Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
Approved by: Maurizio Panarelli
IN THE EVENT OF PROBLEMS OR UNFORESEEN EVENTS – CONTACT THE LEAD CLINICIAN
North Glasgow Clinical Biochemistry Service
Glasgow Royal Infirmary Gartnavel General Hospital Western Infirmary Glasgow Stobhill Hospital
http://www.nhsggc.org.uk
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
CONTENTS GENERAL INFORMATION........................................................................................ 3 Point-of-care testing............................................................................................. 4 Blood gas analysers ....................................................................................................................... 4 Glucose meters .............................................................................................................................. 4
ESSENTIAL SITE-SPECIFIC INFORMATION........................................................... 5 GLASGOW ROYAL INFIRMARY (GRI)................................................................. 5 Emergency requests and out-of hours service x24487.................................................................. 6
WESTERN INFIRMARY (WIG) & GARTNAVEL GENERAL HOSPITAL (GGH) .. 7 Emergency requests and out-of hours service x52476.................................................................. 7
PRINCESS ROYAL MATERNITY HOSPITAL ....................................................... 9 Emergency requests and out-of hours service x24487.................................................................. 9
SPECIMEN COLLECTION AND HANDLING ...................................................... 10 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
REQUEST FORM & PATIENT IDENTITY.......................................................................... 10 SPECIMEN LABELLING .................................................................................................... 10 PATIENT PREPARATION.................................................................................................. 11 SPECIMEN COLLECTION ................................................................................................. 11 SAMPLE IDENTIFICATION ............................................................................................... 11 SPECIMEN PACKAGING .................................................................................................. 12 STORAGE PRIOR TO TRANSPORT TO LABORATORY ................................................ 12 SAFETY AND DANGEROUS SPECIMENS ...................................................................... 12 DISPOSAL OF PHLEBOTOMY EQUIPMENT................................................................... 13 DEALING WITH SPILLAGES AND BREAKAGES ........................................................... 13 COLLECTION OF SPECIMENS FROM NEONATES........................................................ 13
DATA PROTECTION ............................................................................................... 14 REFERENCE RANGES & TURNAROUND TIMES.................................................. 15 TURN AROUND TIME DEFINITION............................................................................................ 24 TUBE TYPES ............................................................................................................................... 24
Maternal third trimester: reference ranges for guidance ............................... 25 PREMATURE NEONATES .................................................................................. 26 HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS............. 28 HORMONES OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS .............. 30 HORMONES OF THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS ............ 31 OTHER HORMONES AND BONE MARKERS .................................................... 33 COMMONLY PERFORMED DYNAMIC TESTS .................................................. 33 TRACE ELEMENTS............................................................................................. 34 MICRONUTRIENT SCREEN................................................................................ 35 PORPHYRINS ...................................................................................................... 36 REQUEST INTERVENTION................................................................................. 37 REFERRAL LABORATORIES ................................................................................ 38 USEFUL TELEPHONE NUMBERS ......................................................................... 40 THINGS TO DO TO KEEP THE SERVICE EFFICIENT .......................................... 41
