CLIN 003 User Handbook 2013 · Routine samples from the WIG are collected by the porters and...
Transcript of CLIN 003 User Handbook 2013 · Routine samples from the WIG are collected by the porters and...
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
Page 1 of 44 Last printed 25/02/2014 11:54:00
North Glasgow Clinical Biochemistry Service
Glasgow Royal Infirmary
Gartnavel General Hospital Western Infirmary Glasgow
Stobhill Hospital
http://www.nhsggc.org.uk
Approved by: Linda Mackinnon
IN THE EVENT OF PROBLEMS OR UNFORESEEN EVENTS – CONTACT THE LEAD CLINICIAN
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
Page 2 of 44 Last printed 25/02/2014 11:54:00
CONTENTS
GENERAL INFORMATION........................................................................................ 3 ESSENTIAL SITE-SPECIFIC INFORMATION........................................................... 5
GLASGOW ROYAL INFIRMARY (GRI)................................................................. 5
PRINCESS ROYAL MATERNITY HOSPITAL ....................................................... 9
SPECIMEN COLLECTION AND HANDLING ...................................................... 11 1 REQUEST FORM & PATIENT IDENTITY.......................................................................... 11 2 SPECIMEN LABELLING .................................................................................................... 11 3 PATIENT PREPARATION.................................................................................................. 12 4 SPECIMEN COLLECTION ................................................................................................. 12 5 SPECIMEN PACKAGING .................................................................................................. 12 6 STORAGE PRIOR TO TRANSPORT TO LABORATORY ................................................ 13 7 SAFETY AND DANGEROUS SPECIMENS ...................................................................... 13 8 DISPOSAL OF PHLEBOTOMY EQUIPMENT ................................................................... 14 9 DEALING WITH SPILLAGES AND BREAKAGES ........................................................... 14 10 COLLECTION OF SPECIMENS FROM NEONATES........................................................ 14 11. SAMPLE IDENTIFICATION ............................................................................................... 14
DATA PROTECTION............................................................................................... 14 REFERENCE RANGES........................................................................................... 16
TURN AROUND TIMES............................................................................................................... 26 TUBE TYPES ............................................................................................................................... 26
PREMATURE NEONATES .................................................................................. 28
HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS............. 30
HORMONES OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS .............. 32
HORMONES OF THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS ............ 33
OTHER HORMONES AND BONE MARKERS .................................................... 35
COMMONLY PERFORMED DYNAMIC TESTS .................................................. 36
NUTRITIONAL SCREEN ..................................................................................... 38
PORPHYRINS ...................................................................................................... 39
REQUEST INTERVENTION................................................................................. 40
REFERRAL LABORATORIES ................................................................................ 41 USEFUL TELEPHONE NUMBERS......................................................................... 43 THINGS TO DO TO KEEP THE SERVICE EFFICIENT .......................................... 44
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
Page 3 of 44 Last printed 25/02/2014 11:54:00
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 outwith 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.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
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Point-of-care testing
Blood gas analysers
The Biochemistry Department also 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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User Handbook
Document: CLIN003
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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
Website: http://www.nhsggc.org.uk/biochemistry
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.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
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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 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: urine samples, samples which would be difficult to repeat (e.g. CSF), high risk samples.
Otherwise samples are collected by porters. The ward collection times are as follows:
Weekdays (am) ........8.00am, 9.00am, 10.25am, 11.20am
Weekdays (pm) ........1.00pm, 2.20pm, 3.30pm
Saturdays and Public Holidays..8.00am, 9.00am, 10.30am
Sundays ....................................8.45am, 9.45am
The emergency blood porter must be paged to arrange transport of urgent specimens. In the main hospital Page 1616, in the Queen Elizabeth Building page 1509.
Emergency requests and out-of hours service (ext 24487)
The emergency laboratory is open 24/7. Results of tests requested as an emergency are normally available from ward terminals 60 minutes after the arrival of the specimen.
Note that all requests for emergency analysis must be arranged with the laboratory (ext 24487) 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 will 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.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
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WESTERN INFIRMARY (WIG) & GARTNAVEL GENERAL HOSPITAL (GGH
EMERGENCY REQUESTS 52476
Address Department of Clinical Biochemistry Gartnavel General Hospital 1053 Great Western Road GLASGOW G12 0YN
Fax 0141 211 3452
Website http://www.nhsggc.org.uk/biochemistry
Contacts
Duty Biochemist .................................................24003/4 option 3
General Enquiries ..............................................24003/4
Duty Endocrine Biochemist ................................24362
Specimen Reception ..........................................53347
WIG, Level 7 Emergency Laboratory .................52476
Professor M H Dominiczak, Consultant Biochemist …52788; pager 07659132346
Lab Manager Mr Ian Louden…………………………....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.
The 24/7 emergency laboratory is at the WIG in the G Block, on the ground level.
Reporting Office/ Interpretative Advice
Call the Duty Biochemist on ext 24003/4 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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User Handbook
Document: CLIN003
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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.
Emergency requests and out-of hours service (ext 52476 at WIG)
Results of tests requested as an emergency are normally available from ward terminals 60minutes after the arrival of the specimen.
Note that all requests for emergency analysis must be arranged with the laboratory (ext 52476 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 will 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.
Nutrition Team
Contact Prof M H Dominiczak (ext 52788).
Specialist Toxicology
The following assays are now 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).
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
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PRINCESS ROYAL MATERNITY HOSPITAL
Contacts Duty Biochemist .................................................24003/4 option 3
For Metabolic advice, contact Dr Peter Galloway, Consultant Clinical Biochemist (ext 89034 or on radiopage via switchboard at Southern General Hospital).
Out-of-Hours Service
Contact the GRI on-call BMS (Ext 24487) or Page via switchboard.
Routine Service
All specimens except those for blood gases and metabolic analysis are sent to the Biochemistry Laboratory at GRI and are processed in the Emergency Laboratory (Ext 24487).
Other requests, e.g. hormones are also processed 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
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
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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.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
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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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Document: CLIN003
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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 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.
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Document: CLIN003
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6 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).
7 SAFETY AND DANGEROUS SPECIMENS
• 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 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!
• 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.
Department of Clinical Biochemistry & Immunology North Glasgow
User Handbook
Document: CLIN003
Revision: 16
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8 DISPOSAL OF PHLEBOTOMY EQUIPMENT
Please refer to your local health and safety procedures for the safe disposal of all materials used during specimen collection
9 DEALING WITH SPILLAGES AND BREAKAGES
Please refer to your local health and safety procedures for dealing with spillages and breakages.
10 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 26 and 27.
• 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.
11. 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. A pre-printed label is preferred. Ward/Clinic is essential for reporting results. The laboratory will not process unlabelled specimens.
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.
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Document: CLIN003
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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.
North Glasgow guidelines for computer terminal usage
• Do not allow unauthorised persons to see the data on screens.
• Log off the system when finished.
• Do not by any action or inaction allow disclosure of information, either directly or indirectly, from the system to any unauthorised person
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Document: CLIN003
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REFERENCE RANGES
Please contact the Duty Biochemist for more detailed information on reference ranges (e.g. sex- or age- related reference limits).
Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Adrenocorticotrophin (ACTH)
B Purple top* (1) < 20 mU/L *See page 30 for full sampling requirements.
7 days
Alanine aminotransferase (ALT) ++
B Yellow top (2) < 50 U/L Same day if rec’d before 12 mid-day.
Albumin ++ Albumin Albumin/creatinine ratio (ACR) Albumin excretion rate (AER)
B U U
Yellow top (2) EMU (20) EMU (5) 24 h Plain UC
35 to 50 g/L < 20mg/L < 2.5 mg/mmol < 3.5mg/mmol
< 20 µg/minute
Male Female
1 day Up to 4 days “ “ “ “ “
Aldosterone 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) ++ Alk phos isoenzymes
B B
Yellow top (2) Red top (2)
30 to 130 U/L Qualitative test
Results high in children and pregnancy, and raised in the elderly. Age and sex related ranges available. Only measured if ALP > 200 U/L.
Daily. Same day if rec’d before 12 mid-day. 14 days
α1-Antitrypsin B Yellow top (2) 1.1 to 2.1 g/L Phenotyping available by arrangement.
Same day if rec’d before 12 mid-day.
α-Fetoprotein (AFP) B Yellow top (2) < 6 kU/L As tumour marker only. Send pregnancy AFP to Medical Genetics, RHSC, Yorkhill.
