HAEMATOLOGY AND BLOOD TRANSFUSION CONTROLLED DOCUMENT
Haematology and Blood Transfusion Laboratory Handbook Please note that this document is subject to the document control system of the Pathology Department.
If you feel that this document is no longer fit for purpose please make laboratory management aware and the document will be reviewed.
DOCUMENT REVIEW HISTORY Review date
Reviewed by
Updated contact details to include all sites for Barts Health
17/01/14
June 2015
Name Q Pulse ID Version Date of Issue Date of Review
Summary of amendments
K Thompson
Format consistent with NHS and Barts Health branding for display on the external website. Implement change requests: CR4953,CR4966,CR4981,CR4844
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
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Contents 1 2 3 4 5 6 7 8 9
Introduction ............................................................................................................................ 3 Location, Address and Telephone Numbers ........................................................................ 3 Laboratory Hours ................................................................................................................... 4 Results, Enquiries and Clinical Advice ................................................................................. 4 Key Personnel ........................................................................................................................ 5 Laboratory Contact Numbers ................................................................................................ 8 Complaints and Compliments Procedure............................................................................. 8 Confidentiality ........................................................................................................................ 9 Processing Requests ........................................................................................................... 10 9.1 Specimen bottles/sample types .......................................................................................... 10 9.2 Sample labelling ................................................................................................................. 11 9.3 Sample Labelling for Blood Transfusion .............................................................................. 12 9.4 Sample rejection criteria ..................................................................................................... 12 9.5 High Risk Patients .............................................................................................................. 12 9.6 Urgent Tests ....................................................................................................................... 12 9.7 Sample Storage Policy and Add-on Requests .................................................................... 13 9.8 Requesting Cross-matches ................................................................................................. 13 9.9 Massive Haemorrhage Protocols (including MOH) .............................................................. 13 9.10 Requesting other Blood Components ................................................................................. 14 9.11 Blood Product Administration .............................................................................................. 14 9.12 Cold chain........................................................................................................................... 15 9.13 Transfusion Reactions ........................................................................................................ 15 9.14 Referral laboratories ........................................................................................................... 15 10 Specimen Transport ............................................................................................................. 16 11 Factors affecting tests ......................................................................................................... 16 12 Reports and Results............................................................................................................. 17 13 Test Repertoire ..................................................................................................................... 18 13.1 Test Combinations .............................................................................................................. 29 14 Haematology Reference ranges .......................................................................................... 30 14.1 Full Blood Count Parameters and Cell Counts .................................................................... 30 14.2 Haemostasis Reference Ranges ........................................................................................ 35 14.3 Red Cell Laboratory Reference Ranges.............................................................................. 41
Name Q Pulse ID Version Date of Issue Date of Review
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1
Introduction
The Pathology specialties provide a comprehensive screening and diagnostic service. This includes the availability of medical and scientific advice at all times. Members of each specialty participate in audit, research, teaching, training and quality assurance schemes. The Haematology department provides Haematology and Blood Transfusion services in laboratories at the four hospitals of Barts Health NHS Trust. The department operates with a Hub and Spoke model, with the majority of non-urgent and specialist work being performed at The Royal London laboratory (hub). Urgent and in-patient work is performed at the spoke sites at St Bartholomew’s Hospital, Newham University Hospital and Whipps Cross University hospital. The Haematology department at The Royal London provides general haematology services and a number of specialist areas (haemophilia, sickle cell disease, thalassaemia, and immune thrombocytopenia). The Royal London also provides general and referral blood transfusion testing, and serves the Royal London Trauma unit, which is the busiest major trauma centre in London. St Bartholomew’s Hospital has a large haemato-oncology department that treats patients with haematological malignancies (leukaemia, lymphoma, etc.) and with the recent introduction of Barts Heart Centre has become the largest Cardiac centre in Europe. The spoke laboratories provide services for urgent haematology and haemostasis testing and general blood transfusion services. CPA accreditation is currently held by the each of the four laboratories. 2
Location, Address and Telephone Numbers
Site
Address
Telephone Number 020 3416 5000
Royal London Hospital
Pathology and Pharmacy Building 80 Newark Street Whitechapel London E1 2ES
St Bartholomew’s Hospital
West Smithfield London EC1A 7BE
020 3416 5000 020 7377 7000
Newham University Hospital
Glen Road Plaistow London E13 8SL
020 3416 5000 020 7476 4000
Whipps Cross University Hospital
Whipps Cross Road Leytonstone London E11 1NR
020 3416 5000 020 8539 5522
Maps for each location can be found at our website http://www.bartshealth.nhs.uk/contact-us/ Name Q Pulse ID Version Date of Issue Date of Review
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3
Laboratory Hours
Haematology and Blood Transfusion services are offered 24 hours per day at the Royal London Hospital, St Bartholomew’s, Newham University Hospital and Whipps Cross University Hospital. Only urgent tests can be processed outside of normal working hours. 4
Results, Enquiries and Clinical Advice
To obtain results via telephone, please use the contact numbers in the table below. Please note we are unable to provide results directly to patients, please contact your relevant health care provider. We are unable to provide Blood Group results over the telephone, these results may be faxed to a safe-haven fax number. Results and enquiries can be made during routine working hours (M-F 0900:-17:00). GPs wishing to make a non-urgent enquiry may contact the GP referral email
[email protected] for clinical advice. Emails to this address will receive a response within 48 hours. For urgent referrals, please contact switchboard at the relevant site and ask to speak to the Haematology Registrar. For non-urgent haemato-oncology queries please contact
[email protected] Need information about blood tests? Lab tests online UK has been designed to help patients better understand the many clinical lab tests, but is also used widely by healthcare professionals as a source of information.