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
GENERAL INFORMATION The Clinical Biochemistry service is provided by the laboratories at the Glasgow Royal Infirmary, Gartnavel General Hospital and the Western Infirmary. There is a small satellite laboratory at Stobhill ACH, which handles emergency samples only. We provide an analytical and interpretative service. Please telephone us to discuss any problems or issues you may have. Our efficiency depends to a large extent on your cooperation. Your compliance with a few simple rules concerning safety, specimen identification and transport of specimens to the laboratory, all outlined in this handbook, will greatly help us deliver an efficient service. Clinical advice Phone the Duty Biochemist for advice on test range, procedures and interpretation. Contact the Duty Biochemist out with working hours through the hospital switchboard. Results Both authorised and non-authorised reports are available electronically. Results awaiting authorisation and comments are shown on the screen in high intensity to alert the clinician that they have not been authorised and do not have interpretative comments. Telephone requests for results Please note that we need to establish the caller’s identity before giving the results over the telephone. We cannot give results to patients or their relatives. We can only provide results to medical practitioners or their authorised deputies. Add-On Requests to Existing Specimens Requests for add-ons may be made up to 48 hours after receipt by emailing northglasgow.biochem@ggc,scot.nhs.uk Please use a secure (nhs.net) email to request add-on tests. These will be processed as soon as is possible. Urgent processing of add-ons is not guaranteed. If an additional test is required urgently it may be necessary to send a fresh sample. Website http://www.nhsggc.org.uk/biochemistry
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
Point-of-care testing Blood gas analysers The Biochemistry Department provides full support for blood gas analysers in North Glasgow Hospitals. Glucose meters A number of wards have their own glucose meters. The Biochemistry Department provides: • A full training and assessment programme • A programme of quality control and maintenance to the wards • Replacement meters • Help and advice when problems arise For further information contact the Duty Biochemist. Research Please contact the head of service to discuss biochemistry participation in research projects.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
ESSENTIAL SITE-SPECIFIC INFORMATION GLASGOW ROYAL INFIRMARY (GRI) EMERGENCY REQUESTS: EXT 24487 Address Department of Clinical Biochemistry, Macewen Building, Glasgow Royal Infirmary, GLASGOW G4 0SF Fax 0141 552 3324 Contacts
External
Internal
Duty Biochemist ................................................. 0141 211 4003/4 ....24003/4 option 3 General Enquiries .............................................. 0141 211 4003/4 .............. 24003/4 Duty Endocrine Biochemist ................................ 0141 211 4362 ................. 24362 Specimen Reception .......................................... 0141 211 4047 ................. 24047 Lead Clinician.................................................... Dr Maurizio Panarelli ........ 20830 Consultant Clinical Scientist (Endocrinology) .... Dr Karen Smith ................. 24424 Consultant Clinical Biochemist………………… . Dr Janet Horner ................ 24631 Consultant Clinical Scientist (Core & STEMRL) Dr Dinesh Talwar………… 24490 Laboratory Manager .......................................... Mrs Christine Brownlie ....25534 Quality Manager ................................................ Mrs Linda Mackinnon ....... 24339 Location of the laboratory and hours of work The laboratory is in the Macewen Building, at Alexandra Parade (adjacent to Accident & Emergency Department). It provides routine service Monday – Friday between 9am and 5pm and on Saturday between 9am and 12pm. An emergency service operates at all times. Reporting Office/interpretative advice Call the Duty Biochemist on ext 24004 from any of the hospitals (211 4004 if telephoning from outside during working hours, and via the switchboard out-of hours). Specimen transport A pneumatic tube system serves the Accident & Emergency Department, the ITU, Ward 65, Theatres in the Queen Elizabeth Building, Theatre Suite, Oncology, and
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
Jubilee Building, all floors of the Princess Royal Maternity Hospital, Wards 4-11 and Wards 28-33. The pneumatic tube system may be used for blood samples. The pneumatic tube system should not be used for:
High risk samples e.g. TB, Anthrax, VHF Sharps Samples for Blood Gas Analysis Pathology samples Heavy material (>kg) Large liquids >30ml such as urine or pleural washes Leaking samples
Contamination results in tube shut down for all users until disinfection process is complete. Otherwise samples are collected by porters. The ward collection times are as follows: Weekdays (am) ........8.00am,
9.00am,
10.25am,
Weekdays (pm) ........1.00pm,
2.20pm,
3.30pm
Saturdays and Public Holidays..8.00am,
9.00am,
Sundays ....................................8.45am,
9.45am
11.20am
10.30am
The emergency blood porter must be paged to arrange transport of urgent specimens. For the main hospital page 1616 For the Queen Elizabeth Building page 1509. Emergency requests and out-of hours service x24487 The 24/7 emergency laboratory is at GRI, Macewen Building ground floor. Results of tests requested as an emergency are normally available 60 minutes after the arrival of the specimen. Note that all requests for emergency analysis must be arranged with the laboratory (x24487) to alert staff to the arrival of an urgent sample. Also, the request form must specify emergency request. Affix an emergency/urgent sticker to the request form – not the specimen bag. If this is not done the sample will be processed as routine and this may take longer. Availability of results The results of all tests are available via ward or clinic terminals in real time (therefore phoning laboratory for results does not save time). Hard copy reports follow daily. The laboratory will telephone grossly abnormal results.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
WESTERN INFIRMARY (WIG) & GARTNAVEL GENERAL HOSPITAL (GGH) Address Department of Clinical Biochemistry Gartnavel General Hospital 1053 Great Western Road GLASGOW G12 0YN Fax ............. 0141 211 3452 Contacts Duty Biochemist ......................................................... 24003/4 option 3 General Enquiries ...................................................... 24003/4 Duty Endocrine Biochemist ........................................ 4362 Specimen Reception .................................................. 53347 WIG Laboratory.......................................................... 52476 Professor M H Dominiczak, Consultant Biochemist .. 52788; pager 07659132346 Lab Manager .............................................................. 52652 Location of laboratories and hours of work The main laboratory is at GGH (in the Laboratory Block of the GGH Complex). This laboratory also provides an emergency service Mon-Fri between 8.45 am and 5 pm. Emergency requests and out-of hours service x52476 The 24/7 emergency laboratory is at the WIG in the G Block, on the ground level. Results of tests requested as an emergency are normally available 60 minutes after the arrival of the specimen. Note that all requests for emergency analysis must be arranged with the laboratory (x52476 at WIG) to alert staff to the arrival of an urgent sample. Also, the request form must specify emergency request. If this is not done the sample will be processed as routine and this might take longer. Reporting Office/ Interpretative Advice Call the Duty Biochemist on x24003/4 from any of the hospitals (or 211 4003/4 if phoning from outside) or page through the hospital switchboard outside working hours.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
Transport of specimens within hospitals and between WIG and GGH GGH has a pneumatic tube system which serves each floor of the main building, the outpatient clinics and the Brownlee Centre. The Beatson Oncology Centre has a dedicated pneumatic tube transport system. These operate during normal working hours. They may be used for blood samples. The pneumatic tube system should not be used for: • • •
urine samples, samples which would be difficult to repeat (e.g. CSF), high risk samples
Outside normal working hours use the portering services. Routine samples from the WIG are collected by the porters and transported to the GGH laboratory by van shuttle. This may take over two hours. Samples registered by the laboratory by 1400 hours are likely to be processed that day. Availability of results The results of all tests are available via ward or clinic terminals in real time (therefore phoning laboratory for results does not save time). Hard copy reports follow daily. The laboratory will telephone grossly abnormal results. Nutrition Team Contact Prof M H Dominiczak (x52788). Specialist Toxicology The following assays are performed by Southern General Hospital • • • • •
Immunosuppressants Antifungal drugs Drugs of abuse Methanol Ethylene glycol
Results for the above are available at the Southern General Hospital by telephoning the Reporting Office on 0141 354 9060 or 89060 (Option 4).