1 day
Aluminium B U RO Water
Heparin* (5) Plain Universal Container (20) Plain Universal Container (20)
< 0.5 µmol/L <1.0 µmol/24 h
< 10 µg/L
10 days
Ammonia B Green top 20 to 44 µmol/L Spin ASAP. Send immediately on ice to Yorkhill Biochemistry Department.
Sent away
Amylase ++
“ Amylase/creatinine clearance ratio
B U U
Yellow top (2) Plain UC (10) Plain UC (10)
< 100 U/L 30 to 600 U/L 1 to 5%
Daily. Same day if rec’d before 12 mid-day.
Androstenedione
B Yellow top (1) -
See page 30 for sampling requirements.
7 days
Angiotensin converting enzyme (ACE)
B Yellow/red top (2) < 88 U/L Same day if rec’d before 12 mid-day.
Anti-Mullerian Hormone (AMH)
B Yellow top (2) Contact Laboratory Please contact the laboratory. 14 days
Anti-thyroid peroxidase antibody (Anti-TPOAb)
B Yellow top (2) < 6 IU/L 1 day
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Apolipoprotein A-1 B Red/purple top (2) 1.0 to 2.2 g/L 1 week
Apolipoprotein B B Red/purple top (2) 0.6 to 1.3 g/L 1 week
Arsenic U Hair
Plain UC * (20) Sealable bag.
< 30 nmol/mmol creatinine <0.5 µg/g
Consult 0141 211 5178 to arrange.
10 days
Ascorbic acid B Green top (2) 15 to 90 µmol/L If delivery to laboratory is outwith 4 hrs contact 0141 211 5178 for sample handling instructions.
10 days
Aspartate aminotransferase (AST) ++
B Yellow top (2) < 40 U/L Same day if rec’d before 12 mid-day.
β2-Microglobulin B Yellow top (2) 1.2 to 2.4 mg/L 5 days
Bence Jones protein U EMU/Plain UC Qualitative test Use serum electrophoresis as first line test.
10 days
Bicarbonate B Yellow top (2) 22 to 29 mmol/L Daily. Same day if rec’d before 12MD.
Bilirubin (Total) ++ Bilrubin (Direct) (Conjugated)
B B
Yellow top (2) < 20 µmol/L <15% total
Only measured if total bilirubin > 45
µmol/L.
Daily. Same day if rec’d before 12MD.
Blood gases (arterial) ++
B Syringe H+: 36 -43 nmol/L PCO2:4.6-6.0kPa PO2:10.5-13.5kPa
10 min
CA125 B Yellow/red top (2)
< 35 kU/L < 25 kU/L
Adult pre-menopausal female. Post-menopausal. Elevated in patients with ascites or pleural effusions.
1 day
Cadmium B U
EDTA (5) 24 h/Plain UC (20)
< 30 nmol/L < 50 nmol/L < 1 nmol/mmol creatinine
Non-smokers Smokers
10 days 10 days
Caeruloplasmin B Yellow/dark blue top (2)
0.16 - 0.47 g/L 0.02 - 0.15 g/L 0.06 - 0.36 g/L 0.13 - 0.47 g/L 0.16 - 0.47 g/L
Adults 0 to 3 months 4 - 6 months 1 - 13 years 10 - 13 years
Same day if rec’d before 12 mid-day.
Calcitonin B Green top* (5) < 15 ng/L *See page 35 for collection requirements.
10 days
Calcium ++ “
B U
Yellow top (2) 24 h/Plain UC
2.20-2.60mmol/L 2.5-7.5 mmol/24 h Ca/Creat ratio 0.04-0. 7
Adjusted = Ca + (0.017 x (43 -albumin)).
Daily. Same day if rec’d before 12 mid-day.
Carbamazepine ++ B *Yellow top (2) 4.0 to 12.0 mg/L *Pre dose sample preferred. Conversion Factor (molar into mass units)
µmol/L x 0.24 = mg/L.
1 day
Carcinoembryonic antigen (CEA)
B Yellow top (2) < 5 µg/L 1 day
Carboxyhaemoglobin ++
B Syringe < 5% of total haemoglobin
1 hour
Carotenoids B Green/red top (2) - See Vitamin A, page 24. 10 days
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Catecholamines adrenaline noradrenaline dopamine
U 24 h/acid < 230 nmol/24 h < 900 nmol/24 h < 3300 nmol/24 h
Give full drug history. Avoid Paracetamol-containing medication for at least 48 h prior to starting urine collection.
10 days
Carbohydrate-deficient transferrin (CDT)
S Yellow top <1.7% Approx 14 days
Chloride ++ “
B U
Yellow top (2) 24 h/Plain UC
95 to 108 mmol/L 150 - 250 mmol/24h
Daily. Same day if rec’d before 12 mid-day.
Cholesterol (β-Quant ultracentrifugation- total Cholesterol, VLDL, LDL, HDL)
B Purple/red/ yellow top (7)
10 days
Cholesterol (Total) LDL(calculated) HDL
B
Yellow top (2)
< 5.0 mmol/L desirable in ‘at-risk’ individuals. <3.0 mmol/L desirable in ‘at risk’ individuals. >1.0 mmol/L desirable in ‘at risk’ individuals. Calculated LDL = Chol – HDL-C - 0.46 x trig
Daily. Same day if rec’d before 12 mid-day.
Chromium B U
Purple top (7) Random/plain UC (10)
< 40 nmol/L < 6.0 nmol/mmol creatinine
MHRA action limit: 135nmol/L (7 µg/L)
10 days
Cobalt B U
Purple top (7) Random/plain UC (10)
< 50 nmol/L < 1.6 nmol/mmol creatinine
MHRA action limit: 120nmol/L (7 µg/L)
10 days
Copper B
U Liver
Heparin/plain (5)
24 h/Plain UC (20) Plain UC
10 - 22 µmol/L
11 - 25 µmol/L
27 - 49 µmol/L
1.5 - 7.0 µmol/L
4.0 - 17.0 µmol/L
8.0 20.5 µmol/L
12.5 22.0 µmol/L
< 0.6 µmol/24 h 8 - 40 µg/g dry weight
(male) (female) (pregnancy)
(0-3 months)
(4-6 months)
(7-12 months)
(1-13 years)
4 days
4 days 6 days
Cortisol “ Cortisol/Creatinine ratio
B U
Yellow top* (2) 24 h/plain UC (10) or EMU/*Plain UC (10)
240 - 600 nmol/L 50 - 290 nmol//L < 250 nmol/24 h
< 25 µmol/mol creatinine
7 to 9 am 9pm-12am *See page 31 for full details. *See page 31 for full details.
1 day 7 days
C-Reactive protein (CRP) ++
B Yellow top (2) < 10 mg/L Daily. Same day If rec’d before 12 pm
Creatine kinase (CK) ++ B Yellow top (2) F 25-200 U/L M 40-320 U/L
Daily. Same day if rec’d before 12 mid-day.
Creatinine ++ “ Creatinine clearance (CL Monday to Friday only)
B U U+ B
Yellow top (2) 24 h/Plain UC 24 h/Plain UC + Yellow top (2)
40 - 130 µmol/L 9.0 - 18.0 mmol/24 h 80 - 140 mL/min
Age and sex related ranges available. Varies with age, and sex. Requires serum creatinine on a sample taken during the urine collection period.
Daily. Same day if rec’d before 12 mid-day.
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Cryoglobulin Cryofibrinogen
B B
Red top (2) Purple top (2)
Normally absent Normally absent
Arrange with Duty Biochemist for warm flask. At WIG and GGH contact Immunology Dept.
3 days 3 days
CSF glucose ++
CSF Grey top (1) > 70% of plasma glucose
Compare with simultaneous plasma glucose.
1 hour
CSF xanthochromia CSF Plain UC (1) Qualitative test Send sample to laboratory without delay. Record exact time of sampling on request form. Arrange with local laboratory.
Sent Away
CSF protein ++ CSF Plain UC (2) < 0.45 g/L Contamination with blood renders this test invalid.
1 hour
Dehydroepiandrosterone sulphate (DHAS)
B Yellow top* (1) 2.5 - 16 µmol/L
2 - 12.5 µmol/L
Male (16-50 yrs) Female (16-50 yrs)
7 days
Digoxin ++ B Yellow top (2) 0.5 to 2.0 µg/L *Collect at least 6h post-dose Conversion Factor (molar into mass
units) nmol/L x 0.78 = µg/L.
