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Biochemistry Department

Biochemistry Handbook

Version 3 May 2021

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Author: Jonathan Scargill Authorised: BMG

Pathology Directorate Biochemistry Department Handbook



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Table of Contents

Table of Contents ....................................................................................................................................................................... 2

Senior Staff Contact Details ........................................................................................................................................................ 3

Service overview ........................................................................................................................................................................ 4

Accreditation status ................................................................................................................................................................... 4

Location of laboratories ............................................................................................................................................................. 5

Complaints/Compliments ........................................................................................................................................................... 6

Personal Information Policy ....................................................................................................................................................... 6 Sending information to other laboratories .................................................................................................................................... 6

Specimen collection, labelling and delivery ................................................................................................................................ 7 Specimen collection ....................................................................................................................................................................... 7 Specimen labelling ......................................................................................................................................................................... 8 High Risk Samples......................................................................................................................................................................... 11 Consent ........................................................................................................................................................................................ 11 Sample delivery to laboratory ...................................................................................................................................................... 11 Patient collected samples ............................................................................................................................................................ 11

Urgent and after hours specimens ............................................................................................................................................ 12

Additional testing ..................................................................................................................................................................... 13

Physiological factors affecting test results ................................................................................................................................ 13

Measurement uncertainty ........................................................................................................................................................ 13

Communication of abnormal results ........................................................................................................................................ 15

Turnaround times ..................................................................................................................................................................... 17

A-Z of tests performed on-site .................................................................................................................................................. 18

Commonly requested referred tests ......................................................................................................................................... 35



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Senior Staff Contact Details

Name Position Telephone Email

Dr Allameddine Allameddine

Clinical Director Blood Sciences, Northern Care Alliance

0161 778 5033 [email protected]

Dr Denise Darby

Clinical Lead for Biochemistry, Northern Care Alliance

0161 206 4955 [email protected]

Jonathan Scargill Consultant Clinical Scientist

0161 656 1428 (71428)

[email protected]

Jonathan Clayton Principal Clinical Scientist

0161 627 8706 (78706)

[email protected]

Michelle Hurst

Biochemistry Service Manager

0161 656 1679 (71679)

[email protected]

Lubomyra Szymanskyj

Technical Manager Health and Safety, Training.

0161 778 5066 (75066)

[email protected]

Delia Gallagher Technical Manager Quality Management

0161 656 1629 (71629)

[email protected]

Neil McAuley

Acting Technical Manager IT Lead

0161 656 1630 (71630)

[email protected]

Raheela Bibi Technical Manager, POCT

0161 656 1357 (71357)

[email protected]

mailto:[email protected]:[email protected]:[email protected]:[email protected]:///C:/Home/Qpulse/Q%20pulse%20docs%20Bio/MartinL/Pathology%20Handbook%20under%20review/[email protected]



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Service overview

The Pennine Acute Hospitals NHS Trust (PAT) is the entity that is held legally responsible for the laboratories activities. It employs over 9,000 staff and provides high quality general and specialist services to approximately 820,000 residents across the north east of Greater Manchester in Bury, Prestwich, North Manchester, Middleton, Heywood, Oldham and Rochdale and parts of East Lancashire. The Trust currently provides services from three Care Organisations, Oldham (Oldham Royal Hospital), Bury (Fairfield General Hospital) and Rochdale (Rochdale Infirmary). The Trust also provides a range of community services. The Pennine Acute Hospitals NHS Trust and Salford Royal NHS Foundation Trust have joined together to create a new Group of hospitals to deliver a variety of local healthcare services; the Northern Care Alliance (NCA). The Pathology service of the The Pennine Acute Hospitals NHS Trust, also known as Pathology North East Sector (NES) provides pathology services to the Oldham, Bury and Rochdale Care Organisations , to North Manchester Care General Hospital as part of a service level agreement with MFT, and to three clinical commissioning groups in the surrounding areas; Bury, Oldham, Heywood Middleton & Rochdale CCGs as well as parts of Manchester CCG. Pennine Pathology is a part of the Northern Care Alliance Diagnostics and Pharmacy Group which is led by a Managing Director and which reports directly into the Northern Care Alliance. The Diagnostics and Pharmacy Group also includes Radiology and Pharmacy at both Pennine and Salford and Pathology at Wigan and Salford (PAWS). The Biochemistry service of the Pennine Acute Hospitals NHS Trust is provided by a Central Facility located at the Royal Oldham Hospital (TROH) in conjunction with Essential Service Laboratories (ESL’s) located at the Fairfield General Hospital (FGH) and North Manchester General Hospital (NMGH). All of the Laboratories are housed in modern purpose built facilities. The service is provided 24 hours a day, 365 days a year by a team which consists of HCPC Registered Biomedical Scientists, Clinical Scientists, Associate Practitioners and Biomedical Support Workers. The Laboratory provides a full service at all sites between the hours of 08:00am–17:00 pm Monday to Friday and a primarily urgent service between 17:00pm-08:00am Monday to Friday. At weekends and public holidays, the service is available primarily to provide urgent results.

Accreditation status

The biochemistry department holds accreditation against ISO standard 15189 by UKAS (reference number 8601). An up to date Schedule of Accreditation is available on the UKAS website:

https://search.ukas.com/#/tabbed/search?q=8601&ati=1 The laboratory also regularly monitors the accreditation status of the referral laboratories used for specialist testing.