Laboratory Site
Royal London Hospital
Phone number for results Main Switchboard 020 3416 5000 60341 60346 (GP’s only)
St Bartholomew’s Hospital
57242
Newham University Hospital
8733/8120
Whipps Cross University Hospital
5810
Name Q Pulse ID Version Date of Issue Date of Review
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
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5
Key Personnel
Name
Position
Tony Halton
CSS Group Director
Simon Ashton
CSS Operations Director
[email protected]
Prof. Finbarr Cotter
Pathology Clinical Director
[email protected]
Nicole Gresham Sarah Glover
Jacquie Wilson
Maureen Finneran Dr Peter MacCallum Mark Kowalczuk Angela Heins
Paul Grist
Sean Platton
Anand Pancholi
Gareth HeywoodBeldon
Julia Lancut
Susan Hood Dr Shubha Allard
Name Q Pulse ID Version Date of Issue Date of Review
Associate Director Pathology Pathology Business Manager Administrator Pathology Business Unit (PA to Professor Cotter and Nicole Gresham) Senior Medical Secretary – Clinical Haematology Lead Clinician for Clinical Haematology Service Manager for Clinical Haematology Divisional manager –Blood Sciences (Interim) Lead Specialist Biomedical ScientistHaematology and Blood Transfusion Principal Scientist Haematology and Haemophilia Centre Chief Biomedical Scientist Haematology and Blood Transfusion (Newham) Chief Biomedical Scientist Haematology and Blood Transfusion (Whipps Cross) Chief Biomedical Scientist Blood Transfusion (Royal London and St Bartholomew’s) Acting Chief Biomedical Scientist Haematology and Red Cell (Royal London) Consultant Haematologist
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
Email Address
[email protected]
[email protected] [email protected]
[email protected]
[email protected] [email protected] [email protected] [email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected] [email protected]
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Dr Laura Green
Consultant Haematologist
[email protected]
Dr Louise Bowles
Consultant Haematologist
[email protected]
Dr Charles Gutteridge
Consultant Haematologist
[email protected]
Dr Olivia Kreze
Consultant Haematologist (Newham)
[email protected]
Professor John Pasi
Consultant Haematologist
[email protected]
Dr Tom Butler
Consultant Haematologist
[email protected]
Dr Dan Hart
Consultant Haematologist
[email protected]
Dr Upal Hossain
Consultant Haematologist (Whipps Cross)
[email protected]
Dr Drew Provan
Consultant Haematologist
[email protected]
Dr Paul Telfer
Consultant Haematologist
[email protected]
Dr Banu Kaya
Consultant Haematologist
[email protected]
Dr Matthew Smith
Consultant Haematologist
[email protected]
Sarah Mills
Matron for Nusing in Clinical Haematology
Angela Maddison
Transfusion Practitioner
[email protected]
Nidhi Sharma
Transfusion Practitioner
[email protected]
Josephine McCullagh
Transfusion Practitioner
[email protected] k
Pascal Winter Michelle Martin Kate Forsyth Aldine Thomas Gaby Olatunde Agnes Oyewole Chipo Madangombe Maxine Scott Name Q Pulse ID Version Date of Issue Date of Review
Lead Transfusion Practitioner Training Officer – Haematology and BT Senior CNS Haemophilia (Royal London) Senior CNS Haemoglobinopathies (Royal London) Nurse Specialist (Newham) Anticoagulation CNS (Whipps Cross) Senior CNS Anticoagulation (Newham) Anticoagulation CNS (Newham) Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
[email protected]
[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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Erum Meraj Abbi Morris Wandai Maposia Louise Taylor Arlene Osias Helena Tee Dmitrij Bartosik Guy Pickford Rokey Jagne Kate Ortiz Ilyas Miah
Name Q Pulse ID Version Date of Issue Date of Review
Anticoagulation Administrator (Newham) Senior CNS Haemophilia (Royal London) CNS Haemophilia (Royal London) Research Nurse Lead (Royal London) Research Nurse Practitioner (Royal London) Research Coordinator (Royal London) Research Practitioner (Royal London) Senior CNS Anticoagulation (Royal London) Anticoagulation CNS (Royal London) Home Visit Admin practitioner Home Visit Admin practitioner
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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6