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
PRINCESS ROYAL MATERNITY HOSPITAL Contacts Duty Biochemist ................................................. 24003/4 option 3 For Metabolic advice, contact Dr Peter Galloway, Consultant Clinical Biochemist (x89034 or on radiopage via switchboard at Southern General Hospital). Emergency requests and out-of hours service x24487 The 24/7 emergency laboratory is at GRI, Macewen Building ground floor. Routine Service All specimens except those for blood gases and metabolic analysis are sent to the Biochemistry Laboratory at GRI. Please refer to Pages 17-24 or telephone the Duty Biochemist (ext 24003/4 option 3) for advice about specialist sample handling e.g. anticoagulant, temperature etc. Metabolic analysis When metabolic analysis including lactate and ammonia are required, please send the sample to the Royal Hospital for Sick Children (RHSC), Yorkhill, Glasgow. During working hours telephone Ext 80339 (option 1) and out-of-hours ask switchboard to Page the BMS. Between 1630 and 0900 hours the sample must be sent by taxi to the main Porter’s Desk at the entrance to RHSC. The package should be marked URGENT and addressed to: Department of Biochemistry c/o Main Reception Royal Hospital for Sick Children Yorkhill GLASGOW G3 8SJ Specimen transport to the laboratory There is a portering collection for specimens to the Department of Biochemistry. This starts at Level 6 of the Princess Royal Maternity Hospital and works down to cover the nurse’s stations of all wards and clinics. The collections start at 8.50am, 10am, 11am, 12-noon, 1pm, 2pm, 3pm and 4pm from Monday to Friday. Saturday collections start at 9am and 11am. On Sunday, page the Emergency Porter (Page 2206) to deliver specimens. Pages 25-27 list the routine repertoire and these also give ranges for guidance. These are not and cannot be definitive reference ranges. This applies particularly to premature neonates (Pages 26 and 27). Reporting Results of tests requested as an emergency are normally available from ward terminals 60 minutes after the arrival of the specimen. Hard copy reports follow daily. The laboratory will telephone grossly abnormal results.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
SPECIMEN COLLECTION AND HANDLING Sample containers of any type should be obtained through normal supply routes for consumables. The Biochemistry Department does not supply containers or packing materials except by special arrangement. Specimens will not be sent to external laboratories on behalf of ward staff unless specifically arranged. Please follow these simple rules to help us provide a service of quality to our patients.
1. REQUEST FORM & PATIENT IDENTITY •
Ensure the request form is completed correctly (Surname, Forename, DOB, CHI No, Hospital No., date & time of specimen collection & brief clinical details.
•
The name and full address to which the report should be sent (Consultant, GP Surgery, Hospital Ward, Clinic etc) must be included on the request form.
•
The laboratory will not process samples that do not have clear patient identification. Handwriting must be legible.
•
Clinical information included on the form permits laboratory staff to assess the validity of results and may prevent unnecessary repeat analyses. Supporting information may be required for correct interpretation. For example, therapeutic drug monitoring requests require information about dosage, time since last dose, and a complete list of prescribed drugs.
•
Confirm the identity of the patient prior to sampling.
2. SPECIMEN LABELLING Normally, the minimum for adequate identification includes the patient’s forename and surname, plus date-of-birth, CHI number or hospital number. •
A pre-printed label is preferred: please affix it to both top and bottom copies of the form (if applicable).
•
When emergency tests are required for unidentified patients the requesting clinician should indicate ‘unknown male/female’ in place of name and surname, and must indicate the exact time of sample withdrawal. The Casualty number, where available, is helpful.
•
The laboratory cannot process specimens that are not clearly identified.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
3. PATIENT PREPARATION •
The patient should be resting for at least 5 minutes before withdrawal of blood.
•
Venous blood samples should be taken with minimal stasis.
•
Hyperventilation by the patient during arterial blood gas sampling may affect results.
•
Many analyses require that the specimen be collected under specified conditions, e.g. fasting. In some cases, the requirements are quite stringent, e.g. for the measurement of plasma renin/aldosterone. In all cases, you should make sure that the appropriate requirements are met. If in doubt, please contact the Duty Biochemist.
4. SPECIMEN COLLECTION •
Ensure that the correct sample container is used for the requested tests.
•
For venous blood use vacuum blood collection tubes.
•
Collect fluid samples (ascitic, drain etc) into vacutainers – the laboratory can provide details of aspiration devices
•
You must use an appropriate container for each test.
•
If more than one tube is collected from a patient, the potassium EDTA tube should be filled last to avoid errors in potassium and calcium measurement.
•
Anticoagulant tubes should be inverted several times to ensure adequate mixing.
•
When taking arterial blood gas samples expel liquid heparin from arterial blood gas syringes. The heparin should fill only the dead-space of the syringe. Air bubbles should be expelled before the syringe is sealed.
•
Some analyses require that the samples be collected into special containers and/or separated and deep-frozen within minutes of collection. Details of the appropriate collection containers for all samples - blood, urine, CSF, and faeces – can be found in this handbook.