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Location of laboratories

Site Address Telephone Fax Number

Royal Oldham Hospital

Central Facility

The Royal Oldham Hospital Rochdale Road, Oldham, OL1 2JH

The laboratory is located on the ground floor of the pathology building on Westwood Way

Specimen Reception 0161 627 8376 Internal: 78376

Main Laboratory 0161 656 1515 Internal: 71515

Main Laboratory

0161 656 1631 Internal: 71631

Fairfield General Hospital

Essential Services Laboratory

Fairfield General Hospital

Rochdale Old Road Bury, BL9 7TD

The laboratory is located behind the Broadoak suite adjacent to Fairfield House

Specimen Reception

0161 778 3447 Internal: 83447

Main Laboratory 0161 778 2596 Internal: 82596

Main Laboratory

0161 778 3002 Internal: 83002

North Manchester General Hospital

Essential Services Laboratory

North Manchester General Hospital Delaunays Road Crumpsall Manchester M8 5RB

The laboratory is located on the ground floor between D and E blocks

Specimen Reception 0161 922 3287 Internal:43287

Main Laboratory 0161 604 5389 Internal:45389

Main Laboratory

0161 720 2886 Internal: 42886



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Complaints/Compliments

Immediate concerns can be raised by contacting a senior member of laboratory staff or alternatively by contacting Delia Gallagher, Technical Manager responsible for Biochemistry Pathology Quality Management. Users are encouraged to use the DATIX systems where possible, to register non-conformances or compliments Complaints are received in the Pathology department either via the Trust complaints department, Patient advice and liaison service (PALS), DATIX incident reporting or individually by letter, telephone or email to a member of staff. Complaints via the Trust complaints department or PALS are usually from the patient or relative directly affected; complaints to an individual are often from another healthcare professional regarding the service we provide to them and their patients. The department follows the Northern Care Alliance Complaints Handling Policy (NCAG005)

Personal Information Policy

Details of how the Trust uses and protects personal information can be found in the link below: http://www.pat.nhs.uk/patients-and-visitors/patient-privacy-notice-how-we-use-share-and-protect-your-personal-information.htm The Biochemistry Department adheres to The Pennine Acute Hospitals Trust’s policy on data protection and disclosure. For further details see the NCA Information Governance Policy NCAF020(20) We hold personal data for the purposes of providing patients with appropriate care and treatment. This helps to ensure that patients receive the best possible care from us. All members of staff working in the NHS and other healthcare organisations have a legal duty of confidentiality to keep your information strictly confidential. Everyone working for this organisation is subject to the Common Law Duty of Confidence. Information provided in confidence will only be used for the purposes advised and consented to by the patient.

Sending information to other laboratories

Whilst the majority of Biochemistry tests requested are processed within the Biochemistry departments at Pennine, some tests are referred to other specialist laboratories. When referral laboratories are selected we are assured that they have relevant procedures in place for the protection of information.

http://www.pat.nhs.uk/patients-and-visitors/patient-privacy-notice-how-we-use-share-and-protect-your-personal-information.htmhttp://www.pat.nhs.uk/patients-and-visitors/patient-privacy-notice-how-we-use-share-and-protect-your-personal-information.htm



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Specimen collection, labelling and delivery

Specimen collection

Please refer to the test A-Z for the required collection tube and specific requirements regarding the timing of collection and delivery of specimens. The order of collection of blood tubes is important to avoid contamination. If you are unsure of the collection and transport requirements for a specimen, please contact the laboratory prior to the sample being collected.

Order of collection

Sarstedt Monovette tube

Preservative Commonly requested tests (please refer to handbook-for other tests)

1

Serum – no preservative Cryoglobulin

2

Serum – no preservative, poly-acrylic ester gel to form a barrier between the serum and cells when centrifuged.

Biochemistry profiles, Haematinincs

3

Plasma – Lithium Heparin. Biochemistry Profiles, Ammonia

4

Whole blood – Potassium EDTA FBC, ESR, HbA1c, PTH, Ammonia, Cryoglobulin, Levetiracetam (Keppra)

5

Plasma – Fluoride Plasma Glucose, Lactate

6

Whole blood -Tri-sodium citrate 1:10

Coagulation



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Specimen labelling

All requests must conform to the Pathology Sample & Request Card Labelling Policy CPDI061. This policy applies to all tests and investigations with the exception of blood samples for transfusion tests which generate a blood group for which policy EDC012 should be consulted. The table below shows the minimum required information for labelling of samples and request forms

Sample Request form

Required Information Required Information

Patients full Name* or Unique coded identifier** Date of Birth* and /or Hospital Number / NHS Number* Date of Collection (and time of collection where relevant) Destination for Report Blood Culture bottles should be labelled as follows.

Full Name*

Patient Hospital Number*

Date and Time of Collection. *Mandatory Information **e.g. in the event of a major incident, an unidentified patient or where unique identifiers are used instead of patient names

Patients full Name* or Unique coded identifier** Date of Birth* & Gender. Hospital number / NHS number * (must be included wherever possible, if a unique identification number is not available for a patient, please state this in the space provided) The Full Surname and initial of the Forename of the Patients Consultant or an approved Healthcare Practitioner with requesting authorisation. Alternatively the unique identification code can be used* and/or Destination for the report* Date of Collection (and time of collection where relevant) Sample type (and anatomical site if appropriate) and investigations/tests required Relevant clinical information about the patient and request including relevant drug therapy (dose & time) Telephone /Bleep number for results. NHS / Private Patient *Mandatory Information **e.g. in the event of a major incident, an unidentified patient or where unique identifiers are used (e.g. GUM patients) instead of patient names



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Samples that were collected with the intention they are processed at the point of care but are subsequently tested in the laboratory must be labelled in accordance with the Policy for Labelling and Safe Handling of Pathology Samples and Request Forms [QM-POL-7]. Samples received in the laboratory will only be processed providing they have been collected in an appropriate approved container. Containers should comply with a recognised British Standard, be robust and leak proof in normal use. The container must have been closed securely and not be contaminated on the outside. Samples failing to comply with this requirement will only be processed if they fall into the category ‘samples that cannot be repeated’. Users are encouraged to use electronic ordering systems (wards and outpatients use Healthviews, GPs use the TQuest system). This offers the advantages of:

No forms to handwrite

No samples rejected due to incomplete patient details

No transcription errors of patient details

No missed tests. When using the Clinical Biochemistry request forms a mark should be made clearly in the box opposite the required test. There is additional space for writing any additional test which is not listed. Request forms MUST bear the PRINTED name and bleep number of the Medical Officer making the requests. To permit processing by the departmental computer and facilitate enquiry for results on ward terminals, the patient's date of birth, FULL hospital number (including any prefix letter with a total of 8 numeric characters) and name MUST BE printed CLEARLY ON EVERY FORM. Please use, wherever possible, the pre-printed self-adhesive labels provided in the case-notes ensuring that the ward details and consultant's name are added for labelling the request forms only. These labels must not be put on sample containers.