1 day
Drugs of abuse screen ++
U Random/plain UC (20)
Qualitative test Screen for amphetamines, metamphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, opiates, phencyclidine and tricyclic antidepressants
Available out-of-hours as an emergency.
Ethanol B Grey Top (2) Reported in mg/dL 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.
1 day (available out of hours)
Calprotectin Faeces (F)
Plain UC/ Random (1-5 g)
0-50 µg/g of stool <10 Not detected. ?IBS. 10-50 Within reference range. ?IBS. 51-100 Suggests possible GI inflammation. 101-200 Suggests probable GI inflammation. >200 Consistent with Active GI inflammation.
7 days
Faecal osmotic gap F Plain UC/ Random (10g)
< 75 mosmol/kg > 75 mosmol/kg
Secretory diarrhoea Osmotic diarrhoea
7 days
Faecal pH F Plain UC/ Random (10g)
< 6.5 bile acid diarrhoea is unlikely > 5.6 carbohydrate induced diarrhoea unlikely
Send to laboratory ASAP, within 2 hours.
7 days
Fasting lipid profile B Yellow top (5) See individual components
Total cholesterol, triglycerides, HDL-cholesterol. Fasting sample.
1 day
Follicle stimulating hormone (FSH)
B Yellow top (2) Sex, age and cycle related
See page 33 for full reference ranges.
2 days
Gamma glutamyl transferase (GGT) ++
B Yellow top (2) < 70 U/L < 40 U/L
Male Induced by many drugs. Female
Same day if rec’d before 12 mid-day.
Gastrin B Green top* (2) < 120 ng/L *See page 35 for full collection requirements.
20 days
Gentamicin B Yellow top* (2) See prescribing protocols
Trough: pre-dose Peak: 1 hour post- dose.
4 hours
Globulins ++ B Yellow top (2) 23 to 38 g/L Calculated value (total protein - albumin).
1 day.
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Glucose ++ “ ++
B CSF
Grey top (2) Grey top (0.5)
3.5 to 5.5 mmol/L > 70% of plasma glucose
Fasting. Compare with simultaneous plasma glucose.
Daily. Same day if rec’d before 12 mid-day.
Glutathione Peroxidase B Heparin/EDTA (2) 15-50 IU/g Hb 20 days
Growth hormone
B Yellow top (2) < 0.4 µg/L excludes acromegaly
Fasting; avoid stress. 7 days
Gut hormone screen B Green top* (7) - *Fasting patient. Contact laboratory for Trasylol/ heparin tubes and precautions. Gastrin, pancreatic polypeptide, glucagon, neurotensin, VIP, chromogranin A, chromogranin B measured.
4 weeks
Haemochromatosis gene (HFE)
B EDTA (Purple) (1) Qualitative result 30 days
Haemoglobin A1c (HbA1c)
B Purple (2) < 7% > 8%
Good glycaemic control Poor control
Haptoglobin B Yellow (2) 0.3 to 2.0 g/L Same day if rec’d before 12 mid-day.
Helicobacter pylori serology
B Yellow/Red top (2) Qualitative Test Compliance with Dyspepsia Management Guidelines (DMG) required.
1 week
Human chorionic gonadotrophin (HCG)
B Yellow top (2) < 5 U/L Varies with gestational age
When used as tumour marker. When used in obstetrics.
1 day
Hydrogen breath test Breath - - By arrangement, call GI Investigation Unit, GRI (Ext 25074). For diagnosis of small bowel overgrowth and lactose intolerance.
Immediate
Hydrogen ion B Syringe (1) 36 to 43 nmol/L 10 min
5-Hydroxy indole acetic acid (HIAA)
U 24 h/acid < 50 µmol/24 h Elevated by dietary walnuts, bananas, tomatoes, avocado, kiwi fruit, pineapple, plantain, plums, pecan nuts. Avoid for 3-4 days prior to starting urine collection.
10 days
17-Hydroxy progesterone
B
Yellow top* (0.5 to 2.0)
< 12 wks of age <40 nmol/L >12 wks of age <13 nmol/L
Adults and normal infants (>4 days). *See page 30 for full details.
7 days. Same day by arrang
t.
Immunoglobulins B Yellow top (2) 6 to 16 g/L* 0.8 to 4.0 g/L* 0.4 to 2.0 g/L*
IgG IgA IgM *Age-related reference range available. Paraproteins quantitated and typed.
1 day 7 days
Insulin-like growth factor (IGF1)
B Yellow top (2) Adults (20 to 60 years). Varies with age. See page 35 for reference ranges.
7 days
Insulin Amended insulin/Glucose ratio
B B
Green top(2)*
< 13 mU/L < 5.0
*See page 35 for full collection details. Collect glucose sample at same time. .
7 days
Insulin C-peptide Green top(1)* 0.36 to 1.12 nmol/L *See page 35 for full collection details
7 days
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Iron ++ Transferrin saturation ++ Iron Iron
B U Liver
Yellow top (2) Plain Universal Container (20) Plain Universal Container
10 to 30 µmol/L
<1.0 µmol/24 h 0.17 - 1.40 mg/g dry weight
Consider haemochromatosis if: >60% (M) or >50% (F)
Hepatic Iron Index 0 - 2.0 µmol iron/gram liver/year
4 days 6 days 10 days
Lactate ++ B Grey top (2) 0.5 to 2.2 mmol/L By arrangement only. Send to WIG for analysis.
Lactate dehydrogenase (LDH) ++
B Fluid
Yellow top (2) Red top (5)
80 to 240 U/L > 120 U/L
Pleural fluid/serum LDH > 0.6: consistent with exudate.
Lead B U
Purple top (5)* Plain Universal Container (20)
< 0.5 µmol/L < 4.5 nmol/mmol creatinine
Legal limit: 2.9 µmol/L Telephone 0141 211 5178 if rapid turnaround is required. Legal limit: 60 nmol/mmol creatinine
5 days 10 days
Lipoprotein A (Lp(a)) B Red/purple top (2) < 30 mg/dL Increased coronary risk over 30mg/dL.
3 days
Lithium ++ B Yellow top* (2) 0.4 to 1.0 mmol/L *Other ranges acceptable depending on clinical circumstances.
1 day
Luteinising hormone (LH)
B Yellow/red top (2) *Sex, age and cycle related
*See page 31 for full reference ranges.
2 days
Macroprolactin B Yellow top (2) 7 days
Magnesium ++ “ “
B U F
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
Excludes magnesium-induced diarrhoea.Sample should be received in lab within six hours after collection. Refrigerate and send on ice ASAP.
Same day if rec’d before 12 mid-day. 5 days 5 days
Manganese B Heparin/EDTA* (5) 70 to 280 nmol/L 6 days
Mercury B U Hair
Heparin/EDTA (5) Plain Universal Container (20) Plain Universal Container (20)
<30 nmol/L <5 nmol/mmol creatinine <2 µg/g
Telephone 0141 211 5178 if rapid turnaround is required. Contact 0141 211 5178 to arrange.
10 days 10 days
Methaemoglobin B Green top/syringe (1)
<1.5% Send ASAP; protect from light. 1 hour
Methotrexate B Red top (2) See Protocols Toxic levels: >10
µmol/L at 24 hrs
>0.5 µmol/L at
48 hrs, >0.1 µmol/L at 72 hrs
LLD: 0.1 µmol/L.
Interpretation related to time since start of dose. If the patient has had prep of mass monoclonal A/B or had carboxypeptidase G2 as a rescue therapy the specimen should not be tested by this assay
Available as an emergency by arrang
t.
Microalbumin Albumin/creatinine ratio (ACR) Albumin excretion rate
U U U
EMU/plain UC (5) EMU/plain UC(5) 24 h/plain UC (5)
< 20 mg/L <2.5 mg/mmol creat <3.5 mg/mmol creat
AER <20 µg/min
Male Female
2 days
Micronutrient screen B Heparin (5) + Trace Element Tube (5)
See under individual analytes
Includes copper, zinc, selenium, manganese and vitamins A, B1, B2, B6, C and E.
10 days
Oestradiol (E2) B Yellow top (2) *Sex and cycle related
*See Page 34 for full details of ref ranges.
2 days
Osmolality ++ “ ++
B U
Yellow top (2) Random/plain UC (5)
275 to 295 mmol/Kg Variable
Fresh specimen required.
Same day if rec’d before 12 mid-day.