Laboratory Contact Numbers Royal London Haematology Laboratory Haemostasis Blood Transfusion Red Cell Laboratory
020 3416 5000 60342 61049 60344 61116
Out of Hours BMS St Bartholomew’s Haematology Laboratory Blood transfusion Out of hours BMS Newham University Hospital Blood transfusion Haematology Laboratory Out of hours BMS Whipps Cross University Hospital Haematology Transfusion Out of hours BMS Specialist Registrars (Royal London and St Bartholomew’s)
Bleep 1422 020 7377 7000 57243 56130 Bleep 0098 020 7476 4000 8123 8273 Bleep 003 020 8539 5522 5888 5670 Bleep 168 61099 General Adult Haematology - Bleep 1243 Red Cell Disorders - Bleep 1241 Haemostasis/Thrombosis - Bleep 1155 Paediatric haematology - Bleep 1239 SIHMDS & laboratory – Bleep 0328 Haemato-Oncology – Bleep via switchboard Bleep 130 Bleep 247 Bleep 075 Bleep 076 Bleep 352
Specialist Registrar (St Bartholomew’s) Specialist Registrars (Newham) Specialist Registrars (Whipps Cross)
7 Complaints and Compliments Procedure The Haematology and Blood Transfusion department manages complaints and compliments through the Barts Health NHS Trust Corporate Complaints Policy. The Patient Advice and Liaison Service (PALS) offer confidential advice, support and information on health-related matters. They provide a point of contact for patients, their families and their carers. PALS can give you information about the NHS complaints procedure, including how to get independent help if you want to make a complaint. To contact PALS, please phone 020 3594 2040 or email
[email protected]. GPs and patients may notify the trust of a complaint or compliment by contacting the Central Complaints Team via email
[email protected]. Name Q Pulse ID Version Date of Issue Date of Review
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8 Confidentiality The Haematology and Blood Transfusion laboratories adhere to the Barts Health Trust corporate Data Protection policy, which sets out the standards all staff must adopt in the handling and management of information about people, to ensure compliance with the Data Protection Act 1998 as amended by the Freedom of Information Act 2000 (section 68). The role of our Caldicott Guardian is to ensure the highest levels of confidentiality and security for patient identifiable information held in the NHS. The Trust’s Caldicott Guardian covers a number of areas of concern, including keeping patients aware of what the NHS does with their information, making sure that our staff are familiar with their responsibilities and good practice, and ensuring that we have good security measures in place on our computer systems so that patient information is not easily accessible by unauthorised users.
Name Q Pulse ID Version Date of Issue Date of Review
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
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9 Processing Requests 9.1 Specimen bottles/sample types The sample requirements for each test are specified in Section 13.
Figure 1: Microtainer EDTA for Neonatal samples
Figure 2: Sodium Citrate 3.0mL
Figure 3: EDTA 4mL
Figure 4: EDTA 6mL
This pink top sample tube is primarily used for whole blood tests such as Full Blood Count. The minimum sample volume is 0.75mL. The sample bottle can also be used for neonatal/paediatric blood transfusion testing. Please note it may not be possible to complete all investigations with this sample bottle size. See section 9.2 for details on labelling. This blue top sample tube is used primarily in Haemostasis testing. It is essential that the tube is filled only to the line (total volume 3.0mL). Under or over filled samples are not able to be processed (see section 9.4). A microtainer tube for neonatal/paediatric patients is also available; this needs to be filled to the line, total volume is 1.3mL. This purple top sample tube is used primarily for whole blood tests such as Full Blood Count, but can be used for plasma tests. The minimum sample volume is 2mL for FBC and ESR requests. This pink top sample bottle is primarily used for Transfusion testing. The minimum sample volume is 3mL. Please note, it may be necessary to provide further samples where additional investigations are required. See section 0 for details on labelling.