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Delays and errors may occur with incorrectly printed or inaccurately aligned sample barcodes.

Correct placement of barcodes-vertical, covering the pre-affixed label only.

Problem barcodes (pictured above):

Barcode at an angle across the sample tube

Barcode placed at the bottom of the tube

Two barcodes applied to the tube

Misaligned printing of barcode, printed near the edge of the label

Faded barcode either due to poor print quality or damaged by pre-injection wipe solution



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High Risk Samples

Samples from individuals known or suspected of having Blood Borne Viruses (BBV) categorised as Hazard Group 2 or 3 such as hepatitis and Human Immunodeficiency Virus (HIV) are NOT classified as ‘HIGH RISK’ in the laboratory as the infectious agents in these samples are not propagated. The universal precautions in place in the laboratory provide adequate protection to laboratory staff handling the samples.

Samples that are from patients suspected of having a Viral Haemorrhagic Fever are always classified as ‘HIGH RISK’. There is a separate policy to cover the way that these samples are handled depending on risk factors identified by the Infectious Diseases Consultant in charge of the patient. Please do not attempt to take any patient samples until the ‘Integrated Care Pathway for Patients Assessed as Being at Risk of Viral Haemorrhagic Fever’ (CPME089) has been consulted. It is essential that specimens from in-patients with Covid-19 are labelled with a priority 10 label. This allows the laboratory to undertake additional procedures to mitigate the risk of aerosol generation when processing samples.

Consent

It is the responsibility of the requesting clinician to obtain consent from the patient for the collection of blood specimens. For certain tests (e.g. genetic testing) the request form for the referring laboratory may include a consent section that must be completed by the requesting clinician.

Sample delivery to laboratory

A pneumatic tube delivery (pod) system is used to deliver specimens to the laboratory from a variety of locations, and should be used where available. The pod system should not be used to send food, drinks personal items, sharps or samples containing Formalin. Specimens for tests that are unstable (please refer to specimen A-Z), blood gas/CSF specimens, and for requests that are very urgent or unable to be repeated, should be taken directly to the laboratory to avoid delay. BLOOD GAS SAMPLES SHOULD NOT BE PODDED Please note that in the event of pod system breakdowns there is a Trust Contingency Plan. For all sites, estates are responsible for the pod system – please contact estates on 44646 or report via the portal

Patient collected samples

Instructions for the collection of 24-hour urine samples are sent with the collection bottles. The collection bottles must be labelled in accordance with the Pathology Sample & Request Card Labelling Policy and in addition, must include the collection start time and collection finish time.



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Urgent and after hours specimens

The following tests are available on one or all sites at all times:

Test (serum/plasma unless stated)

Sites

Renal profile (Na, K, urea, creatinine) (serum and urine)

Available on all sites

Liver Profile (Bilirubin, ALT, ALP, albumin)

Bone Profile (Calcium, ALP, albumin)

Bicarbonate

CRP

Troponin I

Osmolality (serum and urine)

Glucose/Lactate

Cortisol

Creatine Kinase

Magnesium

β-hCG

Ammonia

Direct Bilirubin

Salicylate and Paracetamol

Gentamicin and Vancomycin

LDH

Ethanol

Amylase

Urate

Thyroid function tests

Blood Gases and co-oximetry (whole blood)

Iron profile ROH and FGH Digoxin

ROH only Lithium Theophylline

Bile Acids

Carbamazepine

Phenytoin

Valproic Acid

Glucose and protein (CSF)

Protein/Creatinine (Urine)



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Additional testing

Requests for additional tests from wards must be accompanied by a request form for additional testing available on the trust intranet. Most serum samples are routinely stored for a minimum of 48 hours. After this time they are discarded. Samples that cannot routinely be added on, or can only be added on if within specified time limits, are described below:

Assay Time after sample collection

Ammonia Cannot be added at any time Bicarbonate

Lactate

Procalcitonin Up to 8 hours

Troponin I

PSA Up to 24 hours

Alpha-1-antitrypsin Up to 48 hours Digoxin

Valproate

Physiological factors affecting test results

Many factors other than disease affect the value and the interpretation of a variety of tests. Common factors (i.e. age, gender) are often accounted for with the use of appropriate reference ranges.

Measurement uncertainty

All biochemical results are subject to a degree of uncertainty of measurement. This may be due to a range of factors, including:

Biological variation within individuals

Analytical measurement imprecision

Pre-analytical factors If you require more information regarding the effects of these factors on the outcome of an individual test result please contact the Clinical Scientist on 0161 656 1428 The department of clinical biochemistry regularly reviews the analytical uncertainty associated with the tests results that it produces. This information is available on request.



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Analytical factors affecting the performance of an examination

Common analytical factors that are known to affect the performance of a test or the interpretation of results are described below.

Mixing Thorough but not violent mixing of blood with anti-coagulant must be carried out by gently inverting the tube at least three times, immediately on collection.