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Oxalate “
U 24 h/acid 0.08-0.49 mmol/24 h 0.04-0.34 mmol/24 h
Male Female Children: reference ranges for oxalate/creatinine ratio are available
14 days
Paracetamol ++ B Yellow top (2) Refer to BNF diagram. Treatment levels –100 mg @ 4 h 50 mg @ 8 h 25 mg @ 12 h
Collect at least 4 hours post-dose. Relate to time after dose to assess hepatotoxicity. See chart (available from Biochemistry and in the BNF) for interpretation. Conversion Factor (molar into mass units) mmol/L x 151 = mg/L.
1 hour
Parathyroid hormone (PTH)
B Purple top* (2) 1.6 to 7.5 pmol/L Sample stable for up to 8 hrs in EDTA.
1 day
PCO2 (arterial) ++ B Syringe (1) 4.6 to 6.0 kPa Send on ice, within 30 minutes.. 10 min
pH ++ “
U F
Plain UC Plain UC (5 g)
>5.9
Contact laboratory. Excludes carbohydrate malabsorption.
10 min
Phenobarbitone ++ B Yellow top (2) Neonates: 15.0-30.0 mg/L Adults: 15.0-40.0 mg/L
*Collect pre-dose (not critical). Conversion Factor (molar into mass
units) µmol/l x 0.23 = mg/L
1 day
Phenytoin ++
B
Yellow top (2)
Neonates: 6.0-15.0 mg/L Adults: 10.0-20.0 mg/L
*Pre-dose sample preferred. Conversion Factors (molar into mass
units) µmol/L x 0.25 = mg/L.
1 day
Phosphate ++
B U
Yellow top (2)l 24 h/plain UC
0.8 to 1.5 mmol/L 13 - 39 mmol/24 h
Varies with diet.
Daily. Same day if rec’d before 12 pm. Urine: Mon-Fri.
PO2 (arterial) ++ B Syringe (1) 10.5 to 13.5 kPa Send on ice, within 30 minutes. 10 min
Porphobilinogen U Plain UC (20) < 10 µmol/L Protect from light - See page 39 10 days
Porphyrin screen
B U F
Purple/yellow top (5) Plain UC (20) Plain UC (10 g)
Qualitative test < 300 nmol/L 10-200 nmol/g dry weight
Protect from light. } Protect from light. } See page 39 Protect from light. }
2-6 weeks 10 days 10 days
Potassium ++ “ “
B U U
Yellow top (2) 24 h/plain UC Random/plain UC
3.5 to 5.3 mmol/L 25 to 125 mmol/L Varies with diet
Invalid in old/ haemolysed samples. Interpret with serum concentration.
Daily. Same day if rec’d before 12 mid-day.
Pregnancy test ++ U EMU/plain UC (20) Qualitative result Sensitivity: 25 U/l HCG. Test becomes positive approximately 7-10 days after conception.
3 days
Prostate-specific antigen (PSA)
B Yellow top (2) Age 50 -59 y
PSA <3.0 µg/L Age 60-69 y
PSA <4.0 µg/L Age > 70 y
PSA <5.0 µg/L
1 day
Progesterone B Yellow/red top (2) > 20 nmol/L* Confirms ovulation if taken in mid-luteal phase.
1 day
Prolactin B Yellow top (2) Male < 400 mU/L Female < 630 mU/L
Avoid stress. Macroprolactin screen carried out if prolactin >700 mU/L on second occasion.
1 day
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Protein ++ “ “ “
B U CSF Fluid
Yellow top (2) 24 h/plain UC Plain UC (2) Red top (2)
60 to 80 g/L < 150 mg//24 hour < 0.45 g/L < 30 g/L
Avoid venous stasis. Contamination with blood renders this test invalid. Pleural fluid/serum protein > 0.5: consistent with exudates.
2 days 1 hour
Protein electrophoresis B Yellow top (2) - Paraprotein quantitation and typing. 7 days 14 days if immuno-fixation required.
Renin concentration B Purple top* (5) Adults (supine) < 40 mIU/L Adults (ambulant) < 52 mIU/L
*See page 30 for full sampling requirements.
14 days
Salicylate ++ B Yellow top (2) Intoxication: > 350 mg/L Severe Toxicity: > 700 mg/L >280 mg/L , if under 5 years
Conversion Factor (molar into mass units) mmol/L x 138 = mg/L
1 hour
Selenium B Heparin/EDTA/plain (5)
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
Adult
0 - 2 years 2 - 4 years
4 - 16 years
4 days
Sex hormone-binding globulin (SHBG)
B Yellow top (10) 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
Male <50 years Female <50 years Boys 5 – 10 years 11 – 13 years Girls 5 – 10 years 11 – 13 years
2 days
Sodium ++ “
B U
Yellow top (2) 24 h/plain UC
133 to 146 mmol/L Varies with diet
Daily. Same day if rec’d before 12 mid-day.
Steroid metabolite profile
U See comments Diagnosis and investigation of inherited steroid biosynthetic disorders and steroid producing tumours. By arrangement only. Sampling requirements A 5 ml aliquot of urine from a volumed 24 hour collection (in a plain container) is preferred for adults and children over 10 years of age. Random 5 ml samples from children up to 10 years will be accepted. In babies, a minimum volume of 1ml can be processed. Samples preserved in borate are acceptable.
20 working days
Stone analysis Stone Plain UC Qualitative test 30 days
Testosterone
B Yellow top (10) 10 to 36 nmol/L 0.5 to 3.2 nmol/L
Male (<50 years) Female (<50 years)
2 days 10 days if extraction required.
Free androgen index (Testo. x 100)/SHBG
Not applicable < 7
Male Female
2 days
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Theophylline ++ B Yellow top (2) Neonates: 5.0 to 10.0 mg/L 1 Month - 1 year: 5.0 -15.0 mg/L Adults: 10.0 to 20.0 mg/L (5.0 to 10.0 mg/L adequate in some circumstances).
Collect pre-dose or > 8 hours post-dose for slow-release preparations. Conversion Factor (molar into mass
units) µmol/l x 0.18 = mg/L.
1 day
Thyroglobulin (Tg) and Thyroglobulin antibody (TgAb)
B Yellow top (10) Tg or adults with intact thyroids TgAb <40 IU/mL
Post-thyroidectomy for thyroid cancer.
7 days
Thyroid stimulating hormone (TSH)
B Yellow top (2) 0.35 to 5.0 mU/L 2 days
Thyrotrophin receptor antibodies (TRAb)
B Yellow top (10) < 15 U/L 14 days
Thyroxine, free (fT4) B Yellow top (2) 9.0 to 21.0 pmol/L 14 days
Transferrin Transferrin saturation
B B
Yellow top (2) Yellow top (2)
2.0 to 4.0 g/L
Consider haemochromatosis if > 60% (M) or > 50% (F)
Daily. Same day if rec’d by 12 mid-day
Triglyceride
B Yellow top (2) < 2.3 mmol/L Fasting sample required. 1 day
Triiodothyronine (T3)
B Yellow top (2) 0.9 to 2.5 nmol/L 2 days
Troponin I Bl Yellow top (2) < 0.04 µg/L Take sample at least 12h after onset of symptoms to exclude acute coronary syndrome.
2 hours
Urate ++ “ “ Urate
B “ “ U
Yellow top (2) “ “ 24 h/plain UC (10)
0.20 -0.43 mmol/L 0.14 -0.36 mmol/L 0.11 -0.30 mmol/L 1.5 to 4.5 mmol/24 h
Males Female <9 years (M and F)
Daily. Same day if rec’d before 12 mid-day. Urine: Mon-Fri.
Urea ++ “
B U
Yellow top (2)l 24 h/red top
2.5 to 7.8 mmol/L 160 to 500 mmol/24h
Daily. Same day if rec’d before 12 mid-day. Urine: Mon-Fri.
Urea breath test Breath * < 1.3 del/ml Negative 1.3 to 1.7 del/ml Equivocal >1.7 del/ml Positive
Diabact UBT Kit. 7 days
Valproate B Yellow top (2) 50 to 100 mg/L (poor correlation between serum concentration and effect)
*Collect pre-dose (not critical). Only useful to detect toxicity or non-compliance. Conversion Factor (molar into mass
units) µmol/L x 0.14 = mg/L.
1 day
Vancomycin B Yellow top (2) See Prescribing Protocols.
Trough: pre-dose. 4 hours
Vitamin A (retinol)
B Heparin/EDTA/ plain (5) Heparin preferred
1.0 to 3.0 µmol/L Age-related range
0.5 to 1.5 µmol/L
>18 years. Light-sensitive; wrap in tinfoil if delivery to <1 yr Lab is outwith 24 h.
