8 mmol/L *see patient report for specific age related ranges. 24 hours Source of range – Pathology Harmony reference intervals
  • 68. Biochem Urate (Uric Acid) F: Adult (19+yrs) 140 – 360 umol/L M:Adult (19+yrs) 220 - 430 umol/L *see patient report for specific age related ranges 24hrs Caliper study values for children and Pathology Harmony reference interval for adults. Cyto Urine (malignant cells) 25ml white top universal 5 days* *>50% reported within 5 days - more complex cases may take longer.> Reference should be made to special notes in the Cytopathology section. Biochem Urine Albumin Urine 24hr plain 0-30 mg/24hr 24hrs Reference range : Annals of Clinical Biochemistry 50(4) 296–300 Biochem Urine Albumin: creatinine ratio Universal e arly am F < 3.5, M <2.5 mg/mmol 24 hours Expected values from test kit. It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Biochem Urine Calcium Plain rando m urine No reference range quoted. Units: mmol/L 24 hours Random sample often helpful. Contact duty biochemist to discuss if required. Biochem 24hr Urine Calcium 24hr plain urine 2.5-7.5 mmol/24hr 24hrs Tietz textbook of Clinical Chemistry Biochem Urine Calcium:Creatinine ratio 24hr plain urine Urine Calcium:Creatinine ratio – Adults <0.6 The values for children quoted in the literature vary considerably but they are higher than those seen in adults and decline slowly with increasing age. For example- <7mths <2.42 7-18 mths <1.69 19mths-6yrs <1.18 24hrs Adult and paediatric ranges sourced: J.Paediatrics 123 (3) 393-7, Sep.93 Micro Urine Chlamydia Antigen PCR Sterile plastic Universal 3 days Biochem Urine Citrate (24 hr) Plain 24 hr 1.52 – 7.00 mmol/24hrs 14-21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospital Source of reference range - Southampton Specialist Biochemistry. Southampton General
  • 69. Hospital Biochem Urine Creatinine Urine 24hr plain No reference range quoted. Units: mmol/24hr 24hr Micro Urine Culture Routine Sterile plastic universal with boric acid 1 day Fill container to the line. If low sample volume (<5ml) remove the boric acid crystals first. Biochem Urine Cystine (24hr) Plain 24hr Units: umol/24hrs Interpretative comments given 14-21 days Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Urine Cytomegalovirus Sterile plastic universal 14 days Must arrive in laboratory as soon as possible. Biochem Urine Drugs of Abuse Screen Universal Interpretative comment given 2-3 days It is essential to list all drugs/medications on the request form Biochem Urine Ethanol (Alcohol) Plain random urine Units mg/dL UK Legal driving limit for urine ethanol = 107mg/100ml. Urine ethanol: To convert mg/100ml to mmol/L = x0.216 24hrs Hcoag Urine Haemosiderin Universal 3 days Biochem Urine Kidney Stone Screen- consisting of Urine Calcium, Phosphate, Urate, Chloride, Cystine and oxalate. Universal Urine Calcium, phosphate, urate – In house. Urine Cystine, Citrate and Oxalate – referred tests see individual test. 6 weeks Referral Test to South Manchester Pathology Services, Wythenshawe Hospital Source of reference range - South Manchester Pathology Services, Wythenshawe Hospital Micro Urine Legionella Antigen Detection Sterile plastic universal with boric acid 1 day Please contact Laboratory on 52376 prior to submitting request. Biochem Urine Magnesium Plain random urine No reference range quoted. Units: mmol/L 24 hrs Random sample often helpful. Contact duty biochemist to discuss if required. Biochem 24hr Urine Magnesium 24 hr Plain urine 2.4-6.5 mmol/24hr 24 hrs Pathology Harmony reference intervals Biochem Urine Metanephrines (24hr) 24hr Plain Normetadrenaline Male <5.3 µmol/24hr Female<4.3µmol/24hr Metadrenaline <2.0 µmol/24hr 3-Methoxytyramine 0-18 yrs <2.80 µmol/24hr 18-39 yrs <2.80 µmol/24hr 40-60 yrs <2.60 µmol/24hr >60 yrs <2.30 µmol/24hr 14 days Source of range – Salford Hospital (NMT & MT), 3-MT set according to Clin Chem 2006, 52(11), 2060-4. Paediatric results are calculated as Catecholamine /