Haemolysis Avoid mechanical trauma to red cells. Never inject blood through a syringe needle into a specimen collection tube. Avoid extremes of temperature.

Contamination Do not take blood from the same limb being used for infusion of fluids or decant blood from one container to another. Collect tubes for haematology (EDTA tubes) AFTER samples for biochemistry (serum tubes)

Venous constriction It is essential that there should be no prolonged venous constriction (tourniquet) or active muscle movement during the collection of blood for the estimation of such constituents as calcium, protein, lactate and electrolytes, as this can lead to considerable alteration in levels. If avoidance of constriction is not practicable, its duration must be kept to an absolute minimum

Delay in transport of specimens to laboratory

Considerable changes in the concentration of some blood constituents may occur if the blood is allowed to stand for any length of time before analysis begins, or separation of serum or plasma occurs. For potassium, increases in serum potassium may be seen after around 6 hours in kept on cells.

Interfering substances Previous administration of a substance or drug may cause interference in analysis. It is impossible to list all such potential interferences and advice should be sought from Laboratory staff when there is any doubt. Biotin is known to interfere with assays performed on Roche platforms. Please refer to Biotin memo in the Appendix



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Communication of abnormal results

The results in the table below are communicated to the requesting clinician/location, unless the exceptions listed apply

Test

Units

Lower Limit Upper Limit Exceptions

Sodium mmol/L ≤120

(≤130 if



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Test

Units

Lower Limit Upper Limit Exceptions

Cortisol nmol/L ≤50 Unless part of dexamethasone

suppression test

Ethanol mg/L ≥4000

Paracetamol mg/L

Any detected

Previously higher in last day

Salicylate mg/L ≥300

Previously higher in last day

Urate umol/L ≥340 Ante-natal locations only

Bile Acids umol/L ≥10

Out of Hours, telephone abnormal results to Maternity Assessment Unit NMGH on

43167

Vancomycin mg/L ≥20 (Trough levels)

Gentamycin mg/L ≥2 (Trough levels)

Bilirubin umol/L

Day 0 - ≥50 Day 1 - ≥150

Day 2 – ≥300. Community - ≥200

Neonates (



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Turnaround times

The biochemistry department reviews turnaround times on a monthly basis against local key performance indicators (KPIs) using selected assay as surrogate markers of performance. Turnaround time performance by assay and location can be provided by the laboratory on request. Target turnaround times are described below, and relate to the time between a specimen being received by the laboratory and the results being reported.

Location Target turnaround time for routine tests

Monitored for

A&E >95% within 1 hour U & E, CRP, Troponin I

Inpatients >95% within 3 hours U & E, CRP, Troponin I

Outpatients >95% within 24 hours U & E, Ca125, TSH

CCGs >90% within 24 hours All routine tests

For serum electrophoresis, we aim to complete testing within a mean turnaround time of 7 days for haematology patients. For FIT testing, the turnaround time for CCGs is 7 days. Given the increase in demand for FIT testing to triage lower GI colonoscopy referrals in response to the COVID-19 pandemic, this service is now run daily Monday-Friday.



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A-Z of tests performed on-site

The specimen A-Z below lists all tests that are performed on-site, the sample type required and any specific collection conditions. The median turnaround time from the receipt of the specimen into the laboratory to its reporting is also given. Tests that are calculated parameters are marked with an asterisk. Certain assays listed may be performed in other matrices not listed (i.e CSF, pleural or abdominal fluid). These assays are not CE-marked for these matrices and are therefore not listed here. Please contact the laboratory to discuss if required.



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Preferred sample type Reference/therapeutic range and units

Sites measured on

Median turnaround time (Jan 2021)

Additional information

Alanine aminotransferase (ALT) (liver profile)

Serum (Brown top, gel) 0-55 U/L

All sites



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Sites measured on



Alpha-fetoprotein

Serum (Brown top, gel) < 1 month: None quoted 1-6 months:



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Sites measured on



BNP (NT-pro) Serum (Brown top, gel)

< 400 ng/L for ruling out chronic heart failure < 300 ng/L for ruling out acute heart failure

ROH < 24 hours

Ca-125

Serum (Brown top, gel)



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Sites measured on



Carbon dioxide (Bicarbonate)

Serum (Brown top, gel) ≤16 years: 19-28 mmol/L >16 years: 22-29 mmol/L

All sites < 1 hour

CEA Serum (Brown top, gel)



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Sites measured on



Digoxin

Serum (Brown top, gel) 0.8-2.0 ug/L ROH < 4 hours Therapeutic range applies only to samples collected >6 hours post dose

Direct Bilirubin Serum (Brown top, gel) 60 ml/min/1.73m2

All sites < 2 hours MDRD 4-variable formula used to estimate GFR

Ethanol

Fluoride oxalate plasma



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Sites measured on



GGT Serum (Brown top, gel) F: 9-36 U/L M: 12-64 U/L

All sites < 3 hours

Gentamicin Serum (Brown top, gel) Refer to microbiology

All sites < 1 hour

Glucose

Serum (Brown top, gel) (A&E only) Fluoride oxalate plasma

3.0 - 6.0 mmol/L All sites < 1 hour (A+E) < 3 hours

Reference range applies to fasting samples

Glucose (CSF)

Fluoride oxalate plasma No reference range – interpret w/serum glucose

ROH < 1 hour CSF glucose typically around 70% of serum glucose

Haptoglobin

Serum (Brown top, gel) Up to 1 year: M: 0 -3.00 g/L F: 0 – 2.35 g/L 1 -12 years: M: 0.03 – 2.70 g/L F: 0.11 – 2.20 g/L >12- 60 years: M: 0.14-2.58 g/L F: 0.35-2.50 g/L >60 years: M: 0.40-2.68 g/L F: 0.63-2.73 g/L