10 days 10 days
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Analyte Type of sample
Container (volume, ml)
Reference range Comments Turnaround time
Carotenoids:
α-carotene
β-carotene, Lutein Lycopene
0.7 to 1.5 µmol/L
0.9 to 1.7µmol/L
0.9 to 2.5 µmol/L
14 to 60 µg/L
90 to 310 µg/L
80 to 200 µg/L
100 to 300 µg/L
1-6 yrs 7-12 yrs 13-18 yrs
Vitamin B1 (thiamine diphosphate)
B Heparin/EDTA (5) Heparin preferred
275 to 675 ng/g Hb Contact 0141 211 5178 for sample handling instructions if delivery is outwith 72 days.
10 days
Vitamin B2 (flavin adenine nucloetide)
B Heparin/EDTA (5) Heparin preferred
1.0 to 3.4 nmol/g Hb Light sensitive; wrap in tinfoil. Contact 0141 211 5178 for sample handling instructions if delivery is outwith 72 days.
10 days
Vitamin B6 (pyridoxal phosphate)
B Heparin/EDTA (5) Heparin preferred
250 to 680 pmol/g Hb
Light sensitive; wrap in tinfoil. Contact 0141 211 5178 for sample handling instructions if delivery is outwith 48 days.
10 days
Vitamin C (ascorbic acid)
B Heparin/EDTA/ plain (5) Heparin preferred
15 to 90 µmol/L If delivery to laboratory is outwith 4 h contact 0141 211 5178 for sample handling instructions.
10 days
Vitamin D 25- Hydroxy vitamin D
B Yellow top (2) < 25 nmol/L 25 - 49 nmol/L > 50 nmol/L
Vitamin D deficient, consider supplementation. Borderline low 25-hydroxyvitamin D. Risk of developing secondary hyperparathyroidism. Consider increase in Vitamin D intake. Adequate Vitamin D
14 days
1,25-Dihydroxy vitamin D
B Yellow top (2) 20 to 120 pmol/L 30 days
Vitamin E (tocopherol) B Heparin/EDTA/plain (5) Heparin preferred
3.5 to 9.5
µmol/mmol cholest- erol
Light-sensitive; wrap in tinfoil if delivery to laboratory is outwith 24h.
10 days
Zinc Zinc
B
U
Heparin* (5)
24 h/Plain UC (20)
10.7 - 18 µmol/L
10.0 - 18 µmol/L
3.0 - 21.0 µmol/24 h
Males Blood should be spun Females within 6 h or within 24 h if refrigerated.
4 days 10 days
Zinc protoporphyrin (ZPP)
B EDTA (5) 30 - 80 µmol/mol Hb 6 days
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TURN AROUND TIMES
Turnaround time is calculated from time of receipt to printed report generation. Results are generally available electronically following authorisation. Telephoned emergency requests are normally available electronically one hour after specimen receipt.
TUBE TYPES
Colour-coded tubes: types of preservative- Explanation of abbreviations
Early morning urine in plain Flouride/oxalate SST Tube Heparin Plain EDTA Trace element tube Universal Container- no preservative
EMU Grey top Yellow top Green top Red top Purple Dark- blue top UC
++ Test available at all times
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Maternal third trimester: reference ranges for guidance
Analyte Type of Sample
Container (Volume, ML)
Reference Range Comments
Alanine aminotransferase (ALT) B Yellow top (2) < 50 U/L
Albumin B Yellow top (2) 30 to 42 g/L Avoid venous stasis.
Alkaline phosphatase (Alk Phos) B Yellow top (2) < 40 to 150 U/L
Amylase B Yellow top (2) < 100 U/L
Aspartate aminotransferase (AST) B Yellow top (2) < 40 U/L
Bicarbonate B Yellow top (2) 17 to 26 mmol/L
Bilirubin B Yellow top (2) 3 to 14 µmol/L Protect from light.
Blood gases (arterial)
B Syringe H+: 36 - 43 nmol/L
PCO2: 3.0 - 5.0 kPa PO2: 10.5 - 13.5 kPa
Analyse promptly or send on ice, within 30 minutes.
Calcium Calcium
B Urine
Yellow top (2) Plain Universal Container
2.10 - 2.60 mmol/L 2.5 - 7.5 mmol/24 hr
Adjusted = Ca + (0.17 x (43 albumin)).
Chloride B Yellow top (2) 97 to 107 mmol/L
Creatinine Creatinine clearance “
B Urine + B
Yellow top (2) 24 h/ plain Universal Container + Yellow top (2)
40 to 85 µmol/L 80 to 140 mL/minute
Serum creatinine required on a sample taken during the urine collection period.
Gamma glutamyl transferase (GGT) B Yellow top (2) < 55 U/L
Glucose B Yellow top (2) 3.0 to 5.5 mmol/L Fasting
Hydrogen ion B 1, Syringe 36 to 43 mmol/L Analyse promptly or send on ice, within 30 minutes.
Magnesium B Yellow top (2) 0.6 to 0.8 mmol/L
Osmolality B Yellow top (2) 270 to 285 mmol/kg
PCO2 (arterial) B Syringe (1) 3.0 to 5.0 kPa Analyse promptly or send on ice, within 30 minutes.
Phosphate B Yellow top (2) 0.9 to 1.5 mmol/L Invalid in old/haemolysed samples.
PO2 (arterial) B Syringe (1) 10.5 to 13.5 kPa Analyse promptly or send on ice, within 30 minutes.
Potassium B Yellow top (2) 3.2 to 4.6 mmol/L Invalid in old/haemolysed samples.
Protein B Yellow top (2) 55 to 70 g/L Avoid venous stasis.
Sodium B Yellow top (2) 132 to 140 mmol/L
Urate B Yellow top (2) < 0.34 mmol/L
Urea B Yellow top (2) 1.0 to 4.0 mmol/L
Symbols abbreviations and notes
Fluoride-oxalate SST Heparin Plain Universal Container
Grey top Yellow top Green top No preservative
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PREMATURE NEONATES
Analyte Type of sample
Container & Volume (mL)
Reference range Comments
Adrenocorticotrophin (ACTH) B Purple top (0.5) < 25 mU/L Arrange with Duty Biochemist Ext 24362. Send on ice ASAP.
Alanine aminotransferase (ALT) B Green top (*) < 80 U/L
Albumin B Green top (*) 25 to 35 g/L
Aldosterone B Green top (1) < 5500 pmol/L 500 - 4450 pmol/L
< 1 month. 1 to 6 months. Arrange with Duty Biochemist Ext 24362. Send on ice ASAP.
Alkaline phosphatase (Alk Phos)
B Green top (*) < 600 U/L If > 1000U/L x-ray for rickets.
Ammonia B Green top (0.2) < 100 µmol/L
> 200 µmol/L
Send promptly to Biochemistry, RSHC, Yorkhill, for analysis. Investigate further.
Aspartate aminotransferase (AST)
B Green top (*) < 80 U/L
Bicarbonate B Green top (*) 15 to 25 mmol/L
Bilirubin: total conjugated
B B
Green top (*) Green top (*)
<10 µmol/L
See transfusion/phototherapy chart. Protect from light.
Blood gases (arterial)
B Syringe H+: 36 - 44 nmol/L
PCO2:4.0- 6.5 kPa PO2: 6.5 - 9.0 kPa
Analyse promptly. Aim to maintain. Aim to maintain within stated range. Aim to maintain within stated range.
Calcium B Green top (*) 2.00- 2.70 mmol/L Not adjusted for variation in albumin.
Chloride B Green top (*) 95 to 110 mmol/L
Copper B Green top (0.2)
Creatinine B Green (*) < 80 µmol/L Initially reflects Mother’s then falls over first 6 weeks of life.
Gamma glutamyl transferase (GGT)
B Green (*) < 100 U/L
Glucose “
B CSF
Grey top (*) Grey top
2.5 to 10 mmol/L 2.5 to 4.0 mmol/L
Random. When on IV fluids. > 70% of plasma concentration.
Hydrogen ion B Syringe 36 to 44 mmol/L Analyse promptly. Aim to maintain.
17-Hydroxy progesterone B Green top (0.5) Blood spot
< 40 nmol/L > 50 nmol/L
Arrange with Duty Biochemist Ext 24362. Send on ice. Congenital adrenal hyperplasia.
Hypoglycaemia screen insulin cortisol
B Green top (1) Discuss Discuss
Only take when hypoglycaemic (Glu < 2.6 mmol/L) and on high glucose intake (> 12mg/kg/min). Arrange with laboratory. Send on ice ASAP.