  • 70. Creatinine ratios and interpreted on the basis of reference ranges (Ref: Reed et al. Ann. Clin. Biochem. 1991, 28; 297 – 298) Biochem Urine Microalbumin Universal e arly am No reference range quoted. Units: mg/l 24 hours It is not appropriate to perform this test on a urine which tests positive for protein using a "dipstick" Micro Urine Microscopy Routine Automated (Not CSU) Sterile plastic universal with boric acid 2 days Micro Urine Mycobacteria Cultu re Sterile plastic universal with boric acid up to12 weeks Biochem Urine Myoglobin Not available 24 hours Suggest look for elevated creatine kinase (CK) and positive urine dipstix for haem ("blood") both of which support a diagnosis of muscle breakdown (rhabdomyolysis) Biochem Urine Oxalate (24 hr) Plain 24hr 0.04 – 0.5 mmol/24hr Interpretative comments given 14-21 days Referral Test to Southampton Specialist Biochemistry. Southampton General Hospita Source of reference range - Southampton Specialist Biochemistry. Southampton General Hospital Biochem Urine pH Universal (FULL) Unit: pH No reference range given 2hr A full specimen pot is required and must be received in lab as soon as possible and analysed with 2 hours of collection. Notify Duty Biochemist in advance, when requesting this test. Biochem Urine Phosphate Plain 24hr 15-50 mmol/24hr 24 hrs Pathology Harmony range Micro Urine Pneumococcal Antigen Sterile plastic universal with boric acid Same day Please contact Laboratory on 52376 prior to submitting request. Biochem Urine Potassium Plain 24hr 25-125 mmol/24hr 24 hrs Tietz textbook of Clinical Chemistry Biochem Specimen must be analysed within 24hrs of collection.
  • 71. Urine Pregnancy Universal (EMU) POS/NEG 24hrs Boric Acid preservative collection pot unsuitable Biochem Urine Protein Plain 24hr 0 - 0.3g/24hr 24 hours National Kidney Foundation – Kidney Disease Outcomes Quality Initiative recommendation Biochem Urine Protein: Creatinine Ratio Universal 2 nd void am (not EMU) <15 mg/mmol 24 hours Reference range – UK eCKD Guide 2017 Biochem Urine Sodium Plain 24 hr* 40-220 mmol/24 hr 24 hours * Random sample also useful urinary sodium >20mmol/L makes sodium deficiency unlikely and is consistent with adrenal failure and with SIADH/chronic hypodilution. Reference source - Tietz textbook of Clinical Chemistry Biochem Urine Toxicology (Save) Universal Interpretative comment given N/A Referred to various specialist centres. This analyses are performed in specialist centres and results are not available for immediate management of patients. Samples will be stored frozen unless specifically discussed with a Consultant. Biochem Urine Urate (Uric Acid) Plain 24hr 1.5-4.5 mmol/24hr 24hrs Pathology Harmony range Biochem Valproate Pre-dose 24 hours See Therapeutic Drug Monitoring Section. Pre-dose sample required Haem Variant Haemoglobin identification Interpretative comment given 14 days Contact lab on Ext 33244 or 33245 before taking sample Sometimes samples may need to be referred to King’s College Hospital, London for genotyping and/or IEF Biochem Vancomycin Pre-dose Optimal range for pre- dose is 10-20mg/L. See guidelines on intranet concerning how to dose 24 hours Trough level should be taken immediately before a dose. Peak should usually be taken an hour