ROH < 4 hours

Hba1C

EDTA whole blood 20-41 mmol/mol Hb ROH < 24 hours If requesting a full blood count a separate EDTA sample must be sent

HDL Cholesterol (Lipid profile)


Males: >1 mmol/L Females: >1.2 mmol/L

All sites < 3 hours

β-hCG – pregnancy Serum (Brown top, gel)



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Sites measured on



β-hCG – tumour marker Serum (Brown top, gel) F ≤50 years: 50 years: 1 to 12 years: Male: 0.21 - 2.91 g/L Female: 0.21- 2.82 g/L > 12years: Male: 0.63 - 4.84 g/L Female: 0.65 - 4.21 g/L

ROH < 3 hours

IgG


0 to 1 month: Male: 3.97 - 17.65 g/L Female: 3.91 - 17.37 g/L > 1 month to 1 year: Male: 2.05 - 9.48 g/L Female: 2.03 - 9.34 g/L > 1 to 2 years: Male: 4.75- 12.10 g/L Female: 4.83 - 12.26 g/L > 2 years: Male: 5.40- 18.22 g/L Female 5.52- 16.31 g/L

ROH < 3 hours



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Sites measured on



IgM

Serum (Brown top, gel) < 3 months: 0.06 - 0.21 g/L 3 months to 1 year: Male: 0.17- 1.43 g/L Female: 0.17 - 1.50 g/L > 1 to 12 years: Male: 0.41 to 1.83 g/L Female: 0.47 to 2.40 g/L > 12 years: Male: 0.22 - 2.40 g/L Female: 0.33 to 2.93 g/L

ROH < 3 hours

Iron (Iron profile) Serum (Brown top, gel) F: 9.0-30.4 umol/L M: 11.6-31.3 umol/L

ROH and FGH < 3 hours

Lactate

Fluoride oxalate plasma 0.5-2.20 mmol/L All sites < 1 hour Collect blood without stasis (tourniquet). Send specimen to laboratory immediately

LDH

Serum (Brown top, gel) 125-220 U/L All sites < 2 hours

Lithium Serum (Brown top, gel) 0.4-1.0 mmol/L

All sites < 6 hours Collect sample at least 12 hour post-dose routinely

LH

Serum (Brown top, gel) Under 13: no RR stated > 13 M: 0.6-12.1 U/L > 13 F: no RR stated

ROH < 4 hours In females: Follicular phase: 1.8-11.8 U/L Luteal phase: 0.6 – 14.0 U/L Mid-cycle peak: 7.6 – 89.1.7 U/L Post-menopause: 5.2-62.0 U/L



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Sites measured on



Macroprolactin


Interpretative comment supplied with report

ROH 1 week Add at discretion of Clinical Scientist where prolactin >1,000 mu/L

Magnesium

Serum (Brown top, gel) Neonates 0.6-1.0 mmol/L 0.7-1.0 mmol/L

All sites < 1 hour

Urine magnesium

Plain random or 24 hour urine 24hr: 2.4-6.5 mmol/d Random: None quoted

ROH

Non-HDL* (Lipid profile)




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Sites measured on



Phosphate Serum (Brown top, gel) Neonate: 1.3-2.6 mmol/L Infant: 1.3-2.4 mmol/L 1-16 yrs: 0.9-1.8 mmol/L Adult: 0.8-1.5 mmol/L

All sites < 1 hour

Phosphate (urine) Plain random urine, or 24h Urine 24 hr: 15-50 mmol/d Random: None quoted

ROH

Potassium (renal profile)

Serum (Brown top, gel) Neonate: 3.4-6.0 mmol/L Infant: 3.5-5.7 mmol/L 1-16 yrs 3.5-5.0 mmol/L Adult 3.5-5.3 mmol/L

All sites < 2 hours

Potassium (urine)

Plain random or 24 hour urine 24 hour: 25-125 mmol/d Random: None quoted

ROH 22 hours

Procalcitonin Serum (Brown top, gel) 0.0 – 0.09 ug/L ROH < 3 hours Procalcitonin >=0.5 ug/L suggests high risk of bacterial infection Pending UKAS accreditation

Progesterone Serum (Brown top, gel) None quoted (pmol/L) ROH < 4 hours Please state cycle day Luteal Peak day 21 of a 28 day cycle >30nmol/L

Prolactin

Serum (Brown top, gel) M: 73-407 mU/L F: 109-557 mU/L

ROH < 5 hours

Protein (total)

Serum (Brown top, gel) 60-80 g/L ROH < 2 hours

Protein (urine)

Plain random or 24 hour urine 24hr urine:



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Sites measured on



Protein (CSF)

Plain universal 25mL tube (white top)

< 1 month: 0.20-0.80 g/L >1 month: 0.15-0.40 g/L

ROH 7.5 ug/L

All sites < 3 hours

Rheumatoid factor




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Sites measured on



SARS-COV2 antibody testing

Serum (Brown top, gel) Threshold = 50 AU/mL ROH



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Sites measured on



Sodium (urine)

Plain random or 24 hour urine 24hr: 40-220 mmol/d Random: None quoted

ROH < 4 hours

Sweat testing

Contact laboratory

Testosterone (female androgen screen)

Serum (Brown top, gel) Males



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Sites measured on



Transferrin (Iron profile)

Serum (Brown top, gel) 1 to 14 years: Male 1.86 to 3.88 g/L Female 1.80 to 3.91 g/L > 14 to 60 years Male 1.74 to 3.64 g/L Female 1.80 to 3.82 g/L > 60 to 80 years Male 1.63 to 3.44 g/L Female 1.73 to 3.60 g/L


Theophylline

Serum (Brown top, gel) 10-20 mg/L ROH < 4 hours Trough concentrations routinely measured

Transferrin saturation* (Iron profile)


F: 12-45% M: 15-50%


Triglycerides (Lipid profile)




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Sites measured on



Vancomycin Serum (Brown top, gel) Refer to microbiology All sites < 1 hour Vancomycin Pre-Dose Therapeutic Range : 10-15 mg/L, 15-20 mg/L for treatment of Infective Endocarditis. Please refer to the Antibiotic Policy for further details. For ICU using the Continuous Infusion regime please refer to the Trust Policy.