Lactate B Green top (0.2) 0.7 to 2.5 mmol/L 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%
Target: Only if on nitrous oxide (NO) Treatment. Send ASAP. Protect from light. Decrease NO by 50%. Stop NO.
Osmolality B Green top (*) 270 to 300 mmol/kg
Parathyroid hormone (PTH) B Purple Top
1.0, E 1.6 to 7.5 pmol/L Sample stable for up to 8 hrs in EDTA.
PCO2 (arterial) B 1, Syringe 4.0 to 6.5 kPa Analyse promptly. Aim to maintain within stated range.
Phenobarbitone B Green top (0.5) 15 to 30 mg/L 1 hour post 5th dose, or random.
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Analyte Type of sample
Container & Volume (mL)
Reference range Comments
Phenytoin B Green top (0.5) 6 to 15 mg/L 1 hour post 5th dose, or random.
Phosphate B Green top (*) 1.5 to 2.6 mmol/L Invalid in old/haemolysed samples.
PO2 (arterial) B Syringe (1) 6.5 to 9.0 kPa Analyse promptly. Aim to maintain within stated range.
Potassium B Green top (*) 3.5 to 6.0 mmol/L Invalid in old/haemolysed samples.
Protein “
B CSF
Green top (*) Plain UC
45 to 70 g/L 250 to 900 mg/L 250 to 700 mg/L 150 to 450 mg/L
Neonate. Unsuitable if blood stained or xanthochromic. 1 month. 6 months.
Renin concentration B 1, E Arrange with Duty Biochemist Ext 24362.
Sodium B Green top (*) 130 to 145 mmol/L
Theophylline B Green top (*) 5 to 10 mg/L *Collect pre-dose (not critical).
Thyroid function tests: Thyroid stimulating hormone (TSH) Thyroxine (free T4)
B B
Green top (1.0)
0.2 to 15 mU/L > 50 mU/L 6 to 30 pmol/L
5-day olds to adults. Congenital hypothyroidism.
Trace element screen copper manganese zinc
B Green top (0.5)
Triglyceride 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)
Symbols abbreviations and notes
Fluoride-oxalate Heparin EDTA Plain Universal Container (no preservative)
Grey top Green top Purple top Plain UC Refer to Table on Page 26
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HORMONES OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
A) Assays performed in serum or plasma
Sample requirements Analyte
Type of sample
Container & volume (ml)
Precautions
Subjects
Reference values & action limits
Adrenocorticotrophin (ACTH) Blood Purple top (1) a, b, e, f, tf Adults 0700-0900 hours < 20 mU/L
Aldosterone
Blood Yellow top (1.5)
Adults Adults Neonates 0-1 month Neonates 1-6 month
100 - 400 pmol/L (supine) 100 - 800 pmol/L (upright) 1060 - 5480 pmol/L 500 - 4450 pmol/L
Androstenedione Blood Yellow top (1) - Adult men 18 - 40 years Adult men 41 - 65 years Adult Women 18 - 40 years Adult Women 41 - 65 years Prepubertal children
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
Cortisol Blood Yellow top (2) e, f Adults 7- 9 am Adults 9 pm – 12 mid-night Morning to Evening
240 - 600 nmol/L 50 - 290 nmol/L > 100 nmol/L
Dehydroepiandrosterone sulphate (DHAS)
Blood Yellow top (1) - Adult men (16-50 years) Women (16-50 years) Prepubertal children
2.5 - 16 µmol/L 2 – 12.5 µmol/L < 2.5 µmol/L
17-Hydroxyprogesterone Blood Yellow top (0.5 to 2)
e Adults 7- 9 am Normal infants (>4 days) Stressed/Premature infants Proven Congenital Adrenal Hyperplasia
< 13 nmol/L < 13 nmol/L < 40 nmol/L > 50 nmol/L
Plasma Renin Concentration Blood Purple top (5) b, tf, g 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.
< 40 mIU/L < 52 mIU/L
Symbols and abbreviations
EDTA - Purple top a - Haemolysed specimen unsuitable Gel - Yellow top b - Separate and freeze specimen immediately Heparin - Green top d - Collect after overnight fast NP - No Preservative e - Timing of collection important Plain - Red top f - Avoid Stress g - Do not store or centrifuge at 4° C h - Contact Laboratory j - Ful EDTA tube required tf - Transport frozen (not whole blood)
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B) ASSAYS PERFORMED IN URINE
Sample requirements
Analyte
Type of
sample
Container & volume (ml)
Precautions
Subjects
Reference values &
action limits
Cortisol (UFC) Urine 5, Pl/EMU or 24 hours NP Adults (EMU)
Adults (24 hour)
Children ≤10 yrs
< 25 µmol/mol creatinine
< 250 nmol/24 hours
< 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.
Symbols and abbreviations
Pl NP
Plain Universal Container (no preservative) No preservative
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.
Criteria for normal response Adequate >450 nmol/L Inadequate <450 nmol/L
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HORMONES OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS
A) Assays performed in serum
Sample requirements Analyte
Type of sample
Container & volume (mL)
Precautions
Subjects
Reference values & action limits
Tiiodothyronine (T3) Blood Yellow top (2) Adults 0.9 - 2.5 nmol/L
Thyroid stimulating hormone (TSH) Blood Yellow top (2)
Adults Infants < 15 days
0.35 - 5.0 mU/L < 25 mU/L
Free thyroxine (fT4) Blood Yellow top (2) Adults 9.0 - 21 nmol/L
Anti-thyroid peroxidase antibody (anti-TPOAb)
Blood Yellow top (2) Adults < 6 IU/L
Thyrotrophin receptor antibody (TRAb)
Blood Yellow top (1) Adults < 15 U/L
Symbols and abbreviations
Gel Yellow top
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HORMONES OF THE HYPOTHALAMIC-PITUITARY-GONADAL AXIS
A) Assays performed in serum
Sample requirements Analyte
Type of sample
Container & volume (ml)
Precautions
Subjects
Reference values & action limits
Prolactin Blood Yellow top (2) f Males Females
< 400 mU/L < 630 mU/L
Follicle stimulating homone (FSH)
Blood Yellow top (2) Infants < 11 years Menstruating women - follicular phase - mid-cycle - luteal phase Postmenopausal women
*
Men (<50 years)
0.6 - 3.6 U/L 3 - 8 U/L 2 -16 U/L 1 - 5 U/L 18 - 150 U/L 1 - 12 U/L
Luteinising hormone (LH)
Blood Yellow top (2) Infants < 11 years Menstruating women - follicular phase - mid-cycle - luteal phase Postmenopausal women
Men (<50 years)
ud - 3.4 U/L 2 - 13 U/L 34 - 115 U/L 1 - 16 U/L 16 - 64 U/L 2 - 12 U/L
Symbols, abbreviations and notes
Gel
f
ud
Yellow top
Avoid stress
Undetected
FSH > 25 U/L in an amenorrhoeic woman suggests ovarian failure/menopause
More information can be found in Laboratory Investigation of the Menopause. Contact Duty Endocrine Biochemist (ext 24362).
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Sample requirements Analyte
Type of sample
Container & volume (ml)
Precautions
Subjects
Reference values & action limits
Oestradiol (E2) Blood Yellow top (2) -
Women: follicular phase mid-cycle luteal phase Postmenopausal Men
77 - 920 pmol/L 140 - 2380 pmol/L 77 - 1145 pmol/L <100 pmol/L <160 pmol/L
Progesterone Blood Yellow top (2) e Menstruating women - follicular phase - mid-cycle - luteal phase Pregnant women 9 - 16 weeks gestation 16 - 18 weeks gestation 28 - 30 weeks gestation Term Postmenopausal women Men (<50 years)
<2 nmol/L >1 - 4 nmol/L 18 - 72* nmol/L 50 - 130 nmol/L 65 - 250 nmol/L 180 - 490 nmol/L 350 - 790 nmol/L <2 nmol/L <2 nmol/L *Progesterone > 20 nmol/L in an untreated cycle is consistent with ovulation
Testosterone Blood Yellow top (1) -
Men (<50 years) Women (<50 years)
10 - 36 nmol/L 0.5 - 3.2 nmol/L
Sex hormone- binding globulin (SHBG)
Blood Yellow top (1) -
Men (<50 years) Women (<50 years)
13 - 70 nmol/L 20 - 155 nmol/L
Free androgen index (FAI)
Testo x100 SHBG
- Male Female
Not Applicable <7
Symbols and abbreviations
Gel - Yellow top Plain - Red top e - Timing of collection important
B) Commonly performed dynamic tests
Test/ sample requirements Reference values & action limits
Gonadotrophin releasing hormone (GnRH) test
100 µg GnRH i.v. Blood samples at 0, 30 and 60 minutes for serum FSH and LH
i) Normal basal FSH and LH. ii) FSH increment (men and women < 40 years) >2.0 U/L iii) LH increment (men and women <40 years) >15 U/L.