•
Where there is any doubt about sample preparation, storage, or transport please contact the Duty Biochemist.
5. SAMPLE IDENTIFICATION The minimum for adequate identification includes the baby’s first name and surname, plus date of birth, hospital number or CHI number and, ideally, address. It is preferred that details are printed. Identification of the
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
Ward/Clinic is essential for telephoning results. The laboratory will not process unlabelled specimens. 6. SPECIMEN PACKAGING •
In order to minimise the risk of interchange of samples and cross contamination a specimen bag can contain specimens from one patient only.
•
Always ensure the sample container is securely capped.
7. STORAGE PRIOR TO TRANSPORT TO LABORATORY •
Do not expose the specimens to extremes of temperature prior to transport
•
Samples should be transferred to the laboratory with minimal delay to maintain sample integrity. Delays in centrifugation can affect the values obtained for certain analyses (e.g. potassium).
8. SAFETY AND DANGEROUS SPECIMENS •
The Department cannot analyse, or accept for storage, disposal or onward transmission, any specimen from a patient suffering an illness associated with, or suspected of being caused by, a Category 4 pathogen.
•
Please note that the laboratory will not process a leaking specimen or one that arrives with a needle attached.
•
Potentially dangerous specimens must be labelled as such using a “Danger of Infection” sticker. Samples from patients with Category 3 pathogens, or suspected of having them, must be labelled with “Danger of Infection” stickers on the bag, form and sample tubes The specimen must be double bagged and the clinical details include suspected pathogen. The pneumatic tube system should not be used for such high risk samples.
•
In practice, dangerous specimens are specimens that carry the risk of transmitting hepatitis B virus, HIV and other Category 3 pathogens.
•
The Committee on Control of Infection should be contacted where there is any uncertainty. Such specimens include those from confirmed or suspected cases of the disease, known carriers (e.g. those known to be antibody or antigen positive), as well as patients from an at-risk group (e.g. IV drug abusers).
•
‘Danger of Infection’ stickers should be put on the bag, form and container, and the bag then sealed. For large specimens such as 24-hour urine
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
specimens, specimen containers should be enclosed in individual clear plastic bags which must be tied at the neck. •
The request form should be placed in a plastic envelope which is then securely tied or taped to the neck of the sack. The request form should state the suspected/confirmed infection.
•
Certain 24-hour urine collections require a container with acid – avoid direct contact with the acid.
9. DISPOSAL OF PHLEBOTOMY EQUIPMENT Please refer to your local health and safety procedures for the safe disposal of all materials used during specimen collection 10. DEALING WITH SPILLAGES AND BREAKAGES •
Please refer to your local health and safety procedures for dealing with spillages and breakages.
11. COLLECTION OF SPECIMENS FROM NEONATES •
Specimens from the Neonatal Unit are mainly capillary specimens taken from heel stabs. Care should be taken to ensure that the specimen is taken from the outer aspect of the heel, that there is no contamination, that undue force is not exerted and that the blood is free-flowing and is collected quickly. The appropriate containers are given on Pages 26 and 27 Even with the best blood collection technique, samples may still show haemolysis and results cannot then be given for certain analytes, e.g. potassium, conjugated bilirubin.
•
The volume of blood required for routine analyses (e.g., U&E, LFT, Bone, CRP, bilirubin, triglycerides) depends on the number of tests/test profiles being requested. In general we require 0.25 ml blood for 1 test(s)/test profile(s), 0.5ml for 2 and 0.75ml for 3 or more. However, this is dependent on the haematocrit and more blood will be required if the haematocrit is high. The blood volumes required for more specialised tests are given on Pages 27 & 28.
•
Blood can be taken from an arterial line if the umbilical artery has been catheterised. It is important not to use a line which is used for infusion, since this can lead to contamination of specimens and to increased risk of infection.