Vitamin D


>50 nmol/L ROH < 4 hours Vitamin D 30 nmol/L is deficient. Treatment is recommended. Refer to GMMMG guidelines: Vitamin D 30–50 nmol/L may be inadequate in some people. Treatment is advised in certain groups. Refer to GMMMG guidelines Vitamin D >50nmol/L is sufficient for almost the whole population



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Sites measured on



Xanthochromia (CSF)

Sterile plain 25 mL universal container (White top) 4th container of set. Must be accompanied with completed Xanthochromia request form Paired Serum (Brown top-gel) required

Interpretative comment supplied with report

ROH Samples are only processed within normal working hours

CSF should be sampled at least 12h after a suspected event. Indicate on the request card the reason for request, result of CT scan, time of symptoms onset and time of lumbar puncture. Protect sample from light. (E.g. Place in a black bag or place sample bag in a thick brown envelope). Send the sample to the laboratory immediately. DO NOT USE THE VACUUM TUBE SYSTEM.



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Commonly requested referred tests

The A-Z below describes some of the more commonly referred biochemistry send-away tests. Please contact the laboratory to discuss specimen requirements for tests not listed. Median turnaround times for commoner tests are given, which relate to the time from request entry to result authorisation. The majority of immunology testing is referred to the Greater Manchester Immunology Service (GMIS)



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Test (If the required test isn't present in this list please contact the laboratory for advice)

Reference/Therapeutic ranges with units

Sample Container

Median turnaround Time (Dec 2019)

Additional Information

5-Hydroxyindole acetic acid (5-HIAA)

(Analysed at Salford Royal Hospital)



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Sample Container



Acyl Carnitine

(See Carnitine)

Adalimumab (see Infliximab) Reference range and comments supplied with report

Brown top (Gel) 12 days

Aldosterone - Assayed in conjunction with Renin (Analysed at University Hospital of South Manchester)

For samples taken at random throughout the day:



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Sample Container



Minimum 200uL

Amino acid screen (Plasma)

(Analysed at Central Manchester – Willink Unit)

Reference range and comments supplied with report

Orange top (Lithium heparin) 3 mL

14 days

Amino Acid Screen (Urine) (Analysed at Central Manchester – Willink Unit)


Plain 25 mL universal container (White top)

14 days Freshly voided specimen to be sent at once to the laboratory. Include full clinical details, date of birth, drug treatment and any special diet.

Androstenedione

(Analysed at Salford Royal) Reference range and comments supplied with report

Brown topped (Gel)

14 days

Angiotensin-Converting Enzyme

(Serum) (Analysed at Salford Royal)

20 - 70 IU/L Brown top (Gel) 7 days

Anti-Mullerian hormone (AMH)

(Analysed at Central Manchester) Ovarian status reserve: Undetectable/low 55 pmol/L

Brown top (Gel) 3 days Serum must be separated and frozen with 4 hours of collection.

Apolipoprotein E (Analysed at the Christie Hospital)


Red top (EDTA)



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Sample Container



Beta-2-microglobulin



Beta-2-transferrin- see Tau protein (Fluid-nasal drippings? CSF) (Analysed at Salford Royal)



A paired serum sample (Brown top-Gel) must be sent also.

Beta Galactosidase



Red top (EDTA)

Beta Glucosidase – Gaucher (Analysed at Central Manchester – Willink Unit)


Red top (EDTA)

Beta Hydroxybutyrate and Free Fatty Acids

(Analysed at Central Manchester)


Orange top (Lithium Heparin)

Must be received on ice within 20 minutes of being taken. Needs glucose result to be provided

Beutler Test

(See Galactosaemia)

Biotinidase



Orange top (Lithium heparin)



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Sample Container



Caeruloplasmin (Analysed at Salford Royal Hospital)

0.2 - 0.6 g/L Brown top (Gel) 2 Days To be requested only if Wilson's disease is suspected. Wilson’s disease is rare after 40 years

Calcitonin (Analysed at The Christie Biochemistry)

Female



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Sample Container



Carnitine

(Analysed at Central Manchester - Willink Unit)

Free Carnitine 20-40 µmol/L Red top (EDTA)

Chromium

(Analysed at Central Manchester) Reference range and comments supplied with report

Red top (EDTA) 10 days

Chromogranin A & B Can be requested individually or as part of a Gut Hormone Profile (Analysed at Charing Cross Hospital)

Chromogranin A



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Sample Container



Results should be interpreted in accordance with local treatment protocols and appropriate trough therapeutic target ranges applied on an individual basis dependent upon speciality, dosing, period in treatment regime and clinical status.

State dose and timings

Citrate (Urine)

(Analysed at University Hospital of South Manchester)


24h Urine with 2M HCl preservative

Cobalt

(Analysed at Central Manchester) Reference range and comments supplied with report


Copeptin (CTproAVP)

(Analysed at Newcastle Royal Victoria Infirmary)



Must be separated and frozen within 30 minutes of venesection.

Copper (serum) (Analysed at Salford Royal Hospital)

13 - 24 µmol/L Brown top (Gel) 14 Days

Copper (urine) (Analysed at Royal Liverpool University Hospital)


24h Urine with No preservative

Cortisol Free (Urine) (Analysed at Salford Royal)

< 180 nmol/24h 24h Urine with No preservative

14 days Instructions are available from the laboratory for the accurate collection of 24hr urine.