This yellow top sample bottle is used for serum tests. The minimum sample volume is 2mL. Figure 5: Serum Separating Tube (SST) 6mL
This red top sample bottle is used for serum tests. The minimum sample volume is 2mL. Figure 6: Serum (clotted) tube 6mL
This universal container contains no additives and is used for collection of urine and CSF samples. Figure 7: Universal Container
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9.2 Sample labelling All requests for patients within the Trust should be made via CRS. If CRS is not available, please follow the guidelines below. All GP patient requests can be made via T-Quest. Alternatively, please complete a pre-printed request form and send it to the relevant site laboratory along with the sample(s) in a sealed specimen bag. Please follow the guidelines below. The printed barcoded label must be attached lengthwise down the tube so that the barcode scanners can read the barcode and samples can be processed. Please do not wrap the barcode label around the tube, the barcode scanners cannot read the label and this will delay sample processing and the availability of results.
In the event of a major incident, an incident number may be used in place of an NHS or Hospital number Essential Patient’s full name - spelled correctly or an On Sample Container
Desirable
anonymised coded identifier Date of Birth and/or Hospital or NHS number Sample type Date and Time
On Request form
Patient’s full name - spelled correctly or an
Requester's bleep
anonymised coded identifier
number
Date of Birth
Clinical information
Patient’s sex
Time sample was
Hospital number or NHS number
collected
Patient’s location (Destination for report)
Identity of person that
The requesting doctor (Consultant or GP)
collected sample
Sample type Date sample was collected Urgency of sample Name Q Pulse ID Version Date of Issue Date of Review
Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
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9.3 Sample Labelling for Blood Transfusion Most errors associated with blood transfusion are due to clerical mistakes at the time of collection of the Group and Screen sample, when the product is collected or at the time of administration. To minimise this, the Blood Transfusion department operates a zerotolerance policy on inadequately or incorrectly labelled samples. Re-labelling of samples is not permitted. Samples for blood transfusion must be accompanied by a request form; the label must be hand-written and include the following information: Surname Forename DOB NHS or Hospital Number Date of collection Phlebotomists signature Samples that do not meet these criteria will be rejected. This is in compliance with 2009 Guideline on the Administration of Blood Components issued by British Committee for Standards in Haematology. 9.4 Sample rejection criteria It is the responsibility of the clinician requesting the test to ensure that the details on the request form are accurate and complete. It is the responsibility of the person taking the sample to ensure that the sample is correctly labelled. Samples may be rejected for the following reasons Sample container broken or leaking Incorrect sample received for requested test(s) Insufficient samples Grossly haemolysed or lipaemic samples Old/ aged samples Illegible labelling Inadequately labelled or unlabelled samples 9.5 High Risk Patients Samples from patients who may be suspected to have acquired viral haemorrhagic fever must not be sent to the laboratory without prior discussion; this includes samples for all routine testing. Under no circumstances must these samples be sent via the air chute. Please contact the on-call Virology registrar via switchboard for more information. 9.6 Urgent Tests The expected turn-around-time (TAT) for testing is described in Error! Reference source ot found.. Samples from A&E are processed as urgent samples. If the clinical situation requires urgent testing, please contact the relevant department to arrange for priority testing.
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Haematology Laboratory Handbook HAEM-QDOC1 3 14th October 2015 14th October 2017
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9.7 Sample Storage Policy and Add-on Requests Plasma and whole blood samples are generally stored for 48 hours after the report has been issued. Samples for coagulation testing are generally kept for 24-36 hours. Additional requests may be made by contacting the relevant department within the laboratories; however the sample may not be suitable for testing after some duration of time. The sample validity time for requesting additional tests is described in section 13. 9.8 Requesting Cross-matches Crossmatches can be made in advance for patients with planned elective surgery dates. Please note that sample validity is dependent on a patient’s transfusion history. Please contact the transfusion laboratory to determine if the sample will be valid for the required date and time. This includes transfusions that have taken place outside of Barts Health. Patient last transfused 3 to 14 days 15 to 28 days 29 days to 3 months
Samples to be taken