•
Blood gases are analysed by medical staff in the laboratory at the ward.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
DATA PROTECTION The Data Protection Act 1998 is based upon eight enforceable principles of good practice: 1. Personal data shall be obtained and processed fairly and lawfully. 2. Personal data shall be held only for specified and lawful purposes and shall not be further processed in any manner incompatible with those purposes. 3. Personal data shall be adequate, relevant, and not excessive in the relation to the required purposes. 4. Personal data shall be accurate and, where necessary, kept up-to-date. 5. Personal data shall not be retained longer than is necessary. 6. An individual shall be entitled to have access to his or her data and where appropriate, have it corrected or erased. 7. Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of the data. 8. Personal data shall not be transferred outside EU countries unless an adequate level of data protection exists. Organisations are obliged to comply with these principles. Failure to comply can result in an enforcement notice being issued by the Registrar.
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Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
REFERENCE RANGES & TURNAROUND TIMES Please contact the Duty Biochemist for more detailed information on reference ranges (e.g. sex- or age- related reference limits). Analyte Adrenocorticotrophin (ACTH) Alanine aminotransferase (ALT) ++ Albumin ++ Albumin Albumin/creatinine ratio (ACR) Albumin excretion rate (AER) Aldosterone
Type of sample B
Container (volume, ml) Purple top* (1)
Reference range
Comments
< 20 mU/L
*See page 28 for full sampling requirements.
B
Yellow top (2)
< 50 U/L
B U U
Yellow top (2) EMU (20) EMU (5)
35 to 50 g/L < 20mg/L < 2.5 mg/mmol
Male
< 3.5mg/mmol
Female
Turnaround time 7 days Same day if rec’d before 12 mid-day. 1 day Up to 4 days “ “ “ “ “
24 h Plain UC
< 20 µg/minute
B
Yellow top (1.5)
100 to 400 pmol/L 100 to 800 pmol/L
Adult (supine). Adult (upright). Age-related ranges are available – Please contact Duty Endocrine Biochemist
10 days
Alkaline phosphatase (Alk phos) ++
B
Yellow top (2)
30 to 130 U/L
Results high in children and pregnancy, and raised in the elderly. Age and sex related ranges available.
Alk phos isoenzymes
B
Red top (2)
Qualitative test
Daily. Same day if rec’d before 12 mid-day. 14 days
Only measured if ALP > 250 U/L. α1-Antitrypsin
B
Yellow top (2)
1.1 to 2.1 g/L
Phenotyping available by arrangement.
α-Fetoprotein (AFP)
B
Yellow top (2)
< 6 kU/L
As tumour marker only. Send pregnancy AFP to Medical Genetics, RHSC, Yorkhill.
Aluminium
B U
< 0.5 µmol/L 5.6 carbohydrate induced diarrhoea unlikely See individual components Sex, age and cycle related < 70 U/L < 40 U/L
*Collect at least 6h post-dose Conversion Factor (molar into mass units) nmol/L x 0.78 = µg/L. Screen for amphetamines, metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, phencyclidine and tricyclic antidepressants Conversion Factor molar into mass units mmol/L x 4.6 = mg/dL. mass to molar units mg/dL x 0.22 = mmol/L. Interpretation: refer to Duty Biochemist via Switchboard. 200 Consistent with Active GI inflammation. Secretory diarrhoea Osmotic diarrhoea Send to laboratory ASAP, within 2 hours.
B
Green top* (2)
< 120 ng/L
Gentamicin
B
Yellow top* (2)
Globulins ++
B
Yellow top (2)
See prescribing protocols 23 to 38 g/L
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*See page 35 for full collection requirements. Trough: pre-dose Peak: 1 hour post- dose. Calculated value (total protein albumin).
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10 days 10 days
1 hour 7 days
Available out-of-hours as an emergency.
1 day (available out of hours)
7 days
7 days 7 days
2 days Same day if rec’d before 12 mid-day. 20 days 4 hours 1 day.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003 Analyte
Revision: 18 Container (volume, ml) Grey top (2) Grey top (0.5)
Reference range
Comments
Glucose ++ “ ++
Type of sample B CSF
3.5 to 5.5 mmol/L > 70% of plasma glucose
Fasting. Compare with simultaneous plasma glucose.