C-Peptide (plasma) (Assayed at Central Manchester Hospital)

350 - 1800 pmol/L Orange top (Lithium Heparin) or Brown top (gel)

7 Days Send to the laboratory as soon as possible - Must be received within 24 hours of being taken. A sample for blood glucose



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Sample Container



must be taken at the same time. DO NOT USE THE VACUUM TUBE SYSTEM.

C-Peptide (Urine) (Analysed at Exeter General Hospital)

No reference range supplied –Interpretative website http://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratio

Boric Acid urine container

Cryofibrinogen (Analysed at Salford Royal Biochemistry)


Red top (EDTA) Specimen must be kept warm during transport to laboratory. Please obtain the appropriate sample transport flask from the laboratory.

Cryoglobulin (Analysed at Central Manchester, Immunology)


White top (Not gel) supplied with needle by laboratory and 7 ml Red top (EDTA)

14 Days Both specimen must be kept @37°C during transport to laboratory. Please obtain the appropriate sample transport flask from the laboratory.

Cystine (Urine) (Analysed at Central Manchester – Willink Unit)


Random urine sample in plain container if cystinuria is being queried

24h Urine with No preservative for patients with known

http://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratiohttp://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratio



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Sample Container



cystinuria who are being monitored

DHEA (Analysed at Salford Royal Biochemistry)

Female (



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Sample Container



Scientist prior to requesting

Everolimus



Red top (EDTA)

Free light chains (Serum)

(Analysed at Central Manchester, Immunology)



Fructosamine (Analysed at Salford Royal Hospital)

199 - 313 µmol/L Brown top (Gel) 6 Days

Galactokinase



Galactosaemia screen (Beutler Test)

(Analysed at Willink Laboratory)


Lithium Heparin (Orange top)

Gastrin Can be requested individually or as part of a Gut Hormone Profile (Analysed at Charing Cross Hospital)



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Sample Container



Genetics

(Analysed at St Mary’s Hospital- Regional Cytogenetics)

Report supplied directly to requesting consultant Dependent on tests required Contact laboratory

Glucagon Can be requested individually or as part of a Gut Hormone Profile (Analysed at Charing Cross Hospital)



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Sample Container



Homocysteine (Urine)

(Analysed at Central Manchester- Willink Unit)


25 mL universal container (White top)

Fresh sample required

Infliximab (or Adalimumab) (Analysed Birmingham City Hospital)


Brown top (Gel) 12 days State drug on request form.

Insulin

(Analysed at Central Manchester) Fasting 12 - 150 pmol/L Orange top

(Lithium Heparin) or Brown top (Gel)

7 Days Contact laboratory before taking blood and send to the laboratory immediately on ice. Must be received within 2 hours of being taken. A sample for blood glucose must be taken at the same time. DO NOT USE THE VACUUM TUBE SYSTEM.

Insulin-like Growth Factor 1 (IGF-1)


Brown top (Gel) 6 days Samples must be received and separated within 2 hours of collection.

Lamotrigine

(Analysed at Central Manchester) Serum monitoring not routinely required. Discuss with Clinical Scientist if required


Lead (Analysed at Sheffield Northern Hospital)

Female



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Sample Container



Levetiracetam

(Analysed at Llandough Hospital, Cardiff toxicology labs)


Red top (EDTA) – Gel tubes not suitable

Lipase

(Analysed at Huddersfield Royal Infirmary)

Reference ranges and comments supplied with report

Brown top (Gel) Only sent if the amylase result is abnormal.

Manganese (Blood and urine)

(Analysed at Southampton General) Reference range and comments supplied with report

? Deficiency states-10ml Orange top (Lithium Heparin) ? Excess states Clotted sample or 20 ml random urine in Plain 25 mL universal container (White top) ALL PLASTIC CONTAINER

Ideally blood should be collected using a plastic cannula



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Sample Container



ONLY Medium Chain Acetyl Co-A Dehydrogenase

(Analysed at Central Manchester-Willink Unit)


5mL Red top (EDTA)

Medium Chain Fatty Acids.

(Analysed at central Manchester-Willink Unit)


Red top (EDTA)

Metadrenalines (Urine)

(Analysed at Salford Royal Biochemistry)



14 Days Instructions are available from the laboratory for the accurate collection of a 24hr urine.

Metanephrines (Plasma)

(Analysed at Salford Royal Biochemistry)


7.5mL Red top (EDTA)

14 Days Contact laboratory before taking blood and send to the laboratory immediately. DO NOT USE THE VACUUM TUBE SYSTEM

Methanol

(Analysed Birmingham City Hospital)

Results and comments supplied with report Yellow top (Fluoride)

Discuss with Clinical Scientist prior to sending



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Sample Container



Methotrexate

(Analysed at Christie Hospital) Result and comments supplied with report Brown top (Gel) 8 days For Dermatology take samples

2-3 hrs post dose. Dose and time and sampling time are required on the request from

Methyl Malonic Acid (MMA)

(Analysed at University Hospital of Wales)



Mitochondrial DNA

(for mitochondrial cytopathies e.g MELAS) (Analysed at Central Manchester Molecular Genetics)

Result and comments supplied with report 2 x 5ml Red top (EDTA)

MMP ( see Thiopurine metabolites) Reference range and comments supplied with report

Red top (EDTA)

MODY

(Maturity onset diabetes in the young) (Analysed at Exeter General Hospital)

There is no reference range but the referral laboratory provide a link to an interpretative website http://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratio

Red top (EDTA) 10ml adults 5mL children 1mL neonates

http://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratiohttp://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratio



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Sample Container



Mucopolysaccharide Screen (Urine) (Analysed at Central Manchester – Willink Unit))



18 Days Freshly voided specimen to be sent at once to the laboratory.

Muscle Specific Tyrosine Kinase (MUSK)

(Analysed at The Churchill Hospital)


Brown top (Gel)

Mycophenolic Acid (MPA)



Red top (EDTA)

Myelin Associated Antibodies

(Analysed at The Churchill Hospital) Reference range and comments supplied with report

Brown top (Gel)

NMDA Antibodies

(Analysed at The Churchill Hospital) Reference range and comments supplied with report

Brown top (Gel)

Oligoclonal Bands (CSF) (Analysed at Salford Royal)

Interpretive comments supplied with report

Plain universal container (white top) for CSF and Brown top (Gel) for blood.