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OTHER HORMONES AND BONE MARKERS
Sample requirements
Analyte
Type of sample
Container & volume (ml)
Precautions
Subjects
Reference values & action limits
Growth Hormone Blood Yellow top (2) d, f Adults (unstressed) <6 ug/L
Insulin-like growth factor 1 (IGF-1)
Blood Yellow top (1) Children 2 - 4 years 5 - 7 years 8 - 10 years 1113 years 14 - 16 years Adults 17 - 25 years 26 - 39 years 40 - 54 years 55 - 65 years 65+ years
13 - 180 µg/L 26 - 200 “ 70 - 460 “ 150 - 600 “ 200 - 650 “
100 - 580 µg/L 65 - 350 “ 50 - 315 “ 35 - 240 “ 30 - 240 “
Insulin Amended insulin/glucose ratio
Blood Green top (2) a, b, d, *tf Fasting adults Insulin (mU/L)/ glucose (mmol/L) - 1.7: Proven insulinoma
<13 mU/L <5.0 >30
Insulin C-peptide Blood Green top ((1) b, d, *tf Fasting adults 0.36 - 1.12 nmol/L
Gastrin Blood Green top (2) a, b, d, *tf Fasting adults <120 ng/L
Parathyroid Hormone (PTH) Blood Purple top (2) a, j Normal adults 1.6 – 7.5 pmol/L
Calcitonin Blood Green top (5) a, b, *tf Normal adults <15 ng/L
25-Hydroxy vitamin D3 (25-HCC)
Blood Yellow top (2) Normal adults <25 nmol/L = subnormal; 25-49 = borderline low >50 = adequate
1,25 Dihydroxy vitamin D3 (1,25-DHCC)
Blood Yellow top (3) Normal adults 20 - 120 pmol/L
Symbols and abbreviations
EDTA.........Purple top a ..... Haemolysed specimen unsuitable Gel............. Yellow top b ..... Separate and freeze specimen immediately Heparin .....Green top d .... Collect after overnight fast NP ............No Preservative e .... Timing of collection important Plain ..........Red top
EMU .........Early morning urine in Plain Universal Container (no preservative) f ..............Avoid stress h .............Contact laboratory j ...............Full EDTA tube required *tf ............Transport frozen (not whole blood)
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COMMONLY PERFORMED DYNAMIC TESTS
Test/sample requirements Criteria for ‘normal’ response
Insulin-induced hypoglycaemia test (ITT) of growth hormone reserve Test between 8am and 10am after overnight fast Insulin given IV in doses varying between 0.1 and 0.3 U/kg depending on pathology Blood samples at times 0, 30, 60, 90 and 120 minutes for plasma glucose and serum GH NB: Dextrose and hydrocortisone solutions should be available for IV administration if clinical hypoglycaemia is excessive.
Plasma glucose trough <2.2 mmol/L.
Peak GH >6 µg/L excludes GH deficiency in children.
Peak GH <5 µg/L suggests GH deficiency in children, repeat test (after sex steroid priming in children).
Peak level of < 3 µg/L indicates GH deficiency in adults.
Glucose tolerance test (GGT) of growth hormone suppressibility 75 g of glucose orally as a drink.
Trough HGH <1 µg/L excludes acromegaly.
Emergency analysis should be discussed with Duty Endocrine Biochemist (Ext 24362)
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Symbols abbreviations and notes
EDTA Heparin (Trace element) Plain Plain Plain Universal
Purple Top Green Top Red Top Dark blue top No Preservative
*Diagnosis of Wilson’s Disease: A simple dynamic test - 65Cu-oral uptake test - is available for the diagnosis of Wilson’s disease. Contact GRI Ext 24288 or website.
**Identifying Source of Lead Contamination: Lead from different sources may have different isotopic compositions. Lead from Broken Hill in Australia (used in lead additives for petrol) has a 206Pb/207Pb ratio of 1.04, while old lead pipes in the UK have a ratio of 1.18. In a case of lead poisoning the isotopic composition of whole blood can be compared with the isotopic composition of lead from the suspected source.
Please telephone the laboratory (Ext 24288) for additional information. Current information on the trace element analytical service is available on the Internet (http://www.trace-elements.org.uk)
Contact Persons:
Dr Dinesh Talwar.............. 0141 211 4490 (24490)
Dr Andy Duncan............... 0141 211 5178 (25178)
Dr Anthony Catchpole 0141 211 5178 (25178)
Dr Fiona Stefanowicz ....... 0141 211 5178 (25178)
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NUTRITIONAL SCREEN
The Trace Element & Micronutrient Laboratory offers the following analyses as part of the Nutritional Screen (each of these tests may also be requested separately): Trace elements: copper, zinc, selenium, manganese. Vitamins: A, E, B1, B2, B6, C Specimens required:
• 1 Heparin tube for vitamins & enzymes
• 1 Trace element tube for trace elements
• The assessment of nutritional status should also include measurements of urea & electrolytes, calcium, glucose, magnesium, protein/albumin and CRP.
Notes:
• Medical staff should contact a member of the local Nutrition Team or Duty Biochemist if requiring nutritional screening.
• Blood specimens should be sent to the laboratory promptly, accompanied by one request card appropriately filled and marked ‘nutritional screen’ (Monday to Thursday).
• Micronutrient screening for patients on TPN: blood samples for micronutrient screening should be taken at least eight hours after TPN infusion has been completed to allow micronutrients to distribute from the central compartment to tissues. In patients who depend on long-term TPN micronutrient concentrations should be measured no more frequently that every 2-3 months.
• The inflammatory status of the patient should be assessed (by measuring CRP) before requesting a micronutrient screen, if: o CRP levels <15 mg/l, laboratory assessment of micronutrient status is reliable. o CRP levels >15 mg/l laboratory assessment of selenium, zinc, copper and Vitamins A and E is unlikely to be reliable. o CRP levels >5mg/l laboratory assessment of Vitamin C is unlikely to reliable. o CRP levels >50 mg/l laboratory assessment of selenium, zinc, copper and Vitamins A, C and E is of no value.
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PORPHYRINS
Sample requirements
Test Type of sample
Container & volume (ml)
Precautions Reference values & action limits
Turnaround time
Porphobilinogen (PBG)
Urine Plain Universal Container (20)
All samples for PBG analysis should be protected from light, eg by placing in a brown envelope
<10 µmol/L 1 week
Porphyrin (Urine) “ (Faeces) “ (Serum/plasma)++ “ (DNA)**
Urine Faeces Blood
Plain Universal Container (20) Plain Universal Container (10g) Purple/yellow top(5) Purple top (5)
All samples for porphyrin analysis should be protected from light, eg by placing in a brown envelope
<300 nmol/L 10-200 nmol/L dry wt Porphyrin peak normally undetectable.
10 days 10 days 2-6 weeks
Symbols abbreviations and notes
EDTA GEL Plain Universal Container
Purple top Yellow top No Preservative
Definitive Testing for Diagnosis of Type of Porphyria
** Samples sent to the Reference Laboratory in Cardiff
++ Samples currently sent to Photobiology Unit, Ninewwells Hospital, Dundee
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REQUEST INTERVENTION
Request intervention (RI) procedures have been set up for a number of tests to facilitate more appropriate testing and help reduce unnecessary repeat testing. Appropriate time intervals for repeat testing have been discussed with clinical colleagues before being introduced. Requests for repeat analyses for a limited set of tests are held for viewing by the Duty Biochemist and may be over-ridden if deemed appropriate. Comprehensive clinical details assist the Biochemist in this task. Note requests from relevant clinics/consultants will be exempted from RI and full details of clinic, location and consultant code should be provided on all requests
Analyte Request Intervention interval
HbA1C 60 days
Lipids 28 days
Protein electrophoresis 90 days
Prostate Specific Antigen (PSA) 21 days
Thyroid Function Tests (TFT) 30 days
Vitamin D 340 days
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REFERRAL LABORATORIES
Analyte Referral Laboratory Sample
5- Hydroxy Dihydrotestosterone Royal London Hospital, Whitechapel Road Serum
5-Hydroxy indole acetic acid Crosshouse Hospital, Ayr. 24 Hr Urine (Aliquot)
ACTH precursors Endocrine Sciences Research Group, University of Manchester.