Glutathione Peroxidase Growth hormone
B B
Heparin/EDTA (2) Yellow top (2)
15-50 IU/g Hb < 0.4 µg/L excludes acromegaly
Fasting; avoid stress.
Gut hormone screen
B
Green top* (7)
-
Haemoglobin A1c (HbA1c) Haptoglobin
B
Purple (2)
B
Yellow (2)
48 mmol/molHb 0.3 to 2.0 g/L
Human chorionic gonadotrophin (HCG)
B
Yellow top (2)
Hydrogen ion 5-Hydroxy indole acetic acid (HIAA)
B U
Syringe (1) 24 h/acid
17-Hydroxy progesterone
B
Yellow top* (0.5 to 2.0)
< 12 wks of age 12 wks of age 4 days). *See page 28 for full details.
< 13 mU/L
Green top(1)*
0.36 to 1.12 nmol/L
Yellow top (2)
10 to 30 µmol/L
IgG IgA IgM *Age-related reference range available. Paraproteins quantitated and typed. Adults (20 to 60 years). Varies with age. See page 33 for reference ranges. *See page 33 for full collection details. Collect glucose sample at same time. . *See page 33 for full collection details
Consider haemochromatosis if: >60% (M) or >50% (F) U
Plain Universal Container (20) Plain Universal
120 U/L
Lead
B
Purple top (5)*
< 0.5 µmol/L
U
Plain Universal Container (20)
Lipoprotein A (Lp(a))
B
Red/purple top (2)
< 4.5 nmol/mmol creatinine < 30 mg/dL
Lithium ++
B
Yellow top* (2)
0.4 to 1.0 mmol/L
Luteinising hormone (LH) Macroprolactin Magnesium ++ “ “
B
Yellow/red top (2)
*Sex, age and cycle related
B B U F
Yellow top (2) Yellow top (2)l 24 h/Plain UC Random/plain UC (5)
0.7 - 1.0 mmol/L 2.0 - 11.0 mmol/24 h < 100 mmol/kg
Manganese Mercury
B B
Heparin/EDTA* (5) Heparin/EDTA (5)
70 to 280 nmol/L 350 mg/L Severe Toxicity: > 700 mg/L >280 mg/L , if under 5 years 0.8 to 2.0 µmol/L 0.2 - 0.9 µmol/L 0.5 - 1.3 µmol/L 0.7 - 1.7 µmol/L 13 to 70 nmol/L 20 to 155 nmol/L 44 to 218 nmo/L 22 to 188 nmol/L 52 to 172 nmol/L 38 to 127 nmol/L 133 to 146 mmol/L Varies with diet
Adult 0 - 2 years 2 - 4 years 4 - 16 years Male 50 nmol/L
Hypoglycaemia screen insulin cortisol
B
Green top (1)
Lactate
B
Green top (0.2)
0.7 to 2.5 mmol/L
Arrange with Duty Biochemist Ext 24362. Send on ice. Congenital adrenal hyperplasia. Only take when hypoglycaemic (Glu < 2.6 mmol/L) and on high glucose intake (> 12mg/kg/min). Arrange with laboratory. Send on ice ASAP. Send to the Biochemistry Department , RSHC, Yorkhill, for analysis.
Magnesium
B
Green top (*)
0.7 to 1.2 mmol/L
Manganese
B
Green top (0.5)
Methaemoglobin
B
Green top (0.5)
< 2.5% > 5% > 7%
Osmolality
B
Green top (*)
Parathyroid hormone (PTH)
B Purple Top
1.0, E
270 to 300 mmol/kg 1.6 to 7.5 pmol/L
PCO2 (arterial)
B
1, Syringe
4.0 to 6.5 kPa
Phenobarbitone
B
Green top (0.5)
15 to 30 mg/L
Phenytoin
B
Green top (0.5)
6 to 15 mg/L
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< 1 month. 1 to 6 months. Arrange with Duty Biochemist Ext 24362. Send on ice ASAP. If > 1000U/L x-ray for rickets. Send promptly to Biochemistry, RSHC, Yorkhill, for analysis. Investigate further.