21 Days Indicated only when multiple sclerosis is suspected. Please send a specimen of clotted blood in addition to the CSF and provide clinical details. CSF protein is required by referral lab.



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Sample Container



Organic Acid Screen (Urine) (Analysed at Central Manchester – Willink Unit)



28 Days Freshly voided specimen to be sent at once to the laboratory.

Orosomucoid (Analysed at Central Manchester)

300 - 1200 mg/L Brown top (Gel) 2 Days

Orotic Acids (Urine)

(Analysed at Central Manchester –Willink Unit)



Oxalate (Urine) (Analysed at University Hospital of South Manchester)

Female 40 - 320 µmol/24hr Male 80 - 490 µmol/24hr


21 Days Collect container from laboratory

Paraneoplastic Antibodies

(Hu, Yo, Ri, CV2/CRMP5, Amphiphysin, MA1, MA2) (Analysed at Central Manchester-Immunology

Results and comments supplied with report Brown top (Gel)

Paraneoplastic Antibodies (CSF)

(Analysed at The Churchill Hospital) Results and comments supplied with report Plain 25 mL

universal container (White top

Parathyroid Hormone related peptide (PTHrP)

Test currently not available



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Sample Container



Phenobarbitone (Analysed at Central Manchester)

10 - 40 mg/L Brown top (Gel) 7 Days Take blood pre-dose.

Pre-eclampsia markers

(Analysed at Royal Bolton) s-FLT and PIGF measured. sFlt-1/PlGF Ratio



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Sample Container



Protoporphyrin (Blood) (Analysed at Salford Royal)



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Sample Container



Renin Assayed in conjunction with Aldosterone (Analysed at University Hospital of South Manchester)

0.3 - 2.2 nmol/L/h For samples taken at random throughout the day.


10 Days

Retinol

(See Vitamin A)

Riboflavin

(See Vitamin B2)

Salivary duct antibodies

(Analysed at Northern General-Immunology)


Brown top (Gel)

Selenium



Sirolimus (Analysed at Central Manchester)

µg/L Results should be interpreted in accordance with local treatment protocols and appropriate trough therapeutic target ranges applied on an individual basis dependent upon speciality, dosing, period in treatment regime and clinical status.

Red top (EDTA) Sample taken 12 hours post dose. State dose and timings



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Sample Container



Tacrolimus (FK506) (Analysed at Central Manchester)

µg/L Results should be interpreted in accordance with local treatment protocols and appropriate trough therapeutic target ranges applied on an individual basis dependent upon specialty, dosing, period in treatment regime and clinical status.

Red top (EDTA) 4 Days Take blood pre-dose. Sample taken 12 hours post dose. State dose and timings

Tau protein-see Beta-2-transferrin. Thiamine

(See Vitamin B1)

Thiopurine Methyltransferase (Analysed at University Hospital of South Manchester)



Thiopurine metabolites (6-methylmercaptopurine and 6-thioguanine)



Thyroglobulin Plus anti-thyroglobulin antibodies

(Analysed at University Hospital of Wales)



Thyrotrophin binding inhibiting immunoglobulin (TBII)

(Analysed at Newcastle Royal Victoria Hospital)


Brown top (Gel)



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Sample Container



Tocopherol

(See Vitamin E)

TSH receptor antibody

(Analysed at Royal Preston) Reference range and comments supplied with report

Brown top (Gel)

Vasculitis Screen (ANCA, ANAB, C3 and C4) (Analysed at Central Manchester-Immunology)


Brown top (Gel)

Very Long Chain fatty Acids

(Analysed at Central Manchester-Willink Unit)


Red top (EDTA)

Vitamin A (Retinol) (Analysed at Central Manchester)

0.7 - 2.8 µmol/L Brown top (Gel) 12h fasting sample required. Protect sample from light. (E.g. Place in a black bag or wrap in foil). Send the sample to the laboratory immediately.

Vitamin B1

(Analysed at Glasgow Royal Infirmary)

Not routinely Analysed. Discuss with Clinical Lead if still required. Reference ranges and comments supplied with report


Vitamin B2


Not routinely Analysed. Discuss with Clinical Lead if still required. Reference ranges and comments supplied with


Must be protected from light



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Sample Container



report

Vitamin B6


Not routinely Analysed. Discuss with Clinical Lead if still required. Reference ranges and comments supplied with report


Vitamin E (Tocopherol) (Analysed at Central Manchester)

11.6 - 34.8 µmol/L Brown top (Gel) Protect sample from light. (E.g. Place in a black bag or wrap in foil). Send the sample to the laboratory immediately.

Voltage-gated calcium channel antibodies



Brown top (Gel)



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Sample Container



Voltage-gated potassium channel antibodies



Brown top (Gel)

White Cell Enzyme Screen (Analysed at Central Manchester – Willink Unit)


Red top (EDTA) 5ml minimum sample volume required

21 Days Sample must reach the Willink laboratory within 72 hours of being taken. Do not take blood on Friday or bank holiday when delays are inevitable

Zinc (Analysed at Salford Royal Hospital)

10.0 - 21.0 µmol/L Brown top (Gel) 14 Days Plastic blood collection tube is essential.



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