Heparin
Alpha-1-antitrypsin phenotype Western General Hospital, Edinburgh. Serum/EDTA
Alpha subunits Selly Oak Hospital, Birmingham. Serum
Amino acids Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Heparin *
Ammonia Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Heparin *
Amiodarone Analytical Unit, St George’s Hospital Medical School, London SW17 0RE.
Serum (Plain tube)
Amitryptyline Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Arginine vasopressin (AVP) Royal Gwent Hospital, Newport Heparin
Beta-2-transferrin Walton Centre of Neurology, Liverpool. Serum/CSF
Bile acids Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ
Serum
Bupivacaine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum(Plain tube)
Catecholamine metabolites Crosshouse Hospital, Ayr. 24 h Acid Urine (10mL aliquot)
CA 15-3 Ninewells Hospital, Dundee. Serum
CA 19.9 Charing Cross Hospital, London. Serum
Cholinesterase phenotype/genotype
Southmead Hospital, Westbury-on-Trym Whole Blood EDTA (5mL)
CSF ACE Charing Cross Hospital, London. Contact Lab
Diuretic screen Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Urine (plain container)
Erythropoietin Ninewells Hospital, Dundee. Heparin
Faecal α1-antitrypsin Pru Immunology, St George’s Hospital, London. Faeces
Faecal elastase Western General Hospital, Edinburgh. Faeces
Fluoxetine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Gliclazide Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Glucose-6-phosphate dehydrogenase
Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Serum
Gut hormones Hammersmith Hospital, London. Heparin * (+trasylol)
Homocysteine Royal Hospital for Sick Children Plasma (Lithium Heparin or EDTA)
IGF2 Royal Surrey County Hospital, Guildford. Serum
Lamotrigine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Laxative confirmation City Hospital, Birmingham. Urine
LDH isoenzymes City Hospital, Nottingham. Serum/Plasma
Lipase Pathology Department, Royal Infirmary, Huddersfield. Serum
LSD University Hospital Aintree, Liverpool. Urine (plain container)
Macro CK Crosshouse Hospital, Ayr. Heparin
Metadrenalines (Plasma) Freeman Hospital, Newcastle EDTA *
Mycophenolic acid Analytical Unit, St George’s Hospital Medical School, London SW17 0RE.
Serum (Plain tube) or EDTA
NSAID Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Neurone specific enolase (NSE) Supra-regional Assay Service, Sheffield. Serum
Olanzapine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Oligoclonal bands Neuroimmunology, Southern General Hospital, Glasgow. CSF/Serum
Phencyclidine University Hospital Aintree, Liverpool. Urine (plain container)
Porphyrin classification University Hospital of Wales, Cardiff. Serum
Porphyrin (serum)
Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ Serum
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Analyte Referral Laboratory Sample
PTH-RP Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
EDTA + trasylol Collect on ice, separate and store frozen
Procollagen Type III Peptide (P3NP)
Manchester Royal Infirmary, Manchester. Serum (Red top tube- plain. SST tube also acceptable )
Quinine Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube) Shield from light.
Sulphonylurea Royal Surrey County Hospital, Guildford. Serum/ Urine
Sulpiride Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Thiopurine methyltransferase Department of Biochemistry, Southern General Hospital, Glasgow
Whole blood
THRB Addenbrooke’s Hospital, Cambridge. EDTA
Topiramate Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Transthyretin St George’s Hospital, London. Serum
Tricyclic Antidepressants City Hospital, Birmingham Serum (Plain tube)
Urine citrate University College London Hospitals, London. 24 Hr Urine (Plain, aliquot)
Verapamil Medical Toxicology Unit, Guy’s & St Thomas Hospital, London. Serum (Plain tube)
Xanthochromia Southern General Hospital, Glasgow. CSF
* Special sample treatment required
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USEFUL TELEPHONE NUMBERS
Name/Site Phone
Emergency Lab (GRI)........................................................................ 24487 Emergency Lab (WIG) ....................................................................... 52476 Reception (GGH) ................................................................................ 53347 Reception (GRI) .................................................................................. 24047 General Enquiries/Duty Biochemist................................................. 0141 211 (2) 4003/4
Endocrine Biochemist (GRI) ............................................................ 0141 211 (2) 4362
Glasgow SAS Centre for Cardiovascular Biomarkers (WIG).......... 0141 211 6373
Name Site Phone
Ms Dorothy Bedford ............ (WIG)...............52864
Mrs Christine Brownlie ....... (GRI) ...............25534
Ms Sheena Brownlie ........... (GRI) 24628/24629
Ms Donna Chantler ............. (GRI) ...............24784
Prof Muriel Caslake............. (WIG)...............52161
Dr Anthony Catchpole………(GRI)………….25178
Prof Marek Dominiczak....... (GGH)..............52788
Dr Andy Duncan.................. (GRI) ...............25178
Mrs Charlotte Syme ............ (GRI) ...............24317
Dr Janet Horner……………..(GRI)…………..24631
Mr Jim Irvine ....................... (GRI) ...............24637
Mrs Susan Johnston ........... (GRI) ...............24365
Mr Ian Louden..................... (GGH)..............52652
Dr Jennifer Logue…………..(Univ of Gla)….330 2569
Dr Caroline Millar…………..(GRI)…………...24390
Name Site Phone
Mrs Linda Mackinnon.......... (GRI) ...............24339
Prof Chris Packard.............. (WIG) 52872/51723
Dr Maurizio Panarelli........... (GRI)) ..............20830
Mr Ian Pattie........................ (GRI) ...............24494
Mrs Karen Rankin ............... (GRI) ...............24235
Prof Naveed Sattar ............ (Univ of Gla) ....330 3419
Prof Naveed Sattar .............Mobile 07971189415
Dr David Shapiro................. (GRI) ...............24635
Ms Karen Smith .................. (GRI) ...............24424
Dr Fiona Stefanowicz.......... (GRI) ...............25178
Dr Dinesh Talwar ................ (GRI) ...............24490
Mr Tom Walker ................... (GRI) ...............24339
Mrs Cathy Williamson ......... (GGH)..............53339
Dr Laura Willox……………..(GRI)…………...25178
If telephoning from out with NHSGGC, the main switchboard numbers are: Gartnavel General Hospital....... 0141 211 3000 Glasgow Royal Infirmary........... 0141 211 4000 Western Infirmary (WIG) ........... 0141 211 2000 For direct dialling to a hospital extension from out with the hospitals, replace the last four digits of the hospital number with the last four digits of the Extension you require (i.e., to contact General Enquiries at GRI, one would dial 0141 211 4003). Please note that some numbers may change.
• In case of doubt please contact the Reporting Office
• After 17:00hrs and at weekends call the Operator
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User Handbook
Document: CLIN003
Revision: 16
Page 44 of 44 Last printed 25/02/2014 11:54:00
THINGS TO DO TO KEEP THE SERVICE EFFICIENT
Please remember the following: 1. Tell us who the patient is. Put labels on both the top and the bottom copy of the request form. If there are no labels, please write legibly the patient’s name, CHI No, date-of-birth and the ward. Please put the date and time of the collection on the form and the specimen bottle. Do not put more than one patient’s specimens into one primary specimen bag. 2. Tell us where you are. Write your name and the name or number of your ward so that we know where to send the report. Many results are not delivered because we do not know where to send them. 3. If you are using the phlebotomy service, fill the request form the night before blood collection but make sure that the date of collection is correct. Make sure that there is patient ID on each specimen bottle, that the bottles are not leaking and that they are placed in the polythene bag for transport. We will not analyse blood, which comes in an unmarked bottle. 4. Please send specimens to the laboratory as soon as possible.
5. If you are sending emergency samples notify the laboratory. This ensures priority handling. 6. On Saturdays, Sundays and Public Holidays you need to send samples early. They must reach us before 11am. 7. Use computer terminals to obtain results if at all possible. 8. Call the Duty Biochemist if you need advice.
This handbook is also available on the website at http://www.nhsggc.org.uk/biochemistry. To view the handbook click on the Users Handbook tab on the left. To view the Handbook on StaffNet: Type ‘Clinical Biochemistry Service’ into the Search box. This will take you to our homepage.