15 to 25 mmol/L 50 mU/L
5-day olds to adults. Congenital hypothyroidism.
B Thyroxine (free T4) Trace element screen copper manganese zinc Triglyceride
6 to 30 pmol/L B
Green top (0.5)
B
Green top (*)
< 2.5 mmol/L
Target value when on TPN.
Urea
B
Green top (*)
< 7.0 mmol/L < 3.5 mmol/L
Days 1 to 7: Days 7 + If >8.0 mmol/L analyse creatinine.
Zinc
B
Green top (0.5)
Page 27 of 41
Last printed 30/06/2014 11:14:00
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS A) Assays performed in serum or plasma
Analyte Adrenocorticotrophin (ACTH) Aldosterone
Sample requirements Type of Container & sample volume (ml) Blood Purple top (1) Blood Yellow top (1.5)
Precautions a, b, e, f, tf
Androstenedione
Blood
Yellow top (1)
-
Cortisol
Blood
Yellow top (2)
e, f
Dehydroepiandrosterone sulphate (DHAS) 17-Hydroxyprogesterone
Blood
Yellow top (1)
-
Blood
Yellow top (0.5 to 2)
e
Plasma Renin Concentration
Blood
Purple top (5)
b, tf, g
Subjects Adults 0700-0900 hours Adults Adults Neonates 0-1 month Neonates 1-6 month Adult men 18 - 40 years Adult men 41 - 65 years Adult Women 18 - 40 years Adult Women 41 - 65 years Prepubertal children Adults 7- 9 am Adults 9 pm – 12 mid-night Morning to Evening Adult men (16-50 years) Women (16-50 years) Prepubertal children Adults 7- 9 am Normal infants (>4 days) Stressed/Premature infants Proven Congenital Adrenal Hyperplasia Supine Ambulant Screening for Primary Aldosteronism is positive if an Aldosterone (pmol/L)/ Renin concentration ratio is >35 in samples where the Aldosterone is >300 pmol/L. Patients with a positive screening test require more detailed investigation (ie, salt loading test)to confirm the presence of primary Aldosteronism.
Reference values & action limits < 20 mU/L 100 - 400 pmol/L (supine) 100 - 800 pmol/L (upright) 1060 - 5480 pmol/L 500 - 4450 pmol/L 1.6 - 8.4 nmol/L 1.3 - 6.6 nmol/L 0.6 - 8.8 nmol/L 0.9 - 6.8 nmol/L < 2 nmol/L 240 - 600 nmol/L 50 - 290 nmol/L > 100 nmol/L 2.5 - 16 µmol/L 2 – 12.5 µmol/L < 2.5 µmol/L < 13 nmol/L < 13 nmol/L < 40 nmol/L > 50 nmol/L < 40 mIU/L < 52 mIU/L
Symbols a b d e f g h j tf -
Page 28 of 41
Haemolysed specimen unsuitable Separate and freeze specimen Collect after overnight fast Timing of collection important Avoid Stress Do not store or centrifuge at 4° C Contact Laboratory Ful EDTA tube required Transport frozen (not whole blood)
Last printed 30/06/2014 11:14:00
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook Document: CLIN003
Revision: 18
B) ASSAYS PERFORMED IN URINE Sample requirements Type of
Reference values &
Analyte
sample
Container & volume (ml)
Precautions
Subjects
action limits
Cortisol (UFC)
Urine
5, Pl/EMU or 24 hours
NP
Adults (EMU)
< 25 µmol/mol creatinine
Adults (24 hour)
< 250 nmol/24 hours
Children ≤10 yrs
< 40 nmol/mmol creatinine
Urinary steroid profile
Urine
24 hours
NP
Analysis of more than 30 steroid metabolites available in selected patients. Contact Duty Endocrine Biochemist for full details.
Commonly performed dynamic tests
Synacthen test - cortisol 0.25 mg Synacthen i.v. between 8 am and 10 am. Blood sample at times 0 and 30 minutes for serum cortisol.
Page 29 of 41
Criteria for normal response Adequate >450 nmol/L Inadequate
